A male dentist in a white coat discusses treatment procedures with a young patient and the patient's mom.

Dentist-patient relationships are important to handle carefully but can be fraught with gray areas. For instance, how do you know when to discharge a patient from care? And how do you do so properly to transition the patient to a new dentist and mitigate your own risk?

Let’s dive into some FAQs to understand dentist-patient relationships at a deeper level and clear up any confusion you have.

Here’s what dentists should know about the dentist-patient relationship. 

When does the dentist-patient relationship officially begin?

A dentist-patient relationship may be deemed to begin when an appointment has been made or specific advice is delivered before the patient is seen, or when there is some other interaction which creates a patient’s reasonable expectation of care.

How do I discharge a patient from care?

To discharge a patient from care, you must notify the patient in writing via a dental patient dismissal letter. You have the option of giving the patient a defined reason. If the patient has been non-compliant with treatment or appointments, or if the dentist-patient relationship has been disturbed by litigation, non-payment or threats and abusive behavior by the patient or a family member, you may state a general reason for discharge, i.e., there has been a disruption in the dentist-patient relationship.

If the patient is being discharged for noncompliance, you may state “you have been non-compliant with my recommendations for care and treatment.” If you have received a request for records from an attorney, have been sued by the patient or are merely uncomfortable in continuing to treat the patient, a reason does not have to be stated or you may use the disruption in the dentist-patient relationship as the reason.

Give the patient a reasonable amount of time to seek a new dentist, considering the patient’s course of treatment and the availability of alternative care without interruption. Often 30 days from the date of the letter will be sufficient notice, during which time you agree to be available for emergencies only. The letter should provide resources which will assist the patient to obtain a new dentist, such as the names and phone numbers of the district dental society. We do not recommend that you list the names of specific dentists. The MLMIC Legal Department has sample form letters which can be modified for your use in discharging patients from your care.

Remember, patients with urgent or serious dental conditions should not be discharged without immediate access to alternative care so there is no gap in treatment.

Must I continue to see a patient whose insurance I do not accept merely because I have seen the patient once in a hospital emergency department as the on-call dentist?

The answer to this depends both on the patient’s condition and the requirements set forth in the hospital’s by-laws. If the patient’s immediate problem has been resolved, unless the by-laws require you to provide a follow up visit, you are not obligated to see that patient in your office.

However, if the patient is in need of further care, it is recommended that you see the patient until he/she can be safely discharged by letter. If the patient continues to have an urgent or serious dental problem which requires continued care, you must be sure he/she has alternative and uninterrupted treatment prior to discharging him/her. If you are unable to assure that the patient has suitable alternative care, then you must complete the course of treatment for that particular dental problem before discharging the patient from care.

Like all client relationships, respect and professionalism is of the utmost importance in dentist-patient relationships.

As a dentist, you may come across cases or patients that are challenging, but there is always an optimal way to handle the situation. When in doubt about the right thing to do, reach out to MLMIC or your dental professional liability carrier. We also have several risk management checklists about dentist-patient relationships on our website that you can download and keep around the office to help you and your team remember these best practices. 

Dental professionals can stay up to date on the latest risk management guidance and alerts by reading The Handbook for Practicing Dentists, monitoring the MLMIC Dental blog, The Scope: Dental Edition and Dental Impressions and by following us on Twitter and LinkedIn.