Dentaltown December 2017 - 18

professional courtesy
column

Fare Thee Well, Patient
Parting is such sweet sorrow. These words ring true
when that inevitable moment comes to dismiss a patient
from your practice. The sorrow is fueled by a mix of the
time and energy spent attracting and retaining patients,
your efforts to provide the best care for them, a feeling
that you have failed your patient and, in today's world,
fear of a bad review.
I can think of only three instances in the past 15 years
where I dismissed a patient from my practice-most
recently, last week. During our morning huddle, one of
my hygienists reviewed a patient who was overdue for
routine bitewings and said he would have them today.
Fast-forward a few hours and my hygienist Nancy comes
into my office wearing a frustrated expression as she
reports, "I don't know what to do with this guy. Mr. Lutz
[name has been changed] has refused X-rays many times,
including his last visit, but he promised me he would
have them done today." I told her I would talk with him.
Here's a brief summary of our conversation:
Doctor: Good morning, Mr. Lutz. Nancy tells me
you have some questions about your X-rays.
Patient: I'm frustrated, doc. I don't want to have an
argument about X-rays, but I don't need them. I know
when I have a problem with my teeth and you can take
X-rays when I'm having a problem. I have a family member
who had brain cancer.
Doctor: Have you ever had a dental problem that
could only be seen on an X-ray? (He had once complained
about a dental problem that was "missed.")
Patient: [Long pause.] Yes, I guess I have, but I got
that fixed.
Doctor: Mr. Lutz, I am not meeting my personal
standards for proper diagnostic records. I understand
your reservations about dental X-rays and I know you
will find a dental office that will meet
your expectations.
Patient: Well, if you're going to
make me have the X-rays ...
Doctor: Mr. Lutz, I wouldn't
be comfortable forcing you to do
something that you don't want to
do. Thank you for being part of our
practice, I wish you well.
After I left the room, Lutz said he

had taken enough of our time for the day and he would
get back in touch to reschedule. My hygienist came back
and said, "I don't think he understands that you just
dismissed him from the practice." The following day I
sent him this letter:
Dear Mr. Lutz,
Dentistry is a personalized service that benefits from a
good rapport between dentist and patient. Our relationship
seems to be missing the important elements of trust and
mutual understanding when it comes to dental X-rays. I
believe it will be in your best interest to seek dental care
from another dentist.
Our office will continue to be available to you for
emergency care for the next 30 days while you are seeking
a new dental home. We have enclosed a copy of our records
release form and we will be happy to forward a copy of your
dental records.
Shortly after Lutz left that day, my associate told me
a story about the last time Lutz came to the office. He
showed up unannounced, complaining of a chipped tooth.
My front office team contacted the associate, who was
on his way home, and he agreed to return to the office
and see the patient. When we told Lutz, he said he was
going somewhere else.
This patient was not dismissed from the practice just
because he was overdue for X-rays. Lutz was dismissed
because he was dishonest about his intentions, showed a
lack of respect for one of my hygienists and clearly didn't
value the care he was receiving in our practice.
I've read many threads on Dentaltown.com about
patient dismissal, and I encourage you to share your
challenging situations with your colleagues online. There
are some offices that will identify the patients that have
caused the most disruption over the past year and invite
them to find a new dental home in the new year.
While I have shared my letter and story with you this
month, I will hasten to add that the letter does not serve
as legal advice, and the requirements for proper patient
dismissal do vary by state. Consult your malpractice
carrier for specific advice before dismissing a patient
from your practice.
Your questions and compliments are always welcome
online or via email: tom@dentaltown.com. I'm on Twitter
@ddsTom. ■

by Thomas Giacobbi, DDS, FAGD, editorial director, Dentaltown magazine

18

DECEMBER 2017 // dentaltown.com
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Table of Contents for the Digital Edition of Dentaltown December 2017
