Professional Courtesy: Fare Thee Well, Patient by Dr. Thomas Giacobbi

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 .

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