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Dental Office General Policy Training


Terminating the Dentist-Patient Relationship

The doctor-patient relationship is a voluntary two-way relationship. Terminating this is necessary on occasion, but there is a good way and a bad way to do it.

Top dental consultants recommend you first, attempt to remedy the situation if possible. Document efforts in the patient record.

Second, check your state regulations. Dismissing a patient must be done in accordance with state laws so it won't be considered patient abandonment.

Third, formulate your notification.

General guidelines to keep in mind for patient dismissals:

  • You may dismiss a patient if you cannot establish a satisfactory doctor-patient relationship.
  • It is not required, but you may give a dismissal reason. If you do, there is no need to be overly specific in the letter. Keep it general, professional, objective, brief, and concise. Try not to vent, or say anything to offend or inflame the patient.
  • You usually must complete any procedures that have been started.
  • You should be available for emergency care until the patient finds a new dentist. Give a time period that you will remain available, such as 30 days, or give a specific end date.
  • Letter should state any untreated problems you have diagnosed, and consequences of not treating them.
  • Offer to transfer their records to another provider. Include a separate authorization for release of their records.
  • Have someone other than the letter writer read the letter; try to have the letter seen from the patient's
  • You cannot refuse to send records or x-rays to new dentist or patient just because their account is not fully paid.
  • Send dismissal letters via certified mail with return receipt that documents receipt by the patient. Also send a second copy via regular mail.
  • Document the dismissal in the patient records, including a copy of the letter, and certified mail receipt.
  • If there are factors that led up to the dismissal, make sure they are objectively documented in patient records.
  • Inform all office staff of the dismissal. Make sure staff knows the protocol for these patients, including what to do/say if patient calls or comes in.
  • If there are any factors that might be considered discriminatory or denying access to care because of disability, then you might want to seek specific guidance from an attorney, liability carrier, or consultant specializing in these issues.
  • If you are a contracted provider with the patient's insurance company, check your contract to make sure your dismissal procedure is in compliance.
  • Consider unpaid account balances. A termination letter might decrease collectability of the account, and might increase litigation potential.

There are some sample dismissal letters dental consultants recommend on the Sample Dental Office Letters page.

Reasons why some dentists choose to end the doctor-patient relationship:

  • Patient noncompliance
  • Failure to keep appointments
  • Chronic tardiness
  • Unacceptable behavior (rudeness; belligerence; violence; sexual advances; unreasonable demands)
  • Verbal abuse
  • Drug seeking behavior
  • Refusal of medical advice
  • Failure to pay account balance
  • Providing false or fraudulent information to the provider
  • Filing a lawsuit or threats of legal action

This process is also referred to as:

  • Firing a patient
  • Dismissing a patient
  • Discharging a patient
  • Severing the professional relationship
  • Problem patient dismissal

There are also numerous helpful web pages on this topic. Try a Google search using various terms.

Cambridge Dental Practice Management Logo

What Does A Dental Consultant Do? 

Many dentists will tell you dental consulting works. If dental practice management firms had no worth or benefit they could not stand up to harsh economic realities for long. What a veteran dental consultant brings to the table are systems and protocols successfully implemented in other practices that have been improved and tweaked over many years. Top dental consultants talk and network with each other. They pay attention to what works and what doesn't work across all dental practices.

Marketing & New Patients

Practice management consultants generally have little marketing training or background. 

Note: Cambridge'a consultants are Certified SEO and Ad Words Specialists

Dental Office Systems

Key systems dental consultants implement:

  1. New Patient Phone Call
  2. Insurance Processing
  3. New Patient Experience and Patient Education
  4. Financial Arrangements
  5. Scheduling
  6. Confirmation
  7. Unscheduled Treatment Followup
  8. Reactivation
  9. Huddle
  10. Stat Monitoring
  11. Daily and Weekly Checklists
  12. General Policy Manual

Your Staff

You will not get much ROI from your dental consulting if your staff do not have your back. You do not beed a team of cheer leaders jumping up and down with enthusiasm, but you do need staff who are smart and take some pride and ownership in what they do. If there is more than the usual drama in your practice that needs to be sorted out before you will get any real results.

Staff Accountability 

What gets monitored gets done.

The "big" obvious numbers are important to monitor, but when you look at them they are typically already "in the books". You want your team to concentrate and be accountable daily on the "small" stats that bring about the "big" stats. How many practice owners know how many calls were made to unscheduled patients each day or overdue re-care or inactive patients? Many dentists vastly underestimate how much daily "outflow" is needed to keep a schedule full. How may dentists know what % of slots were open in their hygiene schedule each day? How many know how many NP calls there were yesterday, who scheduled and if they end up showing up? More importantly how many staff know considering it's their job to do?

The only way to monitor what gets done is with daily stats especially for your weak areas. For example, one employee should be specifically responsible for calls to patients who are unscheduled, overdue re-care or need reactivation. Other staff can and should help in coordination with the accountable employee, but that employee accountable reports daily on a spreadsheet like this: 1. # of calls or personal texts sent 2. # of contact
3. # of appointments with name and date 4. # of arrivals

It is the employee who is either making themselves valuable to you or not. If they are doing so, dismissing them will never enter your mind. On the other hand, if they are not making themselves valuable, you will be doing them and yourself a favor by giving them the opportunity to find a practice or other employment that is a better fit for them.  


What most practice owners are missing is not how to book an appointment but how to be effective leaders. The best systems in the world are useless if the staff do not comply. Good leaders know how to get staff to willingly follow through and comply. Agreement among all team members is key. Your written office policies should contain those agreements and should answer most questions staff come up with. Doing so will save you much time and simplify the management of your practice. Staff non compliance is a sure sign of poor leadership. The primary reason practices underperform is staff non compliance.  Key traits of leaders. All it takes is discipline: 

  1. Always keep a cool head especially when "under fire"
  2. Realize that all mistakes are an opportunity for you and your staff to learn.
  3. Set a good example.
  4. Always be learning.
  5. Take care of yourself.
  6. Fight the impulse to address multiple issue at the same time. Frantic activity creates spotty results.

Questions You Should Ask

  1. Do you and/or your staff have to travel or does the consultant come to you?
  2. Is the program mostly one on one consulting versus seminars or courses with multiple clients in attendance? There are advantages to both.
  3. If the dental consulting is one on one who will actually deliver the consulting? I recommend knowing who your specific dental consultant will be prior to signing on the dotted line.
  4. Is program based on a specific dental practice management system? You want to avoid cookie-cutter programs. Ensure the program will be tailor-made to fit your practice's specific needs.
  5. The cost (including travel expenses and downtime) is certainly not the only factor, everything else being equal, it is still a major factor to consider. It's unwise to pay too much, but it's worse to pay too little.

If you do a little homework it should be fairly easy to pick a reputable consultant that is a good fit for you and your practice.