Everybody knows a couple that’s not going to “make it.” They’re destined to part. The question is how much pain or indifference they’ll endure before the inevitable happens.


Occasionally, there’s a doctor-patient relationship that’s not going to make it.


A dentist recently described his story.


Several years ago, he fashioned upper teeth veneers / crowns to reconstruct a patient’s smile. The patient was happy with the outcome.


She returned a year later, asking to have her bottom teeth reconstructed. This is a two step process. Molds for the new teeth are made. The patient is provided with temporary crowns until the new teeth are ready (constructed from the mold). Temporaries are just that – designed to be used for a short period of time.


This patient did not return. The dentist called, emailed, sent smoke signals. You get the picture. The patient still did not return. But, she didn’t go away. She re-emerged about a year later and said she was ready to have the permanent teeth placed. By then, her teeth had shifted and there was no way the reconstructed teeth would fit properly.


As a courtesy to the patient, the dentist started the process from scratch. He made new molds, placed new temporaries, and told the patient to return in two weeks for the new permanent teeth to be placed. The dentist ate the cost.


Guess what?


The patient didn’t show up AGAIN. The dentist called, emailed, and sent smoke signals. Nothing. Until a year and a half later.


To complete the process, the dentist would need to again start over.


What’s the best way to deal with patients who are non-compliant patients in the middle of a treatment plan? If a patient has prepaid for services, they expect to receive those services. Further, a doctor wants to avoid any charge of patient abandonment. And naturally, a doctor doesn’t want to be held financially captive to a patient who fails to do the bare minimum to advance the process.


In this vignette, the patient constructively terminated the doctor-patient relationship. The doctor did all he could to explain to the patient the consequences of failing to follow-up. By failing to return for follow-up visits, the patient abandoned her own treatment.


But, there’s a better way to manage this. If it’s clear that flagrant non-compliance in the middle of a treatment plan will affect the outcome, it’s often better to formally terminate the doctor-patient relationship. A certified letter with the template below might have spared a few headaches:


As a dentist, my job is to help make a diagnosis and recommend treatment. To be effective, I need a patient’s participation. The doctor-patient relationship is a partnership. It does not mean we will always agree. And even if I disagree with decisions you make, I will respect your autonomy to make that choice.


That said, a long-term doctor-patient relationship is based on certain minimum expectations. If you are in the middle of a treatment plan, I expect that you will follow through. If you have appointments scheduled, I expect you will make those appointments. If you choose a different path, that is fine. But, I need you to assume full responsibility for the decisions you make. Given that you have missed several important follow-up appointments, it makes more sense for you to seek continued care with another dentist; one more aligned with offering you the type of treatment you want. In that context, I am terminating the doctor-patient relationship.


Of course, I will make your records available to any dentist at your direction. And, I would remain ready, willing, and able to take care of you for urgent and emergent conditions up to 30 days or until you find another dentist, whichever comes first. Other dentists can be located by contacting the County Dental Society. I wish you well.


Breaking up is hard to do. But, if it’s inevitable, doing it sooner rather than later can prevent long term challenges.