In specific circumstances, it's sometimes necessary to end the professional relationship with a patient. Senior dento-legal adviser Rupert Hoppenbrouwers covers what to do when it's time to say goodbye.
The relationship between a patient and a dental professional is a unique one, and dental professionals are generally very adept at caring for a very diverse group of patients, some of whom may be very demanding or needy.
However, in a very small number of instances, that satisfactory professional relationship could fail to become established or even deteriorate to the extent that it is in nobody's interest for it to continue.
Rules and regulations
The GDC recognises this, and its 'Standards for the dental team' includes the following:
In rare circumstances, the trust between you and a patient may break down, and you may find it necessary to end the professional relationship. You should not stop providing a service to a patient solely because of a complaint the patient has made about you or your team.
Before you end a professional relationship with a patient, you must be satisfied that your decision is fair and you must be able to justify your decision. You should write to the patient to tell them your decision and your reasons for it. You should take steps to ensure that arrangements are made promptly for the continuing care of the patient.
The NHS regulations in all four countries of the UK also recognise that in some circumstances the dentist-patient relationship breaks down. The National Health Service (General Dental Services Contracts) Regulations 2005 for England allow the contractor to terminate an NHS course of treatment if:
- the patient has committed an act of violence or has behaved is such a way as to cause a member of staff to fear for their safety, and the contractor has reported the incident to the police
- the patient fails to pay the NHS statutory charge
- there has been an irrevocable breakdown in the relationship between patient and contractor, notice of the breakdown has been given to the patient by the contractor, and the Local Area Team (LAT) of NHS England has been informed.
It is nevertheless vital to ensure that the decision is fair and would be seen as fair by anybody to whom the patient might complain, because a decision to terminate the care of a patient will understandably often elicit a negative reaction. A resultant complaint may well extend beyond the decision to terminate care, and could involve any treatment provided as well as other issues.
In relation to acting fairly and reasonably, the GDC makes clear that you also mustn't discriminate against patients for any reason.
Failure to launch
On occasions, a satisfactory professional relationship with the patient may fail to be established from the outset. In these circumstances, it may be prudent to terminate the relationship sooner rather than later. If the decision is postponed, the patient's dissatisfaction may increase, along with the risk of a wider complaint.
Equally, if the patient has unrealistic expectations of treatment despite full explanations of what is involved and what can be realistically achieved, it would be perfectly acceptable to decline treatment or to refer the patient to a colleague who may be better placed to meet the patient's expectations.
Provided the patient is treated fairly and with respect, and you are acting in their best interest, you should not be justifiably criticised and you should be in a position to justify your decision if called upon to do so, as you may be.
A fresh start
It would never be justifiable to terminate care simply because a patient has raised a complaint. However, if the complaint demonstrates a total lack of confidence in the practitioner or an irretrievable breakdown in the relationship, it may be appropriate to suggest that a fresh start with a new dentist (who may be a colleague in the practice or outside) may be in the patient's best interest.
In cases where treatment is incomplete, to avoid any subsequent suggestion that the patient has been in any way abandoned mid-treatment, appropriate alternatives or a referral should be offered.
Naturally, all complaints should be answered using the practice procedure in a professional, courteous and helpful manner, with the aim of resolving the complaint at practice level and avoiding its escalation to involve outside agencies.
Senior dento-legal adviser
Rupert Hoppenbrouwers (BDS LDSRCS) was head of the DDU until his retirement at the end of 2015. He is a former general dental practitioner and was director of the School of Dental Hygiene at University College Hospital, London, from 1980 to 1986. He has lectured and written widely on risk management and dento-legal matters, has previously chaired the UK Dental Law and Ethics Forum, and has a particular interest in complex ethical and legal issues affecting dental members.
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