The scene

An associate dentist called the DDU's advice line regarding an awkward patient. On many occasions the patient seemed to think that they 'knew best'. They had contested dental advice and challenged several members of staff at the practice, including our member.

As well as this, the patient had sworn at staff on the phone, and was recently angry and aggressive to reception staff. The member was considering ending the professional relationship with the patient.

DDU advice

The DDU adviser recommended discussing the patient's difficult behaviour with the practice principal and trying to implement steps to address this. In this case, it might be appropriate to alert the patient to the practice zero tolerance policy.

The principal would need to decide if this policy had been breached, and ultimately would be responsible for ending any relationship between the patient and the entire practice. The principal might need to interview any staff who had witnessed the patient's rude behaviour before making their decision.

If the relationship between the practice and the patient was not being ended, but the relationship between the associate and the patient was, it would be important for the associate to be clear of the justification for not seeing the patient again.

As well as informing the patient in writing, our member should take reasonable steps to arrange alternative care, such as providing the name of a colleague at the practice who would be willing to see the patient.

If the practice principal decided to terminate the relationship, recommendations for seeking future treatment elsewhere should be made. For an NHS patient this could include providing the contact details of the local NHS office and suggesting they obtain a list of NHS dental practices that can accept patients.

For an NHS patient in the middle of a course of treatment, the Local Health Board in Scotland, Wales and Northern Ireland would need to be informed. In England it would be the local team of the regional office of NHS England.

Lastly, our adviser told the member to be aware that terminating any patient relationship may result in a negative reaction, and potentially a future complaint - so it would be wise to handle any decision carefully and keep good records of any discussions they had with the patient as well as the decision making process.

This dilemma is fictionalised, but based on calls received to the DDU advice line.

Learning points

Situations with difficult patients are a common advice line call.

GDC Standards 1.7.8. state that, "In rare circumstances, the trust between you and a patient may break down, and you may find it necessary to end the professional relationship.

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."

Remember that a patient may be unhappy with the decision you make, so it's wise to have taken appropriate steps in advance to be able to justify your decision and actions.

The DDU can help draft a letter to send to the patient explaining why the relationship will be terminated. If a principal dentist wants to end the relationship with the practice, they should contact their own indemnity organisation for assistance. As always, good record keeping is paramount.

Like this? You can read more CPD dilemmas on the DDU website.