8 signs it’s time to fire a patient

We tell you how to know when a patient just isn’t good for your practice.

Patients are the lifeblood of your practice. They’re the reason you became a dentist, and it’s your job to help them reach optimal oral health, and to ensure they’re happy with the bright, confident smile you helped create and protect.

But that doesn’t mean you have to put up with patients who disrespect your time or who don’t see the value in the dentistry you offer. Sometimes, you have to let go of a patient who is bringing negative energy to your practice and causing stress to you and your team.

Firing a patient isn’t something you or your dental team wants to do-or something that should be taken lightly-but sometimes it’s the best decision for the practice, and even the patient.

Here is a breakdown of the reasons you might want to part ways with a patient, and the best way to let problem patients know they can no longer call your dental practice their home.

1. They refuse to pay their bill. If you set up a payment plan with a patient and he refuses to follow through, or claims he forgot his checkbook every time he comes in for an appointment, it may be time to let this patient go, said Penny Reed Limoli of Limoli and Associates.

To avoid this situation, make sure patients understand up front what insurance will cover and what part of the bill is their responsibility. Give them a thorough breakdown of the treatment plan and the associated costs. This doesn’t mean you still won’t have patients who try to get out of paying, but at least you’ve done your part to ensure the patient knows what’s due and when.

Work with patients to set up payment plans they can afford, but don’t continue to let it slide if they’re not following through. Finish the treatment you’ve started, but don’t schedule any more chair time with these patients beyond that.

2. They don’t keep their appointments. When patients don’t keep their appointment times, it creates a lot of stress and havoc for you and your team members, Jameson ManagementAdvisor Kimberly Brozovich said. It also takes away from the patients who are compliant and on time for their appointments.

When new patients come to your practice, make sure you tell them your appointment cancelling policy in advance. If you haven’t already, come up with that policy as a team. Include it in all new patient paperwork and talk to patients about your office policy at their first visit. If they know up front your office requires a 24-hour cancellation policy, they’ll be more likely to adhere to that the next time they need to make a change.

Add to your policy how many times a patient can be a no-show before they’ll be dismissed from your practice, and make all new patients aware of this policy. Set boundaries and make those boundaries clear to your patients.

3. They’re always late for their appointments. When this patient pops up on the schedule, your team knows she’ll likely be at least 30 minutes late, throwing off the rest of the afternoon. This is not OK, and the patient should know it.

When this happens, Limoli suggests telling the patient that unfortunately you can’t see her today. Never be unkind, but this lets the patient know she can’t just show up 30 minutes late for her appointment and expect to be seen; there are consequences.

If the patient shows up late again, tell her you know she’s very busy, so is it OK if you call her the next time an appointment time opens up, rather than scheduling an appointment she may not be able to make. Ask her what time of day is usually good for her and note that in her file. If this doesn’t work, you may want to think about parting ways with this patient.

As with no-shows, you may want to develop a policy for habitually late patients. If they’re late four times, it’s cause for dismissal from the practice. Let new patients know this up front and it may help them take their scheduled times more seriously.

4. They’re verbally or physically abusive. Maybe the treatment outcome didn’t meet the patient’s expectation, or he didn’t realize how much of the final bill was his responsibility, so he lashes out at one of your team members. This is a pretty good reason to let a patient go.

“After awhile you get tired of hearing people be negative about dentistry,”Jameson Management Advisor and Speaker Nancy Miller said. “Certain patients are thankful and other patients no matter what you do, it’s a constant struggle and that makes everything you do more difficult. You just can’t meet their expectations and the comments wear you down. You have to decide if it’s worth the income.”

And of course, if a patient becomes physical with you or a team member, cutting him from your practice is a no-brainer. No good can come of treating violent, hot-tempered patients in your practice.

Knowing what patients want can help make them better patients. Check out this Morning Huddle video from Jameson Management:

5. They’re abusing prescriptions. If you’re seeing the same patient over and over for emergencies, there’s a chance that patient is just trying to get a prescription out of you, Brozovich said. When you notice this trend with a patient, it’s time to part ways.

6. They’re stealing from you or other patients. It’s rare, but Miller has heard stories about patients going into the bathroom and stealing toilet paper, coffee, toothbrushes-whatever they can get their hands on.

If possible team members should keep purses and other personal items in lockers, Limoli said, and patient purses shouldn’t be easily accessible.

7. They’re looking for a date. You want to be friendly with your patients, but there has to be a line, Limoli said. If a patient starts flirting with you or team members and making inappropriate comments or advances, that patient may be better served at another practice.

8. They won’t accept necessary treatment. “If patients don’t accept necessary treatment even after you educate them about their condition and the health risks associated with it, you may have to suggest they look for another dentist,” Limoli said.

“Don’t watch things get worse. If the patient comes for recall and doesn’t want to get necessary work done, say ‘I’m concerned about that tooth. Here’s a picture from six months ago, here’s what it looks like today. Before we schedule your next recall appointment, you need to have this taken care of,’ ” Limoli said. “You may hate to do it but you have to take a stand and say ‘I can’t sit here and watch that get worse.’ ”

When you find yourself in this situation with a patient, take the time to tell him his refusal to accept treatment or let you take radiographs makes you uncomfortable and you can no longer treat him if he continues to refuse. Chances are, this patient will fold and agree to that radiograph or the recommended treatment, Jameson Management Advisor Leslie Neveu said.

Providing the proper education and helping patients understand the importance of taking radiographs or treating periodontal disease will go a long way in getting them to comply and keeping them as a patient, Neveu said.

“Once the team really understands the value of communication their confidence builds up so they feel more comfortable communicating what the needs are for the patient,” Brozovich said. “They can turn the patient’s behavior around quicker, or they do come to a point where the patient or provider decides they’re not on the same page and maybe they should part ways.”

How to fire a patient. When you decide it’s time to part ways with a patient, you can’t just tell him he’s no longer welcome at your practice. Limoli recommends giving the patient a written notice via certified mail.

“Give them some options of where else they can go and let them know you will treat them on an emergency basis for the next 30 days, but beyond that you’re terminating the professional relationship with them as a patient,” Limoli said. “Send it in writing instead of a phone conversation or a face to face. If it isn’t in writing and it ends up in court it didn’t happen.”

You can have a conversation in addition to sending the letter, and Miller recommends you keep it non confrontational and reasonable. Tell the patient you just don’t seem to see eye to eye, and he’d be better served at another practice. 

It’s rare but sometimes necessary. Most of your patients are good people who want to do what’s best for their oral health, and who respect your time and efforts to help them make that happen. But occasionally you’ll come across those patients who don’t see the value in dentistry and can’t be bothered to make their appointments on time, if at all.

If a patient is wreaking havoc on your schedule or making someone on the team feel uncomfortable, it’s time to let that patient go. But if you set boundaries and take the time to educate patients on the importance of their dental health, this scenario will be less likely to play out in your practice.

“Ultimately patients have to see the overall value in why we perform these procedures,” Miller said. “I don’t think any patient wants to act that way. It’s up to us to educate them as to what we do.”