AADOM DISTINCTIONcast: Navigating Patient Dismissal: Insights and Professional Practices for Dental Office Managers

This DISTINCTIONcast is an insight into implementation of a dismissal process for your practice. Understanding the sensitive patient dismissal process, the right to dismiss, knowing the laws & developing templates. You will be given examples of patient dismissal letters and issues that impede care, all while maintaining professionalism.

In these challenging times, faced with short patient fuses, financial stresses, and personal issues, we as managers need to be mindful of the business’s best interest as well as maintaining a comfortable & safe culture for your team.

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Read the Transcript Now!

 

Savanah: Hey, everyone! Welcome to DistinctionCasts, where AADOM showcases the best and the brightest minds in the dental industry from within our Dental Management Association.

I’m Savanah Carlson, Director of Member Services at AADOM, and I really want to thank you for joining us today.

AADOM Distinction Casts is more than just insights into dental management. It is a dynamic platform designed to amplify the voices of AADOM’s distinction holders, providing them with an opportunity to educate and inspire their peers.

By tapping into their expertise, we are able to talk to educators who are in the trenches of everyday management, and we aim to empower and support leaders as they navigate the challenges and opportunities of running a successful dental practice.

I am very excited to introduce today’s AADOM DistinctionCasts educator, Ms. Stacey Singleton.

Stacey is the Dental Practice Administrator at Harborside Dental and York County Pediatric Dentistry. She lives in Southern Maine with her family and she’s been in the dental field since 1997.

She holds certifications as a Certified and Expanded Function Dental Auxiliary, a Business Administrative Management degree from Hesser College, and has achieved her Fellowship, Masters, and Diplomat status in AADOM’s Distinction programs.

She’s also the president of the Maine Dental Leadership Coalition, part of AADOM’s DPLN, and she’s an adjunct dental professor at YCCC, where she teaches dental programs.

She was also a dental office manager of a distinction last year in 2023 and a runner-up for dental assistant of the year in 2016.

Welcome, Stacey!

Stacey: Thank you so much for having me, Savanah. It is an honor to be here. This is such a great series that you’ve put together.

Savanah: Thank you. We’re excited to have you.

I do have a question about your career through our distinction program. So, you’ve done the Fellow, the Master’s and the Diplomat. Before we begin, if you could just give us a little nugget of how that has positively impacted your career as a dental administrator.

Stacey: Yeah, absolutely. I was doing a delivery to one of our referring offices over eight or nine years ago. And, the office manager in that practice said, “Are you part of AADOM?”

And I said, “No, I’ve never heard of AADOM.”

She gave me information. The very next year I joined and I started going to AADOM Conferences and it was love at first sight. It was fantastic!

The sense of community that you guys put out there for office managers that really don’t have an outlet to go to was huge and it impacted me on a daily basis.

I was able to do the webinars, to connect with the community around me and other managers so that there was no feeling of inadequacy. It was okay to contact people and have the support.

It grew my actual sense of management tenfold.

And I had the support of my doctor sending me, and, in turn, I brought so much back to the practice and my team. It was very, very insightful from day one.

Become a Member

Savanah: That’s phenomenal to hear. As a fellow peer and knowing you prior to working for AADOM, your expertise in dental management is just so inspirational.

So, with that, I’m going to give you the floor and let you take it away.

Stacey: Sure. Thank you so much! On goes the glasses.

Explaining the Patient Dismissal Process

So, I’m here today to talk about the patient dismissal process. I feel like it’s something that we don’t get to talk about enough because we kind of tiptoe around the issue. Sometimes, we want to get as many patients as we can into the practice and, obviously, build our practice growth with production, but sometimes we have those patients that we have to be okay to dismiss and say bye to.

So, here we go.

First, I’ll slide back a little bit. Savanah went over everything.

And a huge shout out to my family. I wouldn’t be able to do what I do on a daily basis without the support of them. They are my rock for sure. So, thank you to them.

The ADA Guidelines and Implementation on a Dismissal Process in Your Practice

You have the right to dismiss. And the dentist has the right to dismiss in situations where it is impossible to resolve differences or if the dentist cannot abide by the patient’s behavior within the practice, as long as the dismissal is not for a legally impermissible discriminatory reason, which we’ll touch base on in just a moment.

You need to know your state laws. Consult the appropriate state laws, and follow through with the Dental Practice Act to determine any requirements about dismissing a patient in your state, including how many days you need to be available to that patient in case of an emergency. This does differ from state to state.

And then make sure that you’re developing templates. And you can have them pre-done and populated in your system—different letters for different reasons. Fill in the details about the cause for the release objectively and advise the patient of the need to find another provider. Also, detail the number of days you will be available to treat the patient in the event of an emergency.

Issues That Can Impede Care

The biggest thing, first and foremost, is try and remove emotion and remember your anger management techniques before going into this. Some of the reasons are:

• Non-compliance
• Communication breakdowns
• Respect of other patients
• Office safety
• Non-payment of services
• Rude to your team members
• Harassment
• Disruptive behavior
• Inappropriate behavior
• Failure to keep appointments
• Office policy breaker
• Argumentative

So, all of these things, I’m sure that each and every one of you have found in a practice. And when it’s repetitive behavior, it can really lead to a dismissal so that it’s a happier environment for everyone.

Always Remember Professionalism

Some situations become very difficult. Always stay professional and dismiss with tact.

We have to remind ourselves that the patients know how to press buttons, and we want to make sure that we always remind ourselves that you’re doing what’s best for the practice as a manager.

And during this process, you want to make sure that you’re always watching your social media and reviews on your Google Business Profile, your website—anything that you’re attached to—and respond appropriately to that when you have upset or disgruntled patients that are leaving.

You want to thank them for their response: “We appreciate all feedback. Please contact our office to discuss your concerns.”

You definitely never want to respond with another negative comment to them.

Never Base Any Dismissal On This

To circle back, you cannot dismiss based on:

• Race
• Gender
• National origin
• Disability
• Religion
• Genetic information
• Age

Those are the ones that you absolutely have to follow through and not dismiss a patient based on any of those.

Checklists for Your Office

1. When you make the decision to dismiss, make sure that the patient is not in the middle of a treatment plan. You want to make sure that you’re working through what has been recommended and they’ve signed off on before that impedes any thought of dismissal.
2. Notify the patient with a written dismissal letter and sending it certified.
3. Document, document, document. The ADA has a great documentation and patient records resource on guidelines for the practice success and managing patients and treatment recommendations. They have some wonderful verbiage in there as well and some guidelines to follow.
4. Communication is the biggest part. And I’m going to give some examples of good verbiage that you can go over when you do face that issue within the practice: “It is apparent we have not met your needs, and we stand behind our team.”

Those are the biggest things. When your team comes to you with concerns that they’ve had run ins with a particular patient over and over again, you want to make sure that you’re supporting your team so that you keep that sense of support and they know that they can come to you and give a good culture for them to work in, so that they’re comfortable.

Preparing the Letter

You want to send this letter certified, return receipt. Never dismiss a person in person and always draft a letter and send it and document that you’re doing.

So, if the letter is returned, make sure you scan a copy of the attempt and then mail it in regular mail as well. And always scan into the patient file so that you have every attempt and you’re documenting every source that you’ve used to dismiss the patient.

Contents of the Letter

• You should not apologize.
• You want to be respectful and direct.
• Continue 30 days of emergency care coverage (That’s the general number of days, but this could differ per state).
• You can put in a reasoning, but it is not required to do so.
• Resources on finding a new dentist and an explanation of the record transfer process in your practice.

You want to make sure that this can’t be considered abandonment of the patient. So, you want to make sure where it ties back to them not being in the middle of treatment, or you just stopped contacting them.

These are some examples of letters. I have 4 different letters in here. And I believe Savannah has some QR codes as well that you can download these letters where you can screenshot it—by all means and make it your own. And again, just follow up with your state recommendations on how many days and the process of transferring out of the office.

So there are four different letters in here that you can by all means use, and they’re all for different reasons as well, and you can alter those.

What Verbiage to Use

Some of the verbiage that I have found helpful is:

“We stand behind our patient care philosophy in providing the most comprehensive dentistry to our patients. Since our philosophies differ, we are dismissing you from the practice. This will ensure you can find a provider that best fits your needs. We understand that our philosophy and practice values do not match your expectations. There has been an apparent breakdown in our doctor-patient relationship, which is necessary for optimal care. Your dental needs would be better met elsewhere. We will transfer your records once you delegate a new dental home. In the next 30 days, if an emergency arises, please do not hesitate to reach out so we can accommodate the acute issue.”

And then I left some lines so you can fill in other verbiage that you have within your practice. You can talk to your team and see what they recommend in different situations so that you’re all on the same page with what you’re saying and how you’re saying it to the patients.

And the big thing here is on the emergency services, the acute service, it’s something that is an acute issue and not an ongoing issue treatment that they want to just keep prolonging care with. You want to make sure that you’re really cutting those ties.

Examples of Scenarios You Might Face

So, I did do a couple of scenarios here that you can play out with your team.

Scenario 1

A patient enters the reception area where he is greeted and asked to sign the updated office policies. He refuses and becomes very loud and disrespectful, stating he will not agree to the broken appointment policy.

So, I would suggest asking your team this and how they would respond to that to make sure that everyone is on the same page with how that gets handled and then what course of action you’re going to do.

Scenario 2

A patient is argumentative with treatment recommendations.

“I don’t need that. Just fix it.”

He refuses to sign the treatment plan once they have been seated in the chair for a 2-hour reserved appointment.

I’m sure this has never happened to anyone ever, but this is another scenario that comes up and it’s something that you should discuss with your team and make sure that—especially with new hires—this situation might not come across every day, but when it does, you want to make sure that everyone is ready to handle it and what to say and what to do if that comes across.

I believe that is it. If anyone has any questions, you can always email me. I love to talk about teeth. That’s my email. So, anything that transpires or comes up, I would love to speak with you further.

Savanah: Thank you, Stacey.

It’s hard to have these kinds of conversations, too. I know that in your presentation, you talked about always send the letter, but, what would you recommend? How would you address it with a patient right in the office?

If there’s a conversation between, let’s say, a clinician and the patient and you are asked to step in. How would you address it in that moment? Cause sometimes this just happens in the moment.

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Ready to see the full version of this DISTINCTIONcast and elevate your skills?

Join AADOM now to access the full video and a world of resources. Your next big step is just a click away!

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Learn About the Presenter:

 

Stacey Singleton, CDA, DAADOM

Dental Practice Administrator Harborside Dental and York County Pediatric Dentistry.   Stacey resides in southern Maine with her family. She has been in the dental field since 1997.

She is a Certified and Expanded Function Dental Auxiliary. She also holds her Business Administration Management Degree from Hesser College and received her Fellowship, Masters & Diplomate with the Academy of Dental Office Management.

Stacey has been certified by the National Oral & Maxillofacial Anesthesia Board and is an active member with AADOM where she is President of the Maine Dental Leadership Coalition. Stacey is also a Dental Adjunct Professor at YCCC, where she teaches dental programs.

She enjoys volunteering within the local community and has a passion for the dental industry where she has been awarded numerous recognitions in office culture and management. She was awarded Dental Office Manager of Distinction in 2023 and was Dental Assistant of the Year runner-up in 2016.

She has had the opportunity to have published articles, speaking engagements, and consulting guidance with other dental practices. “Find your passion and stay true to its course.”