The doctor-patient relationship is the central focus of any dental practice. This bulletin examines a particularly important legal issue concerning this relationship: properly ending the doctor-patient relationship and thus avoiding charges of abandonment.

As a medical professional, you are trusted to make recommendations and take actions that benefit your patient’s health. However, any doctor-patient relationship may end for many reasons. You may relocate, retire or close your practice. Your patient may move, choose to reject treatment, or seek care from another dentist.

Whatever the reason, termination of care can adversely affect the patient. The law protects the patient in this situation, even when the patient terminates the relationship!

The doctor-patient relationship doesn’t simply end when the patient leaves your office or care. It continues until either party properly ends it. Unless the relationship is properly terminated, the law may consider it to exist even years after the patient and doctor last communicated.

As a highly skilled professional, you are best able to make recommendations about the patient’s health at every stage of care. The law holds you, not your patients, responsible for properly ending or handling the termination of the doctor-patient relationship.

Once a doctor-patient relationship has been established, the doctor has a legal duty to treat a patient until the relationship is terminated. Consequently, patients may bring charges of abandonment against a dentist if the patient has suffered an injury due to the dentist’s failure to continue to perform his duty to treat the patient.

Before we address how to properly terminate the doctor-patient relationship, let’s consider some of the typical ways this relationship might end:

• The patient changes dentists
• The patient moves
• The dentist moves
• The dentist retires or sells the practice
• The dentist dies or becomes disabled
• The dentist initiates termination due to the patient’s:

- Failure to follow treatment recommendations

- Failure to pay for services

- Failure to keep appointments

How you handle the termination of the relationship will depend upon who initiates the termination. If the patient ends the relationship for any reason, you should:

• Document the patient’s decision in your record
• Advise the patient of incomplete treatment plans
• Recommend continuation of unfinished treatment
• Offer to forward records to the patient’s next dentist

If you decide to terminate the relationship because of the patient’s failure to cooperate with your prescribed treatment, be sure to notify the patient through the mail with a certified letter. In this letter you should:

• Indicate the date the relationship will end. Give a reasonable period of notice
• Suggest how to find another dentist
• Offer to forward records to the patient’s new dentist or anywhere else the patient might want records sent
• Offer to provide emergency care to the patient for a reasonable period of time
• Indicate current status of care and future need for treatment

Be sure to keep copies of any related correspondence or conversations in your record. Also, keep the certified mail receipt as part of the file. If the certified letter is returned to you for any reason by the postal service, keep it unopened in the patient record and send another copy of the original letter to the patient by regular mail.

A certified letter will not be necessary when you retire, sell, move or in some other way discontinue your practice. However, you should still provide the patient reasonable advance written notice, at least 30 days, that the relationship will terminate. You should also inform the patient how to seek the care of another dentist in the area (you can reference the phone book or local dental society), provide information regarding emergency care, and include advice for future treatment, if necessary.

Whenever a patient requests transfer of their records to another provider, the patient or their legal guardian should first sign a dated form authorizing the release of confidential information. The form should indicate the name and address of the person to whom the duplicate patient record should be released, and a copy of the form should be retained in the patient record.* A note should also be entered in the original patient record indicating the date, specifying what information was released, stating the name and address of the person or entity to whom the information was released and the name of the person who released the information.

It is important to make sure that the patient’s health is never compromised. Your treatment should only be transferred at a logical point during care, after completion of procedures you have started.

Most importantly, ask yourself the following questions before you terminate the doctor-patient relationship for any reason:

• Is the patient’s current medical status or dental condition at a point that indicates I have responsibly discharged my duty?
• Have I provided care to the point where the patient has no immediate need for further dental treatment?

If you answer "yes" to both questions, there’s a good chance a court would decide you’ve fulfilled your responsibilities.

It takes time and effort to properly avoid a charge of abandonment. However, it’s time and effort well spent.