Get comfortable firing troublesome patients

Estela Vargas, CRDH.
Estela Vargas, CRDH.

Coaching dental clients about managing troublesome patients caused me to think about a scene in the movie "A Bronx Tale" that has stuck with me over the years. I often think about this movie scene when stressed dentists call me recounting conflicts with patients' unrealistic treatment expectations, their disrespect to the staff, hostility, and patients who refuse to pay their bills.

Here is the scene from “A Bronx Tale” to illustrate my point:

Calogero “C” Anello: “He owes me $20. It's been two weeks now, and every time he sees me, he keeps dodging me. He's becoming a real pain in the ass. Should I crack him one or what?”

Sonny: “Sometimes, hurting somebody ain't the answer. First of all, is he a good friend of yours?”

Calogero “C” Anello: “No, I don't even like him.”

Sonny: “You don't even like him? There's your answer right there. Look at it this way: It costs you $20 to get rid of him ... He's out of your life for $20. You got off cheap. Forget him.”

I've received phone calls from panicked dentists when they see a particular patient on their schedule. They know what's coming, and it ruins their day.

How to dismiss a patient

The mental health of the dentist is paramount. Not all friction with patients is about money, as depicted in the scene above, but regardless of the reason, conflicts create stress that is palpable to the team and other patients. Whatever the issue is, it’s essential to get to the root of the dispute and quickly solve it.

Suppose a dispute about the treatment must be resolved, such as the patient is not satisfied with the shade of the restoration or the fit. If it will change the outcome, offering to redo the restoration is an option.

If that still doesn't solve the problem, then a consultation with a specialist to get another opinion is in order. If the patient doesn't want any more treatment but wants their money back, this scenario has potential problems, and now the dentist must consult a lawyer.

Sometimes, refunding and dismissing the patient just for peace of mind is desirable; however, some rules and guidelines must be followed for ethical and legal reasons. One particular issue is that of "patient abandonment."

When the patient is in the middle of complex treatment and needs continuing care or has a specific healthcare issue, it is difficult for the patient to find another provider. In the case of a claim of abandonment, it is far wiser to get legal advice.

According to the ADA, dentists have the right to dismiss a patient when 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.

Some situations (from the ADA) where patient dismissal might be necessary include the following:

  • Friction or personality conflicts between the dentist and the patient or the patient’s family

  • Differences in philosophies of care or treatment goals between the dentist and the patient

  • Noncompliance with the dentist’s recommendations, instructions, or treatment plan by the patient

  • Nonpayment of fees or failure to follow the practice’s financial policy by the patient

  • Abusive, threatening, or violent behavior by the patient or the patient’s family

  • Fraudulent or illegal activities by the patient or the patient’s family

If you dismiss a patient from your practice (from the ADA), follow guidelines and legal considerations to avoid potential liability or ethical issues. Some of these guidelines include the following:

  • Consult the state laws and the state dental practice act to ensure compliance with the regulations and standards of care.

  • Develop a template (available through the ADA, your legal representation, or your state’s dental society) for a dismissal letter that clearly states the reason for termination, the effective date of termination, the availability of emergency care for a limited period, the procedure for requesting a copy of dental records, and a referral to another dentist or dental society.

  • Send the dismissal letter by certified mail with a return receipt requested to the patient’s last known address.

  • Document all communications and actions related to the patient's dismissal in the patient’s record.

  • Conduct regular audits of patient records to identify inactive or nonresponsive patients and send them reminders or dismissal letters as appropriate.

  • Maintain a professional and respectful tone and attitude throughout the process and avoid damaging or derogatory comments about the patient or the situation.

Dentists and their office managers should proactively seek advice from their malpractice or liability insurance provider to ensure they are well informed and legally compliant when terminating a patient relationship.

Adressing the fear of a negative online review in retaliation for termination

One common fear that prevents dentists from taking action to terminate is the possibility of receiving a bad online review. As a consumer who checks online reviews before deciding on a new healthcare provider, I check their reviews and look for clues about their bedside manner.

Most people can discern between genuine feedback and irrational complaints. Crazy reviews are often seen as outliers and do not significantly impact a dentist’s reputation, primarily when handled professionally and respectfully.

Always respond in a positive and caring way to resolve any negative review.

Maintain your professionalism and gain peace of mind

Dentists and management should avoid arguments or confrontations in person and written communication throughout the termination process. All communications should be carefully documented. By handling the situation calmly and respectfully, dentists can mitigate the risk of negative repercussions and preserve their professional reputation.

By embracing their right to create a secure and respectful practice environment, dentists can feel empowered to navigate patient terminations. Dentists can fulfill their primary responsibility: providing exceptional care in a safe environment by leveraging the support provided by malpractice insurance carriers, crafting professional termination letters, and prioritizing safety. Taking control of patient relationships is a crucial step in achieving this goal. Your peace of mind and the end of anxiety-induced insomnia will thank you for it.


  1. Dahl D. 25 A Bronx Tale Quotes From the Coming of Age Gangster Film. Everyday Power Web site. October 13, 2022. Accessed December 6, 2023.
  2. A Bronx Tale. Wikipedia Web site. Updated December 2, 2023. Accessed December 6, 2023.
  3. Patient dismissal. American Dental Association Web site. Accessed December 6, 2023.
  4. Buczko M. How to dismiss dental patients without getting sued. 360 CoveragePros Web site. Published March 1, 2021. Accessed December 6, 2023.
  5. Campbell K. How to respond to negative business reviews and how to improve them. Reputation x Web site. Updated October 25, 2023. Accessed December 6, 2023.

Estela Vargas, CRDH, is the founder and CEO of Remote Sourcing, a dental insurance billing and revenue recovery service. She is a graduate of Miami Dade College's dental hygiene program. Vargas' extensive background in the clinical arena of dentistry is coupled with her experience as a practice administrator and business executive. 

The comments and observations expressed herein do not necessarily reflect the opinions of, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.

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