Ending a professional relationship

ERIC EASSON, dento-legal adviser at the Dental Defence Union (DDU), describes how to end a relationship with a patient in a professional manner. Unfortunately, it is sometimes necessary to

end a professional relationship with a patient. There are a number of reasons why this may occur, for example, if a patient has been violent or abusive to staff at the practice. However, in

some cases it may not be as clear-cut; this may occur if a patient regularly questions your advice over and above the clarifications usually required to ensure valid consent. WHAT DOES THE

GDC SAY? In its _Standards for the Dental Team_ at Standard 1.7.8,1 the GDC states 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. You should not stop providing a service to a patient solely because of a complaint the patient has made about you or your team. 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.' This emphasis on fairness is

important because a decision to terminate the care of a patient may result in a negative reaction from them which could extend beyond the decision to terminate care. For example, a patient

may decide to raise a complaint about the care provided. Standard 1.6.1 also states that dental professionals must also ensure that they do not discriminate against patients for any reason.1

HOW SHOULD I GO ABOUT ENDING A RELATIONSHIP WITH A PATIENT? The first step may be a direct conversation to attempt to clear the air and deal with any issues of concern. This should take

place as close to the time you become aware of the problems as possible and ideally, away from the clinical environment. It would also be advisable to have this conversation before, or after

a course of treatment, rather than midway through if possible. > If the patient has continuing doubts about your advice and > treatment, explain why it may not be appropriate, or in 

their best > interests, for you to continue to treat them. Explain to the patient why it is beneficial to you both for treatment to be carried out in an atmosphere of mutual trust and

respect. Hopefully, this will resolve any issues. But if the patient has continuing doubts about your advice and treatment, explain why it may not be appropriate, or in their best interests,

for you to continue to treat them. Keep a record of this discussion and follow the meeting with a written summary to the patient, confirming the outcome. Meeting the patient to discuss your

concerns can help restore the professional relationship. However, if it is clear that the breakdown in the professional relationship is irretrievable, you can refer to the summary of the

meeting to support your position. If this becomes the case, then it is advisable to contact your defence organisation for tailored advice on how best to proceed. In some circumstances, a

professional relationship with the patient may fail to be established from the outset. If this is the case, it may be prudent to terminate the relationship sooner rather than later. If the

decision is postponed, the patient's dissatisfaction may increase, along with the risk of a wider complaint. Equally, if the patient has unrealistic expectations of treatment, despite

full explanations of what is involved and what can be realistically achieved, it may be appropriate to consider declining treatment, or to refer the patient to a colleague who may be better

placed to meet the patient's expectations. Provided the patient is treated fairly, with respect, and you are acting in their best interests, you should not be justifiably criticised and

should be able to defend your decision if called upon to do so. WHAT SHOULD I DO IF THE PATIENT MAKES A COMPLAINT? You cannot terminate care simply because a patient has raised a complaint.

However, if the complaint demonstrates an irretrievable breakdown in the relationship, it may be appropriate to suggest that a fresh start with a new dental professional (who may be a

colleague in the practice or outside) may be in the patient's best interests. In cases where treatment is incomplete appropriate alternatives, or a referral, should be offered to help

reduce the risk of any subsequent suggestion that the patient has been abandoned mid-treatment. Naturally, all complaints should be answered using the practice procedure in a professional

and timely manner, with the aim of resolving the complaint at a practice level. To access the full library of dento-legal guidance and advice from the DDU, visit:

https://www.theddu.com/guidance-and-advice. REFERENCES * General Dental Council. Focus on Standards. The 9 Principles. Principle One. Put patients' interests first. Available at:

https://standards.gdc-uk.org/pages/principle1/principle1.aspx (accessed June 2024). Download references AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Dental Defence Union, London, UK Eric

Easson Authors * Eric Easson View author publications You can also search for this author inPubMed Google Scholar RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS

ARTICLE Easson, E. Ending a professional relationship. _BDJ Team_ 11, 243 (2024). https://doi.org/10.1038/s41407-024-2686-z Download citation * Published: 21 June 2024 * Issue Date: 21 June

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