All good relationships must come to an end, sooner or later. So also must all less-than-ideal relationships and in both cases, parting company carries potential risks. Sometimes the end of a professional relationship is a moment of sadness, while on other occasions it can be tinged with a sense of relief. In all cases, the continuity of patient care becomes an issue requiring our consideration.
The first thing to bear in mind is the fact that the end of any professional relationship needs to be managed professionally. The patient's needs, welfare and best interests must always be paramount, whatever the background to the parting of the ways.
In most (but not all) cases you can plan for the moment when you will cease practising altogether, and because of this, there is generally sufficient notice to allow the departing dentist to explain the situation face-to-face with each patient who attends for treatment in the months prior to the dentist's departure. This is in many ways the ideal situation, and it may be a condition of the practice sale (for example) that the retiring dentist introduces the new dentist who will hopefully be taking over responsibility for the care of the patients.
Orthodontics presents a particular challenge in terms of the length of time that patients can be under active treatment or review. Just like any other practitioner, an orthodontist's personal and professional circumstances will change, whether through ill health, or domestic/personal issues, or career decisions, or simply reaching retirement age. Some, but not all of these situations can be anticipated, planned for and managed, but there is always the potential for patients to be on a waiting list, or in mid-treatment or at a critical stage in their development, at the time when it becomes obvious that it will not be possible for the treating orthodontist to see the patient through to the completion of their orthodontic care and treatment. Where a practice is sold as a going concern, and/or where other suitably trained and experienced colleagues are willing and able to take over the patient's care, problems at the point of transfer are likely to be minimal. But in some situations a suitable purchaser cannot be found for an orthodontic practice, and in some areas local colleagues are not in a position to accept more than a small minority (or any) of the patients under active treatment or review.
In these cases retiring orthodontists should try their best to discharge their duty of care to the patients, perhaps 'triaging' them to give greatest priority to those patients who stand to be the most disadvantaged (or harmed) by the break in the continuity of care. Keeping patients and their parents informed, and communicating with them in a caring and supportive way is the key to minimizing problems. Individual advice can be sought from Dental Protection if you are a member www.dentalprotection.org
Leaving a practice
If you are leaving a practice, but continuing to practise elsewhere, you may be moving sufficiently beyond the immediate area that it is unlikely to provoke any contractual, ethical or other dispute with your former colleague(s). If you are moving more locally, you may have contractual obligations regarding what you can or cannot say to the patients. However, it is important to recognize, notwithstanding any such contract, that the patient must be free to choose to receive treatment from a particular clinician, and nothing should be done by any party to obstruct that choice - for example, by deliberately providing them with incomplete, misleading or untruthful information about the whereabouts of the previous dentist. Just as with retirement, it is probably ideal if the outgoing dentist is able to personally introduce the new dentist who will be taking over responsibility for the care of the patients involved. It may be possible for a professional and amicable compromise to be reached between the parties, so that the rights of patients are respected, while making appropriate arrangements for the recognition (financially or otherwise) of the transfer of goodwill.
Withdrawing from treatment
Sometimes, for a variety of reasons, you may decide that you need to withdraw from a patient's treatment, or suggest that they seek further treatment elsewhere. You may find it difficult or impossible to treat the patient, or something may have happened as a result of which you are simply not prepared to continue treating the patient. This can often be a dangerous flash point and it needs to be sensitively managed:
1) Try never to lose your temper with a "challenging" patient. Keep your cool and remain professional at all times, however difficult it might be on occasions
2) If you are finding it difficult to treat the patient safely and to an acceptable standard, consider referring the patient to a suitably experienced colleague
3) Never part company with a patient in anger. If for any reason you do decide that you cannot continue treating the patient, make it clear that you are withdrawing from the treatment in the patient's best interests, not your own. Make the necessary referral arrangements, keep the patient informed, and resist the temptation to insert any ˜one liners" in the correspondence or in the clinical records, or worse still in any direct communication you have with the patient. Never give the impression that you are being arrogant, dismissive or petulant when deciding to end your relationship with a "challenging" patient. A few ill-chosen words spoken in the heat of the moment can result in months or years of subsequent repercussions if you end up being sued or facing a complaint to the Dental Council or other agencies.
The last word
When clinicians disappear without warning - other than in the most exceptional of circumstances - patients will often feel let down, or even abandoned. This, in turn, can make them less forgiving if it later transpires that there is some kind of problem with work that you have previously provided. The simplest of gestures, such as a letter to former patients (agreed where necessary with any other interested party such as a new practice owner or incoming colleague) thanking them for their past loyalty, confirming any arrangements you have made for their future care and treatment, and wishing them well for the future, ends what may have been a long and happy relationship on a positive, professional note.
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