Dismissing a Patient: Legal Limits, Proper Process, and Risk Management

Introduction

Ending a dentist–patient relationship is sometimes necessary, but it is never a casual decision. In Ontario, patient dismissal carries regulatory, legal, and professional obligations that require careful handling. Missteps—particularly around abandonment, documentation, or communication—can expose practitioners to complaints or liability.

This article outlines when dismissal may be appropriate, the limits imposed by professional standards, and the steps required to ensure the process is compliant, documented, and patient-centered.

When Is Patient Dismissal Appropriate?

Dentists are not obligated to maintain every patient relationship indefinitely. However, dismissal must be based on legitimate, non-discriminatory reasons and must align with professional obligations. Appropriate grounds may include:

• Repeated missed appointments or non-compliance with treatment recommendations
• Breakdown of trust or communication
• Failure to pay for services (where permitted and handled appropriately)
• Abusive, threatening, or unsafe behaviour toward staff or providers

Importantly, dentists are not required to place their own physical safety—or that of their team—at risk. Where a patient has made credible threats or engaged in serious mistreatment, termination of the relationship may be justified.

That said, dismissal must never be arbitrary, retaliatory, or discriminatory. Professional obligations require that decisions be grounded in objective, documented concerns consistent with maintaining professionalism and patient care standards.¹

Key Legal Limits: Avoiding Patient Abandonment

One of the most critical risks in dismissing a patient is abandonment. In Ontario, abandonment occurs when a dentist unilaterally terminates care without ensuring the patient has a reasonable opportunity to secure alternative treatment.¹

Dentists must be especially cautious when:

• The patient is in the middle of a multi-phase or ongoing course of treatment
• There are outstanding urgent or emergent care needs
• The patient’s oral health condition could deteriorate without timely intervention

In these situations, dismissal should generally be delayed until the patient is clinically stable or appropriate transitional care has been arranged. At minimum, the dentist must ensure continuity of care and provide sufficient notice for the patient to find another provider.

The Importance of a Formal, Documented Process

Patient dismissal is not an informal conversation—it is a formal process that must be clearly documented. A written dismissal letter is essential and should include:

• A clear statement that the dentist–patient relationship is being terminated
• The effective date of dismissal (with reasonable notice)
• A recommendation that the patient seek care from another provider
• Information on how to obtain copies or transfer dental records
• A summary of outstanding treatment needs, including:
  • Nature of the condition
  • Urgency of care
  • Risks of delaying or foregoing treatment

Providing this information is not only good practice—it aligns with informed consent and recordkeeping obligations, ensuring patients understand the consequences of inaction.²

All communications, including the reasons for dismissal and any prior issues (e.g., missed appointments, behavioural concerns), should be documented in the patient record.

Professionalism: Managing Emotion and Communication

Dismissals often arise in emotionally charged situations. However, regulatory expectations require dentists to maintain professionalism at all times.

Avoid:

• Dismissals made in anger or frustration
• Confrontational or accusatory language
• Abrupt termination without explanation

Instead, communications should be:

• Objective and factual
• Respectful and non-judgmental
• Focused on the breakdown of the professional relationship—not personal criticism

Maintaining professionalism helps reduce the risk of complaints and supports defensibility if the decision is later reviewed by the College.

Practical Takeaways

• Ensure legitimate grounds: Dismiss patients only for valid, documented reasons consistent with professional standards.
• Avoid abandonment: Do not terminate care during active or urgent treatment without ensuring continuity and reasonable notice.
• Use a formal dismissal letter: Clearly communicate termination, next steps, and outstanding care needs.
• Document everything: Record the rationale, communications, and patient interactions leading to dismissal.
• Stay professional: Manage emotions and maintain respectful, objective communication throughout the process.

Conclusion

Dismissing a patient is sometimes necessary to protect the integrity of the practice and the safety of the dental team. However, it must be done carefully, with a clear understanding of regulatory expectations and patient care obligations.

By following a structured, documented approach—and prioritizing continuity of care—Ontario dentists and practice managers can manage patient dismissals in a way that is both compliant and defensible.

Endnotes

1. Royal College of Dental Surgeons of Ontario, Practice Advisory: Maintaining the Dentist-Patient Relationship, 2019.
2. Royal College of Dental Surgeons of Ontario, Standard of Practice: Recordkeeping, 2023.
3. Regulated Health Professions Act, 1991, SO 1991, c 18.
4. Canadian Dental Association, “Dismissal of a Patient,” Journal of the Canadian Dental Association, Vol. 66, No. 6.

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