The Refusal, the Record, and the Walkout
A patient arrives 25 minutes late for a scaling and root planing appointment, visibly intoxicated, and insists on being treated. The hygienist smells alcohol, notices slurred speech and unsteady gait, and declines to treat, offering to reschedule. The patient becomes loud, demands treatment, and says, "If you don't treat me I'll report you for abandoning me." The dentist is out of the office. The hygienist writes a brief note: "Patient late and intoxicated; refused treatment; rescheduled." She then posts on a private social media group: "Just had the worst patient ever - drunk and threatening, some people shouldn't be allowed out." A colleague screenshots the post. Two days later the patient files a board complaint alleging abandonment and discrimination.
1. Was declining to treat abandonment? What should the chart note have contained?
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Declining to treat an intoxicated patient who cannot safely consent or cooperate is generally not abandonment - it is an exercise of professional judgment to protect the patient. Abandonment typically requires unilateral termination without notice or arrangements for continued care. Here the hygienist offered to reschedule, which is the right move.
However, the note is inadequate. A defensible record should include: the objective observations (time of arrival, odor of alcohol, slurred speech, unsteady gait), the patient's statements, the specific reason treatment was deferred (inability to safely obtain informed consent/cooperate; risk of aspiration or medical emergency), the reschedule offer and the patient's response, any attempt to contact the dentist, and instructions given (e.g., not to drive, seek medical evaluation if needed). Avoid conclusory labels like 'intoxicated' without supporting observations, and avoid judgmental language. A contemporaneous, objective note is the best defense to the complaint.
2. Assess the social media post and the discrimination allegation. What should the hygienist do now?
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The post is a serious problem. Even in a 'private' group, posting identifiable or potentially identifiable patient information and disparaging a patient can violate confidentiality and constitute unprofessional conduct; screenshots make 'private' irrelevant. It also hands the complainant evidence of bias, which strengthens the discrimination allegation.
Actions: (1) stop posting and do not delete evidence in a way that looks like spoliation - preserve it, but take it down per practice/legal direction; (2) notify the dentist/owner and the practice's privacy officer immediately; (3) cooperate fully with the board investigation and provide the chart and a factual account; (4) expect the board to focus on the record quality and the post, not on the refusal itself.
On discrimination: the refusal must be justified by the observed condition and safety, not by any protected characteristic. The documentation should make clear the basis was intoxication and inability to safely proceed. If the note or the post suggests a personal judgment about the patient as a person, that is the vulnerability. Going forward, refer all such situations to the dentist and follow a written refusal/deferral policy.