Regulatory complaints often arise not from clear clinical failures, but from breakdowns in communication, expectations, and patient relationships.
The recent decision in Leckie v. Kostirko offers a valuable case study for dentists on how professionalism—when consistently applied—can withstand emotionally charged situations when handling patient complaints.
Background
This case arose from a patient complaint concerning dental treatment involving restorative work, including a dental bridge.
The patient alleged deficiencies in the quality of the work, dissatisfaction with the aesthetic and functional results, and concerns regarding the fees charged. Over the course of treatment, the patient returned multiple times, expressing dissatisfaction, prompting the dentist to make adjustments and redo aspects of the work in an effort to address those concerns.
The relationship between the parties deteriorated as the patient became increasingly frustrated, culminating in confrontational communications with the dental office.
Specifically, the patient complained that:
- the dentist did not treat a bump during gum surgery and did not give her antibiotics afterwards (but the record showed that the dentist did address her excessive gum and gave her antibiotics);
- the temporary bridges were uncomfortable and unaesthetic and the dentist over-filed the patient’s canines in preparation for the permanent bridge (but the dentist did talk to the patient about the bridges multiple times and asked for final feedback before the final bridge, and the patient wanted longer canines!);
- the dentist re-used the patient’s old bridge and falsely denied doing this (but the dentist didn’t do this; they just made it look like the patient’s old bridge per the patient’s request);
- the dentist yelled at the patient and told her to leave (the dentist told her that her accusations were abusive and offered to show her lab bills to prove that the bridges were not her original ones but she stormed off and called back to yell at the staff).
- the dentist would not give the patient a refund (but the dentist did the treatment and received payment and did refund an overpayment).
The dentist ultimately advised the patient to seek care elsewhere to complete treatment and implemented boundaries around further communication.
The Issues
At its core, the Committee and the Board were asked to determine whether the dentist’s care, communication, and handling of the patient relationship warranted further regulatory action.
More specifically, the issues included whether:
- the dental treatment provided met the expected standard of care;
- the fees charged were appropriate in the circumstances;
- the dentist’s communication and conduct, particularly as the relationship deteriorated, met professional expectations; and
- the dentist appropriately managed the patient relationship, including setting boundaries and ultimately ending care.
The Decision
The patient complained to the RCDSO’s Inquiries, Complaints and Reports Committee, which, based on the evidence before it, decided NOT to take further action. The patient appealed to the Health Professions Appeal and Review Board (the “Board”), but the appeal was unsuccessful. The Board ultimately upheld the decision, reinforcing that the care provided met professional standards.
What is particularly instructive in this case is not just the clinical outcome but also how the dentist conducted themselves throughout the patient-dentist relationship.
Why Does This Matter?
This decision highlights several practical lessons for dentists, particularly around how patient relationships are managed when issues arise.
Professional Courtesy—Even When Ending the Relationship
One of the most notable aspects of this case is how the dentist handled the breakdown of the relationship. Even when the patient became dissatisfied, the dentist remained courteous and professional. Rather than abruptly terminating care, the dentist took the additional step of advising the patient to seek treatment elsewhere to complete their dental work. This is critical. Regulators expect that when a dentist-patient relationship ends, there must be continuity of care and a clear pathway forward for the patient. This approach reflects a key principle: disengagement must be managed, not reactive. The dentist did not abandon the patient—they transitioned them.
Setting Boundaries with Difficult Patients
Another key takeaway is how the dentist handled escalating patient behaviour. When the patient became angry and used inappropriate language toward staff over the phone, the dentist set a clear boundary: all further communication would occur via email. This is an excellent example of risk management. Creating some distance and documenting communications going forward can help prevent further escalation.
Moving communication to writing serves multiple purposes. It reduces the likelihood of further verbal conflict and helps prevent an already difficult situation from escalating. It also creates a contemporaneous record of all interactions and ensures clarity and consistency in messaging.
Dentists are not required to tolerate abusive behaviour. However, how they respond matters. Here, the dentist did not escalate the situation. Instead, they took appropriate control of it.
Transparency in the Face of Accusations
When the patient became increasingly confrontational and accused the dentist of dishonesty, the dentist responded with transparency rather than defensiveness. Importantly, the dentist attempted to show the patient the underlying lab bills to substantiate the fees being charged. This is a strong example of financial transparency, which is often a focal point in complaints. Many regulatory findings turn on whether a practitioner can demonstrate that fees were justified and clearly communicated. Here, the dentist went further—actively offering proof in real time, even in the face of hostility. Transparency, particularly when tensions escalate, is not just good practice—it is protective.
Documentation: The Deciding Factor
Perhaps the most decisive element in the outcome was the quality of the dentist’s documentation. Every interaction, concern, and clinical step was recorded. This allowed the regulatory bodies reviewing the complaint to assess the case based on objective evidence rather than conflicting narratives. This cannot be overstated: documentation neutralizes emotion. When a patient alleges mistreatment, regulators are not present in the operatory. They rely almost entirely on the written record. In this case, the documentation allowed investigators to focus on verifiable facts, rather than the patient’s subjective dissatisfaction. In many cases, the difference between a finding of misconduct and a dismissal is not the treatment itself—it is whether the dentist can prove what actually happened.
Efforts to Resolve the Patient’s Concerns
Finally, the dentist demonstrated repeated efforts to appease the patient. The dentist redid the dental work multiple times in response to the patient’s dissatisfaction and even refunded a portion of the fees. This is significant. While dentists are not obligated to guarantee subjective satisfaction, regulators do look favourably on practitioners who make reasonable efforts to address concerns. This conduct reflects a patient-centred approach, even in difficult circumstances. It also reinforces that the dentist was acting in good faith throughout.
Bottom Line
This case is a useful reminder that professionalism matters most when a patient relationship starts to break down. For dentists, the real takeaway is not just about the clinical work. It is about how patient concerns are handled, how communication is managed, and whether the record supports what happened. In difficult situations, steady communication, appropriate boundaries, and strong documentation can go a long way in protecting both the dentist and the practice.
