Wednesday, January 21, 2009

Firing patients

Hi everyone,

Did I tell you I have a nine year old boy?
You all know that this kid is the apple of my eye.
But lately his turning from this kid that is all that and a bag of chips to this kid that wants to give us his opinion all the time.
I can tell this kid is changing. Not changing like puberty or anything but changing in a way that he is smart enough to know what we say is sometimes different then what he wants.
So now it is a bunch of "Why do I have to do that?" or "I don't want to take a shower" or it is just plain, "No".
Before this change you could just repeat what you were saying and he would conform. So my wife and I have trained ourselves to either saying things twice (or more) or getting into a discussion about why your way is the better way.
So he will take this as, "If I keep them talking, they may tire and give me what I want."
So this is the thing that we have been dealing with. He is getting mouthy and just plain sassy.
Me, I can handle it. But my is not so easy with her.
It really is a heart issue, but I don't always care about that. Me I just impose my will and maybe the heart will come later. But Hilda's more concerned with the heart and we all know that is the more difficult than just beating him.
I will let you know how it goes.

I am plodding through Jane Erye. It is like Chinese torture. Brutal. But I am going to finish the damn thing if it is the last thing I do.

Remember the story a couple of weeks ago when I took the kids to a matinee movie. I took four kids and bought a popcorn and a drink...$50. And I cussed the movie theater for 2 hours.
This weekend I took the same kids to the dollar theater to see Madagascar II and bought popcorn and a drink....$13, my kind of theater.

I saw Traitor over the weekend. It was pretty good.
I saw the latest Indiana Jones movie...weak at best.

And last but not least WE WON our basketball game. We played a pretty weak team and we beat them 34-12. Oh, yeah.
I think it is all coaching.

Okay topic de jour,
I say this topic of Firing patients is a tough one.
But I would say it is not something I do very often.
This topic is fresh in my mind because I had to fire someone a couple of weeks ago.
Then just yesterday the FDA magazine came and there was an article on "What is Patient Abandonment?".
Then today I get the AGD Impact magazine and it has an article called, "Say, Uncle!"

The main point of the FDA article is to know you patient before you start to work on them.
Because there is absolutely no problem with refusing to treat BEFORE you get started.
The problem becomes when you start to work and then there is a real problem.
The problem is that we, the dentist, only know that patients are crazy AFTER we start working on them.
(Now I am using "crazy" as a term of endearment.)
After you start to work on have to just suck it up.
You can't "fire" a patient if they are in the middle of treatment.
You can't refuse to treat someone if they do not have money to pay. If they have a history of not paying or have a balance it doesn't matter.
Listen to this from the FDA article (written by an attorney for the FDA)...
"As a general rule, the patient's failure to pay will NOT justify the doctor's unilateral termination of the relationship if the patient still needs medical care."
Then it goes on to say, "If the patient is under the continuing care of a dentist and has an emergency but is unable to pay at the time of service, the dentist must provide necessary emergency care and decide later whether to pursue the matter of collection."
The Say, Uncle! article tells of a 42 year old female patient that would get root canals "to relieve pain". After every pulpectomy she would get Lorcet and after every root canal she would get Lorcet.
But she never had the money for the restoration. In the end she got root canals on 2,3,5,9, 10,12,13,14,15,21,22,23,24,25,26,27,29,30.
I am not going to go into the malpractice stuff but when do you fire this patient.
The safe answer is before treatment.
One of the Pankey Institute's sayings is "to know your patient".
Trust me, I think I do it right...I do the new patient interview, and I try to establish a relationship with them before we treat. But sometimes I misjudge someone's mental status (if they are crazy or not).
I get into treatment with them and it is only a matter of time before I am cursing the day I ever started.

Heres one.
I have these two professionals that live and work in my town. One of them misses her New Patient Exam appointment. It is our policy to not call the people that miss this appointment. Our thought process is that if they miss their first appointment with us flag.
She called the next day and said her secretary never told her blah, blah, blah. We made her another appointment.
We called her previous dentist for her xrays and they told us that she had a problem coming to her appointments.
And for the next 4 months with these people it never got any better. She was mean as a snake. She missed about 50% of her appointments. Her husband was very nice and then started missing his appointments. Then they started to run a high bill.
Let me just stop for a second and tell you that Apopka is a "small town". I usually bend over backwards to take care of people of influence in community. Do you do this?
You want to have a good reputation. You want people to talk well of you. I mean the local attorney is going to come into contact with some people that could appreciate the type of dentistry you give.
But it is these people that usually take advantage of your niceness.

Back to the story, once they started running a high bill, he started missing appointments.
Their secretary would call and make appointments. We would confirm their appointments with the secretary and when they didn't show up they would blame the secretary.
Then the secretary called and asked to pay the bill for them.
She started asking questions about their bill. We told her that we were not able to give her this information with out the patient's permission.
So we told her to have the patients contact us and give us permission to talk to their secretary about their account.
Well, all of sudden he was too busy to call us.
Are you kidding me? How difficult can two people be?

This is getting kinda long.
Lets discuss this more on Friday.
Have a great one.

1 comment:

Anonymous said...

First, your blog makes me laugh and has done a fair bit to ameliorate my dental fear somehow. Dentist as human is less scary than destist as masked money grubbing, drill wielding, overbooked machine. And, I can tell you that firing clients or customers is about as hard as firing patients except the rest of the world doesn't have that obligation to continue service once started. But still--uncomfortable.

Second: Try being the patient who is attempting to find a new/good denist! Every dentist wants you to come in for a new patient exam. I get 500 dollars a year in insurance coverage for preventative including cleanings. I NEED those cleanings. I need to maximize my benefit by using that money for deep 'routine' cleanings to help manage this periodontial situation I have brought upon myself. I need a lot of other work too (which comes out of my not very deep but committed pocket). So you scope out the website, check some online review sites (usually one review per dentist -did their spouse write that?), drive by the office, talk the the receptionist and try to get your questions anwsered but about half the answers are " you'll have to talk to the dentist about that at your first appointment lets make that appointment right now close the deal" - all in an attemtp to find a dentist you want to work with for the next few years. But do you meet the dentist? No, not until you shell out $250 of your precious insurance benefit. Come to find out the dentist or staff is not someone you want to work with or has some care policies you don't agree with - extract yourself from the practice and try another dentist. Another new patient exam (minus maybe the xrays if you carry them in with you). Then if you move away, start the process all over again. Auuughhgh. Frustrating.

Similar problem with docs but at least you can ask a lot of questions at your first doc appointment -even in mid pap smear. Hard to do that at the dentist with a hand in your mouth and another patient in the next chair.

On another note: you dentists and your dental association need to step up your lobby in this hopeful new age of medical care reform. All this research on the importance of dental care to overall health and to prevent heart disease etc etc and I STILL only get a pittance of coverage from my insurance. Bah...


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