Wednesday, June 3, 2009

You know, that patient.

How do you like the new photo?
I thought I might change the picture once a month.
Oh, before I forget, I am looking for someone to help me with Monday's blog.
As you can see I am having trouble getting a Monday blog together. So I was thinking someone could, once a week do an article review.
If you read a lot of articles and want a forum to talk about it then it could be you.
Write me at

Magic are in the Finals. WOW!!! I was lucky enough to go the 6th game in Orlando.

I just finished this book called The Glass Castle and I don't know if I told you or not but I am reading a book called Hope's Boy. They are both very good. Remember the Glass Castle is about a woman that came from a really poor home to become a correspondent for MSNBC.
Hope's Boy is about a kid who bounces around from foster home to foster home. Then end's up going to Harvard Law and now is an advocate for foster care kids.
I think what is so great about these books is people that against so many odds succeed.
But the reality is that they are about .000001% of the norm. Which is why these kids that are abused emotionally spin around and around and never get out.
And if you ever have heard me talk about my nephew (I wrote a series of blogs on him) now THIS would be a memoir of a emotionally abused kid and how he never comes out of it (and he is still in it).
I guess it wouldn't be as exciting if the kid wallows in his own misery. It is like the main character in a movie getting killed.
He lived with us for 7 years and then his mother came and took him from us saying, "it is time Seth lives with his mother." Only one problem, she didn't have a place to live. So they lived in a car for two months.

Anyway, to more happy thoughts...
I saw Rocky III with the kids. I pity the fool. Awesome movie. Now I know why the Rocky movies were so popular.
I also saw a movie call Nothing But The Truth. It was very good. It was about the one female reporter that wrote a Pulitzer Prize quality piece and then the law came down on her for not revealing her sources. She ended up going to jail. It was about the highs of writing the article to the lows of losing her family because she was in jail.

Okay topic de joir.
I wanted to talk about this patient I had. This patient was referred by a great patient.
A lot of times you can tell what kind of patient they are going to be by who referred them.
The referring patient thinks I can walk on water and sings my praises all the time.
So this referred patient comes in and their mouth is a train wreck.
I mean not only do they have broken teeth but their teeth are just plain ugly.
So we do an exam and this person has periodontal issues, missing teeth, decay issues and occlusion (bite) issues.
This patient need a multiple facet treatment plan and needed to see more than one specialist.
I did a full work up (doing a lot of educating of the patient) and spent a lot of time talking to my specialist and working up something that I was so excited about because it would have been life changing.
So when it came down to talk about getting started this patient says, "Nothing hurts so I don't want anything."
I was a bit shocked but that is okay.
As long as the patient understood all the things that are going on in his/her mouth and know what will happen if nothing is done. Well that means I did my job and it is their decision. And we all know that if someone does something they don't understand or don't want then they start to resent the provider.
So this patient disappeared for a couple of years and came back in pain.
The patient had a perio abscess. I explained to this patient that there is no easy fix. You have teeth that are unrestorable. You have teeth that need to come out because they can't be fixed. Now you don't want to spend any money on teeth that can't be fixed do you?
I think this is when this patient went to the periodontist and had an exam and never followed up with him.
Another year goes by and this patient shows back up and this time says that it is time.
Now this is not a patient that is excited about doing their mouth. This is someone that kind of blames me for things.
Now I am starting to get a bad vibe from this patient but I still continue.
This patient is plain grumpy.
I am okay with this but it is certainly easier to work on appreciative patients. This person is not a warm fuzzy kind of patient and I am okay with this. But you know what I like working on warm and fuzzy people. It makes it easier to come to work.
And I like warm and fuzzy people to refer their warm and fuzzy friends.
But not this patient.
Not everyone is going to fit the mold of perfect patient and I have to be okay with this.
So we are going to get started and we have had a couple of just talking appointments. Just to educate. This is what we are doing and this is what we will do the next appointment....things like this. Then this patient would go up to the front and say something different than what I just said. So then we move this patient back to the consultation room and reiterate what we just talked about.
Then this patient tells me that they only want to do the lower teeth. "They are the teeth bothering me, so this is what I want to do."
Now all along I am hoping this patient will change dentists.
I am still the friendly, warm, happy go lucky dentist and this patient is maintaining grumpy.
I am thinking that we are not jiving and they are just going to go somewhere else.
But they keep coming back.
So we end up doing the lowers in temporaries. I had to remove some teeth and this patient claimed they were going to go to the periodontist and do some implants. So I told them I would see them after they were done at the periodontist.
A year goes by and no one has heard from this patient, they have disappeared again.
Finally, the temps break after a year and a half and this patient calls. They want to know why these crowns didn't last.
I said because they are temporaries. Temporary crowns means they are temporary.
This patient is confused because they thought they paid for final crowns.
Back to the consultation room. "This is what we did. Remember we talked about this and then did the work and then you said you were going to go to the periodontist."
"I guess." They say.
"Okay so I guess what I am saying is that I want to finalize things but I am not going to the periodontist."
So I know what you are thinking. Why haven't I told this patient to find another dentist.
The answer is, I DON"T KNOW.
Every time this patient would come in my energy would be sucked out of me.
So before we got started I sent this patient a certified letter.
The letter spelled out everything we have done in the past. Everything we are going to do.
I spelled out the limitations by not going to the periodontist and the limitations if the upper is not done. I then spelled out what he has paid and what he is going to be responsible in the future.
The patient shows for their three and a half hour appointment.
But the patient wants to talk to me about the letter first. The letter upset this patient because they claimed all I cared about was money.
The letter was about a lot of things and money was one of them but I just didn't want them to be shocked when the work was done and then my people say you owe $8000 and then say, "I had no idea."
So even though they were pissed at me they were ready to get to work.
I kept saying to myself, "This patient doesn't appreciate me. This patient doesn't like me. This patient doesn't value their teeth. What am I doing?"
Do you have this patient?
Is it just me?

I did the work and saw this patient for the prep and impression appointment. A metal try-in appointment and a cementation appointment. Everything went great. The work turned out great. And nothing from the patient. No accolades. Never warm, just very matter of fact.
This patient always seemed to hate it here and my staff and I kind of hated working on them.
I tried to just do my job and do great work but it is no fun unless you are working WITH someone not ON someone.
Am I making sense?

And the kicker, we were all finished and we showed this patient their new lower teeth and they said, "I don't really care about my teeth, but I know you guys are good so I don't really want to see them."
Was that kind of a compliment...I guess this is progress.

But where do you draw the line. I like doing dentistry. I like people. I like working with lots of different types of people.
I don't know.
Do you have any feelings about this?

Have a great Wednesday.


Anonymous said...

There are too many patients that won't take responsibility for their own health. I try to weed them out during the first phase of their treatment (simple restorative,hygiene, endo and exo). If they are not motivated, I won't start crown and bridge or implant treatment. Too risky for the patient and the dentist. I want to sleep at night.

Anonymous said...

You certainly have more patients than I would. Some people just don't care. My approach is if you are civil and care about your own dental heath I will bend over backwards to help. If you don't care about yourself then neither do I. I would have sent this person a discharge letter instead of a treatment plan.
I bet in a few years what you did will fail due to neglect on the patients part, but you will get the blame.

gatordmd said...

I totally agree.
But for me my problem becomes when I haven't done any work and they are in a holding pattern in hygiene.
I don't want to do any work on them and quite frankly they don't want any work.
Then a front tooth needs to come out.
This patient still doesn't give a crap about their teeth but they want something done. Do you send this patient away to have it done by a dentist not as skilled as you.
Or do you just grit your teeth, do the best you can and document all your warnings.
But now I will worry about about this stuff prematurely failing and it coming back to me. I totally agree with you two.


Anonymous said...

I recently dismissed a patient that had been a patient for many years. Whenever her name was on the schedule, the staff always said, "Oh no, not her!" She came in recently and wanted a nightguard. We took iimpressions and then at the next appointment, she said,"No I had wanted a retainer", which was not what she had said at the previous appointment. We retook impressions and then at the delivery appointment, she said, "I would like both the Nightguard and the retainer". Of course, since she did not want the nightguard, we tossed this. This was so confusing and the patient continued to confuse everyone! Then she went on to say how to file her insurance! What a nightmare patient! It was like a load of bricks off my shoulders when we sent to letter of dismissal. After 20 years as a dentist, it is your best interest to dismiss the problem patients. Your schedule is then open for your "normal" patients.

Anonymous said...

Well if you haven't done any work it is easier to discharge someone. Then you have not started treatment. Obviously you cannot go around discharging patients all the time. But the fact is that if a patients is not going to do the treatment that you think is needed to avoid pain or loss of teeth then they need to see someone else. Both you and the patient must feel comfortable, respect and trust each other. The doctor patient relationship cannot be onesided and will not work out long term just like any other relationship. Sometimes people have personal or philosophical differences and that is ok. The patient just needs to find some else that can better accomodate their desires and needs. You will never please everyone.

Now I am sure it is much harder to find a bad dentist than a good one. Yes there are some bad dentist, but most are good dentist and there are some really good dentist. So John there are some other dentist better than you, most will probably be your equal and of course there will be some not as good. But really unless you recommend someone it is not really your problem or your right to judge who the patient goes to if you discharge them. In the end all that matters is the dentist is good in the eyes of the patient and is happy.
Now think about all that time you spent talking and talking only not to be heard by this person. How much time did you waste?

Anonymous said...

I have been practicing general dentistry for 14 years and have had similar experiences. I can see that you put 100% of your energy and good will into your patients but sometimes those patients won't recognize your efforts and may even blame you for their problems. My advice to you is to LET THEM GO. Don't own their problems. If they don't care about their teeth, why should you? There are lots of appreciative patients who will show how much they value your service. I've realized that if you want to stay sane in this profession surround yourself with positive energy; that is do the kind of work you want to do on the patients you want to work on. You have absolutely NO responsiblity to treat every single person who walks into your office, especially if you want to retain your good nature and goodwill. These patients suck the life out of us - next time see this scenario early on and send them a polite letter indicating that you do not see a productive dentist/patient relationship forming and that they should seek care elsewhere. I have done this a handful of times in my 14 years, but I have never regretted it once and I am glad never to see those patients again.!
Just my two cents, you have an interesting blog,


gatordmd said...

Thank you all for commenting.
I had a feeling this would hit home for a lot of us.
Thanks for reading and commenting.


PLEASE NOTE: When commenting on this blog, you are affirming that any and all statements, and parts thereof, that you post on “The Daily Grind” (the blog) are your own.

The statements expressed on this blog to include the bloggers postings do not necessarily reflect the opinions of the Academy of General Dentistry (AGD), nor do they imply endorsement by the AGD.