Thursday, April 15, 2010

This Patient Has Been Drinking

Man the weeks just fly by.

I had another tough week.
All my teeth this week were hard. Lots of decay. I had a 16-year-old who had big time decay. One of these cases in which her teeth looked fine just looking at them, but after we took x-rays I could see she had some bombs. So we did 6 on the left side in one sitting. They were so deep, and I was trying to avoid doing root canals on her. I ended up having to do electrosurge around one of the teeth just to get the band around it. By the end of it, my hands were sweaty (you know when the glove looks see through), and I had sweat running down my back to my butt. I hate that.

Every impression I took this week was tough. I found decay under this dude's bridge, and after I took it off, it was like-BOOM-decay everywhere. I had to stop and tell him that both of the mesial abutments were decayed to the gumline and they were going to need root canals and post and cores just to get another bridge. I had to tell my front desk to call the next patient and ask if they can come a little later.
That was for #20 and #21.
Now #18 (non-dental people: This is a tooth that is way in the back and really tough because of the tongue) had decay under the crown on the lingual, deep. So when I was done with #20 and #21, I had to tackle the lingual of #18. Can you say butt sweat?

That was every day this week I swear.

But I wanted to talk to you about a patient I had. He had old crowns, I want to say 30 years old, from 6-11 (for you non-dental front teeth). And he wanted to have them replaced.
He is a bit of an odd fella. I think his wife died a couple of years back, and he hasn't been doing that well since. He has been a patient of mine for a couple of years and hasn't stopped talking about "the settlement".
I know we all have patients like this. If it is a loss of life claim or a divorce or an accident, we all have patients that aren't living their lives any more because a lawsuit is consuming their lives.
But this guy apparently lost his wife in a medical malpractice situation and "plans" on getting a couple of million dollars and it is coming "soon".
So he was thinking that since the money is coming soon that he wanted to get started.

This person had lots of questions.
Not that I have a problem with questions, but I am a big fan of "let's do it, who do I pay?" and it gets done.
His questions were, "What are you going to do first? Are you going to give me shots? How are you going to make the temporaries? Will it hurt? How long is it going to take?"
Not in a "I would like..." kind of way, but in a "I'm nervous and I just feel like I should ask a bunch of questions" kind of way.
"Why are you going to send them to Glidewell? What do you mean the temps will stain?"
So, I remained calm and answered all his questions and took all his phone calls.
(Let me back up a sec. It sounds like I have a problem with answering questions. I don't. But this is the kind of patient that has said that he wants new crowns in the front for years. He has been telling me he was going to do it, and we would schedule and then he would cancel. So some of my reluctance to answer all his questions is due to the fact that I have answered them all before. That's all.)

So this time he scheduled. And I know he was serious because he paid the money to retain the appointment.
We did all the preliminary stuff. We did a wax-up. We sent the models to Glidewell, and they made some temps. I went with Glidewell this time because I knew this patient was going to be one of those people who say they will probably have the money for the final restorations in about a month, but it might take over a year. You all have those patients. The ones that you tell that it is imperative that they follow through to the final step and you don't see them again after the temp phase for a couple of years.
Glidewell makes the type of temps that they guarantee for 2 years. When I am working on this kind of person, I always go with the guarantee and charge the patient the $50 extra.

Anyway, the day of the appointment comes. It is like 11 am.
He is jacked up nervous. He is asking a bunch of questions again and is sipping on a coffee-type container. And he puts it down on the counter and every time we go away from his mouth for something, he is jumping up to get this mug.
Then he alludes to the fact that he is running out of "comfort drink".
Then I ask him what he is drinking and he replies, "Well, you know, a little of this and a little of that."
And as he is hitting the bottom of this thing he is acting a bit more relaxed than at the beginning of the appointment.
And we figure it out that this guy is drunk.
Now I am not talking about 85% through the appointment.
I am just finishing up the shots, and he is flying high.
So here is the dilemma.

Do you work on a drunk dude?
Do you send this person home?
For me I am going to be totally honest with you. HELL YES, I worked on a drunk dude.
But I can see how some of you would not agree with me. Do I think in a perfect world I should send this guy home? Yes.
But if this world was perfect, this dude wouldn't be getting drunk IN MY CHAIR.

So my assistant and I are in the backing saying, "He is totally drunk."
And I brainstorm about it.
If I send him home I waste the appointment time. If I send him home you have to say, "Dude, you are drunk. I can't work on you." Then you run the risk of him saying, "Well, if you won't work on me I am going to find another dentist." I also can't put a guy who has been drinking back in a car and send him home.
I am totally not running that risk.
So this brainstorming lasted about 5 seconds.

I mean what am I suppose to do?
Now I know there is some risks of working on a patient that is under the influence, but I don't know the extent. I have to tell you that I have some experience with being drunk and I have some limited experience with marijuana (sorry dad, I love you mom) but I have no experience with anything else. And if some came in high on coke, I wouldn't know it.
I might say, "that person ain't right" but I wouldn't know if they were geeked out (I know all the drug lingo).

I have to tell you that working on crazy messed up people is totally part of the job. I just have to laugh about it and do my job the best I can.
Every day it is something else.
Now I just come to work expecting someone to be drunk or something like that.
I think some day soon that drunk person at work might be me. JK

Have a great weekend.


Cosmetic Dentists Chandler said...

Hi John:

Tough call to make, but I agree with your reasoning. I think that I would have also operated on a drunk patient rather than sending him home.

I had a somewhat similar case years before, but it included a 15 year old with teeth that certainly looks like she's been on meth. I was thinking that I had the responsibility to tell her parents about what I think, but I wasn't sure if that would be way out of line. I didn't. I guess am chicken.

Susie said...

What a nightmare call to have to make! At least if he's drunk he's no trouble but he might have been trying to score another law suit!

I take it the job went fine and he's happy enough with his new smile


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