Tuesday, May 11, 2010

The Wrong Tooth?

Hey all,
I hope you all had a good Mother's Day.
Okay, I am going to get right to it today because we have a guest blogger. (I don't want it to be all about me....well, yes I do, but I digress.)

Something happened at his office, and he wanted to tell you his story.
I am going to hold off what I think until I know what you all think.
So without further ado...

OK, so in March this guy comes in. He’s in shambles because of a horrendous toothache. My assistant gets the X-rays, and they reveal a bombed out, yet very restorable, #18 next to a couple of equally bombed out root tips that use to be #19. The patient is under the impression that #19 is causing his pain. Most reasonable dentists have seen this one before and know (instinctively) that the pain is coming from #18.

So, we get into a long conversation about a variety of options ranging from implants to root canals to extractions to bridges. EVERYTHING is covered. This dude is 26 years old and very low on funds. Antibiotics and some Vicodin are prescribed and I tell him to just let me know how and when he wants to do something. The chart entry from that day reads…he’ll decide (what to do next) after evaluation of estimates and thinking about our conversation. He then misses an appointment six days later. A full month and a half later he schedules and according to the SCHEDULE it says he wants #19 extracted. I had totally forgotten about this guy over that month and a half. Moreover, I don’t bother to look in the chart. One look at his X-rays, and it’s not even debatable that #19 has got to go. NO DOUBT!

In the midst of his mandibular block I start my little Q & A about why we would remove #19 if #18 is in so much pain. He can’t respond, obviously, so I’m just talking and expecting some sort of feedback from Kim, my assistant. Kim tells me they had just rehashed the conversation in a more concise version from a month and a half prior. I actually warn him that it’s likely that #18 would hurt even more after I take out #19. In all of this time he doesn’t say a single word that would dissuade me from removing a couple of rotten root tips that 1,000 out of 1,000 dentists would treatment plan for extraction. I go ahead and get #19 out. It took some creativity and removing the interseptal bone, but it came out.

Later on in the evening I’m at my daughter’s soccer practice, and I get a call from the patient’s girlfriend. She says he’s in a lot of pain and that they feel I pulled the WRONG TOOTH. I say “really?” I am at a loss of course. I don’t have the chart with me. I hadn’t read the chart before pulling #19. I had no reason to doubt her (or him). So what do I do? The next day, on my day off, I meet him at the office with my 9-year-old daughter. I still can’t find his chart and didn’t want to bother any one of the girls who work for me. Plus, the game plan is obvious, pull #18. He then comes at me with this one…”I don’t want #18 pulled. I don’t want to have this huge hole where two teeth are supposed to be.”

Me: Uh, what? You would have wound up missing both had I removed #18 yesterday.
Him: No, I would still have #19.
Me: Yeah, but seriously, is, or rather was, #19 a tooth that you were using. It was hidden under your gums. It was, (pause) it was already gone.
Him: Look, you pulled the wrong tooth.
Me: So, um, what do you want me to do?
Him: Fix this one (#18).
Me: You mean the one that just 24 hours ago you apparently wanted pulled?
Him: Well, considering that I don’t want to have two teeth missing and YOU pulled the wrong tooth. I’ll just do a crown after you do a root canal.

At this point, without the chart his story is sounding reasonable. I even mention helping him out with the root canal. We agree to allow the antibiotics and pain meds work over the weekend and then we’d touch base come Monday. Monday rolls around, and I request his chart only to find that there is no plan to remove #18. In fact his treatment plan very specifically mentions a root canal for #18 and an extraction for #19. There are an assortment of other ideas like implants and bridges with estimates attached. There also is nothing, I mean NOTHING that would lead anybody to believe he wanted #18 out.

Michele, my office manager, calls him to schedule a root canal for #18. She mentions how much is expected, payment wise, at the time of the appointment. Instantly he tells her that it is totally unacceptable. “Dr. A said he would do the root canal for free!” So I call him. Me: Hey, I just read through your chart and uh, well, there is no mention of us…

Me: You do understand that…
Him (interrupting): You do what you have to do, and I’ll do what I have to do.
Me: What does that mean? Hey, I’ll waive the extraction fee from last week and pull #18 at no cost to….
Him: I’M GOING TO DO WHAT I HAVE TO DO! click So there it is. I’m really not sure where it goes from here or what he meant by “I’m going to do what I need to do!” What I need to do is wait for an attorney’s letter I guess. Then what?

Okay, aren't you glad this doesn't just happen to you?
I just shake my head and say to myself, I am glad it was him, this time, and not me.
Do you have an opinion?
I have an opinion (that is a surprise), but I don't want to tell you yet.
Let me hear from you, and then I will write my opinion in the comment section.
Hope you are having a good Wednesday,


Anonymous said...

That is why we have discharge letters informed consent forms and specialist to refer to. You should have discharge him after your first experience. As long as you have everything documented you will be fine. Stop giving in to his demands and kick him to the curb.

Gilbert Cosmetic Dentists said...

I agree with what the first post said. Be sure to have the papers ready and within your reach, so to speak.

Anonymous said...

As a non-dentist, who frequently lurks on this site I find it hard to believe that you would not review a chart, especially after not seeing the patient for over a month. It sounds like you went out of your way to provide a remedy again with out the benefit of your chart, which you could not find. I am not sure what a reasonable solution should be from here but you are the professional not your assistant or the dude in the chair…

I hear a lot of “CYA” and “kick em” to the curb but no personal responsibility on your part on how you could have done this differently.

Anonymous said...

In response to the last post. You are right he the dentist should have known better and not performed treatment he was not comfortable with. In the same way a can refuse treatment recommended a dentist can refuse treatment he does not agree with. Until you have been in someones shoes you don't know what it is like. People hear only what they want to hear and will LIE to you staight in your face. Been there and done that. So while it sounds bad to say kick him to the curb it is actually best for everyone involved except the lawyers!!! As long as you refer him to a specialist to get his treatment there is nothing wrong in doing it.

Dental Treatment said...

Oh dear, sounds like a sticky situation. It's a difficult one although the fact that the dentist never looked at the chart previous to the dental treatment would probably go in the patients favour.


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