Friday, October 29, 2010

No rain...but is it pouring.

Friday - yeah baby!!!

You know that it is smack dab in the middle of hurricane season here. While there have been a couple of named storms this year, not one has even threatened Florida. But even without the threat of hurricanes, we do still get a lot of rain and thunderstorms.

Yesterday it rained. Not alot - just a late evening rain for about 40 minutes. What's the big deal, you ask? Well, it hasn't rained here in 32 days; it has been driest October on record. So, while it wasn't much, we will take it. I tell you about the weather because, even though it is not raining outside, it is pouring in my office.

I have to tell you that I usually am a free-flowing idea kind of guy, but lately my mind has been on only one thing. I didn't want to tell you because I am kind of embarrassed. Not embarrassed, more ashamed.

As you know, I pride myself on being a very good dentist and treating people with exceptional service. But this year has been kind of rough. I don't have too many issues with patients, but lately I have had a rash of them. I have put off telling you, but now I am just going to come out and say it.

A woman come into my office for her first visit. She had gone to an endodontist and she didn't get along with him. Every tooth in her mouth crowned. Now, five years after her full-mouth reconstruction, she has 4 abscesses in the lower anterior.
The endodontist had diagnosed everything and even sent me a letter. I turned on the charm when she got here, and everything went really well.

I told her I would do 2 pulpectomies the first time I saw her, put some calcium hydroxide in the canals, and let them sit for a month. Then she would come the second time and we would do the same thing on the second two teeth. She loved me and told me so. She said she didn't have any money, but paid in advance for 3 of the root canals.

She came for the first visit and it went well. I told her I would see her in a couple of weeks for the second appointment to do the second two pulpectomies.
The second day she came in with a bit of an edge. No big deal - I had work to do.

We started the second two pulps (the second one being a retreat). I want to preface this next part with some philosophy. Lower anteriors are usually easy to get an endo access. But when they have crowns it is a bigger deal to me. I try to make the access very small and I want to make sure I have proper perspective when doing so. This being said, I don't routinely put a rubber damn on for my accesses. I usually gain access, then put the rubber damn on. (You now know where this is going.)

I got access, no problem, in the normal tooth. It was the re-treatment tooth that was giving me trouble. The access was fine but I couldn't get a file down the tooth. The number 8 file kind of hit something and bent and didn't get down. It was the hitting and bending that would lead to what happened next.

The file bounced out of my hand and landed on her tongue. No big deal. I was going to pick it up and before I could move to get it she shot up in the chair. I thought she overreacted a bit, but she spit it out and gave it to me. She laid back down and we went on. I finished both procedures without further incident.

Two weeks later she was supposed to come back to finish the root canals on the first two. She calls 15 minutes before the procedure and says, "I am not coming back and you know why."

This was coming out of left field to me. She claims that she left a message on the machine here at work. I never got it. It seems that what she said on the machine was that that night after the last procedure she had to go to the emergency room. She claims that when she jumped up to remove the file from her mouth that she hurt her back and when she turned sideways she hurt her neck. And then she said she was calling me today to ask me what I planned to do about it.

She said that all this happened at my office and as a result of me dropping a file.
She said, "I don't have medical insurance and I have all these hospital bills that are piling up and I don't know what to do."

I just sat there on the phone and didn't say anything. I couldn't believe this was happening. It was stunned silence. All these things are running through my head. She is crazy. She is some woman that doesn't have insurance and is looking for a big pay out. And she kept asking me what I was going to do about it.

I told her I wasn't going to do anything. She, of course, says something like, "I am not that kind of person that sues people." Then went on to say, "If you don't do anything, I might have to get other people involved."

I said, "Do you what you have to do." I told her that I would get some council on this matter and get back with her.

I've had time to think about it, and I have to tell you, it STINKS. I mean, it really stinks. Yes, I dropped a file in her mouth. Yes, she jumped up. But I think it would be the same if someone slipped and fell in the reception room. I know what you are going to say about the file and a rubber damn but...

I really care about the fact that she got hurt here. I wish it didn't happen. Should I feel responsible?

But I just didn't get the best vibe from her and there are a few reasons why. She came in for her first appointment with her "husband" and he did all the talking. She came to the second appointment by herself and I asked her where her husband was. She said that they are divorced but still living together, and the reason they got divorced is that he beats her. I was starting to put all the pieces together. Now I am in the middle of this thing.

I called my insurance and they are as much help as you guys would be if I asked you.
They said, "If you can find out how much they want and just settle amongst the two of you then we don't have to get involved but if you decide you want to get us involved we will start crawling all over everyone."

So it is going to come down to: how much will it cost me to make this thing go away? I do want to stand behind principle. "You are crazy, and if you want any money from me then you are going to have to go through my people."

I called her back and have left 4 messages on her home voicemail. Her ex-husband finally answered the phone yesterday and said, "She is in bed. She has been in so much pain that she hasn't really gotten out of bed in the last three weeks."

COME ON. Really? He and I went back and forth and he promised to send me all the bills from their hospital visit. I told him that I would look at them and then we would talk.

Apparently when it rains, it pours, and my friends, at my office it is pouring. I am in a bad mood and it doesn't look like it is going to get any better any time soon.

Have a good weekend. If you can encourage me with a nice comment that would really help.

I am going to drink... a lot (the AGD doesn't condone drinking to deal with your problems, but I think it may help).



Cesar said...

well john, as we used to say back in Ohio, feel free tell her to #*%$-OFF. put your man pants back on, glove up, and let's get ready to rumble! caring, principle, attention, love, teddy bears and hugs are all fine and dandy, but you start insinuating things and throwing the S word (law suit) around to my face, you get no more mister nice guy.

call your MP insurance folks back, tell them to start earning their pay, and get back to work. there's plenty of people needing your help.

Tom Gilbert said...

Boy, does that piss me off also. You were folowing the standard of care to access the tooth with the rubber dam off to make sure you didn't perforate out the side of the thin anterior tooth. Once you had a patent access confirmed with radiograph you were going to place the rubber dam and progress forward. You dropped a file, it happens. She is trying to play this big time. Your malpractice carrier should give you much more help than this and I'm sure they will. You should not feel bad. You are an excellent dentist. I can tell. Keep doing what you are doing.

Elizabeth said...

Wow, I really admire you for sharing this... because we all go through it. I was only out of my GPR a few months when the mother of one of my pediatric patients said she was going to file a complaint against me because a pulpotomy I did failed on her daughter's #K, and prior to starting I told her it had a 50/50 chance of working. Oh lord, I'll never give odds again... even though to be fair, I don't think those are good ones.
It sounds like she's going to try to milk this, and I would be interested to see if there are really medical bills. I'll be thinking about you and sending you good thoughts. Good luck.

Anonymous said...

Wow, that sounds like such bullsh*t. I am sorry you are going through this; but I would not allow this woman to steamroll over you. What you should do is contact all the other dentists in her file and see if she has had a similar problem with them. Maybe the reason she didn't want to see the endodontist was that she knew she couldn't pull a fast one on him. In any case, don't panic, stick to your principles and don't admit anything. You did everything right.
Good luck my friend.

jamie said...

i agree 100% with ALL the other posts on this subject!!!

so soemthing landed in her mouth and she jumped..SO WHAT!!! How many times have you taken out an old amalgum without a rubber dam (totally within the standard of care) and a chunk of amalgum goes deep back in the throat, and you need to stop...same bloody thing.

now, if you had said that she SWALLOWED or ASPIRATED the it's time to call the old attorney. but, she didn't, and THAT is the exact reason we use rubber dam for endos (btw i think you were just fine to try to access without rubber dam in a lower incisor). stand your ground...don't back down...tell her to start doing more abdominal workouts (start the late-night ab workout infomercial music....). her lack of being in shape, or having a bad back and putting it out, does not lead to YOU having liability.

also, since when does "hurting your back" lead to a massive hospital bill? what ever happened to "bed rest"? ice and rest your back, not end up in emergency room. seems a bit fishy...smells like a scam to me.

did you perforate....NO
did you fill her sinus with bleach...NO
did you run a bur through her lip or cheek....NO

all of these are "crap happens" and you didn't do any of them....get your peace of mind back and go on. keep up the good work john


oh, and for the record, over this past week i have:
-perforated an endo
-left an obteration 2mm short
-froze a patient up on the wrong quadrent (and yup, it was a block...on the bright side: it could have been worse, i could have DRILLED the wrong one!)

and, i told EVERY patient exactly what happened and they were very nice about it...we all have imperfections. i just try to make them as small and few as possibe!

Anonymous said...

This method of operation is probably how she got all those crowns in her pie hole! You will be wise to not fall for this scam! You are a great dentist period.!

Anonymous said...

The woman's an idiot!

Suzan said...

Sounds like you have a NIGYYSOB on your hands. It's a term a veteran passed on to acronym for Now I Got You You ....the SOB part you can figure out. The behavioral challenge is given a name because it is discussed extensively by those who operate health centered/relational practices. That is; how to recognize and avoid them which evidences a common vulnerability even with the best of care and caring professionals.

Notice the ....I GOT YOU....

I too admire your openness. You serve your colleagues well!

It's eating your lunch which speaks of your soul.

Anyone whose integrity and good intentions are questioned experiences a painful invalidation. May I remind you that you are responsible for purity of motive and integrity of your actions. With all the others I support you in remembering that.

With respect, I also feel it worthwhile to point out that to cry victim may rob you of an opportunity to learn something if you so choose.

The I got you part of the NIGYYSOB I think deserves some thought. Every provider has, in my view, an obligation to help people make choices; not make them for them and not let anyone else but the patient choose. I suspect, looking back you may have seen (perhaps ignored) the red flag when husband was controlling.

Something is amuck when another jumps to control another's choices and decisions and/or in this case, your patient permits another to run such interference. Why would that be? What is being protected? Why the transference of responsibility? In itself it is reason to be suspect and may have been an alarm bell to not get involved.

As I train people in Motivational Interviewing, (get the book if nothing else) it's impossible for the patient to not be involved. The locus of control cannot be shifted to another and if it is - it's a signal to opt out. The patient through the dialogue of making choices, thinking out loud demonstrates a number of values and valuing. A thought pattern is revealed through the expression of their reasoning for a choice. It's the transition from compliance to adherance.

NIGYYSOB's comply and then hold the "care giver" (emphasis on giver) accountable; trapping the provider with any number of unmet (and often unexpressed) expectations because the movement is too quick to treat the condition before we know the patient. The complier then cries foul and abdicates any ownership. In this case, feels someone needs to lose in order for them to win and so they grope at straws. They will find a way to be right at all costs...including the absurd.

Know your patient. Many know the mantra but not it's meaning. Too frequently "knowing" isn't more than rapport.

NIGYYSOB's have a set of characteristics that are highly detectable and recognizable - one I have pointed out already.

In the end, it just isn't right that you pay a price when your intentions and execution were the best of you.

What I offer may seem way to academic and dispassionate even harsh when you're so frustrated; I suspect fearful of what might come (cost, being labelled etc.)and angry that your integrity is being doubted and you now have to jump through hoops...not to mention deal with the hangover...literally and figuratively.

Shouldn't happen to a nice guy like you!

Anonymous said...

Keep your chin up, John. You are an outstanding dentist. Seems to me like you might have a scam artist on your hands. I wish you didn't have to go through this. Sending good thoughts your way and hoping your malpractice carrier tells her to go pound sand.

Anonymous said...

When people are desperate, they will what ever it takes to get what they want. I'm sorry your going through this.Don't drink to much, enjoy your life with others as much as possible.

dental consultants

Edward said...

You are going to be alright. People like this are professionals, just as we are professionals. This is a pattern of behavior that has nothing to do with you. Unfortunately, something similar may happen again in your career, despite your best efforts. Try to focus on the positive people in your practice. I'm sure there are many of them, given your honesty.

Anonymous said...

I read this entry after having a horrible day myself. So you certainly made me feel part of this larger community of good ethical dentists who desperate people take advantage of. Sadly, they have bitterness in their lives and want to take it out on us. And naturally, it all comes to the unhappiness that the lack of money brings to many people. You seem to practice sound dentistry that patients appreciate; although I know exactly how that terrible feeling in your stomach ruins your day in a case like this.


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