Friday, July 22, 2011

He Said, She Said

Hey guys,

Is it Friday already? I didn't even notice. Luke is off at camp this week, so last night I took Noah to the Rays vs. Yankees game. He is 7, which means that by the end of the 3rd he was bored out of his mind, so I bought him some food. Then in the 5th, the sugar kicked in. By the time we got in the car and out of the parking lot he was fast asleep. Great stuff though.

I had a patient come in who has been a patient here for a long time. He liked us so much that he sent a lot of his workmates, so now we have a lot of people from this company. Lots of them are getting work done and I don't really know who referred or works for whom. I don't know that they work at the same company or that he or she is he or she's boss. I just treat everyone the same.

This week, a guy came in and to get his teeth cleaned and started talking about another patient who was his underling. He said this person was fired because he has a drug problem. He had been clean for a while but fell off the wagon and was abruptly fired.

The very next day, and I wouldn't believe it either if it didn't really happen, the other guy called saying he was having a toothache and wanted us to call him in some antibiotics. Of course I thought there must be a full moon or something. I know this guy doesn't have a job, really, and I would rather not deal with this whole thing. I told my staff to tell him that we can't prescribe anything without an x-ray and a proper exam. I thought this would be a deal breaker for him, and that he might just go away. Well, of course, he made an appointment. CRAP!!! (Now, I paint a bad picture of this guy, but it all comes from the other guy. He has always been a pretty good patient: been on time, paid on time, and does the necessary work.)

He came in and started with, "You know I got fired, right? Yeah, that jerk [my other patient] really had it out for me." Then he went on to tell me his side of the story. Of course, I acted like I was hearing all this for the first time.

Anyway, the guy did get an x-ray and an exam and had a legitimate problem. I tapped on some teeth and one of them, with a history of a deep filling that I used Vitrebond™ on, was painful to the touch. He pointed right to it. He jumped when I hit it with mirror. He jumped when I put a Tooth Slooth® on it. He had no hot and cold pain. He had a necrotic tooth and needed a RCT. Of course he said, "I will go ahead and make an appointment. Is there anyway you might be able to write me a script for an antibiotic and some pain meds?"

What am I to do? I think I have to trust myself. I really think I trust the fired employee. I don't doubt that he may have fractured a law or two in the past, but I also don't doubt that he has a toothache. I wrote the scripts. My drug radar sure was up, but sometimes you have to write the script anyway.

Any thoughts?

Have a good weekend.


Shaheda Govani DDS said...

I would have done the same thing. I always trust my gut first and how a patient responds to the tests. Great post!

jamie said...

oh course you have to write the script. you just don't HAVE to give him narcotics. what's wrong with NSAIDS? i can't remember the last time i needed to give narcotics except after surgeries. if he doesn't like it, too bad. covers you both ways.

drdancer said...

Hey, John, I agree with what you did. You have to treat the patient first and not listen to the other input. BTW, what is going on in FL with the new laws on Rx restrictions?? How will that impact you dentists?
We had a post from DOCS recently that made me wonder how the new laws will affect your ability to treat legitimate pain. Care to blog on it? or is it too soon to tell?

Anonymous said...

The true test is if he calls back wanting more pills.

drtomas said...

I'd agree with legitimate toothache, but with no job and loss of any dental benefit, I think you'll have a phantom patient on your hands. Let us know.

Anonymous said...


It is too early to tell what is going to happen. They have currently suspended to Rx rule for either 30-60 days to let everyone catch up with ordering new Rx pads. They passed to law June 17 2011 with an effective date of July 1, 2011. I received my official letter July 5, 2011 by mail after the fact. Theoretically it should only affect the pill mills and those who sell the drugs in their offices. We will see.


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