Saw This One Coming

Well, I hope your summer is going well. Here in Florida, it is a wet and steamy one once again. I have been trying to get my lawn mowed for two weeks, but it keeps raining. In my neighborhood, everyone has a yard person. One other person supposedly takes pride in the fact that he mows his own lawn, but now he has competition. Not only do I mow my own yard, but do it with a walk-behind mower! Beat that!

I have gained 20 pounds since leaving the Navy, and lawn work I actually enjoy somewhat. It relaxes me and I get some exercise while I accomplish something. The time factor is the only problem. Can you believe we are more than half way through the year?! Where has the time gone?

Do you ever listen to that little voice in your head? You know, the feeling in your gut when you meet a patient and it is saying, "Danger, Will Robinson!" I try to, but this time I ignored it and now I feel like the little bug caught in the Venus fly trap: Doomed! I originally wrote this prior to Dr. Jackson's tingle blog, but it falls right in line with what he was blogging about.

I had a new patient that was referred over by a specialist. Let’s call him Fred! He was congenitally missing the maxillary first molars and wanted the space restored. He was about to complete his ortho treatment in the near future. From the moment I met him I could tell it was going to potentially be tough. He just had that aura about him. I cannot describe it, but he was just sort of snotty and demanding. All he could talk about was how little money they had, on and on. (I seriously doubted that because I was told that they owned several businesses and he was wearing a gold, diamond-studded Rolex.)

He was always talking poor. Fred did not want implants due to cost. Fred was not sure if he wanted a bridge since it would "destroy his teeth," and there was no way an RPD would fly. We finally decided on a hybrid zirconia bridge, full coverage crown on #3 and a inlay on #4, and we would do the opposite on the other side eventually. After two or three conversations and a year later, he showed up on the schedule for the right side.

I went in, reviewed the treatment plan, and started the right side. Everything went well, the temporary was done, and he said we did not do the other side. I was surprised because I only thought we were doing the one side. But I had time so I said ok. That little voice told me to put down the handpiece and look at the chart. Well, there was nothing in the chart or signed treatment plan for the left side. So I sent the assistant to figure it out.

I do not get very involved in the financial side of the office; we have a very well-trained, competent staff that I have respect for and trust in, and they know my feelings about money. We need to be upfront and honest from the get-go so there are no surprises in the end. I feel like, no matter how hard I try, we still get burned sometimes.

That is when I had originally listened to the little voice or tingle. Since the original estimate was over a year ago, we had discovered that his insurance had a missing tooth clause and they were not going to pay. Also, the patient was under some idea that the first treatment plan for the right side was the cost for both, even though it was explained that it was for just one side and he signed the treatment plan and cost estimate. Since the original estimate (which was in writing that it was only good for 90 days), nothing had been reviewed with the patient and no other questions asked about the signed estimate.

The patient had a mini meltdown, saying that we were trying to change our fees and we messed up and took advantage of him. Wait, we have a signed treatment plan and estimate for that side for the full fee and estimated insurance payment. The fee was still the same and we were honoring it even though it was over the 90-day period and our fees had gone up. They only thing that had changed was that his out-of-pocket was going to be more since insurance would not pay. The total cost was the same. We could have even raised our fees to our normal rate since this was not going to be a covered service by his insurance company. Yet we are trying to rip him off!!!

I informed him later many dentists would have put that bur on the tooth as soon as he said do the other bridge and they would have said it was just too bad if he was not fully aware of the fees; he is an adult and should have thought about that first. ARGGGGGGGG.

Needless to say, we are halting all treatment other than what has been started. I have discounted my fees on this bridge to almost cost, even though I should not and do not need to because the patient was fully informed and we have it documented with a signed treatment plan for that work.

I found out later that the first thing he did was run over to the other dentist to complain about the office. I want my patients to have trust in my ability as a dentist and in my staff as honest and caring. If I have a patient that openly questions that and makes comments that references that they have lost that trust, I do not think that is a good relationship.

I feel that I have not many options long-term with this patient. I plan on telling the patient that I do not want to restore the other side and that since he has expressed his lack of faith in our office, that it would be best for both of us for him to find a new office. I hate having to do this, but I hate even more treating a patient that thinks we are trying to cheat them. I do not want to feel like I am running from the issue, but it is not worth the anxiety every time I see Fred wearing his gold diamond-studded Rolex on the schedule.

This is a no-win situation, but my blood pressure will probably be better with him gone.

What do you think?

Have a great week,
JJ