Friday, May 11, 2012

Your Staff Leave Something to be Desired

Hi all,

I got a call from a patient who works for (and was referred by) a local professional here. The professional’s entire family are patients here. This patient came in for a NPE. He has a hopeless 5-unit bridge on the upper right and missing lower posterior teeth. He said, "I am at a point where I want to look better and it is time I make my smile pretty.” And then he said, "Money is no object.”

Protocol is to run when someone says, "Money is no object." But, I didn't. I treatment planned this person for veneers and a couple of crowns, to remove the failing bridge, and to send him to my periodontist for implants in the lower posterior and the upper right (where he will be missing teeth when I take out the bridge).

When he went to the periodontist, his story changed. “I had an accident at my house that cost me a lot of money and now I really don't have that much money to spend. Can we do a partial on top and just a partial on the bottom?”

I agreed, but then things got a little crazy. I have to admit: this is where we could easily mess up. See, the treatment plan is in the computer and then the patient calls to talk to me. I am in the back and agree to change the treatment plan. But my assistant doesn't know anything has changed. I probably don't change anything in the computer. I change it in my head, but don't write it down. This is bad.

This patient called to talk about his treatment and schedule, but my assistant had no idea what he was talking about. Then we figured it out and he scheduled. He sat in the chair to work on a crown that was on the treatment plan. I asked him about an alternative treatment plan that I think would work that wouldn't show any clasps on a partial. He was all for it, but wanted to see if he could move some money around.

So we did the crown prep that day but didn’t take a final impression because he was thinking about changing the mode of treatment. We put a temp on the tooth and sent him off. The next week, the temp came off but he was too busy to come in. We told him to put the temp back on with Fixodent or toothpaste.

Then he called to talk about the treatment again. Apparently, there were tons of calls that I had not been privy to because he talked to my staff. He claimed that we kept changing the fees on him. He called and asked what the fee for a cleaning is ($89). Then at check out he was charged $124 (there is a $35 exam fee). Then he said something about me saying that I would charge him $850 for a crown. Our fee is $1,150-$1,250 for a crown. Why the heck would I say something like $850? So, there is a chance that he is hearing what he wants.

Needless to say, this is not a usual patient and we probably are not handling it well. I got the call saying that I am dynamite but my staff leave something to be desired. Then he went on to tell me the whole story. He told me he is still putting the temp on with toothpaste and how the charges keep changing. I told him that it is mostly my fault and I take full responsibility for my staff and that we need to have better systems to handle change.

I do not get carried away with this kind of situation. I don't get mad or feel insecure. I know there are some things we are not very good at. Changing treatment four times makes us crazy. The systems we have in place don't handle that well. When I get involved and talk to someone on the phone, all hell breaks loose.

It would have been easy to throw the staff under the bus to save face. But I am getting older and I don't really need to save face that much. I is what I is. (Listen, I know that sounds very admirable. But I have thrown my staff under the bus about a million times. They know that is part of their pay.) We do need to get better at some things. I need to get better at a lot of things. Communicating would be at the top of the list.

What don't you need to get better at? Do you throw your staff under the bus?

Have a great weekend,


P.S. Now go and get a Mother's Day gift. Hurry!


Marielaina Perrone DDS said...

Thats a great post. Sometimes as dentists we feel like we are on an island, alone in our own worlds. We forget others go thru similar experiences on a daily basis. You handled it perfectly taking the brunt of it and being a good team leader like we need to be. Employees will appreciate that move.

Linda Zdanowicz said...

What a frustrating situation! Don't know if you're looking for solutions, but here are a few of mine. First, as you go through your npe, mention possible treatment ideas to gauge the patients' response. Document, document, document. Write down things he actually says, and impressions you get about his attitude toward treatment. Make sure your staff documents every phone call in which treatment is discussed. Work up a review of findings for each patient with more than basic treatment needs. Bring these patients in for a consult and present the treatment you feel is the best, along with alternatives and tell them the pros and cons of all of it. Finally, patients change their mind and often it's because they don't understand what you are proposing, hence, the consult.
Linda said...

Okay article. I just became aware of your blog and desired to say I have really enjoyed reading your opinions. Any way I’ll be subscribing in your feed and Lets hope you post again soon.


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