Friday, October 5, 2012

I Don't Want an Exam

Well, things have settled down here a little. I think the course went well and it is such a relief to have that behind me. I have another lecture in NYC in three week and another lecture/hands-on in January, but that is all I have scheduled right now.

I did a massive push to get gigs about a year ago and got about 8. It has dried up, so I have to do another push to get gigs again. I was hoping some people would hear about me and call me, but I guess I am not that lucky. The feedback has been very positive but no one has called yet. I have just hired someone to build a website for my lecture so meeting planners can find all the information they need about me. This is a risk, especially if no one goes to the site. But I am trying this thing for a couple of years and we will see what happens. I will keep you posted.

Today I want to talk about the patient that is not very compliant. I have been in this biz for about 17 years and I have seen everything, but still some things amaze me.

I have some friends at my church who go to a dentist near their home. We have gotten to know them well and they both said they wanted to come to my office. The wife came in first for a new patient exam and really liked it here. A couple months later, the husband came in. He has the dental issues. He had braces to try to improve the bite and the cleanability of his teeth and he has been battling gum disease. He has been "keeping it at bay" for about 10 years.

It has been a couple years since he last had his teeth cleaned. You know that a couple years is a long time to wait for perio maintenance. I did perio probings and he had an alarming amount of 5mm pockets and only about 40% of bone on the lower anterior. He has great teeth, a pretty good occlusion and no decay, but the perio is a concern.

I mentioned this and told him that I would put him on a "shorter leash." I want him to come in every three months for a bit while trying to avoid another trip to the periodontist. He said his insurance would not cover that. I told him that his insurance would cover the extractions of those lower teeth. I made it very clear that I recommend him coming to see us every three months for now. He scheduled his next appointment for six months.

I just shook my head. He has been around the block with his perio. He knows what is going on in his mouth and he does not want to spend the extra $170 a year to make sure he doesn't lose his teeth. This kind of stuff baffles me. You are probably thinking that I should not be so hard him because maybe money is a concern for his family. It isn't. I know this couple. They are DINKs (duel income, no kids). The $170 is not the problem.

People are weird. These people are great people. I am not really mad at him. Maybe I am just mad at myself because I must have done something wrong. I must have not educated him enough. I must not have told him the severity of the issue. But I think I did. He knows. He knows what gum disease is and he knows he has it. He knows that being here more often is going to prevent the advancement of this disease. But he just doesn't want to spend $170 out of pocket. This is not my fault.

It baffles me. I know they like it here and I know they trust me. But who do you think is going to have to pick up the pieces when Humpty Dumpty comes tumbling to the ground? You guessed it: me.

What do I do? Do I kick them out of the practice because he won't listen to me? Do I bring it up every single time he comes in and pester the crap out of him? We all know that is why people leave practices all the time. "The hygienist wouldn't stop telling me to floss." Or, “They just kept bothering me at my old dental office." Do I just pretend it isn't there?

I don't know the answer. Do you have one? Let me know what you think.

Have a great weekend.



Anonymous said...

Why don't you pay $170 for him so he could come in? If your friend wanted save $170 over his teeth, then as a good friend of his you would pay $170 for him. As you said it, they are DINKS and that amount shouldn't be a problem. I believe the real reason is not the money like you said, but you couldn't get him to talk so lets go with what information you have. Hopefully he'll open up to talk about his real concern.

Anonymous said...

Hey man you did your best. Actually you did your job. It ends there. People have different ideas about teeth as you know. Some view their loss as a feather in their cap of aging, a badge of distinction based on others that came before them. Like a belief or a even perhaps a religion. Maybe they see it as God's will?

I wouldn't sweat it. Since they go to church the have beliefs not based on fact.

As long as you've documented their sentiments and your recommendations a lawyer cant touch you. Sad as it is defensive dentistry is what it is. We can't help everyone. Frank Spear, the dentist he is not, wouldn't have given a rat's ass. Godspeed!

Anonymous said...

John: I have been active for over 50 are being too hard on yourself. Your patient that is non compliant is making a decision that makes him happy. Those teeth are not going to last long with or without perio treatment.

Merely do the best you can. You may consider some operative/splint to stabilize them for a while.

I , like him , am a control freak. He is happy; you are not. Who is to say that he is correct and you are not? Or vice versa.

My dermatologist, whom I have been seeing for 25 years has recommended a new proceedure. I am not going to do his recommendation. I too, am a control freak . I have noticed changes in is office since his daugher came from med school and joined his practice. More marketing...I beleive this is a marketing change to a proceedure that my inurance will not cover and the dr. can bill me for the entire proceedure. I know this is a common practice in dentistry. So I am suspect.

Each time your non=compliant patient comes, make profuse notes and remind him that his front teeth be lost soon. He can use them until he decides he wants them extracted.

I think they are close to that time right now. You know how to make bridges and partials.

Give the non=compliant patient some slack...he may have a health issue he is keeping secret ....his perio involved teeth may outlive him.

You are doing the best you can. Let it go.

As for my dermatoligist...I think I will walk ; I will us my
feet; I think I will look for another dr. I am comfortable with.

We live in the USA. Not Russia?

Dr. Bob Allen Hampton VA

Anonymous said...

That is why we have periodontist.


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