Wednesday, January 9, 2008

Ms. S strikes again

As I finished writing her a refund check, I had this awesome feeling like “it’s over, and it only took $500 to make it go away.”

I NEED to tell you this story.

Ms. S came to me about two years ago. My periodontist referred her to my practice with a caveat. The caveat was that she was “a little different.” I told him, “No problem, I am used to different. My whole family is a little different.” (Mistake #1)

When she came in for a new patient exam she didn’t seem that bad to me. She was very nice and pretty funny. Her mouth was pretty healthy, but she was missing #14 and she was already set up to have the implant done by my periodontist (whose name is now “mud” around my office).

I think she got a cleaning at my office; yes she did get a cleaning because I remember a big stink around the office because she has a heart murmur and she would NOT take American-made antibiotics. She would only take Amoxicillin that was made in France. (Coo-Coo clue #1)

Then, for some reason, we didn’t hear from her for a long time until one day when she called to set up an appointment to have the crown done. As it turns out, she had gone to another dentist in town to have the abutment placed and the crown done. But she wasn’t pleased, so she wanted me to do it.

The other dentist is a guy I know. So, I called him up. He said, “Yeah, I know her. DON’T touch her with a 10 foot pole.”
He went on to tell me that he put a crown on and the next day she made him cut it off and give her her money back. She said it was too tight and there was no fixing it, so take it off. (Coo-Coo clue #2)

I thanked him and said to myself, “How hard can it be? I can do this. It’ll be the easiest $1000 I’ve ever made.” (Mistake #2)

I saw her. The abutment was already placed. Both opposing teeth were virgin. I mean this was a slam dunk.

So, I reprepped it and placed cord. I took an impression and made her an awesome temporary. She said it felt great. I even gave her a discount because it was so easy. I only charged her $900 (Mistake #3).

I called her the next day to see how it was going. She said things are great; see you in two weeks for the cementation of the permanent crown. Well, the cementation appointment went on without a hitch. She said it felt great, but just in case; let’s cement it with temporary cement--just to see. So, the next day when I called her she said it was not tight but it seemed to be catching food at the gum line.

“Huh?” I said.

She came back in and I took off the crown and made her another temporary. I told the lab to try to close the embrasure space. We had her come back in a couple of days later to try the permanent crown again. This crown, again, felt great, but we cemented in with temporary cement--just in case.

Well, the next day she called me telling me she was having teeth pain, headaches and general soreness in her mouth.

“Okay, let’s get you back in here and see what we can do.”

Well, after checking the occlusion in every way, I found nothing. I assured her I thought things really looked good.

Well, that lasted about a week.

“I want a new crown, this one is no good”.
Back in the office. Cord. Impression. Temp. The temp has always been perfect for her. (What can I say? I make a mean temporary.)

Well, you know how the story ends. So, I can just say we went round and round. Finally, she started to ask me about the makeup of the metal inside the crown. I called my lab technician and got all the information about Captek crowns. She boiled it down to the fact that while she was not allergic to the gold, platinum, or palladium, she was allergic to the trace metals in the crown (even though she has other PFMs in her mouth, amalgam fillings and an implant and abutment). (Coo-Coo clue #3)

At this time, I had had enough. I sat her down in the consultation room and said, “I feel for you, and I am trying to do the best I can. But I think I have given you everything to the best of my ability. I feel like I have given you $900 worth of product. I have made you two crowns and about four temporaries and adjusted each one about three times each.” I continued, “I want you to be happy, so you can stay here and I can continue to try, I mean, we can make you an all porcelain crown, but whatever I do from now on you are going to have to pay for. Or, I can give you back some of the money you paid so that you can try to get what you are looking for somewhere else.”

She, of course, wanted to go somewhere else. She told me she would go to her old dentist in New York. I told her I would come up with a reasonable figure to refund her. We agreed to part ways. My thought process was: I charge $400 for a temporary crown, so I was going to charge her that and I would take $100 for the rest of my troubles. I wrote her a check for $400.
She came in for the check and when she saw the amount she just shook her head. “This is not enough.”

I said “How much do you want?”

She said she wanted $500.

I told her I had lost way more than the $900 she spent on the crown. The hundred dollars was just a drop in the bucket.

I get about one Ms. S every two years. I think I do a pretty good job on my New Patient Interview getting to know people, but….

I should have listened. “Don’t touch her with a 10 ft. pole”, he said. I said it was going to be a slam dunk. More like slamming my head against a wall.

Thanks for listening, this was such good therapy for me.


Anonymous said...

It's reassuring to know that there are others out there that do get some of these "overly-demanding" patients. They have often made me feel like there must be something in my personality that is sending out whacky attraction vibes and I'm drawing them to myself inadvertently.
Thanks for letting me know it's not me, it's them.
-a general dentist from a small southern town

Anonymous said...


Nice to hear my own thoughts on paper. Had a similar experience recently but unfortunately had noone to warn me ahead of time. Heard the bells ringing in my head but didn't listen. Won't ignore the tolls next time. Great Blog. Enjoy it.

A. Verma (Germantown, MD)

Anonymous said...

Enjoyed the post. Been there done that. Being pedantic comes with the job I guess. Name is Mud is actually Mudd. This comes from the doctor Mudd who was involved with the Lincoln assassination and hence received his notoriety. He is a relative of Roger Mudd the newscaster. ADA guide lines for antibiotic prophlylaxis have changed and your Coo-Coo might not have needed pre-med.

gatordmd said...

Mudd or Mud, neithter or either.
Your post reminded me of a joke. Did you know that Lincoln was Jewish? Yeah, he was shot in the temple.

Thank you all for your comments. I will continue to try to be real and write about things you will like.

Anonymous said...

Great post!!! I've had a few of these in my day too!

Anonymous said...

I know, the problem here was you antibiotic prophylaxed without finding out what type of heart murmur it may not have had to gone there in the first place if it was a congenital non-pathologic murmur (like most are...) But the AHA has totally updated it so these coo-coo's will keep coming wanting their antibiotics. I refused accepting a patient into my practice once when they demanded antibiotics for MVP (no regurgitation!). I worked for a dentist one time that premeded antibiotics for a "screw in the knee" and she was doing a facial filling on #9! Give me a break! There is such a history among dentists just giving out the premed "aimlessly" or "it can't hurt" mentality, these coo-coo's are all over the place...have we bred them this way???

Anonymous said...

I read your blog. The part that struck me was your comment, "It’ll be the easiest $1000 I’ve ever made..." Wow! Is that why you became a dentist? Dentisty should always be about helping the patient, serving your community with a needed service and not about how much money can be generated in the shortest amount of time. What motivates you? Are you a doctor or a business man? Truthfully, you cannot be both. You must choose. Meeting the patient's need or your greed? Making a living is one thing but looking at your patients as dollar signs is quite another. When the latter is chosen, then the quality of work diminishes. The LOVE of money is the root of all evil.

And regarding the "difficult ones" you will find many patients are allergic to (PFM)... this is especially true when there are already existing crowns (whether noble or high nob) and amalgam restorations in the mouth. All of this factors into play here. Crowns can cause trouble because the body does not recognize the foreign material. Think about it. Don't forget the immune system in your quest to cement foreign objects to natural teeth. Your first mistake was giving her a Captek, knowing her health problems. Do your research. Know the risks involved with PFM. Hyper-sensitive patients are not usually allergic to gold but what the gold is fused with is the problem. I would recommend researching Zirconium oxide for all patients sensitive to metals.

gatordmd said...

Hey, why don't you give me your phone number because I think Ms. S. is still looking for a new dentist.
I think she is looking for someone who is as knowledgable and altruistic as you.


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