Wednesday, March 16, 2011

Putting off x-rays

Friday. Enough said.

Gators won, so I am okay for now.

Slept okay but had to get kids ready for school today, by myself, so that went about as well as expected. It is organized chaos. "Why did you do it by yourself?" you may ask. I worked on Monday this week so I could have today off because my wife is going to South Carolina with the girls to a "conference" for four days. I've got a baseball game and a basketball game on Saturday that I have to bring four kids to. Then getting the kids ready for church on Sunday. Those are the three big things. If I can succeed at all of them, I will be alright. Wish me luck.

In this economy (you know I hate saying that), there are things we have to deal with. One of things that I have heard from other dentists, and am dealing with myself, is people putting things off. I am not talking about someone putting off a crown they know they need; this is all the time, not just nowadays. It is the "No I don't want x-rays" thing that I am talking about. "I don't want the doctor checking me today, I just want my teeth cleaned." I have been thinking about this for a month or two, and I have to tell you that I don't have an answer for you.

Let's say Mrs. Warren comes in for a cleaning. She is 75 years old and has been a patient for 15 years. For the most part, you don't do much restorative work on Mrs. Warren. She doesn't like x-rays. She kicks and screams every time you tell her it is time for x-rays. She again tells you she doesn't want them. This is the third recall appointment that she has denied x-rays, so it has been two years. What are your choices?

1) You tell Mrs. Warren that these are the rules and if you don't want to abide by the rules in MY office, you can look elsewhere for your dental care.

Let's talk about this option for a sec. I don't think anyone is going to do this (at least in these times where patients are at a premium). We used to have this attitude and there are still times when putting your foot down is necessary, but this option scares me and I will tell you why.

Pre-med used to be necessary for a heart murmur. I had a patient with a heart murmur that didn't take drugs because she was a Christian Scientist. She didn't want to take drugs and filled out a waiver that said she knew the consequences for not taking the drugs and she was taking full responsibility. I had a hygienist that felt really strongly about not cleaning her teeth, and she got the other two hygienists scared. None of the hygienists would clean her teeth. A struggle of wills ensued and I lost. I ended up telling this patient that she was going to have to seek her dental care elsewhere. Two years later, they came out saying that pre-med was not necessary.

2) Do nothing.

I am not saying that x-rays are not important, but my point is this: let someone make their own decisions on their health. You make them understand the problems that could arise because of not taking the x-rays and make them sign something saying they understand.

There is this thing with Americans now a days, a kind of CYA mentality, and I will tell you what - I don't buy into it. If someone doesn't want to do something that could be detrimental to them, let them do it (or not do it). You can tell them it is bad and they can do what they want. Are doctors responsible for telling people that smoking is bad? Yes. Are they going to kick people out of their practice because they won't quit?

People have to start taking responsibility for themselves. PERIOD. And when it blows up on them, which it will sometimes, they have to lay in the bed they made.

3) This option is kind of a philosophy. I try to have a relationship with my patients (sometimes a pipe dream, I know), but this goes a long way when it comes to things like this. They don't think I am pushing products on them. They don't feel like a gravy train for me. Hopefully, they feel like I have their best interest at heart.

Now don't get me wrong - I have those patients that don't want anything. They have cracked teeth and gum disease and I haven't seen between their teeth in decades but that is how they want it. I have them fill out a form saying they understand what they are denying and we continue. I have a patient family where the mother doesn't want a single x-ray on anyone in the family because someone had cancer. They always say, "When you think I need an x-ray let me know and we will take ONE." I have a couple of families like that. You know, I am not that opposed to that.

I know I have responsibility for their care, but how far do you want to go with this? I think it is my job to inform before I perform. I informed and they don't want me to perform.

I don't know what else to say. I know I am babbling. I emailed the Florida Dental Association to find out if there is a law or a "requirement," but I haven't heard back yet. I read like 4,000 laws and I didn't see anything about x-rays (even though I know there probably is something that I missed).

Do you have an opinion on this? Is it different now that the economy has tanked? Would you have kicked them out of your practice 4 years ago?

Hey, have a great weekend. I got to go, my son is wailing and calling for mommy. I totally know what he means.



Anonymous said...

Just have them sign the waiver that you are not responsible if anything happens because you cannot provide proper treatment with out radiographs to diagnose their condition. If they sign it I treat them. If they get the radiographs I treat them. If they do neither I do not treat them simply as that.

And no still tell people I will no longer be their dentist when it is in both our interest to separate. You know you never will please everyone.

Unknown said...

Hi John: I am a big fan of Daily grind,most of the times i feel that you are a mind reader, you spill out the situations what exactly i go through, feels good that i am not the only one. And i agree with you sometimes we run into situations, i had a patient who refused x'rays because his school teacher said that radiation coming from x'rays in dentist office are harmful. Though i tried to explain to him,even to the point, i got info on exact dose of radiation,he still refused it, i had to make him sign consent for refusal.
Can't wait to read your next blog :) Have a great weekend, good luck !

Anonymous said...

Hi John, I enjoy reading your blog. Thanks for taking time to write. I have had similar problems with periodontal charting. I understand and respect my patients' point of view. One patient even wrote to the state board of dentistry asking not to have this procedure done. They wrote back not only supporting my point of view that it aids my diagnosis, but stated that I would face disciplinary action if I failed to provide this service. I know this patient would never turn me in to the board, but this is my livelihood. I imagine x-rays are the same.

gatordmd said...

Aparna and anonymouses (what is plural of anonymous?)

Thank you so much for the kind words.
It is people like you guys that make it easy to write this blog.
I hope you keep reading and keep commenting.

Have a great day because you made mine

Anonymous said...

Well i had a similar experience a couple of days ago with the folks at Mydentist. I have always agreed to any xrays as I know they are important for the correct diagnose of my wellbeing. However all I wanted was to simply put off my xrays until April 2011 because that is the month I'm due for my baby. I explained all of this. The dentist said " Let me be clear to you, if you do not agree to the xrays I will not work on your teeth. I will not even look at them." I felt forced to comply so I guess you could say my " attitude" rubbed off. At that point, he says, I'm very concerned about this patient/ doctor relationship and I was thrown out of the office, ( which is not his practice, mydentist is a corporate chain). I wanted to be seen by another dentist and he would not allow that. I understand the importance of an xray but I still feel like I was treated badly. It was a situation that did not need to progress to that point. I also offered to sign any form about anything if they were willing to cooperate with me. They said those forms did not exist in that office.

gatordmd said...

Let me get this straight.
You wanted to put off taking x-rays because you were pregnant and the dentist was put off by this.

RUN, RUN!!! from that office as you can and find someone that is going to treat you like a person....not a number or a $$.
Don't think about it one bit more.

Now, before you forget call up the MyDentist headquarters and lodge a complaint.

Thanks for writing.
Good luck finding the right dentist. There are a ton of good ones out there.



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