Sorry about yesterday; I had a crazy day and was not able to write a blog.
Everything went okay this weekend. Nobody died and we all made it to church. I watched Grown Ups this week. I was pleasantly surprised. It was good. I also saw a movie called Listen To Your Heart. It was okay. It was worth the money (it was free).
Today's topic is "that guy." I have a patient. I think you might have this guy too.
He is in his early- to mid-eighties. He lives right down the road and he walks to the office. And he is at my office all the time. He just shows up, no appointment. He has never had an exam, but he came in because he had some pain. He has numerous issues, but his biggest issue is that he is missing a bunch of teeth (including some upper front teeth). I did minor restorations and made him a Valplast upper partial. I thought I was done with him. OH NO.
This is a man that has the pain tolerance of a 4 year old girl. He walks in and asks to see me to "adjust his partial." I bring him in the back and zip, zip and he leaves saying, "That feels so much better."
Am I supposed to charge him? I just made the partial 3 weeks ago, and I usually give an adjustment with a partial. BUT... then the next week he comes in again. Zip, zip. "Oh, yeah, that feels much better." No charge.
I am serious when I tell you this happens 10 more times. Zip, zip. "Oh, yeah that feels better." Each visit lasts about 2 minutes. I think he is kind of lonely. We treat him well and we're so nice to him, so of course he is going to keep coming back. He probably bugs the poop out of his family. We probably treat him better than his family.
And it is still happening. So last time, I had to say to him, "Mr. X, I am going to have to start charging you for these visits." He says, "Yes, of course. I was wondering about that."
He comes in again this week saying that he is having pain on the lower. I look in there, and he has a bunch of cavities. I realize he has never had a new patient exam. And it looks like he hasn't brushed his teeth in a week. He has so much plaque on his teeth, I can't even see the decay. There are so many things wrong with this whole situation.
I never did an exam. I have never cleaned his teeth. I have never taken x-rays.
I have seen this guy about 15 times, and have never looked around his mouth. He said the partial was rubbing his gums, so I relieved the partial. He said this tooth hurt; I saw a cavity on that tooth and I filled it.
You know, sometimes you don't do the things you normally do on elderly people because you don't want to take advantage. But me trying not to take advantage of him is causing me to not treat him properly. I sit here shaking my head in disgust with myself.
Here is a guy who frustrates me because he is at the office all the time, but really, now I am frustrated because he has taken me off my game. If he would have come in for an exam, we could have done it my way. If he didn't come to the office 10 times, I wouldn't try to rush him out.
I have to go. I have to call his daughter and tell her that we are going to have to start over. I will tell her we are going to have to do an exam, x-rays, and a cleaning before I see him again. And then when we do all this, then I can go back to seeing him once a week again.
Do you have this guy in your office? Is it a lonely thing? Tell me I am not alone in this.
Have a great Thursday.
john
ps. Gators play at 7pm tonight. Man, if we can just win two more games, I will be tinkling myself.
Hi John
ReplyDeleteYep. You are not alone. I have a few versions of "that guy" because I practice down the street from a 55 and over development. Sometimes, I think they are coming in to see my staff and I'm just "the guy who works in the back," who terminates their visit by doing whatever adjustment that takes care of them. Thankfully my staff members are patient and don't mind talking to these people. And, you are absolutely correct in insisting that they come in for an exam and initial X-Rays. Usually, they respond positively and agree.
When "that guy" finally does come in for the exam and X Rays, be careful he doesn't side track you into addressing yet another dental problem. Stick to your guns and then, if you have the time to do a "zip zip," go for it. Good Luck.
Vinny
Valplast not my favorite thing.
ReplyDeleteI give 3 adjustments no charge. Usually unless there is a real problem they will stop bugging you.
Unless it is broken or hurts they have to have an exam before we do anything else.
I have a better story for you. There was this lady who kept complaining the interproximal 14 and 15 did not feel right to her tongue. 14 and 15 were rotated and had really large amalgams, contacts were closed, no decay, but there were at a forty five degree angle and had a concavity due to recession. No opposing teeth. Restorations were good (very old) and whomever did it is my hero.
But every 3 months she would come in and complain. I would look and tell her everything was ok because it was. Nothing ever hurt she just did not like the way it felt to her tongue because there was a hole there. Felt bad so I never charged her for those look see visits. But after the 10th or so time I started charging her an office visit. She went to two other offices and got quotes for crowns $1600. Then she came back in all mad and complaining about the cost. Again I told her there was nothing wrong and to stop playing with it. Finally I told her just take them out if they bother you that much since she didn't use them anyway. Have not seen her since then.
I apologize for commenting on an old post, but I just found your blog (and enjoy it).
ReplyDeleteBecause of the gentleman's age, I suggest that he may have some dementia. One of the early signs is a lack of inhibition, which can include attention seeking. His poor care of his teeth might be another sign. I am glad that you planned to speak with his daughter.