These are experiences I have had recently out of school that no one prepared me for or that no one talks about
I Want A Refund
I had a patient who had the audacity to call in a couple days after an extraction to ask for a refund because she was still in pain. The office manager asked me what I wanted to do and I said, Are you serious, I got the tooth out right? How do you give a refund for that?
A few months ago I had a patient who came in for two crowns on #19 and #20. She was the type of patient who would always complain and was a bit difficult in the chair. What made it worse is her "insurance" was more of a discount plan which made her portion for the crown DIRT CHEAP, like $550 bucks for each crown! We prepped the crowns, got the impression and sent off to the lab for fabrication. The crowns came back and we seated the crowns and showed her them with a hand mirror and she was thrilled. She was happy and glad to be out of her temporaries and even was considering when she could get scheduled back for the last crown she needed.
The next day, our office manager told me she got a call from this patient saying she was unhappy with the crowns and wanted a refund. When I met with the patient a few days later the patient explained she was unhappy because the teeth "didn't feel pointy like her teeth before", she didn't like the metal on the inside of her tooth (PFM lingual margin), her crowns felt like they didn't touch with the top teeth, and a bunch of other reasons that were kind of rediculous. I explained that crowns aren't and will never be exactly like the natural tooth and that the lab can only make the crowns as pointy as her occlusion will allow, and that the PFM was l like that for specific reasons for strength and to preserve lingual tooth structure. After explaining she still kept making up more reasons she was unhappy with them and the reasons got worse and worse; I could tell she just wanted her money back, but still wanted to keep the new crowns. I finally stopped her ranting and told her, Option #1: I am happy to re-make these crowns at no charge to you and can try to have the lab fix some of your concerns but I can't give you a refund, or Option #2: I can drill the crowns off and send them back to the lab and give you a full refund. You can take that money and go find another dentist who you think can do it better (yeah right for $550 a crown). I said that I could not keep the crowns on her teeth that would be deemed clinically acceptable by any professor or clinician and still giver her a refund. I said I am happy to give her her money back, but that I woul dneed the crowns back. She of course stormed off and cussed her way out of our office! She did not want "better crowns"! She wanted free dentistry! It was obvious that she was making excuses. She was thrilled the day she left our office with them. Perhaps she has buyers remorse after she got them?
Anyways, she contacted Care Credit who helped finance her crowns and sent in a complaint trying to get them to somehow refund her crowns. they had us write up a dialogue of what happened and she ended up not getting her money back form them. We dismissed her as a patient. A few months later our office manager saw her in the local Wal-Mart and she said the lady apologzed to her.
These types of experiences can ruin your day and it is hard to recover from them. You will always find these difficult patients in any practice. Patients can be frustrating, demanding, and emotionally draining. The key is to go back in your office and take a deep breaths, get a drink, go to the bathroom, and mentally reset before you go see the next patient. Take the quick break even if you have other patients waiting on you!
The other day I had a lady come in with sharp pain on lower anterior mandible. Pt said pain was constant and keeping her up at night and that she hadn't slept in days. It had been years since she had been to the dentist. We took a radiograph which showed moderate to severe bone loss with calculus surrounding the lower anterior teeth. The lady jumped out of the chair and screamed when I even pulled back her lower lip. I explained that I saw no infection from caries but that her problem was from gum disease and years of neglect. She asked if there was anything I could do for the pain. I said, our hygenist can do a deep cleaning to allow your gums to heal. She asked well what do I do for the pain? Tylenol doesn't work for me. I told her that no pain medication was indicated and that I could loose my license if I prescribed marcotics for a condition or diagnosis that did not warrent them. She got up in her chair and said are you serious! Well what am I going to do!? I said well I can't prescribe narcotics for this condition because the condition you have does not have symptoms like you hare having and I told her that she had been prescribed other narcotics recenlty from other offices. She said, oh for my back surgery! She angrily got up and stormed out and was very rude to our front desk on her way out. I looked back at her medical history she filled out that day and sure enough, no back surgery written down under surgeries section and no medications listed on her health history...
Dental Discount Plans
The company I work accepts "most insurances" so we see a ton of Medicaid and accept pretty much any dental insurance no matter how crappy and inconvenient. Some patient;s have this Humana plan that covers one exam a year and 2 bitewing xrays a year. They got 0% coverage on everything else but this plan sets the fees for all work done on these patients and it is rediculously low! The plan isn't really insurance at all, it is more of a dental discount plan. This Humana company is basically trying to print patient's coupons for our office. It would be like GEICO printing a 1/2 off coupon tfor a new BMW and the BMW dealership can only sell the BMW at 1/2 price to this customer.
This company is obviously charging these patients a monthly fee and they literally pay out nothing to the denal offices their patients go to. How is that fair?! These patients come in thinking they have "dental insurance and have to pay for 100% of the cleanings, fillings, or crowns. This company is committing highway robbery! They are charging our patients a monthly fee to print our patients coupons for OUR office! They are making free money and the dentist is supposed to eat the cost since their fee is so low?
I have this patient who comes in who has a dental discount plan and he has this Humana discount plan. His crowns are set at like $500. His root canal was like $200 and a core build up was like $60, which is all less than Medicaid pays out!!!! I think we did a 3 surface filling and he paid like 67 bucks! Our office is literally breaking even at best on these patients.
I talked to the owner about the situation and he agreed these fees were far to low. We are now working to not accept these "discount plans" because they are not profitable. He agreed and we are working to phase out of accepting these plans. Of course I have this patient who has this plan and he has a tooth that started showing symptoms of sensitivity after we did a crown so I've seen the kid like 5 times all for a $500 crown to follow-up on the tooth to make sure it doesn't need a root canal. I think that lady who wanted the refund on her crowns in the story above had this Humana plan too!
Post-ops and Whiners
There are some days in the schedule that are full of limited exams, crown seats, and post-ops. I have found quickly that you need to limit each of these to a certain number per day to stay sane. A schedule full of these will lead to an unproductive day where you are still exhausted from running around without doing much dentistry. There have been a couple days where I can't catch a break even to grab a bite to eat, all to do is a few extractions here or there. Crown seats mean production for other days and they need to be done but try to space them out a little bit and not have 4 in a row on the same day. Limited exams can be nice on slow days but again, 4 in a row takes it's toll on you. I have found that limited exams can bring in their fair share of crazy patients!
One of Those Weeks...
This has been one of those weeks no one talks about or no one prepares you for. Christmas and New Year's is over and January is in full swing. Today we had an assistant call in sick while one was scheduled already to be off. We are down to one assistant. To start we had a grandma who couldnt get her 12 year old grandson out of bed to come to the appointment but brought the grandaughter (11 year old) for hers. She gets in the chair and tightens her lip and wont even open her mouth to do the fillings she needs. The grandma isn't much help and we end up referring both of them with those two high production visits off the schedule. We have had 3 or four kids crying just to get xrays. One dude who kept trying to get me to show her 5 year old a syringe and needle to scare her into brushing her teeth. No one has money to do treatment and the schedule falls apart day after day for a week straight.
I don't share this to complain, but rather to chuckle at dentistry as a profession. Two weeks can go by and all be pretty good and then you will have a week like this. some weeks you get all the crazies or all the tough patients. It is easy to beat yourself up about it but do your best to get through these weeks and it will make you appreciate the good weeks and the good patients. Dentistry is so up and down! Both people and teeth are so unpredictable. Embrace it and laugh often or else you will go crazy!
I recently did an immediate denture on an older lady and pulled quite a few teeth on top and bottom. The patient is very dramatic and had teeth worn down to the nerve on top and bottom from years of grinding her teeth. We pulled all the teeth and delivered her dentures and gave her the usual instructions. Three days later she comes in with the denture still in hysteric and crying saying it hurt so bad. She said she wasn't able to take the denture out after the first day because it hurt so bad. She said she wasn't able to take the pain medication I prescribed because it made her feel sick. She had been smoking and hadn't followed post-op instructions worth a darn! She would hardley let me touch the denture it hurt so bad. Here was this lady who just got a mouth full of extractions and has had her denture sitting on top for 3 days and nights straight with no pain medication! I asked her why she didn't call to get a different prescription she could tolerate and she made some excuse. LIKE WHAT DO YOU EXPECT REALLY? I want to tell patient's that it is like amputating your leg then walking with a prosthetic leg the same day; you think that's going to hurt? I try to prep patients with immediate dentures talking about how to get teeth in quick for esthetics you sacrifice comfort, fit and it will be painful, but I think patients are so quick to think that dentures will "replace" their natural teeth. I always tell my patients that the dentures they chose are the LAST RESORT and remind them that it is the CHEAPEST OPTION to try and replace years of failing teeth. It was hard to bite my tongue and try to be empathetic to this patient who disregarded all instructions we gave her and was showing up with the consequenses.
Immediate dentures, you love 'em and you hate 'em!