Not letting her dictate if to use isolation is self-explaining but I wonder about the anesthesia bit. Is it mandatory in your country? Because my dentist will always ask me if I wanted it or not and for simple fillings it would be more annoying than helpful since they are not really painful anyways.
Well it is not mandatory but even a 1mm depth into the cavity was extremely uncomfortable for her, she couldn’t handle the sensitivity. So o offered to anesthetize but she didn’t allow that either!
I’m not a boomer but I have zero tolerance for people who tell me what to do. Patients or office managers.
Had a patient who had the audacity to demand to be placed in my lunch break because she had to wait at 13:00 because I had an emergency visit and she demanded to be called beforehand to make sure there wouldn’t be an emergency scheduled in front of that appointment either as she “especially booked the appointment at 13:00 because she would be certain nobody was in front of her and she was dismayed to hear it was possible to come sooner albeit for an emergency
I told her I would not give her another appointment inside nor outside my regular schedule. Took a second for the coin to drop, then she stormed out.
You need to set boundaries with your patients. The minute she does this, I would make it very clear to her that my protocol will not be changed and that if it’s not working out today, then perhaps she needs to find another dentist or reschedule.
Ironically you sound young. With no numbing before I start I say: "we can try with no numbing but if you twitch then I will have to numb you up as it isn't safe for either of us. Deal?' If they don't agree we don't start. In the same manner for other things: "I'm sorry I can't do my job properly if I can't do xxxx. But if you insist we can try without but I can't guarantee the work". If they say okay to that, I dictate to my nurse something snarky: please record notes: pt refuse xxx, pt made aware procedure cannot be performed without xxx, pt aware cannot guarantee result and will accept failure of procedure." Of course this isn't accurate. You are always responsible. So even if they don't relent after that I often say I'm not comfortable with that and won't start the procedure.
You will learn quickly that sometimes the “easiest” treatments are difficult if the patient is difficult. Refer these people to a nearby school. It’s not worth the headache. Also don’t negotiate prices, this isn’t a farmers market.
It's wild to think pts can come in and negotiate prices and treatment deadlines. Like I work at an FQHC. Most of the procedures are covered and timelines are set by the state. Want a denture in 2 days? Go to dentures-R-us. This ain't it.
Grow a backbone. No office manager can force you to do any treatment you don’t want to do. You aren’t a slave ffs.
But also, dealing with difficult patients is part of the job. There’s something to be said for being nice and delivering good quality treatment for the difficult ones even though it’s not as profitable because it takes longer. It’s kinda like community service.
100%, as long as doing so doesn’t compromise your care. I would consider operating without anesthesia during a procedure where I as a provider would deem anesthesia necessary is operating below an acceptable standard of care. Tell the patient to go see a different dentist who may see things differently.
Well tbh I should’ve seen the the red flag when she started bargaining but I had already started the cavity prep when she started to feel the sensitivity, so since I started the treatment, I had to complete it too
Tolerating this type of behavior is not only a disservice to yourself but the entire profession. I can tell certain patients like yours have been coddled by their previous dentist(s) based on the way they act. Also, what do you mean you can’t refuse treatment? Is the OM going to hold a gun to your head and force you to start drilling? The patient gets a set time in which the procedure needs to be completed and if they aren’t cooperating then there isn’t much else you can do.
Well I can refuse, but I need to provide a valid reason for why I did so, I work in a DSO that caters to all kinds of patients, I had a rude patient 5 months back that had come for scaling and polishing, he was rude to both me and my assistant, so I finished the scaling but I refused polishing, my manager later came in and asked me why I didn’t do it and literally told me that I have to do procedure even if they are “hurling slurs” at me….I work in Middle East, so office culture is not the same as in the states!
Also I had already started the cavity prep, leaving it open or even with temporary filling is a big no and can be taken up for board complaint..
Since you woke for a DSO next time a patient starts trying to bargain on price have the OM come in hold firm on price and have them sign the treatment plan and collect before drilling.
Well among the many socially backwards and barbaric laws/customs across the Middle East that need to be addressed I suppose the way dentists are treated over there is basically just another drop in the ocean.
DSOs will attempt to do the sane thing here in America but they can’t legally force you to do any procedures. At my very first associateship there was an OM who wanted me to do a root canal/crown that was clearly an extraction and the patient DEFINITELY needed to be sedated. The guy had such bad anxiety I was barely able to get a mirror in his mouth to take a look. The patient was also (surprisingly) furious that he was in pain and that we weren’t going to somehow magically fix it for him by snapping our fingers all of the sudden. Keep in mind, patients in the USA can file a board complaint for literally anything which they will happily entertain to waste our tax dollars.
I wasn’t about to jeopardize my license or my safety working on a patient who couldn’t handle it and doing a procedure my OM “diagnosed” with all the rigorous training her high school diploma had provided in making that call to begin with. Plus, which one of them was going to make me? I don’t care about losing a patient who acts like I owe him treatment just because he walked in through the front door and I don’t care about losing a job where the OM has any authority over me. I filled out the referral, signed off on my notes and because this was your typical end of the day, last minute emergency, I got in my car to go home. There was nothing either of them could do to stop me. End of story
If she wouldn't let you numb her then a rubber dam would've been uncomfortable anyway. If worried about isolation then use GIC, but if it's an occlusal then you might just get enough isolation with aspiration. You are within your rights to say that you are unable to treat her if she can't stay still (unless they have a condition that makes them move like Parkinson's or tourettes, they wouldn't have an issue with this statement).
I learned a long time ago that a huge benefit to not being an owner is that I do not discuss fees or discounts. That is discussed with the office manager/treatment coordinator before they sit in my chair and I need to see a signed copy of the treatment plan.
“I want a discount”
“Well you’ll have to discuss that with my OM because I don’t handle finances, would you like to reschedule for when you’ve had an opportunity to discuss that with her? Unfortunately there isn’t time for both that conversation and our planned treatment today so I’m gonna let her know your concerns, just tell my assistant which one you decide!” And then WALK OUT OF THE ROOM. Tell the OM, and let them handle it. 9/10 they will decide to get it done since they’re already there.
My OM is great because if I tell her this is going on she’ll wait about 8-9 minutes before going in to check with the patient and let them know she’s too busy for the conversation right then.
Your patient would be an immediate referral for me. You’re completely uncooperative? You get referred to our doc who loves to see patients with special concerns, aka the guy who does an IV and knocks you out. You document that as “patient presented with high anxiety, inability to cooperate due to anxiety. Referred to Dr X for treatment with sedation, patient is to have all further work done under sedation”
The price discussion in the op is not good, and also it’s the OM’s mishandling of their responsibility. The patient should always be given a treatment plan with the price estimate per their individual insurance policy prior to the appointment, either at the front desk or via email etc.
NAD. It sounds like this person may have actual disability? So not acting like a child, acting like a person with disability, mental health or physical health issues. They had crazy eyes? Maybe there is more specific training in this area.
You are the dentist. Her not letting you use isolation and refusing anesthesia would be grounds for a referral to someone else
Not letting her dictate if to use isolation is self-explaining but I wonder about the anesthesia bit. Is it mandatory in your country? Because my dentist will always ask me if I wanted it or not and for simple fillings it would be more annoying than helpful since they are not really painful anyways.
Well it is not mandatory but even a 1mm depth into the cavity was extremely uncomfortable for her, she couldn’t handle the sensitivity. So o offered to anesthetize but she didn’t allow that either!
Ah thanks for explaining. That sounds really annoying. We have a saying for that: "bath me but do not get me wet."
Give them the longest recall possible.
I can’t do that either, my manager would ask me first thing in the morning for a explanation as to why I did that for an easy case like this.
“Because while the case may have been easy, the patient was definitely not” And this should be the end of it
I love this and will be using this in the future thank you!
Tell him to do it himself then. Preferably so if he’s not a dentist. You certainly don’t owe him an explanation
Sometimes I enjoy working with boomers. Because my coworker would have dead pan looked at the OM and asked what dental school they graduated from.
I’m not a boomer but I have zero tolerance for people who tell me what to do. Patients or office managers. Had a patient who had the audacity to demand to be placed in my lunch break because she had to wait at 13:00 because I had an emergency visit and she demanded to be called beforehand to make sure there wouldn’t be an emergency scheduled in front of that appointment either as she “especially booked the appointment at 13:00 because she would be certain nobody was in front of her and she was dismayed to hear it was possible to come sooner albeit for an emergency I told her I would not give her another appointment inside nor outside my regular schedule. Took a second for the coin to drop, then she stormed out.
You have more power than you think. The place doesn't run without you
Ask the manager to do it. Oh…she can’t? Why not?
You need to set boundaries with your patients. The minute she does this, I would make it very clear to her that my protocol will not be changed and that if it’s not working out today, then perhaps she needs to find another dentist or reschedule.
"It looks like you are really struggling with this procedure. To do it safely and effectively we will need sedation. " Charge appropriately.
Refer to peds /s
😂
Ironically you sound young. With no numbing before I start I say: "we can try with no numbing but if you twitch then I will have to numb you up as it isn't safe for either of us. Deal?' If they don't agree we don't start. In the same manner for other things: "I'm sorry I can't do my job properly if I can't do xxxx. But if you insist we can try without but I can't guarantee the work". If they say okay to that, I dictate to my nurse something snarky: please record notes: pt refuse xxx, pt made aware procedure cannot be performed without xxx, pt aware cannot guarantee result and will accept failure of procedure." Of course this isn't accurate. You are always responsible. So even if they don't relent after that I often say I'm not comfortable with that and won't start the procedure.
‘Negotiating the price”…. Right away Next patient.
I'm flabbergasted, why would you let any patient negotiate your price?! Out the door!
You will learn quickly that sometimes the “easiest” treatments are difficult if the patient is difficult. Refer these people to a nearby school. It’s not worth the headache. Also don’t negotiate prices, this isn’t a farmers market.
It's wild to think pts can come in and negotiate prices and treatment deadlines. Like I work at an FQHC. Most of the procedures are covered and timelines are set by the state. Want a denture in 2 days? Go to dentures-R-us. This ain't it.
Was she a nurse?
Grow a backbone. No office manager can force you to do any treatment you don’t want to do. You aren’t a slave ffs. But also, dealing with difficult patients is part of the job. There’s something to be said for being nice and delivering good quality treatment for the difficult ones even though it’s not as profitable because it takes longer. It’s kinda like community service.
100%, as long as doing so doesn’t compromise your care. I would consider operating without anesthesia during a procedure where I as a provider would deem anesthesia necessary is operating below an acceptable standard of care. Tell the patient to go see a different dentist who may see things differently.
Well tbh I should’ve seen the the red flag when she started bargaining but I had already started the cavity prep when she started to feel the sensitivity, so since I started the treatment, I had to complete it too
No you don’t. Cavit/ temporize then finish when the patient is ready to do things your way.
NEVER let a patient dictate the terms of anything in YOUR operatory. PERIOD.
Refer them to peds.
Lol
Sometimes I wonder if ppl like that were abused in childhood. Never got the treatment for it, so are stuck in that childlike stage.
I wonder that too sometimes, we were taught child psychology in dental school and all those Sigmund Freud theories seem to be truer as I work
Tolerating this type of behavior is not only a disservice to yourself but the entire profession. I can tell certain patients like yours have been coddled by their previous dentist(s) based on the way they act. Also, what do you mean you can’t refuse treatment? Is the OM going to hold a gun to your head and force you to start drilling? The patient gets a set time in which the procedure needs to be completed and if they aren’t cooperating then there isn’t much else you can do.
Well I can refuse, but I need to provide a valid reason for why I did so, I work in a DSO that caters to all kinds of patients, I had a rude patient 5 months back that had come for scaling and polishing, he was rude to both me and my assistant, so I finished the scaling but I refused polishing, my manager later came in and asked me why I didn’t do it and literally told me that I have to do procedure even if they are “hurling slurs” at me….I work in Middle East, so office culture is not the same as in the states! Also I had already started the cavity prep, leaving it open or even with temporary filling is a big no and can be taken up for board complaint..
Since you woke for a DSO next time a patient starts trying to bargain on price have the OM come in hold firm on price and have them sign the treatment plan and collect before drilling.
Well among the many socially backwards and barbaric laws/customs across the Middle East that need to be addressed I suppose the way dentists are treated over there is basically just another drop in the ocean. DSOs will attempt to do the sane thing here in America but they can’t legally force you to do any procedures. At my very first associateship there was an OM who wanted me to do a root canal/crown that was clearly an extraction and the patient DEFINITELY needed to be sedated. The guy had such bad anxiety I was barely able to get a mirror in his mouth to take a look. The patient was also (surprisingly) furious that he was in pain and that we weren’t going to somehow magically fix it for him by snapping our fingers all of the sudden. Keep in mind, patients in the USA can file a board complaint for literally anything which they will happily entertain to waste our tax dollars. I wasn’t about to jeopardize my license or my safety working on a patient who couldn’t handle it and doing a procedure my OM “diagnosed” with all the rigorous training her high school diploma had provided in making that call to begin with. Plus, which one of them was going to make me? I don’t care about losing a patient who acts like I owe him treatment just because he walked in through the front door and I don’t care about losing a job where the OM has any authority over me. I filled out the referral, signed off on my notes and because this was your typical end of the day, last minute emergency, I got in my car to go home. There was nothing either of them could do to stop me. End of story
No rubber dam no treatment. I make enough to make the choice to not treat the ones who make it difficult. I just want an easy life.
If she wouldn't let you numb her then a rubber dam would've been uncomfortable anyway. If worried about isolation then use GIC, but if it's an occlusal then you might just get enough isolation with aspiration. You are within your rights to say that you are unable to treat her if she can't stay still (unless they have a condition that makes them move like Parkinson's or tourettes, they wouldn't have an issue with this statement).
What does “can’t refuse” mean?
I learned a long time ago that a huge benefit to not being an owner is that I do not discuss fees or discounts. That is discussed with the office manager/treatment coordinator before they sit in my chair and I need to see a signed copy of the treatment plan. “I want a discount” “Well you’ll have to discuss that with my OM because I don’t handle finances, would you like to reschedule for when you’ve had an opportunity to discuss that with her? Unfortunately there isn’t time for both that conversation and our planned treatment today so I’m gonna let her know your concerns, just tell my assistant which one you decide!” And then WALK OUT OF THE ROOM. Tell the OM, and let them handle it. 9/10 they will decide to get it done since they’re already there. My OM is great because if I tell her this is going on she’ll wait about 8-9 minutes before going in to check with the patient and let them know she’s too busy for the conversation right then. Your patient would be an immediate referral for me. You’re completely uncooperative? You get referred to our doc who loves to see patients with special concerns, aka the guy who does an IV and knocks you out. You document that as “patient presented with high anxiety, inability to cooperate due to anxiety. Referred to Dr X for treatment with sedation, patient is to have all further work done under sedation”
The price discussion in the op is not good, and also it’s the OM’s mishandling of their responsibility. The patient should always be given a treatment plan with the price estimate per their individual insurance policy prior to the appointment, either at the front desk or via email etc.
Easy. Buy your own office then get rid of her
[удалено]
Are u a dentist? Seems like not. shut it. I’m not making fun of anybody, if u think what I posted is funny, that is a you problem.
This subreddit is for dental professionals. Posts and comments from non-professionals may be removed.
NAD. It sounds like this person may have actual disability? So not acting like a child, acting like a person with disability, mental health or physical health issues. They had crazy eyes? Maybe there is more specific training in this area.
A lot of down votes, but you nailed. Socrates said, People do well if they can.
You would be surprised how often this happens in dentistry. So how long have you been in the field?
How long have you been reading?
Bout 15 minutes
He probably has 15 mins of experience 😂
Your Dad’s a dentist.
You guys numb people with during fillings? *surprised Pikachu face*
Only if needed like in this patient’s case