From High to Low in a Single Day

Today was a great day.  And, then it wasn’t.

First it was great!

I had one patient scheduled for the morning – to deliver six porcelain veneers.  This patient has been with me for a number of years.  And, she had talked to me about her four old veneers and not being happy with them.  They were done nearly 20 years ago.  Finally, she decided to move forward and the treatment plan was for Six Month Smiles short term orthodontics and then six new veneers.  Without turning this into a big case presentation (which I will do at another time), here’s a quick before and after.  The after photo was taken immediately post-cementation.

My patient was very happy, and the whole office celebrated her new smile with her.

Next I had lunch with a good friend (another dentist).

The patient right after lunch was another long-time patient who is elderly (90-ish) and not in the best health.  His teeth are severely worn.  Recently, I built some teeth up with composites.  And, I also prepped five teeth spread out over 3 quadrants for crowns.  Garden-variety functional restorative dentistry – nothing glamorous.  All five crowns dropped in with some minor adjustments.  Another victory.  Everyone in the office is riding high.  A good day.

And, then it wasn’t.

Then the phone call came.  It was one of my more recent patients.  We started her Six Month Smiles ortho treatment about 2 months ago.  Apparently, she was in Ohio on vacation and, under circumstances unknown to me, saw a dentist there.  Per the patient’s story, the dentist in Ohio told her that the “brackets were not put on correctly.”  I asked the patient about the dentist (GP or ortho?).  He’s a GP.  She told me, “He sees a lot of patients with braces on (put on by an orthodontist) and his three kids are in braces.”  Oh, I see… that surely qualifies him to criticize… SHIT!  OK.. I didn’t say that.  But, I was thinking it!

The only thing two dentists can agree on is that the third one is an idiot.

She tells me that she now wants to get a 2nd opinion from an orthodontist.  Great.  You’re two months into treatment and NOW you want to get a 2nd opinion?  Because some  anonymous bastard dentist in Ohio says the brackets are on “wrong?”  WTF happened to the “trust” we had established?  POOF!  Gone!  Just like that.  Lovely.

I told her that if she had any questions she could always come to me.  I also explained that it’s considered unethical for any doctor to disparage another’s treatment without knowing the facts.  The dentist in Ohio could call me, and I’m sure that I could explain things to his satisfaction.  No dice.  She wants to pick up her records and see an orthodontist.

I don’t know if she’ll continue treatment with me.  Even if she decides to stay, I’m not sure I want to continue the relationship.  I like trust to be a two-way street.  And, I’d LOVE to talk to the dentist in Ohio.  I’ve always liked dentists, in general.  But, at times I really wonder about some of them.

I’m open to suggestions from my fellow Dental Warriors.

PS… I was on the other side of this type of situation not too long ago.  But, I didn’t throw the other dentist under the bus.  Click here to read that blog.

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7 Responses to From High to Low in a Single Day

  1. Hi Mike:
    Whether due to the economy, or due to just plain low self-esteem, this happens I am sure, to every dentist walking the planet. I used to think ‘its only us 2th docs, but upon talking to a chirporactor and a prominent attorney in my family, both held in high regard in their respective professional communities, they also get an appalling number of negative critiques by their fellow ‘counselors’. The human condition- its simply unfortunate.
    But not to worry, Mike, we think you’re great!
    Ed

  2. Aussie dentist says:

    Love reading your blog! But I didn’t quite understand the 5 crowns on a 90 year old? At $1500 a pop – that’s 7.5k…. Firstly can’t believe a 90 year old would spend that much on his teeth and even if they wanted to, I don’t think a lot of dentists here in australia would even do that treatment? Were they symptomatic? Extractions or even leaving them alone contraindicated? Very curious and please don’t rea this as an insulting post… I’m just extremely curious…

    • The Dental Warrior says:

      Cheers, Aussie Dentist! A perfectly good question. Actually this patient could very well use a full mouth rehab – a crown on every single tooth. His teeth are severely worn down, and he has trouble chewing. Lots of open contacts due to the wear, and his biggest complaint is food packing between them. So, yes… they were symptomatic.

      It’s interesting that many modern western cultures diminish the value of quality of life in the later years. Just because they’re “old,” they don’t deserve or shouldn’t spend money to make their lives more comfortable and ENJOYABLE. And, oddly enough, the older you get, the more EATING becomes a source of pleasure. (By the way my ALL CAPs are to emphasize words, not yelling.) :)

      So, the way I see it, this patient can spend HIS money on HIMSELF to make his twilight years more COMFORTABLE and ENJOYABLE. Or he can suffer (unnecessarily) in his “golden years,” then die and leave his money to someone else (who didn’t earn it). :) If you’ve got the money, why not put it to GOOD use?

      Ultimately, I always give (all) my patients options. And, the FIRST option I give EVERY patient is: NO TREATMENT. And, then I discuss the potential consequences of no treatment. With the exception of pain and infection, all dentistry is elective. People don’t need teeth to live. We have electricity and blenders now. But, some choose to have teeth.

      One thing I NEVER do is pre-judge my patients. I never make assumptions. I give them options, and they choose. My biggest cases are typically on “ordinary” working people. You never know. And, I’m proud to have been chosen by this 90 y.o. patient to perform his dentistry. He could EASILY have found a much cheaper dentist. I’m glad I was able to help him be more comfortable in the “autumn” of his life. He’s been a great patient for many years. Fun to talk to. Very sharp. Brings in the Wall Street Journal every appointment.

      Thanks for chiming in and asking a good question. Hopefully my reply is at least a bit thought-provoking. :)

  3. Aussie Dentist says:

    Cheers Mike! Excellent answer and definitely thought provoking! The part about the money spent on himself in his final years is def food for thought. I own a couple of dental practices in lower socioeconomic areas and although similar patients present, hardly any of them have the funds to afford the ideal treatment at that age. But I completely agree, if they have the money spend it for better quality of life! To be honest because of the areas I work in , I am probably a little guilty of judging as mentioned in your reply. Def something to work on for myself. As an aside, your tips on google has been excellent and bought the DDS GP app and patients love it. My employee’s also enjoy it thoroughly when explaining concepts to patients. In my areas it’s also a useful point of difference!

    • The Dental Warrior says:

      We’ve all been guilty of assumption at one time or another or to some degree. But, over the years I’ve learned that such assumptions are often wrong. Most of my “big case” dentistry is for patients most would have considered unable to afford the treatment. In just a moment I’m seeing a patient we did a full mouth rehab for. He’s a stock clerk at Walmart. He spent over $40,000 on his teeth. Some dentists have asked me, “Where did he get the money?” My answer: WHO CARES??? None of my business!

  4. Days like this happen to all of us. Trust should be a two way street, and its’ earned. If I am in a situation where I have earned the trust (and that can be from a hard earned reputation and referral) then I would fire the patient.
    I have been in this situation in my own job as a dental sales consultant. I understand I am not made to work with everyone, its’ come to the point where I tell them – “It’s not you, it’s me.” and sleep better at night.
    Wish you all the best Mike – I would trust your advice if you were my dentist!
    Smile!
    Warren
    PS – typed out before my morning coffee…

  5. Pingback: Don’t Throw Your Colleagues Under the Bus! | The Dental Warrior

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