Paul
We’re trying to figure out how to best manage pts who are overdue in hygiene. How much chasing do we do? How do we balance the need to keep hygiene busy without being a pain in the rear, even though we believe in what we’re doing? How do you do this in your office?
Thanks
This is a complex problem which really requires a situation-by-situation approach. People fail to return for many reasons, and you really can not know how to best “facilitate their return" until you know what is going on in their head (and not just their mouth). Some will simply be too busy to make the commitment. Others perhaps have been negatively influenced by their insurance carrier (or even friends, or S/O’s) who have caused them to think that you are too expensive due to the constant disinformation campaign generated by the industry. Others are simply forgetful, or truly (very rare) can not afford to come in. More often, returning is simply not a priority to them at the time. And others yet may have been confused, hurt, or percieved limited value in what they recieved the last time from you. The key question to ask yourself is “Why is this individual choosing not to return?” Discovering the answer requires some investigation WITHOUT using any “shaming tactics”. As L.D. said, “People change, but not very much” so don’t think you have the power to change other people’s behavior. The best you can do is to help others to discover within themselves a reason why they should return – a reason which is of value TO THEM. This type of thing needs to be handled by your Administrative Leader, yourself, or your Hygienist (but only by a someone who has a long-term successful working history with the person). Otherwise, the person will simply lie to you or create some grandeous story “My pet bird is sick and I just can’t make it in any time soon” because you are the next thing to a stranger to them, and they simply do not care what you think or how you feel about their behavior.
After all of this investigatory work has been done (and in the cases where we are making no positive progress), we next send out a “Reactivation Letter” which really is a tool for us to figure out whether or not we should continue attempting to keep the relationship alive or archive the record (and inform them that when we deactivate the account they can only return to the practice after the completion of a new examination and an updating their records). In other words, I actively try to eliminate people who are floating around “out there” who I have not seen in years and who suddenly have a crisis and feel they can call me on Saturday night when I am having dinner because “I am their dentist”, or who feel they have the "right" to be seen at a moment's notice during my pre-planned work day when their tooth chips and they have a critical meeting that afternoon and are afraid they are going to look like an idiot .
Paul
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Hey, Paul
Attached are photograpsh of XXXXX. She is the wife of my insurance guy. She’s about 50 yrs old and lives very well. She drives a Mercedes. XX, her husband's father is enormously wealthy. He drives a Porsche & they live on a farm with all kinds of animals. XX has always preached that doctors make too much and my fees are high. He feels that insurance Co executives earn their money because of their huge responsibility.
XXXXX has been very sporadic in her dental care and has bounced around among different dentists. One time she left because she “needed” someone who administered Nitrous.
She came to me last week for an estimate on what it would cost to replace her missing back teeth. She wants the insurance to pay for it, crying poverty, which is a total crock.
This, to me, is a full mouth case no question, dx wax up, anterior guidance, with a night guard. The trick is in the presentation, I think. Jim suggested some scripting along the lines of her being a discerning person in other aspects of life & that she truly is at a crossroads in her dental life. I think I can handle it but I also think that the likelihood of case acceptance here is low. I know I can help her, but to me this is an all-or nothing/my way or the highway situation.
Your thoughts? BTW, a few of the photos were not quite up to snuff- I must have missed in my focusing
Thanks---------------------------------------------------------------------------------------------------------------------------------------------------------
Alan,
I would not have a “case presentation” with her. I would initiate a discussion (co-dx) with her via photographs as a communication tool. I would say right at the outset:
“Shelly I want you to know that I have come into this meeting with no specific plan for you. Since there appear to be several issues overlapping and influencing each other, I felt it would be best to first just review what we know, and how things seem to be trending right now….
Once you are more familiar with all the variables at play here, you will be able to tell me more clearly what you think you want to do. And I can tell you what your insurance policy is likely to cover. Once you know that, we hopefully will be able to develop a plan together. If it is a plan that involves more than just basic care, then I will likely need to do some planning and developmental work – much like an architect would do if you were considering building a new house or putting on an addition. And then when I have completed that, we can discuss in more detail what would be involved, how long it would take, and how much it would cost.”
“Do you have any specific issues or concerns you would like to discuss before we start to review the information we currently have available?”
I would not:
- Do a diagnostic wax-up (yet)
- Would not quote her any specific fees until I was hearing from her precisely what she wanted and was willing to personally pay for (what she values)
- Would not try to “close” her in any way. Her history screams she does not place a high value on dental health, this is likely NOT to change, but it might if you can present information to her in a non-judgmental, conversational way that allows her to envision what her life is going to be like when she starts to loose her front teeth (or needs endo, etc) and/or how her posterior dentistry will fail quickly if anterior issues are not addressed simultaneously or first.
Make her come to you and beg you to do it all the right way for her. Then get a rock solid consent agreement. Don’t even think of proceeding until she signs it. And if she never does, you will likely be better off. Any dentist who proceeds with any level of elaborate dentistry on this person at this time will quickly regret it as she will not take ownership for anything. And when it starts to fail they will be redoing for free or talking to her attorney.
Paul
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