When I was starting out in practice I was desperate to be successful. I took on any and every patient who came along.
But, after I’d gained a few years of experience I started to realise that some patients cost me a lot of anguish and stomach lining.
Here’s my personal list of six dental patients who I try to avoid.
Patients who say: “Patch it for now and I'll get it fixed properly later.”
With such patients, “later” never comes.
Whenever I take them on I find myself doing endless rounds of patchwork treatment. And, when that treatment fails, they don't remember that I was doing it to help them out. They expect me to fix it for free because it was “only done 12 months ago”.
It's demotivating to wrack my brains figuring out how to glue something together when I know it's just a short term compromise like painting over rust on a car and that my work might break the first time they bite on it.
In my entire career I've never found a “patch it” patient who became a good regular member of the practice. “Patch it” patients use me when they need me and fail appointments when it suits them.
Patients who blame previous dentists for the disastrous state of their teeth.
Some patients come in looking like they swallowed a hand grenade — multiple missing teeth, rampant decay, abrasion, attrition, erosion and advanced periodontal disease.
The ones who worry me are those who tell me that it's not their fault and that all the problems were caused by “incompetent” dentists.
The first thing that worries me about such patients is that they only have a tenuous grip on reality. The fact that their mouth is in such a state yet they think it's not their fault shows that they do not have a clue how things work.
The second thing is that I will very likely become the next on their list of “incompetent” dentists even if I’m blameless.
The third thing is that they never accept my advice. Even if I work out a beautiful plan to fix their mouth, they continue with the same poor decisions and behaviours that got their teeth into that state in the first place.
Patients who hold the mirror very close to their mouth when pointing out aesthetic problems.
Patients who are aware of tiny aesthetic problems are virtually impossible to satisfy. The closer they hold the mirror, the more they should be avoided.
I once had a lady who was convinced that the lengths of her two front teeth was unequal but I couldn’t see it. I even got a ruler out and held it across the edges of her front teeth — it was perfectly straight as far as I could tell, and the nurse too. The woman didn't agree.
Taking on such a patient is a recipe for disaster. Suddenly I’m on my third remake and totally losing the plot.
I only take on people with big, obvious cosmetic problems that I can easily see from conversational distance. Anything that I cannot see at a glance is way too much trouble.
Patients who, the moment you start to put the chair back, say “don’t lie me back too far”.
Nothing gets my back and neck sore quicker than working at a strange angle where I struggle to see. It also compromises the quality of my work.
Some patients don't even get to 60 degrees before they start complaining. Yet, the vast majority of them can lie flat in bed at night to sleep.
I'm sympathetic to the rare few patients who have a peculiar medical condition that prevents them lying flat but for the rest, they need to get over it.
I prefer to avoid a trip to the physiotherapist.
Patients who move constantly and won't keep their mouth open.
If you're like me you take pride in your work — you want to do a nice job. But, certain patients make that impossible.
Within a second or two of starting work they act like they're drowning and start flailing around. Or, they want to rinse every 5 seconds even though there’s nothing in their mouth. Or, even though the tooth is totally numb they suddenly and without any warning pull their head away. Or they close their mouth constantly so that you become like a broken record saying: “Open your mouth”, over and over and over. Or they move their head side to side and up and down constantly for no apparent reason. Or their tongue puffs up like a tennis ball the moment they open their mouth.
A simple filling becomes an epic event at the end of which I’m like a rung-out dish mop and running 20 minutes late. Life is too short.
Patients who fail multiple appointments.
Practice overheads are usually more than 50% of gross revenue. That means that if a patient turns up for every second appointment and fails the other one I’m doing their work for free or even losing money.
I was once in a practice where a patient had failed 14 appointment over the course of 2 years. 14 appointments equates to over $5,000 of lost revenue. The practice would have been better off to give the patient $1,000 as a reward for going elsewhere!
The only way to convert an unreliable patient into a reliable one is to demand a deposit on all appointments. But, most unreliable patients refuse to pay a deposit.
I once had a lady who pleaded with me not to charge her a deposit when she’d failed her two previous appointments. She said those appointments were aberrations and she would definitely turn up next time. Foolishly I relented.
Guess what. She failed once again.
Perth 2 December
The art of case acceptance returns to Perth. Don't miss it.