Naive dentist

[aphistis]

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For those of you not in dental school yet, there are some very real and important realizations you will come to that at first seem like your making a personal judgement about the patient (they don't deserve to keep their teeth) or you don't really care enough to help them keep their teeth.

The entire post is terrific, but this part in particular deserves to be engraved on a plaque somewhere.

Exercising good professional judgment means drawing hopeful & humanist conclusions about some of your patients, frankly uncomplimentary conclusions about others, and for everyone, framing your patient care within the frequently-limiting confines of *reality* instead of the idealized, N20-induced illusions that are threatening to drown this thread.

 

[toofache32]

I'm impressed Gavin, your words are sounding not like someone whose mid way through dental school, but a clinician whose been in practice for 10+ years. Very, very rational thought process and I'm being completely serious when it bodes very well for your future business.

On a different note to put things into perspective, I found out this morning, that one of my patients (21 years old) was killed this past Tuesday AM while on a mission against the insurgants with his Army unit about 20 miles West of Baghad. When I last treated him before he enlisted 2.5 years ago, as he put it to me, "I have some issues with parental authority, but I know the military is exactly what I need, and I look forward to defending this country." He voluntarily re-enlisted for 4 more years this past January. Not only does he leave his parents, but 2 younger sisters and a younger special needs brother. 😱

If you ever have any doubts about whether or not we should be over helping to liberate the Iraqis, talk to someone whose been over there. I have about a half dozen or so patients who have served in either Iraq or Afganistan and every last 1 of them would go back in a second. Also when the come home, their dental care is 100% on me. These are the real people who we should all be taking care of free of charge 👍

On a serious note, Good for you, DrJeff. There are few people in this world I have more respect for than our military. They sacrifice what I would have a hard time giving up. This is a good idea for my future practice as well.

 

[ItsGavinC]

I simply don't agree with you guys on this. I just don't. No amount of dental education or lack there of is going to change the way I view the world or the role I can play in it. End of story. You can give back, educate, and make a profitable living.

True, but not everybody wants to be educated. In fact, very few people seem as though they do. So while you may have fulfilled your part of the "being a professional" partnership, the patient must also fulfill theirs.

Compliance is their part to ensure that what you are doing to them doesn't HINDER or HURT their oral health. If a patient is noncompliant, or their history suggests so, providing your services (either free or at full price!) is not really a service to them.

As a clinician, you'll be asked to deliver products in the here and now, but you'll have to evaluate your options based on how the patient will be doing in 5, 10, and 20 years down the road. Nearly everything works out perfect in the here and now, but you'll see lots of patients returning months or years later because your field of vision was too narrow at the time of delivering services.

 

[ItsGavinC]

It's just not the case. Sometimes it is a disservice to the patient to restore their teeth. That's a hard one to wrap your brain around sometimes but necessary because you will be help the patient understand that this is their best choice.

Very well put. I didn't fully realize this until I began treating patients.

 

[grant555]

After spending time praying and sleeping on this, I realize my error here. It is wrong of me to try to force my stance on the community aspects of dentistry down the throats of others, which is not the Lord's way. In time, it will come apparent what are and what aren't the best ways to give back. The key is not letting passions, medical ethics, and at some point, clinical feasibility clash. In retrospect, such action is counterproductive to say the least.

More can be done and with less friction by contacting other individuals locally and ultimately abroad such as those listed on the links below to see what more I can do. At the same time, I stand by my views and will help those I can when I can. It is my right to do so. Take care and GOD bless.

http://www.christiandental.org/directory/index.htm

http://www.bmdf.org/contact.htm

Take care and GOD bless.

 

[DrJeff]

On a serious note, Good for you, DrJeff. There are few people in this world I have more respect for than our military. They sacrifice what I would have a hard time giving up. This is a good idea for my future practice as well.

I strongly feel that everyone in our profession should being doing this. I did have one situation though about 2 years ago where one person just back from a tour in Afganistan needed an implant for #12. Since I don't place them, I sent him to the OMFS guy that places them for my patients and had lunch with him and explained the entire thing how this person had been in Afganistan for the last 8 months, had been able to use a toothbrush for a month at one point, and how I was doing this entire case (4 endo's, 8 units of crown and bridge, many restorative surfaces, perio, etc, etc, etc - my costs alone were closing in on $2000 and 15+ hours of chairtime) at no charge to the patient for the service to our country that he'd done. I told the OMFS guy to send me the bill(if any) for this case(mind you on average I send this OMFS guy 30+ implants per year, many, many wizzy cases, and in general about 90% of my OMFS referrals - basically I send him alot of $$ per year. About a week after he placed the implant, I got a bill for the full $1250 that he charges for placement. 😕 😱 😡 I honestly couldn't believe this, so I called him up and asked about it. He pleaded "poverty" to me, I reminded him of this situation and all the referrals I give him a year, and he still wanted the full amount. I paid it, and threw away the rest of his referral slips. Now when I see him at dental society meetings he asks me why I don't send him anymore patients, I tell him its over $150 of titanium on an veteran.

This entire thing really irritated me, because as toofache nailed it, if it wasn't for what our soldiers are doing to prevent attacks on our way of life, we couldn't enjoy the incredible lives that this profession gives us.

 

[tx oms]

It's hard to look a 25 year old in that face and say - complete dentures.

Actually, I find it pretty easy. 16 is my personal best, but I'm always looking to improve.

On a serious note, Good for you, DrJeff. There are few people in this world I have more respect for than our military. They sacrifice what I would have a hard time giving up. This is a good idea for my future practice as well.

I'll second that.

 

[tx oms]

I paid it, and threw away the rest of his referral slips. Now when I see him at dental society meetings he asks me why I don't send him anymore patients, I tell him its over $150 of titanium on an veteran.

Awesome. I would have done the same thing.

 

[Biogirl361]

just because you make a commitment to give someone free work doesn't mean all of your colleagues should have to also... sort of nasty to force your beliefs under penalty of no referrals... just my opinion, though i know you can and will refer to whoever you want. if you want a patient to get free work from another doctor for whatever reason then I think it's reasonable you should pay the bill if requested rather than expecting favors even though they might be in order.

that said, i wanted to thank all of the upper level dental students and dentists for their comments here, i always learn something listening to you guys 🙂

 

[UConn_SDM]

just because you make a commitment to give someone free work doesn't mean all of your colleagues should have to

You're correct but this is the way things work. You scratch my back I scratch yours - especially in an area like CT were there are lot of alternative options.

To me the important lesson is that the oral surgeon missed a golden opportunity to donate 20 minutes of his time (the time it takes to place a single implant) and solidify a lifelong source of referrals. I'm sure had he only charged $150 for the implant, 20 years from now (and after a few thousand referrals) DrJeff would still be thinking about how this oral surgeon helped him on this case.

That's the kind of collegial marketing only 20 minutes of your time can buy. 😉

 

[toofache32]

Now when I see him at dental society meetings he asks me why I don't send him anymore patients, I tell him its over $150 of titanium on an veteran.

You know...you can still send him your TMJ patients... 😱 Maybe then he would get the idea.

 

[TucsonDDS]

just because you make a commitment to give someone free work doesn't mean all of your colleagues should have to also... sort of nasty to force your beliefs under penalty of no referrals... just my opinion, though i know you can and will refer to whoever you want. if you want a patient to get free work from another doctor for whatever reason then I think it's reasonable you should pay the bill if requested rather than expecting favors even though they might be in order.

that said, i wanted to thank all of the upper level dental students and dentists for their comments here, i always learn something listening to you guys 🙂

I think that it is perfectly acceptable for Dr Jeff to stop refering to a doctor that doesn't have the same beliefs and visions of practice that he does. In a professional relationship like the one he has with the other dentists in his area he should only refer patients to other dentists that feel the same in the way that patients should be treated. I personally would have done the same thing. Even if the OMFS billed half of his rate it would have been ok with me, but definitely not the full amount.

 

[drhobie7]

I really admire DrJeff for his goodwill. I don't think there's a board certified OMS in the entire US who needs $1250 that badly. However, I've found that explicit communication, even about things which seem understood or accepted, is often necessary to prevent arguments, disagreements, and disappointments with another party. This is especially true with patients. I nearly lost my first denture patient because I didn't explain to him he had to pay half his bill before we processed the denture. I brought it up 2-3 appointments into treatment and he was taken off guard. He almost bailed on the whole treatment over the "principle". He and I had different expectations going into the treatment. This wasn't cleared up in the beginning and the result was we butted heads.

DrJeff and the OMS had different expectations as well. While it seems like common sense that the OMS would have done the procedure gratis, he had something going on that made him do otherwise. Greed? He didn't know DrJeff expected him to? I admit that sounds ridiculous. I can't say what the reason was. It seems silly to say DrJeff might have had a more pleasant outcome with the OMS if he explicitly asked him to do the procedure for no charge. But I think sometimes you have to say the obvious because people occasionally aren't using their common sense or they're not on the same page as you. Unfortunately you often don't find that out until it's too late.

DrJeff could had said to the OMS, "This case is really special to me. I want to do everything free of charge. Can you do this procedure for free?" If the OMS said no, DrJeff could have said something like, "Our philosophies towards patient treatment are too different. This is something I occasionally expect of the specialists I refer to. I'm sorry you feel that way. I can't work with you anymore." It's all out in the open. Money hasn't entered the picture yet. Each party knows where the other stands.

I think it benefits all involved if you say exactly what you expect whenever you're dealing with another person. Even if you sound like you're stating the obvious it will save you unpleasant experiences.

Just think of all the guys and girls out there who thought they were in monogomous relationships only to find out the other person was dating several people. When dealing with humankind you can't assume anything.

Again, I'm not criticizing DrJeff. I have nothing but respect for him and value his insights and contributions to dentistry as a profession. (Whenever you do pro bono work you do something great for the patient, yourself, and dentistry)

Hindsight is 20/20. This is what I've learned and it's my philosophy towards patient interaction as well as relationships outside dentistry.

 

[grant555]

that said, i wanted to thank all of the upper level dental students and dentists for their comments here, i always learn something listening to you guys 🙂

Agreed. If everyone on this forum shared the same viewpoints and levels of experiences, the forum would be useless if not boring. Health and education disparities concern me far more than differences of opinion.

Take care and GOD bless.

 

[DcS]

I have a feeling I would have done the same thing as Dr. Jeff in that situation. With that said, I can't help but see it from the Oral Sxs point of view. Most people have a soft spot for specific things, whether it be single moms, the elderly, or in this case, those brave enough to serve our country. Just because Dr. Jeff rightfully respects our soldiers doesn't mean this other guy does as well. For all you know, he's a vehement bush opponent and the topic of troops in Iraq chaps his ass. However, you are judging his character buy his refusal of a single charity case. Its possible the guy does a ton of free work in other arenas that you are not aware of, things he truly believes in. I think it's harsh to cut him off from your referral base because he didn't have mutual respect for our troops. If he was a bad overall person, interested only in profit then okay...but from this single incident that's no indication of greed.

 

[Biogirl361]

yeah, if you are passionate enough to cut someone off over something like this, i agree that at least 1) communication beforehand should be explicit, and 2) the gp should approach the subject from the favors-for-referring aspect and leave the personal views about who should recieve free treatment part out of the negotiations with the other doc. anyway,

i don't mean to change the subject here but i thought it might fit in... what kind of things (other than free work favors since we already covered that) do specialists usually do to show appreciation, if anything? basket of bagels for the staff once a month? flowers? bigger things?

 

[DcS]

yeah, if you are passionate enough to cut someone off over something like this, i agree that at least 1) communication beforehand should be explicit, and 2) the gp should approach the subject from the favors-for-referring aspect and leave the personal views about who should recieve free treatment part out of the negotiations with the other doc. anyway,

i don't mean to change the subject here but i thought it might fit in... what kind of things (other than free work favors since we already covered that) do specialists usually do to show appreciation, if anything? basket of bagels for the staff once a month? flowers? bigger things?

I know the office I worked for received a ton of stuff during christmas...baskets of chocolate, cheese, wine, cookies, etc.

 

[Biogirl361]

i once read on dentaltown that one of the docs recieved something rediculously expensive each year, like a fine crystal vase or something. they also said sometimes specialists in their area would have wars of who could send the nicest gift in hopes of getting the most referrals. thats crazy, i can't wait to be a gp haha. but the office i worked at usually got something similar to what you said, a fruit basket and flowers each summer or something like.

 

[DrJeff]

You know...you can still send him your TMJ patients... 😱 Maybe then he would get the idea.

I'll have to keep that one in mind! Especially those TMJ patients who are already on a half dozen or so psych meds! 😀

 

[DrJeff]

DrJeff could had said to the OMS, "This case is really special to me. I want to do everything free of charge. Can you do this procedure for free?" If the OMS said no, DrJeff could have said something like, "Our philosophies towards patient treatment are too different. This is something I occasionally expect of the specialists I refer to. I'm sorry you feel that way. I can't work with you anymore." It's all out in the open. Money hasn't entered the picture yet. Each party knows where the other stands.

QUOTE]

This OMFS was COMPLETELY aware of this patient, his tour of service in Afganistan, all the free care I had done so far (at that point we were talking a few endos and crowns, some extensive perio work and a bunch of restorative with more to come), and that I was definately expecting at worst for him to send me a bill for materials cost only. To really give you and idea of my shock when the bill for $1250 came to me, was that about a year before this OMFS had placed an implant for #29 in my own jaw (congenitally missing), and he refused to bill me a cent even after I insisted that I at minimum pay for the materials cost. - afterwards I gave him a gift certificate for him and his wife to goto diner and a play, and the value of this night out for him and his wife I know was more than what ITI charges him for an implant.

In general, I'm not the type of person that asks for any favors, or expects any special treatment. I'll even grab the lunch check 1/2 the time when I go out to lunch with my local specialists to discuss cases. During the holiday season, when specialists send gift baskets to my office, I'm on the phone personally thanking them that same day. So when in this instance, I actually asked a favor of this OMFS who I had a very solid working relationship with and a high amount of respect for (like I said, he screwed titanium into my own jaw), so when the bill camne, and he was serious about it, I was stunned/disgusted, etc, etc, etc.

As a bit of a follow up, the OMFS guy that I now send almost all of the work that I used to send to the originally guy(I used to send this other OMFS maybe 1 out of every 20 or 25 OMFS referrals) thanked me at the end of last year for the over $50,000 of additional treatment I had referred to him over the previous year - and this other OMFS's fees are about 10 to 15% lower than the original OMFS's fees. So plain and simply billing me full fee for a little $150 or so dollar piece of titanium placed into a war veteran who I treated for free had cost this OMFS over $50,000 (and counting) so far.

 

[DrJeff]

i once read on dentaltown that one of the docs recieved something rediculously expensive each year, like a fine crystal vase or something. they also said sometimes specialists in their area would have wars of who could send the nicest gift in hopes of getting the most referrals. thats crazy, i can't wait to be a gp haha. but the office i worked at usually got something similar to what you said, a fruit basket and flowers each summer or something like.

In my area it tends be be a bagel basket, or a Harry and David tower. Although my local endo group sends a case of wine 👍

The biggest thing that you'll learn as a GP (or take note future specialists) is that the way to keep a GP's office happy is to give a basket/gift that keeps the staff happy. Hence, things with baked goods and/or chocolate leads to a happy staff, which leads to a happy dentist which leads to more referrals.

My staff's (Hygenists, front desk and assistants) favorite person, isn't a specialist, but our Crest rep. Every time he comes to the office, he on average will have 2 or 3 bags of Hershey's minatures, lunch for the staff and a whle bunch of chocolate based deserts (chocolate cake, chocolate cream pies, chocolate chip cookies). After my partner and I get back from out own piece and quite lunch and return to a staff that's in a chocolate induced frenzy, we have to order a whole bunch of Crest products that my staff is now raving about to keep them quiet 🙄

Now if tyhis rep really wanted to keep me and my partner happy, all he'd need to do is get us a dozen golf balls and a 6 pack of Bud light 😀 😉

 

[drhobie7]

Hi DrJeff,
I understand the OMS knew the patient's history and that you were doing everything for free. But the OMS didn't understand that you expected him to do the procedure for free. Should social common sense have dictated this? Obviously, but not everyone has that. My point was that in this case it was necessary to explicitly state your expectations from the outset rather than leave potential for misungerstandings ("send me the bill"). Unfortunately, it's difficult to be certain that people are on the same page as you without explicitly asking if they are.