Rant:Stupid Patients Who Don't Come In

[mike05tusdm]

Hello All, I will admit this is a bit of a rant. I'm sure many of us who are in clinic and many people who are in private practice can relate to this.

With a good patient-one who keeps appointments, comes in, and appreciates the importance of what you do, dentistry is a joy.

However, everyone in my class(I think) and I think many practitioners have what are(for lack of a better term) stupid people who don't come in. These are the people who will not show up for appointments without calling and waste your time, or will cancel the day before for a variety of stupid excuses(like "oh, I forgot that I have to go to the eye doctor" or "oh, it's too cold outside" or "oh, i don't feel well so i'm not coming in today.") The excuses may sound legitimate if you hear it once, but after several cancelled appointments making up stupid excuse after stupid excuse, it get's old really fast. These are the same people who will not return phone calls when I continually call and leave voice mail after voice mail trying to get people to come in. I have already had to discontinue several patients and several more are on their way out as well. What is the worst is when they are in the middle of treatment-like they already have a temporary crown on and they don't come back in to complete it. It means that I've already done the work on them for absolutely nothing.

What I wonder(and several of my schoolmates have had this same discussion) is why are people so stupid that they avoid coming for dental care? Why do they not come in for something that they need(dental care)? They avoid coming in unless they are in unbearable pain and will come and get a tooth extracted in emergency clinic, then they won't come again. Why do people care so little about their oral health? Why do they value dentistry so little?

Obviously, this is someone that I would not post on a "general public forum" since some of my comments may be on the offensive side, but I'd like to get other people's thoughts on this.

Mike

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[mmapcpro]

This might not be the situation in your particular case, but many people live paycheck to paycheck if they are lucky enough to not have been laid off during this recent recession.

So after buying bread and milk, paying for the electricity, making the car payment, paying the rent/mortgage, etc., if they have a couple of dollars left over, they usually have to pray that nothing breaks (car, water heater, air conditioner)...but of course, something usually happens.

So if they are not in direct pain to where it is hindering their ability to function, and thus pay the bills, they will tend to not spend for preventative care.

However, if they actually MAKE an appointment and don't come in without calling to cancel/reschedule with appropriate notice, then they are just inconsiderate doles.

I'm not trying to make any justification...just pointing out possibilities.

 

[blankguy]

Originally posted by mmapcpro
This might not be the situation in your particular case, but many people live paycheck to paycheck if they are lucky enough to not have been laid off during this recent recession.

So after buying bread and milk, paying for the electricity, making the car payment, paying the rent/mortgage, etc., if they have a couple of dollars left over, they usually have to pray that nothing breaks (car, water heater, air conditioner)...but of course, something usually happens.

So if they are not in direct pain to where it is hindering their ability to function, and thus pay the bills, they will tend to not spend for preventative care.

However, if they actually MAKE an appointment and don't come in without calling to cancel/reschedule with appropriate notice, then they are just inconsiderate doles.

I'm not trying to make any justification...just pointing out possibilities.

That's one of the big draws of dentistry for me , SECURITY of employment. I do notice that people tend to take dentist lightly but I don't care because I've worked in retail where people treat you like crap. They turn their backs on you while you talk to them, I wouldn't there do that in say a cocktail party.

 

[UBTom]

Hi Mike,

I can sympathize... I think this is true at most dental schools.

I'm glad my school has a strict patient dismissal policy that protects the students-- You can't help a patient if the patient is not willing to work with you. Three abruptly-cancelled or no-show appointments, the student is authorized to discharge the patient from the school. Buh-bye.

The sad thing is those patients sometimes do have things treatment-planned that you need to satisfy clincal requirements.. But if they are not willing to help you help them, no sense hanging onto them. Get rid of them pronto so you can pick up new patients who might be more cooperative and willing to work with you so you can get your requirements done.

Let me guess why you needed to vent today: This past week must have been pretty crappy, right? Same here in Buffalo and most other northeasten schools because of the current deep freeze!

 

[aphistis]

Most of the dentists in this neck of the woods have no-show policies that are enforced pretty strictly. If someone fails to show for an appointment without calling (usually) 24 hours in advance, they're stuck with the appointment fee. Usually, the only way the dentist will forgive the penalty is if the patient can document a legitimate emergency. It seems to be working.

 

[odie77]

i've heard of a strategy that works. haven't done it but know of students who have: offer to pay for your patient's treatment. sucks huh, to be that desperate to graduate....

 

[UBTom]

That's what most dental students do for licensing board patients I believe.

For regular dental school patients it wouldn't be a good idea though-- Not when you are generating treatment plans after the comp exam visit that can be anywhere from $200 to $15,000!

 

[blankguy]

Originally posted by UBTom
That's what most dental students do for licensing board patients I believe.

For regular dental school patients it wouldn't be a good idea though-- Not when you are generating treatment plans after the comp exam visit that can be anywhere from $200 to $15,000!

$15,000!
What type of treatment costs that much??

 

[Supernumerary]

The problem with that though is word gets around town. Patients have been know to "blackmail' students here if they know the students are under pressure to finish requirements or find a board patient.

 

[UBTom]

to Blankguy:

That's the most expensive tx plan I've proposed to date.

It was a patient who is missing all the molars in all quadrants. The patient was given the option of going for two Kennedy Class-I removable partial dentures (cheapest, at $570). The patient was also informed that implants can be a good option since the alveolar ridges have favorable contour. Took the patient to Postgrad Perio for a consult, the PG Perio resident says it's a great implant case, so we drew up the new tx plan-- 8 two-stage endosseous implants and restorations. $15,000. After considering all the pros and cons, the patient is willing to go for it and signed on the dotted line.

Finished up all the basic tx (prophy, operative, and one premolar endo, prefab post+core and PFM crown) and sent the pt to PG Perio for implant surgery. It's been 4 months s/p implant surgery and the patient should be receiving the restorations in another 2.

No way I'll ever pay for that for the patient! My yearly living expenses in Buffalo is 30% lower than that!

Then again, such a case is the exception rather than the rule-- Implant surgery is mostly elective and pretty darn expensive, and a patient will agree only if he/she REALLY can pay for it!

Those guys at NYU will see lots of patients who opt for implant surgery though. While I was there over the summer, I found out that they have an exclusive-use arrangement with an implant manufacturer. Because of that, they charge only $750 per implant and restoration. Unbelievable. Here at my school it's ~$1600 per.

 

[thisisit]

We used to have a sign that said we would charge the pt if they cancel without a 24 hr notice. We had to take it down since I never enforced it. IMHO, these policies never work. If you charge a pt for a no show, guess what? Either he leaves your practice or he is the type of patient you don't want in your practice. The no shows are part of dentistry, in real life or in dental school. Get used to it and consider it part of doing the business of dentistry.

One suggestion: Let the patient know that you have reserved this time ESPECIALLY for them and how important it is to come by and be on time. Explain to them that you have to pay for the clinic time whether or not they show up or not unless they let you know 24 hrs before the appt. You are not lying because you will pay extra if you don't graduate on time.

 

[larryt]

Originally posted by thisisit

One suggestion: Let the patient know that you have reserved this time ESPECIALLY for them and how important it is to come by and be on time. Explain to them that you have to pay for the clinic time whether or not they show up or not unless they let you know 24 hrs before the appt. You are not lying because you will pay extra if you don't graduate on time.

Good idea! I didn't think about this before. I discontinued my dental hygiene care for couple of patients with 2 no-shows (my school allows 3 no-shows). Next time I will emphasize your suggestion to my patients then.

Thanx thisisit.

 

[gryffindor]

If it came down to it, I'd pay for the patient's $350 RPD to graduate on time. If that RPD was the last thing I needed to get out of there, I wouldn't hesitate. There are two options: pay the $350 for the patient and graduate on time, or do the proper thing & discharge the patient and pay the school an extra $10,000 to stay the extra semester to graduate. I think that's a really simple choice to take...

You have to be strict with your patients in order to get them in. UBTom posted our school's policy; technically it is two disappointments and they can be discharged, but I, like Tom, will give them three. I have told a patient that I am not going to pass the semester if he disappoints on me - I said this at his first disappointment. It wasn't entirely true, but I wasn't ready to put up with wasting all that time and being in stress and agony over the patient who doesn't value my time. I gave the patient the option - commit to treatment now, or call me in the next semester when his schedule gets better and I am not in danger of failing. That was over a year ago, I have yet to hear from him, and the patient is a neighbor that lives 5 doors down from me. Values dental care? I don't think so.

I also inherited patients from upperclassmen who never bothered to look into why the patient wasn't showing up. Sometimes all it takes is a conversation where you show your genuine concern for the patient and listen. You'll find out that they can't afford dental treatment because they don't have an income even though they know dental health is important. Or they might value it and have the money, but have no way of getting to the school to make the appointments on time. Our school set up a really nice program of social workers we can consult who will look into programs available to helping these people out. I was able to get one of my patients health insurance this way, because the social workers helped her become eligible for programs she didn't even know existed for people in her income situation. I have gone out of my way to call and book the senior citizen transport van for the patient who doesn't drive. Not every patient at the school will be the ideal patient who comes on time and commits to the full treatment plan of perio surgery, crowns, bridges and bleaching. I have learned just as much from managing these non-dental concerns of my patients as I have from their dental needs.

Don't feel guilty if they are in the middle of treatment and you have to discharge the chronic disappointer. If the patient really wanted to get that crown down, they would set aside as much as they could, save up for it (even if it was $5/week), and CALL YOU when they were ready. If the patient in the temp crown doesn't come in, someone in the class of 2008 will experience their first extraction on this patient.

Tom, there is a cheaper option than the RPD. I always tell my patients missing teeth that they can do nothing. Not having teeth replaced never killed anyone (not the same when you're missing like a heart or some other organ). Some of them seem to appreciate that I'm not trying to push any treatment on them when I lay out the four options of edentulous spaces - 1) do nothing 2) RPD 3) bridge (if there are abutments) or 4) implants.

 

[larryt]

Thanx everyone for sharing your experiences.

Any more suggestion to improve the situation ?

 

[no2thdk999]

Originally posted by mike05tusdm
What I wonder(and several of my schoolmates have had this same discussion) is why are people so stupid that they avoid coming for dental care? Why do they not come in for something that they need(dental care)?

I'll go one better. Why don't they maintain a reasonable diet and perform some oral hygiene once and a while? Heck, a working knowledge of a $.50 toothbrush would fix 90%+ of the problems patients present with everyday. Human nature ensures that patients will always need more than routine prophys but also means no-shows are a fact of life.

But to your question, I think patients dodge appointments for one of a few reasons. Money, fear (of pain, loss of control, or dentists in general), or lack of perceived need. If you can educate them to see the value in dental health, provide them with a comfortable experience, and then provide them with a way to pay for it without breaking their budget no shows won't go away but they will be fewer and farther in between.

In my office the first missed appt. gets a an easy going "just checking to make sure you're ok since you missed your scheduled appt" letter that say we'll waive the usual $40 fee since we understand that life sometimes gets in the way of good intentions. The second missed appt. the patient gets called and advised that since this is becoming a pattern they will need to pay a deposit of $X that will go towards their treatment cost before they can schedule again. After the third no show they can't reserve time in the office again but they can call when they know they are available and see if we have an opening.

All of this is flexible and can be adjusted if it is a good patient or they have a good excuse. We rarely enforce a missed appointment fee unless we want to get rid of the patient b/c like thisisit said it just keeps them from coming back. There are better ways to improve their compliance than imposing a fine.

JMHO
Bob

 

[River13]

 

[River13]

 

[River13]

I actually paid one of my classmates $20 for him to transfer one of his good patients to me in order to get the grade I needed once. Usually that would be a free transfer, but he needed it as much as I did, and I wanted an A, while a B was OK with him...That's a testament to the truth that clinical grades are shady measuring sticks...I've offered this to different patients at various times too...I figure if I spend $100 to buy an expensive textbook in Biochem to get the 4 credit "A", why not $20 in the clinical class? Gotta do whucha gotta do.

 

[3geminal]

I'm in Canada, so I don't know if this is a Canadian thing or what:

My own dentist's receptionist calls me 24 hour before the appointment to remind me. I'm in first year and don't work in the clinic yet, but I would guess they do the same. By calling outside of the 24 hour grace period, you can give the patient an out to cancel right there. It gives you a bit more time to fit someone else into the slot, and now the pt. can't complain about no-show fees.

Is the calling thing done down there?

 

[larryt]

Originally posted by 3geminal
I'm in Canada, so I don't know if this is a Canadian thing or what:

My own dentist's receptionist calls me 24 hour before the appointment to remind me. I'm in first year and don't work in the clinic yet, but I would guess they do the same. By calling outside of the 24 hour grace period, you can give the patient an out to cancel right there. It gives you a bit more time to fit someone else into the slot, and now the pt. can't complain about no-show fees.

Is the calling thing done down there?

Yeah... school requires us to notify our patients by mail 7 days ahead of time and by telephone 24 hrs before their appointment. We have to document in patient's PR every attempt of contacting them.

 

[endotom]

Here's a story that I pasted from a thread I started a
while ago (1/11) called "Some Funny Dental School Stories":

Story #1

When I was in school, we usually scheduled our patients for 3 or 4 hour appointments, so a no-show or a late cancellation was a real waste. I happen to have the school record for the best excuse for a no-show. Seems this was the last of 8 apointments for my denture patient when I was going to insert the denture and finally it would walk out the door and I would get credit for the case. The bill had to be payed at the buisness office, final insertion and adjustments done, then I get my credit. Maisey, lovely very overwieght gal didn't show. Reason: " I cut my toe nails to short last night and I couldn't walk down the hill." Beat that one.


endotom

 

[Frank Cavitation]

suppose a deadbeat patient who was inactivated decided to come back and you refused, what is the risk that they can successfully sue for "patient abandonment"? They probably signed something in the patient agreement informing them of the consequences of no-show, but how strong are those contracts in a court of law?

 

[UBTom]

Hi Frank,

As long as 1) the patient's history of frequent noncompliance and 2) your repeated attempts to inform the patient of the importance of completing a treatment is well-documented in the patient chart, it is sufficient grounds for you to end the doctor-patient relationship. To cover all bases, upon terminating the relationship, you can also refer the patient elsewhere or advise the patient to contact the local dental society to find another dentist.

If you did all that, no lawsuit for abandonment against you would ever hold up in court... In the U.S. at least.

Not sure if Canadian laws are any different..?

HTH!

 

[HIM0098]

Each of my patient including transportation cost plus a lunch or dinner, depends on the time of the appt..

And I have done with all my clinical requiremnt before I even enter the 4th year clinical .I even did extra..lots of strang cases..like class II combined with class V. After I was done with tooth preparation it looked like a twisted tunnel..

But you see I was not in US for my schooling. But I think money has the same effect no matter what color it may come.