Why can't you do a simple cleaning!?!

[oralcare123]

Had another one of those today. Perio patient demanding "simple cleaning". All my reasonable explanations were met with a face "You wanna rip me off". Need new ideas

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[TanMan]

Had another one of those today. Perio patient demanding "simple cleaning". All my reasonable explanations were met with a face "You wanna rip me off". Need new ideas

You shouldn't have to do any explaining. It only matters if you don't have enough patients. I'm sure they'll find some patsy to do what they want and either they'll do a good job at prophy prices, get upsold, or more commonly, a crappy polishing and gtfo.

Why are you having to explain multiple times? You should only have to go through it once with the patient and have your staff seal the deal. If not, then at least your staff's time was wasted, not yours. You and your staff have to know when it's pointless to continue talking to a patient and cut your losses. I find that not catering to these types of patients reduces your liability as these are the types not to take responsibility for their own health, and not having them in my practice increases the value of my practice since they are replaced with paying patients who actually trust their doctor.

 

[Chicago_predental]

You shouldn't have to do any explaining. It only matters if you don't have enough patients. I'm sure they'll find some patsy to do what they want and either they'll do a good job at prophy prices, get upsold, or more commonly, a crappy polishing and gtfo.

Why are you having to explain multiple times? You should only have to go through it once with the patient and have your staff seal the deal. If not, then at least your staff's time was wasted, not yours. You and your staff have to know when it's pointless to continue talking to a patient and cut your losses. I find that not catering to these types of patients reduces your liability as these are the types not to take responsibility for their own health, and not having them in my practice increases the value of my practice since they are replaced with paying patients who actually trust their doctor.

A great point!

 

[PerioDont]

I discovered in my perio residency…if you do Supra g scaling/prophy on perio pts…they will develop periodontal abscesses.

As the coronal tissue will heal up, and the anaerobic bacteria sub g will have a party. So yeah stick to your guns for those pts

 

[oralcare123]

GTFO is on my mind all the time

 

[schmoob]

I tell them a cleaning is called a prophylaxis which by definition is a preventative procedure. They have active infection that needs to be treated before they can get cleanings.

Sometimes I have to resort to analogies. Apologies if this is crude but I tell them that getting a preventative cleaning while they have active periodontitis is analogous to getting your wife pregnant and then continuing to use a condom. Again, apologies for the crudeness, but it gets the point across often.

 

[DrJeff]

Another line I like to use, is lets say that the patient hasn't had a prophy in 3 years. That would be typically 6 prophies worth of build up that needs to be dealt with. Tell the patient that because of the added 6 visist worth of build up it will take something more than the typical prophy that they have had in the past to take care of their current needs. That may be a gross scale/perio debridement followed by a prophy at a later date, or it may be scaling/root planing and more ferquent perio maintenace visits after, etc.

 

[702]

Another line I like to use, is lets say that the patient hasn't had a prophy in 3 years. That would be typically 6 prophies worth of build up that needs to be dealt with. Tell the patient that because of the added 6 visist worth of build up it will take something more than the typical prophy that they have had in the past to take care of their current needs. That may be a gross scale/perio debridement followed by a prophy at a later date, or it may be scaling/root planing and more ferquent perio maintenace visits after, etc.

These are good.

 

[Big Time Hoosier]

Them: “Why can’t you do a simple cleaning?!”

Me: “I have a boat payment to make.”

Big Hoss

 

[pubhealthdent]

I've had good luck with analogies. SRP isn't just an upgraded/more expensive cleaning (which is all most people understand it as), it's an entirely different procedure to fix a completely different problem.
Say you've got an oil leak in your car. Sure you can just put more oil in it, it'll fix the problem for a few weeks but it's not addressing the actual problem and it could lead to even worse problems down the road. You could do just a prophy, but it's just going to lead to worse issues in the future because you're not addressing the actual cause of the problem

 

[Rfrosty]

"If you hire a bad exterminator who only gets rid of the pests they see, you'll pay a lower fee initially while the costs to repair damages to the interior of your house accrue until finally you have thousands of dollars worth of damage. If you hire a good exterminator who gets rid of the source, then you'll pay a larger fee initially and will only need to worry about maintaining your infrastructure. In which scenario are you getting ripped off?"

I had a patient who wanted a bridge with an abutment on a tooth missing bone to about 2-3mm from the apex. I said not unless we fill in that bone with a graft because the bridge will fail. 2 months of no contact later I called to check in since I hadn't heard from them. They told me they got the bridge in another country. I told her we'll see her later then (although I think she missed the meaning behind the words "see you later").

In my opinion, if you have to argue with your patients multiple times about why they need something (discussing is fine and encouraged, having to jump through hoops or being accused of ripping them off constantly is not) and they don't want to listen, you should probably just cut your losses and drop them. They'll get the poor treatment they want from someone willing to actually rip them off. All you can do is inform them of the consequences.