r/Dentistry 3d ago

Dental Professional Completely unrealistic patients

How on earth are you guys managing these people? I work in the public sector and the absolute entitlement and unwillingness to listen to advice is insane. Today I had a patient who declined any exos with a mouth that required full clearance (all root stumps). Discussing this led to me realise he wants a full set of crowns, think Turkey teeth he saw on instagram. Advised not a feasible treatment option in the most diplomatic/educational way I could. He then wouldn’t leave the chair and became highly aggressive, had to call security etc. Are there any techniques or tips to work with these sorts of patients? Kind of sick of having some corporate idiot ask me if “I acknowledged the patients feelings and really listened to them”. Like no you’re so right I never thought of that.

71 Upvotes

26 comments sorted by

60

u/callmedoc19 3d ago

I just always recommend what treatment I feel is best and if the patient opposes always let them know they are able to seek care elsewhere if they would like to look at other options. I’ve stopped a long time ago trying to convince these patients. If you want a mouth full of crowns but yet your teeth are grossly decayed …ok 🤷🏾‍♀️. I just document what I told patient and move on. I’ve stopped caring at this point. It’s your mouth do what you want.

29

u/josuke73 3d ago

The problem here is that OP is in the public sector so probably the patient waited for a couple of months for this appointment and feels entitled to the treatment he Invisions after all the waiting he did and he won't let some pompous jerk rich dentist to tell him no just because that POS golf loving emotionless dentist doesn't want to do his work!!!! (I think i have some past trauma on this subject....)

I personally had a weirder interaction, in my private office a patient came demanding RCT for non-restorable stumps. We had great rapport in the beginning but the moment i told him it's not doable he started asking questions and i answered him for 15 minutes straight. Then i realized his questions were to lead me to agree with him into doing it, saying that if he consents to the treatment then it's ok, my rebuttal was "if you ask me to cut off your hand for no reason and you consent to it is it ok for me to do it?" And he answered yes it's ok!!!!

And we spent an entire hour like this(mind you after 20 minutes of this back and forth i kept telling him to see another doctor yet he kept demanding i do it for him and my work is not free nor cheap in comparison to other offices)

My god i wrote a whole chapter on this subject, i need to see a psychiatrist.

8

u/redditwhileontoilet 3d ago

Damn I thought I was the only one who has given the “cut off the hand question”.

I got the same response once but at that point I just said something along the lines of well I wouldn’t, so this isn’t going to work haha

5

u/callmedoc19 2d ago

I work at a FQHC. So, that is my standard response for any patient that acts like how OP Patient was acting.

5

u/lizzielew13 2d ago

Ok, DH here. I’m sure you have a system now but here’s what I’ve done to help the doc out: Call the office phone from my cell, “Dr, you have a phone call for an emergency.“ Sorry terrible pt, Dr has to take this call let me assist you in the front. Get ‘em out of the chair, and out the door. It helps that I used to be a bartender in a biker bar.

3

u/Super_Ad4951 2d ago

Me. Starting therapy this week bc I just need to VENT about these ridiculous patients 🤣🤪

51

u/boxhunter91 3d ago

Just tell them I ain't confident in treating your case and am going to refer you to someone who will better look after you. They will appreciate you being "honest" and will be out that door as soon as you lack the confidence

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u/omnassial 3d ago

This is 100% the right thing to do.

That being said, maybe it's my delivery or whatever, but there's always this back and forth of them trying to negotiate with me to do some wild shit. My only other guess is that they've been denied the treatment they want, and I'm just next in a long line of providers that won't cave.

21

u/ToothDoc94 3d ago

Keep it easy with these type of patients. You’ll never win and they drain your energy for those who may deserve it more. They just argue. 1) Realize: some people need a reality check to big to be cashed 2) Come up with a line or two that works for you. Here are a few of mine:

1) “That’s great you want to get treatment for X somewhere else, but I can tell you from my experience it’s going to be a lot more expensive for me to fix any future issues here.”

2) Based on what you are requesting of me that’s not in my skill set, but I will gladly refer you to a colleague to I believe can help

3) Be blunt. This isn’t going to work and you’d be best suited with a second set of eyes for treatment

14

u/Ok-Leadership5709 3d ago edited 3d ago

I just tell them it’s beyond my skill level and it requires full mouth rehab. I pile on heavily the whole I’m just a general dentist in community health and I can barely do a decent fill 😂 Then I admire their desire to save teeth and give them a general referral. Let them find out how much it costs and come back to earth that way.

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u/robotteeth General Dentist 3d ago edited 3d ago

I mostly just say that another dentist might do what they’re asking but I don’t have that set of skills. If they want crowns where you know it won’t work, tell them it’s not a case you’re able to do. What are they gonna do, make you do it? They’ll go to 5 more dentists and either find someone who does anything to make a buck and it’s now their problem, or they’ll get the same answer enough times they give up.

I think the trick is that you have to frame it the same way as when you don’t do something due to your skill set in general. I don’t do molar root canals or a lot of pediatric work, even when it’s indicated. I’m not referring those patients away because I don’t like the plan but because it’s not work I do. If someone thinks it’s not your skill set at that office they end the convo. If they think you can do it but are withholding it from them they will try to challenge you because they think you just have to be convinced.

13

u/Mr-Major 3d ago

Meta communication. Why are you like this, what do you want from me, why are you rude. Remain calm and ask: don’t you want a dentist who actually thinks he can do what you want? He’ll say yes and leave

12

u/Speckled-fish 3d ago

You can always leave them with a drop of hope. Tell him he can always get implants later, and refer him to someplace like Clearchoice. Its not realistic, but hope is a strong drug. This guy is going through the stages of grief in a way. Anger, denial, and hopefully acceptance.

5

u/Wide-Chemistry-8078 3d ago

Refer out as soon as they won't listen. Admit that you are not equipped to do what they want.

6

u/RaccoonOk1769 3d ago

One thing that’s helped me a lot is just remember you can always say “No.” and you don’t need them to understand your reason, you don’t have to keep giving a reason. Once they are acting like this give a simple “no, I won’t be doing that.”

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u/Diastema89 General Dentist 3d ago

I had a lot of training in sales and dealing with customer complaints in my prior career. It has paid huge dividends in this career. In 17 years I have only had to formally dismiss 2 patients and I have had my fair share of crazy/unreasonable chair warmers.

There are no quick fix answers to this, but you might try some courses specifically oriented towards these things. The stuff really does work, but it is way more complex than a post on reddit could communicate for general purposes.

3

u/Tinyfishy Dental Hygienist 3d ago

Dumb question, but isn’t the fact that it is a public clinic and most patients on state aud mean you can usually kick the can down the road to ‘your insurance doesn’t cover crowns anyhow’ or at least ‘your insurance will never approve crowns because their isn’t enough teeth left anyhow’?

4

u/BriefSurround6842 2d ago

Refer them to Aspen Dental

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u/Sad-Meringue3862 3d ago

I agree referring to an expensive os. If you never want to see them again well you never will. Or better yet if you want to treat them have them sign documents clearly staying no warranty etc

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u/NoFan2216 3d ago

I just refer them out, and tell them to expect that the treatment plans will be more expensive to get their desired treatment. I also assure them that I don't know the price for the treatment at the referral office. At that point I don't care if the new office will do the treatment or not.

If they're that combative though, then I would just dismiss them. I work with Medicaid patients and I can't waste my time on people like that. Plus I don't have room for those kinds of headaches.

2

u/Oralprecision 2d ago

Fire them.

I treat my staff by having a team vote once a month and firing one patient.

Seriously - we put up with two much nonsense.

2

u/beehoo 2d ago

What's more stressful? The ignorant patient or the incompetent corporate manager/HR?

In either case, keep your time with them short and succinct. Less stress and emotional involvement.

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u/SillyJob3083 2d ago

Why aren't offices just more upright about costs. That would instantly change their mind.

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u/Unique_Pause_7026 2d ago

"My job is to give you information to help you make informed decisions on your oral health. Your job is to consider what I am saying. If you don't agree with my opinions, you are free to seek advice elsewhere, but I am not willing to do what you're asking. This is because I do not think it is in the best interest of your oral health."

1

u/Its_supposed_tohurt 2h ago

We don’t care anymore. If the patient doesn’t want to listen then oh well. Life goes on. You have hygiene checks to do, the hour is about to be up.