The Most Heated Argument Ever on This Blog

A few months ago I wrote a post called “5 Red Flags that Make Me Want to Fire a Patient” which highlights a difficult part of being a dentist.  Yes, we love our patients and it is an honor to treat them.  Sometimes our patients are in a bad mood or even have quirky personality traits that make treatment challenging and that’s fine.  Effectively managing people is part of the job.

But there are people who we should avoid treating.  Those who would lie, cheat, and steal their way around your office;  those who would try to bully you and your staff.  My article was an attempt to categorize these behaviors so that dentists could identify them early on before the trouble starts.  I thought the piece came out decently and it was passed around online quite a bit.  Unfortunately it also attracted attention from non-dentists who took it completely out of context.

What follows is one of the  heated discussions that took place in the comments section of that post:

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Flossie says:

This entry just sounds like arrogant whining to me. I get the impression that you think the vast majority of dentists do only what dental work is needed, only within the scope of their expertise, and only rarely make mistakes. I am quite sure you are not that naive.

Patients are perfectly right to question the diagnosis, treatment plan and fees involved in any medical treatment, seek second opinions and alternatives and it doesn’t make them a bad patient. It sounds to me like the only really “good patients” are sheep, that lie there, submitting to whatever the dentist recommends, pay in cash up front, never complaining about anything, and never questioning anything.

Did it ever occur to you that these “red flag” patients didn’t just develop their attitude for no reason, but were subjected to unethical, unskilled dentists, and fear that you are going to do exactly the same thing to them so are being overly cautious and defensive? If you find your patients are overly defensive, blame their previous dentists, not the patient.

How about a blog entry on how a patient can spot the red flags indicating a problem dentist that overtreats, overcharges, and/or has marginal skills? If you want to reduce the number of “problem patients” then that entry would likely be a good start.

 

Okay, so I pissed someone off.  Here was my response:

Chris says:

Thank you for sharing your thoughts. I’d like to offer some clarification.

I’m not sure what you do for a living, but if it involves relations with other people then you certainly must be able to identify with the concerns I’ve raised. These red flags apply to virtually every profession, whether you are in health care, the restaurant business, auto repair, a retail store owner, etc. Only certain professions (e.g. school teachers) do not have an ability to choose the people they serve.

I am very sympathetic to good people who have had bad experiences with dentistry. Some have had bad dentists. Some are just dental phobic. My heart goes out to them, as I stated in my article above, and I do everything in my power to improve their situation and make them comfortable.

I also am sympathetic to patients who are overwhelmed with the complexity or expense of larger treatment plans. It can be confusing and stressful to explore options for treatment. That is why I offer free second (or third or fourth…) opinions for these people in need. I will also not turn my back on my patients who have sought opinions from other dentists.

But the fact of the matter is that dentists have entered into bad relationships with bad patients just like patients have entered into bad relationships with bad dentists. This was a post discussing the former. I have also written posts on the latter.

I appreciate your invitation to write about the red flags of bad dentistry. I have written several posts on the subject which can be viewed here, here, here, here, and here, to name a few. There are dentists who are unethical towards patients and unethical towards other dentists and I devote a good amount of time on this blog calling out that bad behavior.

I could write a post geared specifically for patients, but this is a blog for dentists. I do have many non-dentists who stumble upon the site and engage in discussion on various topics. I’m always happy to welcome them and offer advice on how to proceed with their treatment. I hope that additional explanation helped clarify my perspective.

 

I thought I adequately addressed the comments from Flossie.  But here comes another commenter:

jan says:

I totally agree wit Flossie regarding the arrogant post.
A few weeks ago I had work done by a dentist that asked me for several thousands of dollars up front to do extremely invasive dental work. After he did the work he became afraid of the fact that it would not work. And started to do things to discourage me from continuing the dental work in this practice. He claimed that I was not happy in his practice and left my work have finished. He also damaged several teeth.

 

Okay, so this person seems to have been in a tough situation.  But that doesn’t mean that my original post is wrong.  I responded:

Chris says:

Jan, if he left work unfinished then that is legally classified as “abandonment.” I highly recommend that you contact the local dental society and share your story with them. There are several measures they can take to help you. Obviously I don’t know the whole story, but it sounds like you may have been mistreated. I’m sorry to say that there are bad dentists out there; most of us are good!
But just like there are bad dentists in the world, there are also bad patients. Many good dentists have gotten in trouble trying to help them, just like you are a probably a good patient taken advantage of by a bad dentist. This is a blog for the dental profession, so I wrote to my audience warning them about the warning signs of those people that they should avoid.
This isn’t arrogance. An arrogant post would be if I were to complain about patient behaviors in a flippant matter without adding constructively to any particular subject or debate.
I wish you good luck and I know you will find a great dentist you can trust.

 

Next, a dentist and regular reader of the blog jumped into the discussion to help:

Eric says:

Some of these posts convey a large amount of anger. When you bring that anger into a relationship with your dentist… That is a problem. I am a dentist and I am here to help my patients. I am not here to put up with your anger or negative emotions. Your problems are just that… Yours. When you badger the person trying to help you… What do you think will happen. It’s all about respect. Regarding fees… You get what you pay for. I charge about $1,200 a crown. If you think my work is equal to the guy charging 800 for the same thing… Then go there. That’s like saying “those damn Mercedes dealers are rip off artists… I got a used ford for half as much.”. Everyone can afford dentistry… You just have to make choices and choose not to pay for a six pack or that fancy iPhone. PS… This is a blog for dentists. If you’re not a dentist… You’re a guest. Where I cone from it’s considered very rude to come into someones home and badger them.

 

I liked what Eric had to say. 

Chris says:

Thanks, Eric! I like your car analogy regarding fees. When I see those angry posts from non-dentists it makes me a bit upset. Not only is this a blog for dentists and the allied dental profession, I also believe there is nothing offensive to patients in the main post. Most of our patients are wonderful, caring, respectful, and honorable people. It is our privilege to treat them! But there are some real jerks out there as well and we need to be on our guard when we encounter them in our practices. I find it interesting that some non-dentists are offended by that concept. I don’t know what they do for a living, but don’t they also encounter jerks at work?

 

All was quiet for a while, then Flossie came back for Round 2:

Flossie says:

“If you’re not a dentist… You’re a guest. Where I (sic) cone from it’s considered very rude to come into someones home and badger them.”

Huh? You really are assisting me in making my point. Its always the patient’s fault, never the dentist. Now we are badgering you in your home by simply making a comment on an open blog? Give me a break. I’m guessing that listening to your patients isn’t your greatest strength.

Dentists are granted a license to practice from the public. They have been given the privilege to serve their communities dental needs, and in return make an excellent living, often working far less than most professions, and are held in high esteem in the community, or at least used to be.

If you’ve seen any surveys lately on the public’s trust of professionals, you’ll notice dentists have been falling year after year, seemingly coinciding with when dental advertising and marketing was allowed. It used to be dentists never did unnecessary work, but then the esthetics industry got rid of that problem, treating perfectly healthy teeth, and now that we are much farther down that slippery slope there seems to be no treatment that can’t be justified with the right marketing. Is it any wonder patients are suspicious, defensive and angry? Why are dentists now doing botox injections for instance? The botox seminars are crammed with dentists looking to hop on that gravy train.

As one commenter noted they had 3 occlusal adjustments! This new revenue generator is probably doing more harm than good, but is highly profitable. You get to charge very high fees for the adjustment(s) (sometimes many hundreds for a 10 minute procedure)and then charge to repair all the damage you did, treat the new teeth sensitivities, crown the now weakened teeth, treat the TMD and other likely repercussions. Patients are getting wise to this.

I guess you can stick your head in the sand, remain arrogant and continue to “red flag” all your patients who expect more than overdrill, overfill and overbill, or you can do something about it, and call out the bad dentists so that they’ll either improve or leave. Bad dentists are more destructive to the industry than bad patients, I can assure you of that. They make the good dentists look bad. Fix that problem, and the unhappy and angry patient problem will magically disappear.

 

Okay, now it’s time to take off the gloves:

Chris says:

Flossie, you have made some correct observations and some incorrect assumptions.
(1) I agree with you that dental advertisements have contributed to a change in perception of dental services.
(2) I agree with you that you can find examples of bad dentists taking advantage of good patients, such as the case made another commenter. I’ve discussed bad dentists and bad dentistry on this blog many times, which I’ve referenced in my comments to you earlier.
(3) I disagree with your assumption that dentists, “make an excellent living, often working far less than most professions…” The opposite is more often true. There was a time in the 70′s and 80′s when many dentists did well, but those days are over. Today, dentists graduate with over a quarter of a million dollars in debt, on average. There are numerous other factors that have hurt the profession, which you can read about here. I have no context for your statement about dentists “working far less” other than to say that dentistry is an extremely difficult profession mentally, physically, financially, and emotionally. Part of the reason it is difficult emotionally is that we occasionally work with patients who are rude and unappreciative, which is what this post was about in the first place.
(4) I disagree with your assumption that I am arrogant based solely on the evidence of this blog post. It is written for dentists and dental professionals. Yes, it is an open forum in the sense that any person can view it. But Eric is correct in pointing out that coming here to start a debate based in anger is not a wise strategy. This is because the discussion in this blog is for dental professionals; a non-dental professional audience will take this information out of context. Our conversations sound like arrogance because they are candid. We also have candid discussions pointing out the failings of dentists as I pointed out in # 2. So for someone to isolate this post is to take it out of context. To be a non-dental professional and read the information is to take it out of context. If you would like to engage in a civilized discussion (e.g. no name calling) and inquire about our practices I would be happy to reply. I field questions from non-dental professionals all the time. I give free advice on their care and help them find new dentists to take great care of them. I welcome non-dental professionals to use this blog as a resource, but I do not write it with them in mind. So to critique the writing style because it wasn’t designed for patients is incorrect.
(5) I disagree with your assumption that ridding the world of bad dentists will also rid the world of bad patients. The purpose of this post is to identify personality traits that are red flags for trouble with the dentist-patient relationship. I don’t automatically fire patients if they exhibit these characteristics; I keep them in mind as I learn more about their history. You also assume that patients get red flags because they wanted to be treated with respect and not over-billed and over-treated. Nothing could be further from the truth and I suggest you re-read my post.
In conclusion, it sounds like you’ve have some negative experiences with dentists and I’m sorry to hear that. But please do not expand your rancor to include an entire profession. If I have a bad experience with a dermatologist, plumber, etc I do not hold that against their colleagues.

 

But then something unexpected happened.  Flossie largely conceded the argument.  I think Flossie is a good person who was burned by a dentist and needed to vent a little.

Flossie says:

Points taken. Its my desire to see highly trained dentists making an excellent living, doing some pro bono work, and having enough time to continue education classes, mentor junior dentists, etc. This is unrealistic I know, but seems a worthy goal worth fighting for.

I agree that its a very difficult profession, and for this reason only students who really want to do dentistry should be encouraged and rewarded, and the students looking for a easy living should be discouraged.

The most depressing thing I’ve noticed above all else is the precipitous drop in craftsmanship and pride therein going on in assembly line dentistry, and I don’t think patients can be responsible for that. I might be reading between the lines, but I get the feeling that you think that a troublesome patient is one that throws a wrench into the assembly line operation many clinics have become. Ask too many questions, express any doubts, want a second opinion, concerned about costs, concerned about safety, and all of a sudden you’ve been red-flagged as troublesome. I take troublesome clients as a professional challenge, and more often than not I can turn them into fans. They’ve often just been abused by my colleagues.

Perhaps next time you run into one of these patients, rather than red flag them you can challenge yourself to turn them into a fan of dentistry. You just might end up with a better marketing tool than Facebook ever could be.

 

And my final response:

Chrissays:

You and I are in agreement. There has been a rise in dental practices that have more of an assembly line approach to dentistry. I agree with you that patients should challenge this kind of approach. Dentists should also be wary of working for these places. There was a fascinating expose on this type of practice by PBS Frontline called “Dollars and Dentists” that came out this year. I wrote a blog post discussing why I thought it was actually a great program, which you can check out here. Both dentists and patients should be aware that there are those who would see oral health become more business than health care. Who’s to blame for the rise of this mindset? I think that question has a complex answer.
I certainly do not blame a patient for being suspicious of my care. When I note the kind of behavior that I describe in the above article, I don’t point fingers; I ask questions. Many times the patient has had a bad past experience and in those instances I see it as my duty to earn that patient’s trust. I never write off a patient simply because they challenge the status quo. On the contrary, I like to see that they are thoughtful about their care. Few things are more rewarding for me than renewing a patient’s faith in dentistry. The “red flag” immediately disappears as I discover the patient is a perfectly reasonable and good person who simply had legitimate concerns.
The purpose of this article was to point out the rare cases when a patient relationship should be ended. Sometimes it’s because that person has fundamental personality and/or moral issues that will forever preclude them from a positive relationship with a dentist. Other times it’s because that patient is a good person who is unable to overcome prior traumatic history with a dentist, despite all good-natured attempts. Those cases are quite unfortunate. Their inability to move forward doesn’t make them a bad person, but it should raise concerns on the part of the dentist who now has to treat them. If the dentist feels up to the challenge, then that’s wonderful. But the dentist should be aware that they do not have to enter into that complex relationship if they feel that they do not have the ability. Both the patient and the dentist will be best served by going their separate ways.
Thank you for sharing your thoughts in this forum. I think our discussion has emphasized the important point that dentists should consider the reasons for unusual patient behavior and work to understand where it comes from. The occasions that I have been able to change a patient’s perception of my profession have been incredible. I know I speak for many of the dental professionals who read this blog when I say that we have all endeavored to build positive relationships with our patients even when they get off to a rocky start. That spirit is what makes us dentists and not “tooth carpenters.” We can treat the patient as a person, not a collection of teeth that will make us money. We can serve the population with acts of charity and selfless deeds. Those who abide by this credo are true health care professionals. And I’m happy to say there are a lot of us out there.

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In the end, I really did appreciate “Flossie” for his/her comments.  As dentists, we all know that some odd patient behavior can be attributed to negative past experiences.  Of course we wouldn’t want to dismiss a patient just for that.

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