What should you do when patients say...

How about if "for now" is going on 18 months? How about if "just a cleaning" is for a wedding in a month?
minnesotamike
Official Townie
Member # 9358

I give them what they want, then chart says "Pt refuses treatment of perio dx; just wants prophylaxis. Pt is fully informed." Many will eventually allow treatment or referral and follow through.

Discharging them is tantamount to saying, "hey, you ignorant jerk, you are scum!" My job is to inform and respect the decision of a patient to accept or refuse treatment, then give them what they want in a non-judgmental fashion. Cardiologists don't refuse angioplasty and stents because a patient is obese and smokes Luckies.

Why should we be that way. Sure if a dentist just can't STAND the thought of a patient not accepting their recommendation, or their ego won't allow it, they should discharge the patient for the sake of sanity. But a little bit of kindness, compassion and understanding of patients fears and skepticism is good for THIS dentist. Keeps me humble...

I find it curious how many dentists will do large oversized composites or amalgams on teeth that need crowns, but will boot a patient like this for refusing active perio tx.
marshall_white_dmd
Official Townie
Member # 7916

I agree with Marshall. Just this morning we had good ole' Dr R. who is a neurologist come in for his 3 month recare visit. Once again we requested that we take x-rays on him and once again he refused. We once again explained to him why it was necessary and he still said he didn't care. We just made him sign a consent form saying that we can't be held responsible, blah, blah, blah... I think I've got a stack of those from him. I'm not going to worry about it and let my ego get the better of me. Besides, his wife is a wonderful patient and worth having. I'm not going to jettison him just because "he's a doctor and knows better".

I find it interesting that he probably lights people up with x-rays yet he claims he doesn't want any done because he is scared of radiation (and we use digital!).

The point is this--people are free to make their own informed decisions about their dental health. Just CYA and get written documentation/consent. If it becomes too much of a problem then suggest they go elsewhere. In Dr R's case, he doesn't present any problems other than the x-ray issue and I feel that we will eventually get him to come around. Every case is different.
ceramiccowboy
Official Townie
Member # 8341

I agree with Marshall and Greg, but offer one caution. I assume you know that you are essentially limited to cleanings without radiographs. No diagnoses can be made without them. And, the perio condition can worsen and lead to tooth loss.

I would suggest adding a short passage to Marshall's entry: "Pt refuses treatment of perio dx; just wants prophylaxis. Pt is fully informed. Explain his choice can lead to tooth loss and assoc probls."
jefftonner
Official Townie
Dental Malpractice Defense Attorney
Member # 9032

Jeff beat me to it. A patient CANNOT legal consent to negligent treatment. Treatment without radiographs is negligent. Even a prophy without radiographs could be negligent. Why? Well... a prophylaxis cannot be done here in Florida without an "examination." An examination implies diagnosis. Diagnosis of many pathologies is impossible without radiographs. "Your honor, I've been going there for cleanings and checkups for 3 years, and Dr. Prophysonly said I was fine. Now I'm losing my teeth!!"

That all said... Legal issues aside, I ask you this... Why on earth would you make an effort to keep a patient in your practice who only desires "cleanings." Are we merely "cleaning services?" I will summarily dismiss any patient who refuses x-rays. It has nothing to do with my ego. I see it as risk management. When a patient refuses x-rays, even after a thoughtful explanation of the necessity and safety of dental x-rays, I see it as a complete lack of trust. Lack of trust, in and of itself, is a precursor to potential legal problems. Not worth it to me. Why would you want a prophy's only patient in your practice?
Mike Barr
Official Townie
Member # 8298

That being said, I offer an alternative:
"Pt advised of [needed tx] and refuses due to[radiation][money][time][ins bene][other]. Explain disease process and how delay can result in tooth loss and assoc probls. Pt understands. [have pt sign chart]."
jefftonner
Official Townie
Member # 9032

No kidding on this one. I had a patient sit in my chair and tell me this regimen to "cure" his periodontal problem.

Swishes with rubbing alcohol, baking soda in water, hydrogen perioxide and finish with "just a dab" of iodine. When I suggested that it may simply be the grade 3 furcations that harbor bacteria and that he may need to see a periodontist for surgery he wrote me a letter.
ecnar
Official Townie
Member # 7934