E48: Podcast: What NOT To Do (In Your Dental Practice)

You’re listening to Ascent Radio and my name is Dr. Kevin Coughlin. Today’s podcast is titled What Not to Do. You’re listening to Ascent-Dental-Solutions. My name is Dr. Kevin Coughlin and the focus of Ascent Dental Solutions is on development, training, knowledge, and a combination of teaching episodes to try to improve the health care along with the business of health care.

What Not to Do is something that I thought would be interesting to our listeners. I am a practicing dentist full time. I have 14 locations located in Massachusetts and I provide all levels of general dentistry, including IV sedation, hospital dentistry, laser care, iCat scanning, you name it and I would say we do it in our dental offices.

At this point in time, I have been providing expert help in the process and procedures of helping dentists in all phases of their career from the very beginning to the growth stage to the exit strategy. And it struck me interesting over the last couple of months, a couple of particular instances that happened that I thought I would share and open up. Although I consider myself an expert, I’m also human and the mistakes here will show an excellent example, in my opinion, of what not to do.

The first example is an individual who is periodically late for their appointments. When I say periodically late, I would say between 50 and 75 percent of the time, they are between 15 and 20 minutes late for an appointment. This is not a rare situation. I think most health care professionals deal with this.

What struck me interesting was how our company handled this particular episode. The first thing that happened is when the individual arrived at the office, they said they were sorry that they were late, they knew that they were late, but they were struck in traffic. A common excuse that we hear quite often, but it was an excuse and the individual owned up to it.

The receptionist or front desk coordinator or team member, however you’d like to refer to your employees, said to the individual, “You’re almost 20 minutes late and something like this cannot continue to happen.” And the individual turned around and walked out. I can assure you that within less than 45 minutes, I received an email saying how dissatisfied this patient was with our organization. How unhappy he was about the way he was treated. He heartfeltly tried his best to be on time for his appointment.

The results of that particular process and procedure, that in my opinion was a failure, means that we lost that individual as a patient who’s been a patient in our practice for over ten years. We also lost their wife and we lost their three children. The result of inappropriate process and procedures has a dramatic effect on your day-to-day bottom line and your reputation. At this point, I haven’t seen a social media post of this dissatisfaction, but I can assure you that will occur shortly.

The correct way that this should have been handle — and keep in mind I’m coming across as an expert in process and procedures, this is my own office and I’m someone who prides themselves on training and education. The correct way would be to first have the patient seated. Explain to the patient that their appointment was at such and such a time and that because they were running late, we would do our very best to coordinate and complete their care. In this particular case, it was a hygiene appointment. I think most up-to-date offices will have dental assistants, dental hygienists, front desk personal, doctors and associates that I think could handle a hygiene appointment, regardless of how late that patient is.

The point I would try to make in this example is the negativity should have occurred after the appointment was completed, not before or during. My personal opinion is if this was handled correctly, I think the average individual would accept the fact that they were late and they would understand that perhaps we may not be able to do as excellent a job as we would like. But in most cases, I think offices can handle this particular crisis. The result of not handling it properly was a financial hit to our company and to our reputation. And I’m sure if it’s happening to me, it’s happening to others.

So the take home point in this example is keep the negativity until after the appointment is completed and then have your treatment plan coordinator simply say to Mr. or Mrs. Smith, is there a time that is better for you so that you won’t be late? Is there a way that we can coordinate the appointment so it is easier for you and there’s less stress on you? That proper communication and relaying of that information could have created a much better outcome. In my opinion, we had the worst outcome that could possibly occur.

The second example is an individual who has 12 broken appointments over the course of two years. The patient has not been in the office for a period of two years. Out of a total of 28 teeth, 26 teeth have dental carries. Although it’s not critical, this particular patient was a Medicaid patient or MassHealth patient. And for those listeners outside the state of Massachusetts, it’s basically a government-assisted program for those individuals who are of the lower income bracket and need financial assistance.

This individual, in my opinion, was rude, they were abrupt. Their treatment plan, their radiographs, their diagnostic photos, their diagnostic impressions, everything was done. All I’s were dotted, all T’s were crossed. Her last appointment, two years ago, were to surgically remove tooth number 21 because of gross carries and inappropriate approach to endodontic or periodontal treatment, in my opinion, was valid. The tooth was deemed topless and needed to be removed.

For a variety of reasons that are not necessary to go into at this point, the patient scheduled appointments but never showed up for those appointments and on a recent visit, she arrived at the appointment on time demanding that the treatment be done. A complete and comprehensive exam had to be redone to bring her records up to date and an evaluation concurred that 21 needed to be removed.

In my opinion, this patient was a pain in the ass. This patient was miserable, rude and just someone you’d rather not treat. As a courtesy and in my opinion, I felt that because of the clinical situation, she was definitely uncomfortable, antibiotics, in my opinion, would be a short term approach and the tooth needed to be removed. I removed the tooth surgically by laying a flap vertical releasing incision, I packed the extraction site with a Collaplug and shuttered it, homecare instructions were given. A treatment plan letter was written up and signed.

What the patient really wanted was pain medication. So after I went to the entire length to do everything possible to get her comfortable, really what she wanted was narcotics. She wanted more pain medication and I refused. She then insisted and actually threatened if I did not give her a narcotic, she would go on social media and register a formal complaint and how bad a health care provider I was and how horrible our organization was.

I share this with you because how not to handle this problem, I handled it poorly. I simply said, “I’m not interested in your comments. Please remove yourself from my office and I would like to discontinue your care. Please find another health care provider. I have no interest in providing you care or service any longer.” This, of course, did nothing but infuriate the patient. And of course, she left the office demanding her records and also her final comments were, “I will put this on social media and I will make sure everyone knows how horrible you and your organization are.”

So here I am as an expert speaking to you podcast after podcast about process and procedures. The question that I pose and I assume most listeners have had this particular experience, is what do you do? Do you cave in and give the patient the narcotic just to get rid of them, do you toe the line and simply say the answer is no, accept two Tylenol and two Motrin over the counter every four to six hours for the next couple of days and if your signs and symptoms haven’t been relieved, we’ll see you again for a follow-up emergency? The way I handled it, in my opinion, was inappropriate. I took it personal. I was irritated and aggravated at the schedule, at her and a combination of other events. And in my opinion, the worst possible outcome occurred. She then went on social media and did exactly what she said.

I guess the proper process and procedure would be to be firm, be direct, don’t cave and give the narcotics because that, in the long term, is unhealthy for your patient, but to be professional, be above the fray and continue to maintain your cool no matter how difficult it is, and simply say, “I’m sorry, I can’t give you this particular medication. I believe that it will be detrimental to your health and wellbeing.” It hurts me to share these very personal stories because it’s a reflection in how, after 35 years in this profession, I still make mistakes day-to-day. But I thought, perhaps, our listeners could learn from these mistakes and try to do better than I did.

I hope you enjoyed this particular podcast titled What Not to Do. If it’s well received, which I expect it will be, you’ll hear others. Because unfortunately, these mistakes that I’m talking about occur more frequently than I’d like to admit and perhaps sometimes we learn more from the mistakes than what we do correct.

You’ve been listening to dental health matters and this podcast is Ascent-Dental-Solutions. My special thanks to Mr. Doug Foresta and his company Stand Out and Be Heard, who’s responsible for this professional podcast. I also would like to give special thanks to Mr. Aidan Crawford and his company Short Circuit Media for helping marketing this podcast and putting together these programs.

I hope you enjoyed this evening’s podcast and I look forward to speaking to you in the near future.