Figure 2: Four mini implants supporting and assisting retention of a conventional overdenture. This highly successful restorative service was completed rapidly and at minimal cost.
Click here to enlarge imageI must admit, as a prosthodontist interested in the best quality I can deliver for the money, the conservative, noninvasive, small-diameter (mini) implant is very desirable for simple restoration of edentulous jaws. I have had great success with these implants over the approximately seven years I have placed and restored them.
Unless the patient prefers a more stable, rigid attachment of the prosthesis, I lean toward using more minis and fewer conventional-diameter implants.
For more information about mini implants, their placement, and restoration, see our new video, V2317 Mini Implants for Your Practice. Call Practical Clinical Courses at (800) 223-6569 or visit our Web site at www.pccdental.com.
Q I have quite a few patients who are difficult to treat because of apparent psychological reasons or due to differences between the patient"s personality and mine. Treating these difficult patients frustrates everyone on the staff, and it always takes significant time to recover from the bad feeling we have after their visits. My practice is a successful one, with ample patients. I do not need additional patients in my practice, and I am asking you for a tactful, legally nonproblematic manner in which I can refer my problem patients elsewhere. Can you help me?A Every health-care practitioner has been amazed at the differences among patients relative to acceptance of the services they have been provided. Some patients are trusting, cheerful, and noncomplaining. They sit quietly and allow the treatment to be provided without challenging the dentist. They do not argue about fees. They actually thank you for the service rendered!
Other patients are constantly questioning and overtly distrusting. Some express the feeling usually unjustly that the practitioner is looking out for himself or herself and not for the patient, in spite of the reverse being true. Why there is such a wide difference in patient behavior and attitude I don"t know. Fortunately, most practices have only a few patients in this negative category. I estimate that the percentage of disagreeable patients in a typical practice is below 5 percent but their characteristics make the group seem much larger!
I have a few suggestions for you about eliminating these patients from your practice:
1) Are you committed to treating the patient because he or she is a relative or someone else you feel obligated to treat? If not, eliminate that person from your practice as soon as possible.
2) Have you done any treatment for this patient that is not up to community standard of care? Each of us has bad clinical days. Don"t leave any treatment in patients that some other dentist could classify as substandard. Redo any procedure you have done that is questionable.
3) Is there any treatment you have begun for this patient that has not been completed? If so, complete it to a satisfactory quality level.
4) Although there are many potential phony excuses to eliminate patients from the practice, in my opinion, an honest approach is the most appropriate way of handling this. Take the patient into a private place in your office. Have a staff member present to hear the conversation, and tell the patient something like the following: Mr./Mrs. Disagreeable, you know we have experienced some personality challenges during your treatment, and I know that I may have made you uncomfortable from time to time. For those times, I apologize. It is clear to me that our personalities are not similar. I would like to make dental treatment more pleasant and acceptable for you. For that reason, may I please suggest a few other practitioners with whom you might have a more satisfactory and enjoyable experience? May I suggest that you have Dr. A, B, C, or another dentist become your practitioner of choice? Make sure to give patients you are dismissing several names, so the decision is up to them, and you can"t be blamed for sending them to a dentist they don"t like. Then, again speaking to the patient, say: After you select the dentist you wish to serve you, we will be happy to send your records to that doctor. It has been our pleasure to serve you, and we wish you well with your new dentist.
5) Be firm with the dismissal. Some patients will apologize and attempt to have you retain them. You must make your decision to dismiss them and hold to your position before you confront the patient. Your decision is the final one.
It is uncomfortable to dismiss a patient, and you want to do it tactfully and respectfully. When it is done and you don"t see that person"s name on the daily schedule anymore, you will know you have done the right thing. If you continue to gradually weed out the problem patients, almost every day in your practice will be enjoyable and productive for both you and your staff.
Dr. Christensen is a practicing prosthodontist in Provo, Utah. He is the founder and director of Practical Clinical Courses, an international continuing-education organization initiated in 1981 for dental professionals. Dr. Christensen is a cofounder (with his wife, Rella) and senior consultant of Clinical Research Associates which, since 1976, has conducted research in all areas of dentistry and publishes its findings to the dental profession in the well-known CRA Newsletter. He is an adjunct professor at Brigham Young University and the University of Utah. Dr. Christensen has educational videos and hands-on courses on the above topics available through Practical Clinical Courses. Call (800) 223-6569 or (801)226-6569.
