Lines In The Sand

Oct 21, 2019

Lines in the Sand

 

Have you ever started treatment on a patient only to regret it later?

 

We all have.

 

When I think about the story I'm about to share - and think about some of the other patients where I feel like I lost control a bit - you can put the main problem into one of three categories.

 

1. Financial
2. 1. The Practice failed to adequately bill for the services.  Either too much time is being spent in the treatment, or too much money on lab services.
   2. The Patient failed to adequately prepare or meet their financial obligations to the practice.  When this happens mid-treatment a lot of conflict can result.
   1. The Practice planned and began treatment that was beyond the skill set of the doctor.
   2. The Patient is difficult to manage in the chair, or presents certain challenges that the doctor must overcome.
3. Techincal/Clinical
   1. The Practice didn't communicate expectations clearly.
   2. The Patient didn't communicate expectations clearly [or wasn't given the opportunity]
4. Behavioral

 

Here's the story:

 

Samantha has been a patient of the practice for more than 20 years.  Her oral hygiene is impeccable, the value she places on health and oral health is high - and she did not like how her lower teeth were crowding.

I also knew that her value for esthetics was high, as were the demands created by her attention to detail.

Together, we decided that she was a good candidate for Invisalign -- and we made the appointment to start.

Now, we are still analog [for the most part].  She put up the usual fuss about the impressions.  But, was re-assured that this only happens at the beginning and the end.

Why did I say that?...

Those words were my "kiss of death".

Not only did the first set of impressions get rejected [probably because I removed them too soon to ease her discomfort]  But, later she needed a mid-course correction 

If that was the only problem, I wouldn't be telling you the story.

Sam also couldn't tolerate:

the IPR - too sensitive - it hurt a lot

the buttons / attachments - how was she supposed to eat

the lingual ramps on 7-10 - these had to be removed

Sam's discomfort, her willingness to express her discomfort, my desire to make her comfortable and my inability to do so... I felt like I was failing her.

If it were just one area, or only at one appointment, I think it wouldn't be such a big deal.  But Every. Single. Appointment.

 

It got to a point where I just died on the inside when I saw her name on the schedule.

If Sam sees this she will probably recognize herself, and I have to say that Sam is a patient that I love seeing.  She is an absolute joy.  Which is why I had to stop and figure out what went wrong with her case.

 

Going back to those main three reasons, it is obvious to me now that our problem was behavioral.  the trust that she has in our practice was miss-read by me as an understanding of the treatment that she was about to go through.  It's that simple.

 

Thanks to Sam - I now have two short phrases that I share with every patient.

 

No Strangers.

No Surprises.

 

These phrases remind me of a sign that might be scribbled out in crayon and hung on the outside of a kids clubhouse.

The best part? They open the conversation about how we do things in our office.  How it's different.  And Why they should care.

I can think about several points during Sam's treatment that I don't think would have happened if she and I had had a more open conversation about what she should expect.

Even at the beginning -- the very first complaint -- I know that if I had stopped what I was doing, sat knee to knee, and explained my fear about her going forward Sam would have either accepted what was coming or said that she wasn't ready for it.

Either of those situations would have been better than what we both lived through.

For the record, Sam is still in treatment [we are almost done!!!] and she's thrilled with the results [as am I]

No Strangers.  No Surprises.  Those phrases have given me an ability to draw my lines in the sand when and where I need to.

I can be rigid and dogmatic when appropriate, and I can flex when that's needed as well.

I encourage you to reflect on the last time you had a feeling of regret after starting treatment.

What area was your challenge in? What could have been better? Was your line in the sand too firm? Not firm enough?

Please tell me about it - I'd love to hear.