Lines in the Sand
Have you ever started treatment on a patient only to regret it
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
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.
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.
The Practice planned and began treatment that was beyond the
skill set of the doctor.
The Patient is difficult to manage in the chair, or presents
certain challenges that the doctor must overcome.
The Practice didn't communicate expectations clearly.
The Patient didn't communicate expectations clearly [or wasn't
given the opportunity]
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
If that was the only problem, I wouldn't be telling you the
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.
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
Thanks to Sam - I now have two short phrases that I share with
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
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
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
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.