Compensation Culture Sucks

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A 30-year-old lady had been to see a hygienist for a scale and polish, went home and took a small mirror that she put inside her mouth to have a look behind her front teeth.

“Stains!!”

She went back to the surgery and complained to the receptionist about inadequate scaling. She was booked in to see another hygienist who confirmed there were some stains left behind (palatally) the upper front teeth. Otherwise the scaling was done well enough.

Patient left the practice seemingly happy but the next day she called the practice that she still wasn’t happy. She also complained about the dentist she had seen.

The hygienists and the dentist discussed about the patient and came into conclusion that this patient could not be pleased and the complaints would be never-ending. They all had had the same feeling about the patient when she was in the chair. It was a feeling of unease and of a need to explain excessively everything they were doing or saying to avoid a complaint. They decided together that the patient would not be welcomed anymore and the practice manager was the one to break the news to the patient.

Thankfully the practice owner was supportive over the decision.  He said

“We don’t need that kind of patient in our practice. She will only bring bad blood and it’s just not worth it. We can’t help her.”

The Compensation Culture

The compensation culture in the UK (and perhaps even more so in the US) is making a life of a dental professional very hard. It is ludicrous that the main focus of seeing the patients is in the avoidance of possible complaint.

The rotten apples amongst us dental professionals are perhaps to blame. And the media has done their share as well (has there actually been a program about rogue dentists?). The way the media is sharing news is focused on gruesome headlines and there seem to be less and less investigative journalists in the payroll of the media. Instead there are these copy-paste-wannabe-journalists whose main focus and reason for existence is to get as many clicks as possible on their news. Here’s one example:

Dental anguish: Indiana man who expected to have four teeth pulled woke up in hospital TOOTHLESS” (Find the news here)

This and similar headlines were quickly released around the world without giving the dentist a chance to respond. He would have wanted to respond, I’m sure but there are laws that prevent us dental professionals responding publicly to the accusations made against us when it is about doctor-patient relationship.

Later on the dentist was allowed to discuss the patient case but far fewer media released his response (you can find the response here). So the dentist suffered financial loss over these headlines only because the media is fishing the clicks. Of course there wouldn’t be these headlines if there weren’t people clicking them…

Learn the Phrases

You know what? It is time to fight back the compensation culture. You can do this by learning to use certain phrases. I will list the phrases I use myself when I see a patient. And without sounding like a super human, I rarely get complaints. It is just the opposite. People are happy after they have seen me.

And before you tell me that there is no time to explain everything to the patient I will say that it takes no extra time. You can use the time when you have your fingers inside the patient’s mouth. Don’t wait until you are finished with the treatment. You chit-chatting might even relax the patient!

Ok here we go and remember these are just examples and you can easily create your own phrases for every situation.

The phrases need to cover:

Post-operative pain/sensitivity/bleeding and instructions

“The gums might feel tender afterwards and it is ok to take a painkiller for them. But do not take aspirin because it might make the gums bleed.”

“Sometimes the teeth get sensitive after scaling which normally will pass very soon. If prolonged it is advised to use a sensitive toothpaste.” 

“Some stains cannot be removed by scale and polish. They are in the deep grooves or inside the enamel or between the filling and a tooth and only replacing the filling will help.”

“The teeth will feel very different afterwards as the tongue has got used to the tartar. You will feel the gaps between the teeth.”

Looks and the feel of the new filling

“You might have sensitivity after new white filling and in the worst case the sensitivity can last for months but it should gradually get less and less. If not, you need to come back to have it checked. And if the pain gets worse you need to come back straight away.”

“The filling is never the same as your natural tooth (so you should think twice next time before you snack between the meals and neglect the teeth… )”

The list of these phrases is endless.

And the most important thing is to remember to write down every advice and information you have given so that it can be easily checked what the patient was told if they complain. In this digital age it is a matter of copy-paste if you have created templates on you computer.

Tell What You Do

It takes no extra effort to babble while you are treating the patient. Of course some people won’t like us talking while we treat them but telling the basic stuff is normally ok. This means very simply informing the patient what you are going to do next.

“I’m going to tilt the seat back…”

“I will rinse now..”

“I will use a drill next. There will be water and you will feel vibration…”

I hear it numerous times per week that the patient felt it was good that I told everything I did. I think it is only respectful thing to do. After all patients come to see us, trust their health in our hands and pay our wages.

There. Now go on and try these advises out! I’m sure you won’t regret it.

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Are You Telling the Truth about Your Health When You See Your Dentist?

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Interview Is the Most Important Part of the Check Up

When you see your dentist for a regular check up it should always start by interviewing you. No matter how long you have known your dentist and you think they know you inside out, the same questions should be repeated every time. These questions make the treatment you might need safe to perform when it comes to your health.

If the dentist or dental hygienist does not ask about your medical history when you see them for a check up or an emergency visit, I would advice you to change the practice. In worst case your life might be at risk.

If your dentist or dental hygienist does ask about medical history, you are in good hands but only if you are honest. Do not hide anything even if you think something is not relevant or you are embarrassed about it.

The most important ones to mention are

  • anticoagulants (all of them – even aspirin and omega 3-products) and why you have been prescribed these
  • allergies – all of them! The ones the patients often fail to disclose are food allergies and allergy to latex. One might think that why would food allergy make any difference to dentist but it does. There is milk protein in a product called GC Tooth Mousse that is used e.g. after teeth cleaning
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  • antidepressants – you don’t need to be embarrassed about them, we are professionals and will take matters as they are
  • eating disorders – the past and current ones. There is no reason to hide them from the professionals. It might be actually a relief for you to share it with somebody (believe me, I have witnessed this several times during my professional life)
  • excessive alcohol consumption – even if you won’t tell us we can often see it from your mouth or how you response to the treatment. Heavy alcohol consumption may affect the effectiveness of the local anaesthesia – it might be difficult to get your tooth numb. Also certain drugs like antibiotics won’t be effective enough. These are just two examples. If you are interested to read my post about alcohol, please click here.
  • if you have artificial joint/s
  • all the systemic diseases
  • if your immune system is impaired – HIV, hepatitis A or C. This won’t change the way we treat you as we should treat all the patients in such way that no cross-contamination can happen. But we need know in case we see something in your mouth (e.g. soft tissues) we do not understand unless we know about your illness. Also the information will help us in the case of unfortunate accident if one of us professionals cut ourselves by contaminated instrument.

It Is All about Trust

Everything you tell us at the dental office is confidential. Even if you are a public figure.

I must tell from an experience that I felt utterly disappointed and mistrusted once when a well-known person who had seen me for years, told in the press that she has had hepatitis C for a long time. You tell this publicly but not in a place you should! Why o why? Trust us for God’s sake!

Yet Another Anti-Patient

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How on earth did I not remember this type of Anti-Patient? I guess it is all coming slowly (but surely) back to me after returning to work.

Before you read any further, it might be good idea to read my post Anti-Patient so you know what I am on about.

Anti-Local Anesthesia

Now, this type of patient is not so uncommon in the dental chair. Let me tell you about the two of the most typical situations I face.

Patient Case I

I am about to start the scaling and root planing and I can tell from the looks of the gum that it is going to be painful. I offer local anesthesia (LA) but the patient declines by saying:

“I once had such a bad experience with LA that I have not taken any since..”

Or

“Oh, I never take any LA, not even when I have a filling done.”

I explain that it will most likely hurt but the patient does not change his mind. Not even when I explain we could use topical LA (I use Oraqix) which would not require needles.

So I begin the treatment. The sonic scaler goes relatively well but when I begin to scale those deep pockets the patient is jumpy (as if somebody was poking his limbs with a needle), turns his head suddenly (exaggeratingly) and is kinda slowly sliding towards my lap as he’s pushing from the handles of the chair.

After I have nearly injured my own finger and patient’s lips for the third time because of the unpredictable motions and after I have three times asked patient not to move his head, I stop the scaling and tell the patient that I won’t be able to carry on unless he keeps the head absolutely still. Because it’s not safe. I offer the LA again and usually at this point they agree.

Patient Case II

The patient (who also just declined LA) keeps still throughout the treatment (scaling) and says she’s fine when I ask her if she’s ok  (multiple times). So naturally I carry on to finish the treatment.

Once the patient gets up from the chair she does not look happy and says

“It hurt a lot.”

Or

“Oh I hate having this done.”

Or

“It’s never hurt before.”

Soooo annoying! Did I or did I not offer you LA? Of course it hurts if you decline LA when it is recommended. And why would you say you are fine when you are not?

What is the most annoying in all this is that she will go and tell ten of her mates how horrible experience it is to have the teeth cleaned. Simple marketing rule – bad experiences you tell to ten people, good experiences to one. So unfair!