Dental Critic

December 10, 2017

Every doctor will at some point experience a new patient walking in your office and your excitement will quickly change to nausea when they ask, “Did the last doc screw up?”  There is no question that makes me pause more.  How you respond to this question can have a huge effect on your relationship with this patient and dentists in your community.

My first piece of advice is to breathe.  This is not a time to rush into discussion about the tooth without much thought.  Take a moment to think about what you want to say and more importantly how you say it.

Second, try not to be over critical.  Try to remember at some point, if not already, some dentist will be asked this question about a crown you did.  You are most likely a highly skilled and clinician of excellent caliber, but you are human.  Somewhere out there, a crown you did has an open margin.  A filling you did has poor contour.  An implant you placed doesn’t have the perfect angulation.  It happens.  Even a highly trained dentist with the best intentions will have an off day.  Every one of us in this industry has failed to achieve the perfection we hope to obtain and we need to be understanding towards each other on this issue.

Third, you weren’t there.  Maybe the patient is incredibly challenging to work on with a wild tongue and has a sensitive gag reflex.  The tooth may have been very compromised to begin with and has already had work six times previous to this dentist working on the area.  We all have that one patient that we know is going to be a huge struggle to complete even the smallest task.  We cringe at the sight of them in our schedule.  Maybe for that doc, this was that patient.

Fourth, get all the facts.  If you are going to tell the patient what they are hoping to hear, that the dentist before was a hack, make sure you have your facts straight.  Personally, I one time received a call about a crown from a patient.  He said he had gone to another dentist about a year later and was told my crown had to be redone.  This dentist told him this crown was poorly done and was the wrong type of material for a posterior tooth.  I called the dentist to get more information.  The dentist went off about how he disagrees with EMax in the posterior and the crown was horrible.  After much ranting, he finally mentioned the tooth number.  My ears perked up when I heard the words “ number 3”.  I let him finish his rant.  I calmly asked him to confirm the tooth number again for me.  He did.  I then explained I have only ever completed one thing on this patient ever and it was number 14.  He was silent.  He quickly tried to get off the phone with me and said he would talk to the patient.  Three days later, I received the most apologetic phone call.  I wasn’t mad.  I simply told him, how relieved I was the patient decided to reach out to me in the first place.  Otherwise, I would have had a patient running around telling people I screwed up due to a tooth I didn’t even complete.  He agreed. It was an eye-opening experience for both of us.

Fifth, keep it positive.  The way I personally handle this is to approach it from a positive and forward-thinking mindset.  I don’t dismiss the patient or try to avoid their question.  I take time to evaluate the xrays and the tooth clinically.  I ask for a history from the patient, knowing that there may be significant missing information.  I discuss with the patient something led to this tooth to end up requiring the filling or crown unless it was purely cosmetic.  I refer to the tooth as a compromised tooth due to decay, cracks, wear or previous work.  We discuss without being there when the treatment was completed, I won’t have all of the information.  I offer to reach out to the previous dentist to discuss the treatment. I explain how I believe all dentists hope their patients are satisfied with their work and have every intent to perform high quality treatment.  I end with explaining where we are with the tooth today and how we can move forward together.  So far, the patients have seemed satisfied with the discussion and are open to moving forward without much concern.

The next time a patient tells you “this doc screwed up all my treatment”, take time to remember someone has possibly thought that about you.  Try to treat other dentists’ work the way you hope they would treat yours.  Understand even the best-intentioned dentist will mess up from time to time and if they had been given the opportunity they hopefully would have done the right thing by fixing it for the patient.  The patient may have never gone back and given them that chance.  Dentistry is a hard industry and if we treat each other with a little understanding and kindness we can help make our profession a little brighter.

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