Today I am going to share a very personal tip about something that made almost want to quit dentistry.
IMPORTANT
Before I start today’s very personal tip, please know this is the 2nd email sent by the new email server. The new spam filters are very aggressive.
To PROTECT YOUR email address and KEEP RECEIVING my email tips + job/practice listings please reply to 2 of my email tips (including this one). You can simply say “got it” but 2+ replies helps whitelist your email with the new email server.
To protect your email address could you please take 2 seconds to reply + let me know you got this?
Tough job
I want to share with you some hard moments I’ve had in dentistry.
This is a long post, and I’m including a lot of tips, but I want to share with you a very personal story. The moment I am going to share with you made me almost want to quit dentistry.
Unfortunately these are things that are NOT taught or discussed in dental schools.
Dentistry can be a really tough job. Dentistry can also be incredibly rewarding as we get to help people and improve the quality of their life all day long, but there are from time to time some very tough moments.
One of the things is, patients will say some really mean stuff sometimes.
No matter how hard you try.
No matter how nice the dental work is.
No matter what you do, certain patients are going to say some really mean things that are not true.
How it started (quit dentistry)
So I did a routine dental filling. Back to back class II MO and DO.
Not deep. Very routine.
Super normal.
Nothing clinical to note.
But as you know, clinical dentistry is only half the battle.
Patient is fairly anxious. I’ve seen her before. Jumps a lot in the chair. Comes in with a bit of a chip on her shoulder. We’re nice to all our patients, but we’re always extra nice to her.
You have to remember, going to the dentist can be very stressful for certain patients.
Sometimes patients who are nervous will say or do things that they do not necessarily mean as a way to cope with their nervousness.
So for this particular patient we finish the filling. Not deep, actually fairly shallow, very routine.
I took a photo of the decay and decalcification visible prior to finishing the prep.
Slot preps
As a side note, this photo is mid-decay removal. You will see from the upcoming radiogarphs, I do not do slot preps. Slot preps and restorations personally do not work well in my hands, and I find a lot of dentists have the same experience. When the decay is purely interproximal, I will still place a very small and shallow occlusion extension. There are plenty of different ways to get to the same excellent clinical result, but generally speaking I do not recommend slot preps (but aware there are dentists out there that have great results with them).
At any rate the fillings were completed without complication or issue, and other than the patient mentioned not feeling the greatest, possibly coming down with a cold, there was nothing to note.
Two days later
Two days later the patient comes in and says things feel odd.
We do our usual protocol for a sensitive filling, which I’ve shared before in a past email. PA and BW show no apical pathology as well as the restoration was fairly shallow.
Here they are.
Super shallow, and no signs of apical pathology on the PAs.
I check the patient’s bite, palpate, percuss, and cold test.
Did the full gamut.
Everything comes back as normal. I let the patient know the discomfort could be a sinus issue, as everything is checking out with the teeth, and thankfully we removed the decay early when it was still very conservative.
I let the patient know it’s normal to have some post op sensitivity for a few weeks, and as long as the bite feels ok (she said the bite was good) things should resolve on its own over time, but to call me if things change.
Now remember when I told you this was a fairly anxious patient? I’ll give you a tip that I follow to a T these days, and also share with you why these small fillings almost made me want to quit dentistry.
Post-op
So a few days later I decide to give the patient a call to follow up and see how she is feeling.
Turns out to be a pretty awkward phone call.
I can tell right away she’s really upset.
This is not normal.
This is not good.
Patient tells me she just got home from the emergency room 6 hours earlier. The skin around her eye started to get really swollen, which is being treated by IV antibiotics, the patient has a staph infection, the physician told her that it’s likely a dental infection from the dental work, and it was lucky she came to the ER because another few hours she might have lost her eye.
Woah woah woah. Back up a moment. What the heck?
So before I get to the next part of my story, here is a tip. Make sure to do post-op phone calls on your more nervous patients. Most of the time you will not need this, but once in a while, boy will you be glad you called.
Wait, what?
First off, let’s back up. I know I’ve talked about this before, but we do NOT know what the physician really said.
Who knows if the physician really said this staph infection was from a dental infection.
The physician could have said it’s possibly from a dental infection, which is a BIG difference.
Or perhaps the physician explained that staph is typically a infection from bacteria on the skin and nose, and the patient pressed and asked “could it be from a dental infect?”
We will NEVER know, because we were not there with the physician, but what we do know is this:
(1) the patient BELIEVES the doctor said her staph infection is from a dental infection
(2) WHAT the patient believes can be a big problem
For the record, I think the patient got some things mixed up. Physicians know Staph is on the skin and nose, and not in the mouth. Something does not make sense.
But here is the thing.
Perception is king. We need to remember that. It is not important what the physician said or not, but what it is important is that the patient BELIEVES her statement to be true.
At the end of the day, that’s what is making the situation uncomfortable. It’s the patient’s perception.
Clean?
Then the conversation turns nasty.
I remind the patient that we took a look 2 days ago and there was no signs of dental infection, but if things have changed we should take a look.
The patient then says to me “you’re always so dismissing… I came in, you say it’s not a tooth problem and then I end up in the hospital with a dental infection.”
Patients CHOOSE WHO they want to believe, and in this case the patient was clearly siding with what the physician said.
Not good. Because it’s my personal opinion that this is not a dental infection, but I do not and refuse to throw another clinician or physician under the busy.
That one hurt a bit. I did a full follow up emergency exam as a courtesy (no charge) with radiographs to rule out odontnogenic infection. I was NOT rushing through anything. There just was not much dental to talk about
She then asks in an exasperated voice me “were the needles clean?”
Ouch. That one really hurt.
Of course they are.
Of course the needles are clean.
Needles are all single-use and sterile coming out of the package. Practically everything in dental is single-use.
But I cannot lose my cool. I have to keep the conversation from taking a very bad turn. So it’s important to let the patient know you are hearing and listening to them, and transition the conversation.
Are they clean?
If a patient ever asks you this, you cannot show doubt or hesitation. Of course they are clean. Everything is single use.
Remember, in the patient’s mind, it is not what is fact, but the patient’s perception.
Here are some tips:
Do NOT get defensive. Do NOT get angry. But you CERTAINLY NEED to deliver your answer the needles are clean with CONFIDENCE.
State it as fact, then move on in the conversation to helping the patient. That’s ultimately what the patient wants. To be taken good care of.
Bring them in
Here is another tip for upset patients.
When you have an upset patient on the phone, it’s best to bring them in and have a face to face talk in the dental office.
As uncomfortable as it may seem, people tend to be nicer and more reasonable when in person.
Gives you a chance to talk to the patient.
As dentists, we know when people are emotionally charged, they not always ready to listen, and certainly not always ready to reason.
But seeing the patient face-to-face you’ve got a LOT better shot of them being reasonable, rather than on the phone, and certainly more than in email.
This is stuff nobody told me while in dental school, but I wish that someone did. That’s why I am trying to pass these tips on to you through my free email tips.
While on the phone, the easiest way to get someone to come in to your office for a follow up exam is show concern (which you do), and let them know the exam will be without charge.
When possible
Here is another tip. If things are getting bad, a second set of eyes isn’t necessarily a bad thing (when you have that option). Try to get the patient to another dentist in your office.
One caveat. If the patient is going to see another dentist, make sure that they’re going to be factual and not throw you under the bus.
I am NOT saying they cover for anyone, because there is nothing to cover for, but make sure they understand the facts, and are delicate with the conversation, to avoid provoking an irrational patient into a more upset state.
For this situation, I have another other dentists in my office who had seen this patient for years, before I met the patient and has a more established relationship with the patient.
So I scheduled a follow up visit and exam with this other dentist in the practice and briefed him on the conversation prior.
For those that are in a solo practice, or there are dentists that might not be good to offer a second opinion (for whatever reason), do NOT let the patient walk.
Get the patient in, and document that you offered to do a follow up exam and radiographs as a courtesy. If the patient refuses to come in, then make sure you document that you offered and were flexible with the times you offered.
Which leads me to my next tip.
Document
Before I get to the part about me wanting to quit dentistry, let me say this.
Document your phone calls.
When you call patients for post-op checks. Document the phone call.
When patients call upset and you call them back. Document the conversation.
When patients say things like “are the needles clean” absolutely document that the pt asked this, and you reassured patient that the needles are single use, and absolutely are clean.
Wanted to quit
But I tell you.
As much as I knew NONE of it was TRUE (staph infection, dirty needle).
As much as I KNEW the needles were fine.
As much as I knew this staph infection most likely was not connected to dentistry,
It still stung.
And didn’t make me feel good.
Big tip
So here is today’s big tip.
Nobody talks about this in dental school.
But you are GOING to run into moments like this in your career.
It happens to all of us.
And as much as it sucks, it does happen on occasion and unfortunately it is normal.
So I want you to know, that you are NOT ALONE.
You WILL have tough moments as a dentist.
I love helping people
I love helping change patient’s lives and dental health in a positive way.
So it’s up to you to sail out of that storm.
Things will get better. But YOU have to guide that ship.
No happy ending
I wish I had some more advice and tips on this topic, but know that it happens to everyone. And as I said earlier, YOU ARE NOT ALONE.
So it is important to learn how to let the 1% of patients who make really nasty comments or do really nasty things, to brush it off, and get back up to ride another day.
It’s easy to remember the 1% who do mean things, but help 100% of your patients, and focus on remembering the 99% of your patients who are truly appreciative of what you do and how you help them.
One thing that helps is having other dentists around me. That’s one thing I really like about Dental Clinical Pearls is the community. I know there are other dentists out there, going through the same things. If you are not a member yet, you can join for free at https://facebook.com/groups/DentalClinicalPearls/
We have a great index of tips, including a series on the stresses of dentistry. Here are 15 of the 40+ great tips and links from this index:
(1) https://helpfuldent.ist/2rnRlvB (avoid getting burnt out tips)
(2) https://helpfuldent.ist/2miEZ5a (Dentistry and suicide)
(2b) https://helpfuldent.ist/2UVUmzD (dentistry and burnout tips in comments, #2)
(3) https://helpfuldent.ist/2rnRlvB (parenting and dentistry)
(4) https://helpfuldent.ist/2qqfa5a (suicide in dentistry, must read post)
(5) https://helpfuldent.ist/2SuA4fx (stresses of dentistry)
(6) https://helpfuldent.ist/2ROacLz (avoiding burnout tips)
(7) https://helpfuldent.ist/2QM4UQi (dentistry and suicide #2)
(8) https://helpfuldent.ist/2SB2u7F (warning signs, to help someone)
(9) https://helpfuldent.ist/2Eh5gvB (Columbia Suicide Severity Rating Screener)
(10) https://helpfuldent.ist/2SBiW7V (importance of contacts and support group)
(11) https://helpfuldent.ist/2LnzBta (great self-care pearl)
(12) https://helpfuldent.ist/2W1cF8a (another self-care pearl for those w/ with self-guilt)
(13) https://helpfuldent.ist/2Uc3PCG (good way to reduce stress)
(14) https://helpfuldent.ist/2HMVHGw (managing burnout as a dentist)
(15) https://helpfuldent.ist/2Gr09sW (work/life balance pearl as a dentist)
So know that you are not alone.
The last tip
If you have not yet, invest in some inexpensive but reliable intraoral cameras and have them in every operatory.
Document things. It helps mitigate or take away the patient-said, dentist-said conversation. Helps keep the conversation rooted in fact, and not emotion.
To make things better, for this one situation, at the very least, the patient did not say “were the cavities really there?”
But we’ve all had that conversation where the patient questions if the decay exists or not.
My thoughts and advice? Take a photo of the decay mid-prep, PRIOR to removing all the cavity on EVERY PATIENT and EVERY TOOTH.
It costs you seconds, and the electricity to run the camera. That’s it. But it saves you hours of headache.
I do it for every tooth I fill. Every cavity I fill, I stop mid-prep and take a photo of the decay before I remove it.
Why?
Because you never know when you will need it. We all know x-rays do not always show the extent of decay from a 2-D pre-op x-ray. Take some I/O photos as you go.
Once I even had an ex-patient I had seen once for a follow up exam (bite adjustment) call me up 3 years later telling me her current dentist said she never had any cavities. I had NEVER even drilled on this patient and she called me mad that “there was never any cavities.” Boy was I glad that the previous treating dentist had taken I/O photos of the cavities on the teeth. I provided the ex-patient those images, and never heard from her again.
My point is, you NEVER know when you will need them, but you will be GLAD that you have them.
Summary
So lots of stuff covered in this email. I will summarize the points.
1) While rewarding, dentistry is a tough job
2) Personally, I do NOT recommend slot preps on class II restorations
3) Do follow up phone calls on your nervous patients. Keep a closer eye on them.
4) Patients often can get confused about what other dentists, physicians and health-care professionals said. Remember that. What the patient reports is OFTEN NOT what was ACTUALLY said.
5) When in these situations, do not focus on WHAT another clinician said, worry about what the patient BELIEVES. Perception is king.
6) Patients choose who they want to believe. It is not always going to be you.
7) If a patient questions something, do NOT get defensive. Do NOT get angry. But you CERTAINLY NEED to deliver your answer with factual CONFIDENCE. Then transition the conversation towards how YOU can HELP the patient (ultimately that is what patients want, to be taken good care of).
8) When you have an upset patient on the phone, it’s best to bring them in and have a face to face talk in the dental office. Easiest way is show concern and let them know the exam will be without charge.
9) Get the patient a second opinion from a different dentist, when possible. The dentist needs to be factual, and make sure the dentist does not have the habit of throwing someone under the bus.
10) Document your follow up phone calls
11) You are going to run into nasty patients who make mean and untrue comments. They sting, but know that YOU ARE NOT ALONE and it HAPPENS TO EVERY DENTIST. It helps having a community like Dental Clinical Pearls.
12) It is very easy to focus on the negative patients all of the time. Help 100% of your patients, but focus on remembering the 99% who are appreciative, versus focusing on the 1% who say mean things.
13) Take intraoral photos of every cavity mid-decay removal, and have inexpensive I/O cameras in every operatory. More on that here: https://helpfuldent.ist/2lF3JEk
14) Remember, you are NOT alone.
I hope that these tips are helping.
Thanks for your time,
Dr. Greg (aka “The Helpful Dentist”)
P.s Do not forget to reply to this email – a simple “got it” or “ok” will POTECT your email address – I sent this message from the new email server.
P.p.s. If you find these free email tips to be helpful, please help spread the word about my free email list (it will always be 100% free) that you can join at HelpfulDentist.com.