Dealing with Difficult Patients (E.302)

“Whose problem is this? It’s theirs, not yours.” – Dr. Maggie Augustyn

Brief Overview of the Episode

Every dentist has faced it: the patient who walks in angry, entitled, or resistant to treatment. In this raw and candid conversation, Dr. Maggie and Dr. Chad share real stories of difficult patient encounters, the emotional toll they can take, and the strategies they’ve learned to protect both their practice and peace of mind.

What This Episode Reveals

• Why transparency and clear communication are your best defense
• How to draw boundaries without losing professionalism
• The hidden cost of undervaluing your time and expertise
• Why standing firm on your worth can actually restore respect

What You’ll Learn

• How to respond when patients demand refunds or dispute charges
• Practical language to set expectations upfront
• The importance of balancing empathy with authority
• Strategies for turning tense encounters into opportunities for leadership

If This Sounds Familiar

• You’ve ever walked out of an operatory frustrated by an entitled patient
• You feel guilty about charging what your services are worth
• You’ve burned out from carrying patients’ problems as your own

Next Steps

Listen to the full episode and learn how to protect your time, energy, and value, while still delivering exceptional care.

TRANSCRIPT

[00:00:00] Dr. Chad Johnson: Everybody. This is Everyday Practices Dental Podcast and I’m sitting talking with my co-host, Dr. Maggie Augustyn. Here. Dr. Maggie, how you doing? 

[00:00:09] Dr. Maggie Augustyn: I am doing great, and we have been in the middle of a conversation, um, a 

[00:00:13] Dr. Chad Johnson: A heated, 

[00:00:14] Dr. Maggie Augustyn: A heated conversation, and then we thought, you know what? Why not, why not let, it’s your listeners in on this because this is a struggle that we are constantly having with our patients, and in this particular podcast episode, we are going to cover how patients complain about paying or not paying for a service. 

[00:00:38] Dr. Chad Johnson: We’re gonna complain about complainers. It’s awesome. 

[00:00:42] Dr. Maggie Augustyn: Listen, we’ve got our own, we’ve got our own right, you know, people that we, that we are here to help and we all learn from each other’s experiences, and so, um, Chad here is a little hot and heavy. So I’m gonna let him calm down for just a second because I’m gonna start us off with a conversation about a patient. Now, I, I, I am completely forthcoming and always have been. I practice as an in-network PPO dentist, and so, um, there’s a way to make that work a hundred percent, and, and, and we’re definitely doing that, but I want to start us off with a story about a patient that I saw. Who came in for a consultation on an implant and someone had told her that this implant wasn’t working, and then she came in for our hygiene visit, and these probing depths are getting higher and higher and higher, and she just does not know why, and so, you know, something very special happens after you’ve been doing dentistry for 25 years. It’s like. I don’t know if you say that you enter the matrix or you exit the matrix, whatever it is, but you, there’s a lot of things that kind of start to overlay, and so I look at the radiograph of this implant and, um, well, the abutment that was used is larger than the implant, and so, well, why do you think you’re having problems, right? These, these, this is mismatched, and look, I’m not here to call out another dentist, because we have all had our own learning experiences, but she comes in hot and heavy, very hot and heavy. This is a very difficult patient to manage. First thing I did is I put on my white coat, which I almost never do, and the reason why I did that is because this particular patient needed an air of authority. You just kind of pick that up, right? And then I go in and I say, “This is what’s happening. You need to have surgery. You need to have this cleaned out. You need to replace the crown, and you need to have the correct pieces used here, or what’s going to happen is you are going to lose this implant, right? You’re already on the way there. There’s already threads exposed. This is the best that we can do,” and so I have this conversation with her. I don’t know, at least an hour. Now again, uh, this is a Delta patient, so imagine how much I’m being paid for this hour, right? Right. I don’t know. I’m lucky if I got paid 60 bucks right, for the consultation and if my hourly is at $1,200, I basically set $1,200 on fire there, right? Right. So then the patient comes back in and she leaves a message and says, I do not wanna hear her voice, her being me. I do not wanna hear back from her. What I need you to do is I need you to call the insurance company and reverse the claim because she didn’t touch me, she didn’t do anything. She didn’t fix anything. Right. Which of course is all completely untrue, um, and so what I ended up saying, you don’t wanna talk to me, fine. I’m not gonna make you talk to me, but what I ended up doing and, and talking to my, to my team about is I am in network and I have this contract. So I can’t pretend that this didn’t happen. I can’t pretend that I didn’t give you advice and, and so then I overheard one of my team members talking to the insurance company basically saying, “Look, she wants you to reverse the claim because she didn’t like what she heard,” and so here I am, um, we would be grateful to lose this patient. In all honesty, she’s been difficult from the very beginning, but, but here’s the point of the story, we just have such difficult patients that are so, um, 

[00:04:21] Dr. Chad Johnson: Entitled, 

[00:04:22] Dr. Maggie Augustyn: Entitled, and they’re so needy, and you know what? You need to stand your ground. You need to charge what you’re worth, and on patients like that, you need to cut the cord, and if they’re saying, “Hey, refund me this money, or I’m never coming back,” one, I can’t refund you this money because I’m obligated by the insurance to charge you for, for what we did too. I set $1,200 on fire of my own production by sitting there and talking to you, and three, good riddance, please don’t come back. Right? Um, and so, I think this is, this is, you know, a great segue of, of you, Chad, going into your story and, and how you set this one particular patient who came in hot and heavy. So tell us that story and let’s see how we can break it down and, and learn from it and give our, our, our listeners here some advice on what to do when these hot and heavy conversations come up, and we feel like there’s no feeling, okay, we are being taken advantage of. 

[00:05:33] Dr. Chad Johnson: Mm-hmm.  So for anonymity’s sake, I’ll call him Jerry, and I also apologize ahead of time. If I back the microphone away and I’m yelling, so your, your, your volume control might need to be on your fingertips in the vehicle as you’re driving. Okay. Tom and Omaha just thought I’d say hi to Tom, Dr. Tom, listening right now. So, goodness. Okay, here I go. So Jerry, uh, comes in. I’m seeing patients on a Saturday. We get him scheduled and I come in Saturday morning, um, he hasn’t been in for ten-ish years. He’s got a lower denture over denture with two locator implants that I had placed the locator broke off, um, he’s been at another dentist for, you know, a few years and he, uh, uh, has the screw broken off the other dentist, you know, doesn’t know what to do. So I, uh, get it out. It probably took me 10 or 15 minutes, which I was super impressed. I told him, I was like, “Number one, when we do this, we can’t be sure that it’s going to, you know, even work getting this, the, the broken off screw head out, and if we do get it out. Is it going to be, uh, are, are the threads gonna be stripped on the inside, you know, while we’re messing around with the inside? So let’s give it a try, but, you know, no promises, hate to say it, but you know, like your only other option is to leave the implant there or pull it out anyway, so, you know, no harm, no foul. Let’s give it a go.” 

[00:07:06] Dr. Maggie Augustyn: So I’m gonna short just, just small interruption here for our,

[00:07:10] Dr. Chad Johnson: Yes, by all means, 

[00:07:10] Dr. Maggie Augustyn: because here’s the thing. The way to start this conversation is to be completely transparent with the patient. Mm-hmm, and say, this is the issue. This is not my issue. This is your issue. As Bruce Baird says, right, your problem, this problem is it. This is your problem, but here I am to solve it. This is what can potentially happen because having that really honest conversation upfront with our patients is going to and inadvertently keep us from being in trouble because had you not had that part of the conversation and something would’ve happened, it would’ve been your fault for breaking this screw. Yep, perfect. It would’ve been your fault for this then and the other. So communication is key. Love it. PDA teaches, right? So step number one is to be completely transparent and make sure that the patient understands that this is not your problem. 

[00:08:00] Dr. Chad Johnson: Yep. 

[00:08:00] Dr. Maggie Augustyn: You are the hero here and you are trying to help them solve this problem.

[00:08:04] Dr. Chad Johnson: That’s right. So, Saturday morning, um, he’s been billed for limited exam peri apical, and, uh, I don’t know. I, I just thought, uh, you know, for. I don’t, I don’t know. It’s neither here nor there whether someone else charges. I didn’t charge for the screw removal, um, why most of the time I’m not gonna be successful and I, uh, don’t want people mad at me. So there’s that, and I, uh, 10, 15 minutes later, I get the screw out. If you’re wondering how, since this is everyday practices, I’ll tell you how, um, I got outta Cavitron and worked in a counterclockwise, um, and I also, uh, broke off a Q-tip and used the flat end of the little wooden, uh, topical Q-tip and pushed it down in there and turned, uh, and then I also did a slow speed, um, uh, round burr on the top of it and, uh, put it in reverse and use that to, you know, kind of torque on it. So, uh, between those three things, I started seeing the screw move up and got the screw out. That isn’t the problem, uh, he gives me, 

[00:09:15] Dr. Maggie Augustyn: I’m gonna interrupt you one more time because on that particular, on that particular instance, I think it would’ve been very helpful for you to tell the patient, “Hey, Jerry, what I just did for you is one, I charged $1,800 to open an office, which I did not charge you for, and two, I removed this screw and everybody else would’ve charged you $1,500, and that is my gift to you,” right

[00:09:37] Dr. Chad Johnson: That would’ve been brilliant. At times I’m brilliant. At this time I was not, so, I, I mean, I was super impressed that I got the screw out. Let’s, let’s say that, but I, I wasn’t, you know, using my best, uh, Augustyn verbal skills. So I got this, uh, screw out and, um, you know, no anesthetic, no pain, no nothing out the door, you go. I’ve got the little piece, uh, of the broken part, and so I’m going to, um, order the new one. I had it written down, um, at that point, this is dumb. I had it written down which, uh, which size of abutment that we had used at the time, and so, and this was a different implant system too, but I found it on a website, custom ordered it, um, overnighted it, it didn’t show up for four business days. He’s on a Thursday now, um, and he’s coming in to, uh, to get it, it, you know, says that it’s, you know, being shipped, it’s getting here soon or whatever, and it doesn’t show up normally we get our deliveries, you know, 10 or 11. So he shows up, um, 10-minute drive from home. It’s unfortunate. I go in and, you know, and I tell him, I’m like, um, you know, bu deal that we don’t have the, um, the part yet, and so let’s get you rescheduled, and I apologize, we should have, you know, known ahead of time. So my office manager says, “Why don’t we go over, um, cost estimate,” and so, um, she goes over the cost estimate, says it’s gonna be $720, that’s gonna be 600 for the abutment, uh, six for the new, um, uh, locator attachments, and so then he gets all mad, what the f is this and this and that, and he is all mad and stuff. She comes in and is like, “Man, he’s swearing at me. He’s all mad and stuff,” and I was like, “I was like, uh, you know, Jerry’s a uh, uh, a gruff guy, so it just is what it is, and, um, you know, but like, he’s not necessarily mad or, or he’s just kind of that way,” you know, the angry trucker type or something like that, you know, just like, well, well, what in the world cost of coffee these days? So I, uh, I go in the room, you know, ’cause I, I hear man, he’s mad and stuff, so I go in the room, Jerry, 

[00:11:58] Dr. Maggie Augustyn: I’m going to make another small interruption. When a patient is complaining about cost, yes. Okay. I invite them to go to fair health.org and on there is, it’s a website that shows you what is a reasonable cost for this area. Right. So if you’re charging $680 for this particular abutment, be like, “Jerry, go to fair health.org. Why don’t you look up what I should be charging you,” and chances are that you’re, I know how you are and your fees are probably way too low, um, and so then, and that’s another mind blowing thing for them, bro, I just gifted you $3,200 on Saturday, and now instead of charging you $1,200, I’m charging you six 80. Okay? I’m getting all riled up too, so just keep 

[00:12:46] Dr. Chad Johnson: No, and, you know, I, so I did. I came in and I was like, Jerry, what’s the deal? What are you upset about? Well, I don’t know why I am, you know, getting charged this last time it was, you know, half the cost, and I said, well, we’ve printed $15 trillion in the last five years of, of money, so I’m not surprised that things cost more, and so I, I actually don’t know why you aren’t surprised that things cost more. It just is. I said, you go find me. I’m gonna, this, this, I’m gonna keep it short, not go on my full rants of, because I was, I came in unusually hot and bothered by this, and I said, you go find me three other cost estimates. Go get three other cost estimates. Do it, and you find me a dentist who will do it $30 cheaper. I’ll match it because I just don’t believe that’s the case. This is a steal of a deal. I came in on a Saturday. I took the implant screw out at no cost because says, no, you charged me. I said, “Heather, look that up. I could be wrong. What happened, uh, limited exam for this much and a peri apical for this much,” and I said, “Oh, okay. So my apologies. You were charged. You weren’t charged for the screw removal. So you’re correct. I’m correct, but let me be clear, you were not charged for the screw removal. You paid for the exam and the x-ray, you paid for my expertise. There are very few dentists that can do this, and have done it successful, and I didn’t even charge you for that. So now you’re getting charged for the abutment and it’s nothing more than what it was before,” and he says, “Well, it wasn’t what I was charged before.” “Office manager, what did we charge him last time?” We look it up? Come to find out. We gave it to him last time at no cost. So I said, “Jerry, let me get this straight. Are you upset that I’ve been more generous with you in the past that I gave it to you for free? Yes. Than now? I mean, like is that what you’re upset about? Is that I’ve been too generous with you in the past and. He didn’t have much to say. He kind of like, I think he took my energy and was like, oh shoot, this guy is, you know, he’s legit. Oh, and he’s upset because I think,” you know, like the goal was I’m gonna be the upset patient. Then I come in and I’m like, “Well, I’m the upset business owner and you’ve taken advantage of me too long, and he came back the following Thursday, which was yesterday, and I gave him a gift card for a local gas station and for not, you know, having the stuff on time for his appointment,” and he knew about that. 

[00:15:15] Dr. Maggie Augustyn: That was kind of you. That is actually, that works also. That’s another, that’s another bit of information that, um, our listeners can take. Yes. Think from this is like, okay, so sometimes stuff happens, and if it does just have a bunch of those gift cards. 25 bucks, 20 bucks, gas station 

[00:15:33] Dr. Chad Johnson: 25 in Chicago, 2020 in Iowa, you know, uh, but, uh, uh, you know, 50 in Hawaii, right? So, um, so I, I, I just, and I gave him a legit apology too. I was like, Larry, Hmm? I was like, Jerry. There was another one, Matt. Sorry. I was like, “Jerry, here’s, you know, here’s the deal. I am really sorry that we didn’t have the stuff on time for your appointment. Here’s a gift card as promised last time, because I just don’t like working that way, and I’m super glad that that abutment went in today, that we got the new part switched out, that it clicked down well, um, this is a really a win-win, and,” uh, I didn’t say this and yet I’m just like, I hope. I hope to never see you again. Like just move on, and, but at the same time, I was very transparent and authentic with him. I think overall I was professional. I probably had some borderline moments, but it was very cathartic to share my frustrations with him and not necessarily get bent outta shape. Did I raise my voice? Yes, um, but it wa and I told him though at the time, I said, “Jerry, I’m not mad at you. I am mad though that I feel taken advantage of, that you know, that I’ve got all this expertise to do what very few people can do successfully, and it’s, it’s not good enough and that that is frustrating and I hope you can understand that,” and turns out my office manager’s door was open. I couldn’t see anything but red. So, um, and the whole office heard this conversation and they were proud of me. Maggie. Yes. They were proud of me. They were just like, 

[00:17:25] Dr. Maggie Augustyn: I would,  had I been there, I would’ve been clapping too. Yes, I would’ve, you know what? I would’ve brought you cupcakes. Yep, um, it would’ve been like, like with a candle and everything. I mean, you, you definitely, you stood up for yourself. That’s right. 

[00:17:37] Dr. Chad Johnson: Yes. Yep. 

[00:17:37] Dr. Maggie Augustyn: And, and, and it’s hard to do. 

[00:17:39] Dr. Chad Johnson: Yep, and to restore the relationship, like, you know, I don’t really want to say, but like, let’s say he came back in and then from now on he’s just chipper as ever and brings us cupcakes. Okay, cool. Like, but I think I needed to, to stand up for myself and my office and my value and what it’s worth. So, for what it’s worth, listeners, I’m actually, that’s, you know, the fourth or fifth iteration into telling the story. So now I’m, I’m kind of cooling down about it, but, uh, probably in another five times of me telling it, I’ll laugh about it, but right now it’s just like, “Oh, it made me so hot.”

[00:18:13] Dr. Maggie Augustyn: Well, it, and it’s frustrating and it was, you know, raise your hand if you’re not driving a car, you know? Doesn’t this happen to you all the time? Yes. So here we are and this is what we’re doing. We are empowering you. 

[00:18:26] Dr. Chad Johnson: Yes. 

[00:18:27] Dr. Maggie Augustyn: To do the hard and right thing. Right. It’s not, this isn’t easy to do and it took me 25 years of being in dentistry before I grew, “Hey, I’m just gonna say it,” the balls to say what I need to say to patients. Now, it doesn’t always work that way because there’s plenty of really kind people, and by me being so abrasive at the wrong time, I actually turn them off and it’s a learning experience for me. In fact, I have to make a phone call to apologize to a patient  who was really kind and I treated her with this kind of a tight grasp and I shouldn’t have.

[00:19:08] Dr. Chad Johnson: Yeah. 

[00:19:09] Dr. Maggie Augustyn: Um, so it’s, it’s a learning experience we’ve gotta kind of find, um, the balance between when to be soft and when to stand up for ourselves. Right? And it doesn’t always work out, and it’s, it’s, it is, it’s just a learning experience in our lives. 

[00:19:28] Dr. Chad Johnson: Furthermore, um, Google almighty tells us that CDT Dental Code 6056, uh, generally ranges between 400 to a thousand dollars. Though some have, uh, fallen out. 

[00:19:41] Dr. Maggie Augustyn: You are welcome Jerry. So how much Jerry did you really get from me? Like four grand worth. 

[00:19:48] Dr. Chad Johnson: Right. 

[00:19:48] Dr. Maggie Augustyn: Of free treatment, uh, so you know what you should do? Um, Jerry, you should buy me cupcakes. 

[00:19:55] Dr. Chad Johnson: That’s right. Send and send me a thank you card for the awesome service I just did.  

[00:20:00] Dr. Maggie Augustyn: But you know what I, I think the universe or God or whatever you choose to call the power that looks over you, or if you don’t have any power that looks over you, you know, karma, whatever you wanna call it, this will come back to you and this will eventually bless you for how helpful you have been to this man even if he doesn’t realize it. Yep, um. You’re, you’re earning brownie points somewhere. 

[00:20:26] Dr. Chad Johnson: Yes, and I do like, uh, pointing out, and this is just a personal opinion, uh, not the those of Productive Dentist Academy, but karma is rough because if you get what you deserve, then that’s always a good thing when you feel like you deserve it. Right. You know, like you earn something, but then sometimes we’re cruddy people and we should get what we deserve in the bad way. I’m just so thankful to God that it’s just like that. I don’t get what I deserve at times, and so that might sound sanctimonious to some people. Like I’m just, you know, spewing off stuff, but, uh, I’m so thankful for this profession and I, being in a, a grateful mindset is, uh, is valuable and just being like, I really don’t deserve to be a dentist. I sure tried and stuff, you know, so it’s not that, it’s like, “Oh, I don’t deserve it,” but it’s like, listen, um, I’m thankful for it and I’m thankful to be able to treat the patients. Sometimes they are buts and they are difficult and though it might be rare and for some people it might be every day, and then that just gets bold. If you need someone to talk through, um, you can write both of us. 

[00:21:32] Dr. Maggie Augustyn: They could do Dr. maggie@myhappytooth.com. There you go. R-M-A-G-G-I-E, and that’s fine. Yeah.

[00:21:38] Dr. Chad Johnson: Um, you know, or chad@productivedentist.com if you remember mine better, and then just, I can send it along to Maggie, or I can, 

[00:21:46] Dr. Maggie Augustyn: Or you just attention more than I do. 

[00:21:48] Dr. Chad Johnson: Oh, no, I certainly do. Hey, uh, listeners, thanks for, uh, you know, listening on the drive. Hopefully that was a fun, shorter thing, and thank you for being my counselor as I cathart, um. You know, I don’t know a better word, barfed up my, my junk over the last week and a half of Jerry. 

[00:22:10] Dr. Maggie Augustyn: And listen, I’m gonna, I’m just gonna ask you one thing that you learned from this barf, cathartic barf. 

[00:22:20] Dr. Chad Johnson: Yes. 

[00:22:21] Dr. Maggie Augustyn: Gimme one thing. What is your takeaway from this conversation? 

[00:22:24] Dr. Chad Johnson: Um, finding a way to stand up for yourself and yet dialing it in to where you’re not acting ridiculous or un whatever, just that you’re, you’re also coming to this person, treating them humanely and you know, with decency enough, even if there’s yelling, even if there’s consternation between the two of you, to be like, “Jerry, I’m not mad at you. I’m mad that I, that I feel this way,” and, you know, just laying it out, but also setting up some boundaries. So it was a boundaries test without being a ridiculous caveman. 

[00:22:59] Dr. Maggie Augustyn: Yeah. I love that, and, and for me, this has a a lot to do with looking at yourself and balancing the energy, because I struggle with this, of when to go in hot and heavy and when to kind of move back, um, because this is something that I’m still learning about myself, and then always the biggest takeaway that I hope everybody takes from this particular podcast and the words of Bruce Baird is, whose problem is this? 

[00:23:28] Dr. Chad Johnson: Theirs. 

[00:23:29] Dr. Maggie Augustyn: It’s their problem, right? You are the one that’s helping with the situation. You’re not creating the situation, and enough is enough. Yeah. Patient’s coming in and blaming us for what’s going on in their mouth, that has got to stop and we’re going to do everything that we can to teach you how to not take on that problem, and maybe this is a great segue into inviting back our good friend Eric Wrecker, because we carry other people’s issues with us. 

[00:24:00] Dr. Chad Johnson: Right. 

[00:24:00] Dr. Maggie Augustyn: Unfairly, we shouldn’t be doing that. That’s not our problem. That’s their problem, and let’s find a way to, because that, that’s, that’s, that’s what creates the burnout. We’re not here to save everybody. We’re there to help them because ultimately, they’re the ones that have created these messes in their mouths. Yeah. I’m not saying it’s their fault, it’s just the situation, but we are not. We’re, we’re here to help and not, not to be blamed for what’s happened. 

[00:24:26] Dr. Chad Johnson: Yep. Maggie, great discussion with you listeners. Thanks for coming on. Until next time, Everyday Practices Dental Podcast. 

[00:24:34] Dr. Maggie Augustyn: See you later.