Episode 189 – Requested Replay: Managing Crazy Patients

“It’s important as a dentist to understand that some of your patients are psycho.” ~Dr. Bruce B. Baird

The crazy patient.

You know the kind I’m talking about. This is the patient you dread seeing. They never have anything positive to say. They complain about everything. They’re nasty to your team.

Now I always believe I can turn patients around but there are just some people you can’t. To put it bluntly, you can’t fix crazy but here’s a little thing I learned over the years: just because they walk through the door doesn’t mean I need to work on them.

As a whole, we as dentists are helpful, compassionate people. We want to help our patients live healthier lives but we also need to protect ourselves and our teams. So today I’m going to share what I learned in my career about how to handle the crazy patient including:

  • Red flag behaviors to look for when patients walk in
  • Having conversations that set behavior expectations
  • Options for what you can do with these patients

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This is Dr. Bruce Baird, of The Productive Dentist Podcast. Today we’re going to be talking about another one of my own risk factors that I added to John Boyce’s risk factors, which I call the psychological risk, or psycho risk, and what’s important for you as a dentist is to understand that some of your patients are psycho and I would like to find out who they are before I do a treatment plan and who is a psycho patient. I mean, first of all, it’s not the demanding patient, it’s not those patients, it’s the one who brings in a bag of 30 sets of dentures. It’s the one who always has something negative to say about everybody. They have something negative to say about the kid who brought them to the appointment, they have something negative to say about their spouse and their life. They’re sick all the time, they have, now some people you know, God, who are they just unfortunately, they’re sick all the time, but that doesn’t mean I have to work on them. It doesn’t mean that I have to work on every single patient that walks in the door.

So how do I deal with that? Well, I think if you go back to the risk factors and the exam process, I want to make sure I ask questions and I want to make sure I go through a certain protocol for my exam, which allows me to ask questions and to let the patient talk because letting a patient talk about what’s going on in their mouth, will start to give you a little bit of insight into what type of person they are, what type of personality, not had, oh, I’ve had patients who were male or female, who were very demanding with my team, and who were rude with my team and then I walk in the door and it’s, “Oh Hi, Dr. Baird. How are you?” And I used to just go well, they just liked me and they don’t like you but that’s not what I do anymore. What I do now is I go, I actually, I love I read the book called Crucial Conversations, an amazing book but what it does, it kind of gave me the permission to have crucial conversations with other people, whether it be my kids, whether it be people I love, whether it be a new patient, whether it be a patient I’ve been seeing for years but I call that the relationship time questions. Meaning if you’re going to hang out in our office, there are a couple of things you’re going to do. You’re going to take, you’re gonna love my team because they’re my family and if you’ve got negative things to say, say it to me, okay, and most times, if I bring this up to him, they’ll go, “Oh, my gosh, I’m so sorry. I never meant to do that,” and so they turn around, they become great patients, because I address the issue immediately. What about the patient who just comes in is talking bad about everybody my previous dentist was this and then I went to this dentist and I went to that dentists.

Now, I’m not going to pre pre pre diagnose that person as being psycho but I sure am going to perk up. I mean, they may have had the run around in dentistry and gone to several different offices and never been given a good, a good opportunity or good options that took into account their risk factors and all those things. So I’m not automatically just going to, you know, put an X on that patient and send them down the street but I do want to listen much more carefully to those patients. So when you hear a patient that begins the complaints, and they start, what I do and back in the day, you know, I don’t know how many have you ever listened to if you’re older, you might have gotten Dick Barnes, five slides. He had five slides, you’d put them up on a little slide projector back in the day and you’d show patients these different things but he called those difficult patients, though psycho patients, he called them, you know, he increased the fees on those patients and he called that a heart muscle and stomach lining fee, and I can’t remember what it was but you know, back in the day, I would sit and as I’m taking notes in their chart, and as we’re talking, every time they would say something negative, I would just put a checkmark in the chart and every checkmark equal to $100. So I would let them speak as long as they want to today, my check marks are $250 and we call that a reconstruction fee and it’s not covered by insurance. It’s not covered by anybody except the patient and I’ll be talking to the patient and I’ll say, “You know, Mary, you know, we’ve been talking today and you know, you have really had a run of things, you know, you you’ve really had difficulties from, from going to these different dentists and not having to deal plus your health and then you’ve got this other that your case is extremely complicated. Obviously, you already knew that, and when I say obviously you already knew that,” the patient always nods, “Yeah, you’re right,’ and I said, “So what you’re going to notice in your treatment plan is you’re going to notice something called a reconstruction fee. Now that fee is not covered by insurance and it is it’s really based on the difficulty of your case, you’re in the right place. We do a lot of these cases but it’s it that’s what I wanted you to know is that’s what that reconstruction fee is.” Why do I say that? Because when Summer comes in, they got the reconstruction fee on your case, the biggest one I’ve ever had is $13,500. That’s a lot of negatives but what happened? Well, the patient said, “Okay, I’m ready to get it done.” Why? Because I listened to him, did the whole deal and I told Summer to go back in and tell him that was just for the upper the bottom is another 13,500 I didn’t do that but I wanted to. So I saw the patient I did the work. Most times when I ended up doing the work on those patients. It’s never been worth it. I’m not gonna say never been worth it. It is. There have been times where the patient has just become such a great patient wasn’t expecting but mostly, if I picked them early, I picked them right and had one patient and this is this is what happens in dentistry because every year I mean I think Don’t you feel like you’re getting better as a dentist, you’re just getting better and better every year. I mean, hopefully you do. I mean I go to more continue to add. You know, I see things in the math that I never saw before because I just went through a course on grafting or I went of course on this or whatever it is and I had one patient and she would come in And she would I did a few implants, some crown and bridge work and I had a precision partial made and everything seemed to be pretty fine. She was a nice lady, but she came in about two weeks after we did it and she says, I’ve got a sore spot and I looked at it, there’s a little red. So I adjusted it. Then she came back a week later says, “I’m sore on this other side.”

Okay and check the occlusion with a T scan really evaluated the case very carefully looking at it going, “Wow, okay.” Then it got to be every day she came in. Every time every day I walk in, she’s on the schedule and I wondered, well, maybe she’s just lonely and she just wants to come in because we’ve got a great team. We’ve got a, you know, a lot of fun going on at the office laughing, smiling that type stuff. Maybe she just wants to hang out but this went on for like 60 days and finally, I’d had enough. So I went in and got the checkbook out and I wrote her a check. I think the cheque was like for $12,000 or something like that. It was it was a whole lot of money and I wrote the check. And it included every hygiene she had had with us. Fluoride that she’d taken home with her every penny she had ever spent in my office. I gave her a check back and when I presented it to her, she’s, “Oh, no, I don’t want my money back. Dr. Baird, you’ve done a great job.” I said, “No, no, no. Now, we really I tell you, I just know I’ve haven’t,” and she has I don’t want them. I know I want you to have it and and I and I kind of stood her up, you know, and then I handed her the check. And I said give me a hug. Give me a big hug. You know, because there’s a friend of mine down the street, I think that could probably get you fixed up. Of course, that’s the guy that you really don’t like down the street. Just cut. Just kidding but no, I’m not you. So you send them down there with cash to go do the work. and I was so happy. I mean, everything was great and I tell this story because of how two years later, she shows back up in my office and she was having a problem and me being the much better dentist than I was two years ago because back this was back in the day when I was taking responsibility for all of these wacko cases. She said, Can you help me? And of course, being the better dentist, I decided, “Oh, well, of course I can help you,” and we did some more dentistry on her probably six or $8,000 worth of dentistry, I don’t remember exactly and she seemed to be doing great. Everything was good and then she started coming in for adjustments again the only thing that worked with her was when you live in a town by size you we only get a newspaper twice a week and I always go to the same place in the newspaper and this is really bad on many levels but I saw her in the obituaries and I figured out that was the only time she was ever going to be happy with anything and I was sad. I mean, but I think we had people you know, given a fist pump and what you should not do when someone passes away but I will tell you that you’re much better off identifying psycho patients before you start doing treatment on them and I always think I can turn patients around. I always believe I can, with positive attitude with positive, you know, help to have a great team around me and by golly, there’s just some folks who just can’t fix crazy, okay and so the choice is yours. If you’re gonna do those patients, identify him, and Jack your fee up, whatever you think it’s gonna be worth. Now you’re signed up with all these PPO plans and everything else. I don’t know what the hell you do. I guess you have to see him and you can’t raise your fees but I’d come up with some fee somehow, some way to make that patient go, you know, that’s way too much. There’s just no way I can do it. I understand that there’s another guy down the street. He’s pretty darn good at this and he’s less costly than I am. So you might want to go down and talk with him. So anyway, that’s the psycho risk patient. That’s the psycho, Dr. Bruce Baird psycho risk profile and I hope you heard all that because it’s really important. Identify him before you start working on them. It’ll make your life much much easier.

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