We all have patients we love to treat. The dentist likes them, the staff like them, and they like us. They might not like having dentistry done TO them, but they would prefer not to have anyone else doing it. They are a pleasure to treat.
Now on the other side of the coin, we have patients we don’t like to treat. These people cover a wide spectrum, and the reason we don’t like them is down to a host of factors. This is not the same as those patients that are difficult to treat (the ones with the uncontrollable tongue and the pronounced gag reflex for example). No, we are talking about those that are:
- Rude
- Aggressive
- Bad attenders
- Thieves
- Litigious
- Late payers
- Unappreciative
I think you know the ones I mean. You do them an examination on the NHS, and they complain about the price. You refurbish you practice and they complain about the new colour. You book them for a 2 hour appointment, and they don’t turn up. They are as nice as pie to the dentist, but rude as hell to the receptionist. And most practices have them. And you know what; there is no reason that these people should be part of your practice. You should remove them from your life.
“That’s easy for you to say”
Well yes it is, because it’s been done before. One of the pillars of a successful practice is to have a patient base of people you actually like. That way you still have difficult patients, but at least you know they appreciate what you are doing, and at least they are, in your mind, worthy of your care. Why treat patients that you don’t like and who don’t like you? This to me does not make sense. Remember, you are not the only dentist in the world. If you eject them from your practice, they may well find a dentist who is more suited to their personality type. You are actually doing the ethical thing (of course you should consult with your defence organisation on the best way to go about this).
“But I can’t just ask them to leave”
Why not? You’ve done it before. There will have been patients that you asked to leave your practice for one reason or another. Be they private or NHS, you control who you see, and have an absolute right to refuse to treat anybody you don’t want (without discriminating of course). A social conscience is well and good, but not when YOU end up suffering by dealing with people that you find unpleasant and who turn into heart sink patients.
So what should you do? If you are an associate you should let your principal know that, from this moment, you refuse to treat these patients. Some associates work in a practice where the WORST patients are fobbed off onto them. As an associate, you have a right to refuse to treat patients you don’t want, even under the NHS, because you are a principle in your own right (unless your contract says otherwise). So if you don’t want to see Mr Faceache, you don’t have to. Remember that.
If you are a principal, you get rid. Ask you receptionist, your nurses and your associates who are the bad patients. They will know. Remember, a lot of the bad ones don’t show the signs when they are in the surgery. It’s a bit like Jekyll and Hyde. Hyde only comes out at reception. Get rid of them. Write to the PCT and wave goodbye. If you are private, write to the patient and ask them to go elsewhere. As long as you are polite, careful and your work is of a high quality, you have nothing to worry about. Ask your defence organisation how best to go about this. Of course if you’ve done a dodgy RCT on them and they go elsewhere, you might hear from them again, via a less than friendly solicitor. This is why you have to be good at what you do. But we get into this in another section.
“But I’llhave spaces in the book if I get rid of patients. My numbers will suffer”
Well if you think treating Mrs Nightmare are worth the hassle, then fine keep them. If you think that Mr Awkward is worth the monthly Denplan payment then fine, keep them. But remember this; you no longer have the right to complain about them. You choose your patients. You choose who you treat and who you don’t treat. They may well walk through your door, but you are the one that ACCEPTS them into your practice.
“I can’t just tell someone to go because I don’t like them. There might be an argument.”
Yes you may get a phone call or a visit from the patient, and occasionally they will rant and rave at you, but doesn’t that sort of prove that you were right about them? And surely a slight disruption is better than having to deal with someone that could easily turn into a heart sink patient. Because once you START treating them, it’s harder to get rid of them until that treatment is complete. You have to be smart here. You have to use that thing between your ears.
Grade your patients
If you have a present patient base that you are thinking of doing a cull on, then you will need to grade them. And this will take many months. But it is well worth it. You grade your patient A,B,C,D.
A) Patients love you and you love them. They also have the financial resources to afford top quality dentistry
B) Patients love you and you love them. However, their finances are limited, and will unlikely be able to fund extensive treatment
C) These patients are borderline. They cancel appointments, miss appointments, and say things like “I hate dentists” to your face. You aren’t sure about them, and they aren’t sure about you.
D) Rude, ignorant, abusive and will complain that you don’t give out free toothbrushes. You know who I mean.
You get rid of the C/D’s and keep the A/B’s. There are many ways of getting rid of the C/D’s. The D’s are best just got rid of. No messing, just do a mass mailing and delete them from your practice. But what about the C’s? Well, the first thing to do is have tight systems in place for the appointments. If appointments are cancelled with late notice, or missed, you have a system to deal with this. Some practices charge for missed appointments, other have a three strikes and you’re out policy. The decision on this is yours. You also need a strict account systems to follow up delinquent debts, which also takes into account the problems some people often have paying for treatment. C’s soon realise that they are at a practice where C behaviour is not acceptable. And they either convert to A/B or they leave to go elsewhere. If you are a private practice, you can also incorporate the following system. Every time the C patient breaks one of your rules, you put the cost of any future treatment up by 10%. The idea is, the more the patient misbehaves, the more it costs them to have their treatment done at your practice. This is not my idea, but I include it for your consideration.
However, as we know, it’s not that simple. There is still the problem of new patients.
New Patients
It’s all very well asking people you don’t like not to come back, but surely there must be an easier way. Well there is. It doesn’t prevent the D patient from walking through your door, but it greatly limits the risk of this. This is what you need to do:
- You know there are dentists out there that do a patient interview? If the patient meets the criterion of the dentist (i.e. isn’t an obnoxious idiot) then they are invited to join the practice. Admittedly, this takes some balls to do this. But there are other ways, probably the easiest for most people being a standard letter (with a refund, very important that) which is sent out after the initial appointment where you realise that ther patient is not for you.
- Get rid of your D’s – People talk to people, and hang out with people that are similar to themselves. So when you ask your D’s to leave (politely of course) they will no doubt talk about this fact to their friends. “You’ll never guess what my bloody dentist did……….” The word will get out amongst the D’s that your practice is not the practice for them. This is how word of mouth works. They will then be more likely to find a practice and a dentist who is more suited to their personality type.
- Have strict written terms and conditions for your patients – these should be fair but strict. “If you do not turn up for your appointment we will do X…” This should be in your welcome pack which is given to all new patients BEFORE their first appointment. Once they have received it, and digested it, they are then invited to join your practice. Some of them won’t ring. You have already filtered out some of the undesirables.
- Use your existing A/B patient base as a referral network. You should ask your existing patients to refer you patients of SIMILAR QUALITY to themselves. Remember, people hang around with people of similar personality. So the likelihood is, if A/B patients refer you people, they will be more A/B. You can go even further, and give your existing patient base referral cards. A new patient can only get onto your books with one of these cards.
Now isn’t that better than putting an ad in the yellow pages and keeping your fingers crossed.
But what about patients in pain?
This is something that has always troubled me about the average dental practice. Is it right to inconvenience your existing patients for that day, by squeezing in a patient you have never seen before? I will ask that again. Is it fair to keep Mr A and Mrs B waiting for half an hour whilst you deal with someone that could well be Mr D? This is the social conscience thing again. When this happens, a lot of dentists suddenly think “Oh, I am the only dentist in the world; I must see this patient immediately”. I would disagree with this statement. You have no duty of care for these patients. Unless you are having a problem building up your patient numbers, then I would suggest referring them to the PCT where their problems can be dealt with by referal to another dentist. That is what the PCT is for (at least until they scrap them). Many of you will disagree with me on this, as well as other things I have written. But that’s fine. I am after all not telling you what to do. I am simply offering you what may be a better way to deal with your patients. You get to choose what you do with the information. This is simply my philosophy. I could well be wrong.
“But nGDS forces me to see all and sundry”
You know, I’ve read the contract, and whilst I am not a lawyer, I cannot see anything that says you have to see someone you don’t want to. All you have to ensure is that you don’t discriminate. Feel free to discuss this with your defence organisation………… you pay them a lot of money because of all the dentists being sued because the majority of them didn’t have rapport with their patients.
