When to Fire Patients

Dr. Kuba and Bethany discuss a gut wrenching issue today – when to fire patients, how to fire patients, and everything else related to this topic. They reflect back on a recent episode where Dr. Jones described an unruly patient. Together, they discuss the pros and cons of firing a patient as well as the underlying question of “How do you know when it is the right time to fire a patient?” It is a difficult subject that plagues practice owners from time to time, so tune in to hear tips and points to consider before you decide to fire a patient from your practice. 

Previous Episodes Worth Revisiting: 

Dr. Jones Divulges His Worst Moments as a Practice Owner

How to Respond to Angry and Unhappy Patients 

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Transcript

Are you looking for a podcast where you can hear from real people regarding their real dental drama? If so, then
0:09
you've come to the right place. Join hosts Bethany Penny and Dr. Reena Kuba
0:14
as we dive into the solutions we've created and the mistakes we've made while managing dental drama.
0:22
Let's get started. Giddy up. Giddy up. Woohoo. Howdy. Howdy. Howdy. Um, I'm going to take us back in
0:29
time a little bit because um I've been wanting to talk about this and I keep forgetting.
0:35
Yeah. And um possibly my favorite episode I've listened to of ours in 5 years. Like my
0:41
favorite episode was Dr. Jones. The most recent one he did about the where he dug deep to find his inner
0:48
cranky which was not at all cranky which was precious. Anybody else that would have been like you're full of it. Um
0:55
quit faking and just you know but with Dr. Jones. I'm like, "Oh, he really is just so positive and so sweet." Like,
1:01
okay. Um, but I made him dig deep and I wanted to know his worst.
1:06
Mhm. And um I still I still would have liked a little bit more meat on the um assistant one. I feel
1:14
like he kind of glossed over that a little bit, but Well, maybe next time. Well, several of these. Actually, I was
1:20
going to start this by saying normally I love sitting next to you, but not today. I want him, not you. all the questions
1:26
for him and that would have been one of them. I need more details on this assistant one. Um, but the two questions
1:33
that I had that I'm hoping we can talk about, um, you're just going to have to do.
1:39
Well, I'll do my best. Uh, but they are in your wheelhouse. I'm sure you will have some great tips. But
1:46
two things that came out of that episode. So, first of all, if you haven't listened to that episode, like honestly, like he is so precious and I
1:51
thought there were so many good things to learn from that episode. Um, but two questions I had, um, rather than me
1:58
hitting both, can I just hit one and talk about it and then I'll hit the other. Yeah, let's do that. So, he talked about a, um, the the
2:05
patient that he talked about that I thought was like, not that I ever want him or anybody to
2:11
go through anything like that, but in my mind, I was like, "Oh, good lord." This sweet, positive, gentle soul, and
2:19
patients still hate him. like, you know, we're we're all susceptible to these
2:25
patients. And I just fig honestly like I thought older Caucasian gentleman with
2:31
lots of experience, he probably doesn't get these crankies like we do. Like people probably don't mess with him.
2:37
Well, this one messed with him. So, it was kind of like kind of refreshing that anybody can be targeted, right?
2:43
Like I am not alone. That's good. Yes. Not that I want him targeted or anybody, but it can happen to you, too.
2:48
So that was kind of um you know refreshing to to find that it's you know he still has to deal with stuff and
2:57
almost like okay if I'm still practicing you know in the next 20 years I'm still going to be dealing with these
3:02
crazies and whether I like to or not at least it's good to have that the expectation is cuz I would have expected
3:10
older gentleman Caucasian dude in this small town everybody loves you and you're not going to deal with crankies
3:17
and so the fact that he was. But my question was like he talked about how
3:22
she carried on and carried on at the prep appointment and was really upset
3:28
and how he had to be like you need to calm down or how he grabbed her face or grabbed her shoulders or whatever was
3:33
like you need to this is all in your head and um how do you come back from that was my
3:40
question. So what what I mean by that is like how did you wrap up that appointment without her going this man
3:48
yelled at me and told me this was in my head and I am you know you you have I feel
3:54
like most of us people would be like you don't you're not relatable. You're cocky. You don't believe me. It was
4:02
painful to me. How dare you say it wasn't. You're full of yourself. You're a terrible D. I could see us all being
4:09
assaulted with that either verbally or online for sure. Somebody would leave a review like that or a board complaint,
4:16
whatever. Um, and so I guess in my mind, how did how
4:21
did you get her out the door? Mhm. Um, and then when it was time for her to
4:27
come back, how did you guys prep for that? Cuz I can only imagine the vibe in the office is like, damn it, her bridge
4:33
is here. Like who's going to who's going to tell her that? Like Yeah. So to make the call and have her come in
4:40
and then he's got to see her like was he like, "Hey associate, you go deal with that?"
4:46
Yeah. How did he muster up the courage and and what was it? Did he just act nonchalant
4:51
like that had never happened and here we are? It's a whole another appointment. Did he walk in and say, "Hey, you doing
4:57
better?" Like do you acknowledge it? Do you not acknowledge it? Like who do you do you send in the same team member? Do
5:03
you send in a different team member? How are we navigating that? How did he get that crown seated is my question.
5:10
So, just all of those things I try to put myself into that office going, "How the hell did you get her out the door?
5:15
How the hell did you get her in the door to crown seated and back out the door?" There must have been a lot of strategic
5:20
planning in all of that. And I kind of wanted if he was here, I'd want to know like how did they do that?
5:26
We don't have him. So for you kind of going, what would you advise him or advise us?
5:32
You know, cuz normally something like that had happened to me, I'd be calling you going, "Oh my god, what do I do here?" So can you kind of walk us through?
5:40
Yeah, for sure. And this happens a lot. I can't tell you how many times I'll get a call or a text from a client that's in
5:45
a panicky moment of what do I do with this patient, this problem patient? and
5:51
the I mean first and foremost I think you assume planning and projecting and
5:57
all of that. I I don't know that that's everybody's default. I think there's plenty of providers and teams out there
6:04
that are just like let's bury our heads and not think about that again. Um and
6:09
we can't do that. We do have to navigate the situation with some sort of openness
6:15
and willingness to talk about it. So on this particular case, what I what I
6:21
would have told my dad um and his team is, hey, we need to talk about it before
6:26
everybody leaves for the day. So we need to talk about it when it's fresh. Because one thing that changes when we
6:33
move away from the situation is it clouds what actually happened for better or for worse. It clouds it. Distance
6:41
either makes the situation worse. So when we go home and then we explain it to spouse or kids or you know whoever
6:48
else we're talking to our buddy about it, we can sometimes if we're if we have
6:54
a flare for the dramatic then we can add to it. Not lying about the situation.
6:59
We're just going to make it more fun than it it more fun of a story than it actually was. And our brain starts to
7:07
block that in as memory. Um and then it can also do the opposite.
7:12
we can walk away going, "Oh, she must have just had a really hard day and it'll be okay. She's not going to do
7:19
that again. Uh, and we can justify it as we walk away from it." So, it's really
7:24
important to address it same day is what I would always recommend and just say, "Hey, do a quick cuddle at the end of the day." Um, that goes, "Okay, let's
7:32
talk about Miss Jones and what happened with her. You know, so and so, you were
7:38
in the room with me. What is your perception? What amplified her? What made her worse? What did I say or do
7:45
that could have prevented that before she exploded or before I kind of lost my
7:50
patience with her? Um, how was she ladies at the front? How was she when she left? What did she say? What did she
7:57
do? So, we need real time reactions. Then after we have real-time reactions,
8:03
I would definitely recommend somebody kind of making an email of that. We discussed patient A today.
8:10
This is the collective summary. She did this. She said this. We did this. We said this. Just so it's on record. So,
8:18
we're not going to get confused. We're not going to overamplify this or undermplify this. Then we can come back
8:23
at a different time and make a plan for what do we do with Miss Jones or patient A. Um,
8:30
and so this one is challenging because she
8:36
was in the middle of that was her prep day. So she has to come back for a seat.
8:43
So to me, our the the options are limited. If we just finished, she needed
8:48
a couple fillings and we finished, we've got lots more options because she's not in the middle of care. we were able to
8:55
at least, you know, fix the teeth that needed to be fixed. This one's challenging because she walked out with
9:00
a temp. Um, so in that particular case, this is where having alternate doctors
9:07
on the team is helpful because Dr. Jones, my dad, does not have an alternate doctor on the team. It's him,
9:13
so he has to deal with her. But if there was an alternate doctor, even though that alternate doctor didn't prep the
9:20
crowns, it would have been very helpful for him to be able to punt this patient
9:25
to somebody else to seat the crowns. So then that would be my one question there is should you are you hiding from
9:31
the patient cuz you know you yelled at them and they might still be mad at you and so is it looking like I'm fearful of
9:38
you and I'm hiding from you and that's why I punted. Were you looking forward to seeing me next time? So, you could either apologize to me or you could yell
9:45
at me again or whatever. Like, how yeah, how do you figure out who should see the patient next time? Like you said, he
9:51
didn't have a choice. But if you do have a choice, should you use that get out of jail card or should
9:57
you hang on to it? Like what are your thoughts on that? To me, that depends on the rendering provider, the doctor that did the
10:03
initial. If they feel anxious, um, angry, still frustrated
10:11
with the patient, then I would say we don't do our best dentistry in those modes. And to me, if it's somebody is
10:17
just like, ah, water under the bridge, it's fine. She just had a rough day. And they can walk in with the same energy
10:24
that they would have for other patients that I'm like, okay, you get a chance at this. But if there's any like, I'm going
10:29
to be nervous. I'm going to be jittery. I'm not going to be myself. we don't function best clinically in that mode.
10:35
So in that particular case, I do I would just make the executive decision to punt it to somebody else.
10:40
And then maybe if the patient does say something like, "Oh, where's Dr. Jones today?" "Oh, he's with another patient. Um, did
10:47
you need to see him? Do you want him to swing by?" Yep. Exactly. Because then the patient still has the opportunity to at least
10:53
talk to the other doctor, the rendering the original rendering provider. Um, I mean
10:59
it could easily be scheduled if she left and didn't have her seat appointment scheduled and the docs work different
11:05
days. It could be that we just preemptively um when the crown comes in, we preemptively call her and put her on
11:12
a day where the other doctor works and we're like, "Oh yeah, no, Dr. Jones isn't here today. This is his off day.
11:18
You know, he's off on Fridays." So, or whatever the case may be. Um, I think it's easy to potentially work around
11:24
that. um if there's a pres-scheduled day that the doctor was going to be off for personal reasons, like put her on that
11:30
day. That way it doesn't look like we did this intentionally for her to not be able to see the doctor. Um so that's
11:38
option one if you have another doctor. Option two, unfortunately, if it's in
11:44
the middle of something like a crown and a seat like we were in this particular situation, then we need to book that
11:50
patient at a at a time when our doctor is at his or her best, which are like we
11:56
put crowns at 8:00 a.m. I understand that. But if Dr. Jones is most peppy,
12:02
happy, able to handle stressors at 8:00 a.m., which is why we have our crown preps
12:08
there, then Miss Jones needs to go in that spot because we need our doctor
12:16
functioning at his or her very, very best. And even if that means we break template to be able to do that, then I
12:22
think it's worth it. So, we strategically put that patient where the doctor is going to be able to best
12:27
handle. And then we do need to assess what team members need to be in the room to buffer. So if and I don't know this
12:36
with my dad's example, but if Dr. Jones was in the room with an assistant that's kind of mousy and nervous and calm and
12:44
would never like jump in and try to like help take control of a situation, that
12:49
doesn't need to be the person in the room. We need to have our person that has the ability either to woo that
12:55
patient into happiness. Um, you know, in our last week's episode, we talked about sanguin personalities that are just
13:01
naturally likable. Maybe we put our sanguin assistant in there who can kind of butter the lady up and get her ready.
13:07
Um, but also so that our assistant, our sanguin assistant is the one chatting
13:12
throughout the appointment that Dr. Jones needs to kind of, hey, you you
13:18
stay a little bit quieter this time because we don't want any potential friction between the patient and the
13:24
doctor to come up. Um, so to me, the second option is we can't change out
13:29
doctors, but we can change out team members that might be in there as a support staff. And we do that all the time where I'm
13:35
like, okay, this parent will do better with Sanguin in there. So, so and so, I
13:40
need you. Well, I was supposed to be on hygiene for I know you are, but y'all need to at this time watch this. You
13:46
need to make sure you're available to jump over here and so and so, you cover that. And I know that's not normally what you do, but for this interaction,
13:53
or if it's a patient that I know is more of the calery type and is a little bit more
13:58
uh, you know, grim and I know Sanguin's going to come in and irritate them with all their pep and cheer and they're
14:05
already irritated. The crown fell off and they had to take another day off work to put the crown back on and now
14:10
Sanguin's coming in. And parents like then a lot of times I'll send my cleric
14:17
like hygienist in there. Well, the hygienist is not the one who's used to feeding crowns like, you know, but
14:22
that's okay for this interaction because if the parent's going to be snippy, my calerics are able to shut that down
14:29
and buffer for me. Yes. Yeah. And we don't think about this probably as often as we should. I think
14:36
it's super helpful to know or to be able to pinpoint our patients or parents personality types and then to adjust
14:42
staffing wise accordingly if you can. If you can, if you've got the luxury of that many team members or
14:49
being able to spot the patient or parent personality, absolutely, let's accommodate that. It just makes our
14:55
lives easier. It makes patient satisfaction better or parent satisfaction better. So, we don't think
15:01
about it enough. I was just doing a phone training with a team on Friday and
15:06
we talked a lot about patient personalities. I had been able to pre-screen hours and hours of their
15:12
phone call before this uh team training and I can pick up on patient personalities like within two seconds
15:18
over the phone like second sentence in and I'm like I that's a cleric because of just key things that I've learned to
15:24
look for. And so as I talked about it with this team we then played calls after we talked through patient
15:30
personality and our own personalities and I would have them guess the patient
15:35
personality after we listen to a phone call. I'll just pause and be like, "What personality?" And 95% of the time, dead
15:41
on, they could pick them. We've got the skills. If we can pick a phone call, a
15:47
patient's personality over the phone, then it's 10 times easier in person. If we've met this person, we should know
15:53
their personality for the most part. But we don't spend enough time doing that.
15:58
So, I think that's a key takeaway on this. If we know angry patient really likes soft, buttery, like sweet comments
16:07
and all that, we got to stick our sanguin in there. If she wants to get in, get out cuz she's nervous Nelly and
16:12
she wants to be in and out within 10 minutes, then we got to put our most efficient person in there so we can move that appointment along very quickly.
16:19
So, I think the question I have for you here, or what I can imagine the the response to that will be like, well, I
16:24
only have three people on my team or who has the time and energy for that? What's the big deal? I've never really done
16:31
that. We're just fine. I think about a colleague of mine and he is the epitome of it's all fine. It's all fine because
16:38
he's such a laid-back guy. And honestly, I start going, you know, aren't things
16:44
usually fine for him? And I'm like, that never would have worked out that way for me, but it worked out that way for you. So,
16:50
is it a me issue? Like, was I over dramatizing this and I was flipping over
16:55
backwards for no reason? I mean it goes back to
17:00
melancholy and this is what's going to happen but if
17:07
plan B is this but then what if mom and dad are both there then I need to think about this and he's like what are you
17:13
doing? Yeah. And I'm just like what are you doing? You you have no preparation whatsoever.
17:18
And he's like why would I prep for that when I don't know who's going to come and I don't know maybe they're going to be in a fine mood or maybe this. like
17:24
I'm just not going to worry about it until they come in. And to me, I find that stressful. So, does it boil down to the doctor's
17:32
personality issue or does it really impact patient care is my question to you cuz he would argue,
17:39
eh, it'll be fine. It's always fine. And I would agree with him 90% of the
17:44
time. Nine times out of 10, it's going to be fine without all of this
17:49
accommodation. But what we always plan for is the 10%. Because the 10% is the
17:54
stuff that can blow up in our face. And so, yeah, can we can we potentially spot
18:00
that 10% that's super like this is not a good parent or this is not a good
18:05
situation? Maybe. But maybe we just make good habits of
18:10
planning for potential worst case scenarios or personalities that might kind of rub against each other. If we're
18:17
always in the habit of doing that, then we're planning for a 100% of success in our patient experiences. But yeah, I
18:24
agree with him. We could probably sit back and do nothing and 90% of the time we're just fine. But how bad is that 10%
18:32
that we could have potentially avoided? So my question then is, but is that 10% worth it to stress ourselves out over?
18:38
What how bad could the 10% be? And do you think that the 10% could be somebody leaving a bad review? Okay. Well, nine
18:45
are going to leave good reviews, so it's not that big a deal to worry about this. Or is it more of, well, that one could
18:51
be the one that the board complained and now it's costing me thousands of dollars to go through. So to avoid the one odd ch like
18:58
I can just see him going, you're you're a nut. You do it to yourself. And I
19:03
don't think he's wrong a lot of the times, but on the other hand, I'm like, well, but you're not an owner yet. You will be.
19:09
And then I'm curious to see how you're going to change this whole me, it'll be fine. Is it because you've not had to
19:15
deal Yeah. with the 10%. And I would say in my mind it's more than 10%. I want to say it's
19:20
20 probably. And so to me like ultimately you are not responsible for problem solving that
19:27
20%. So to you it may as well be 100%. Cuz it was fine as far as your
19:34
uh contribution to the solution. Yeah. Um you know and some of us are more
19:40
risktakers. Maybe to him he's like, "Yeah, well, a board complaint every year is not that big a deal. It's what I kind of bank on and it'll be fine." But
19:48
to me, I'm like, "That's I feel like I'm ready to hang up my drill if I were to get a board complaint." Like, that is a
19:53
big deal to me. So, I I think it's this kind of I guess that's where I go and say what what you just said. Um
20:01
I would argue and say, "Okay, he's right if we have those discussions and arguments like it boils back down to our
20:07
personalities." However, where I do say, but it does affect the patient experience.
20:12
Yeah. And all of us should be striving for 100% patient satisfaction. And so in his
20:18
mind, if he's like, well, that's never going to happen. That's just unrealistic. You're going to expect 20% of patients not to be happy. And if
20:24
you're okay with that, but to me, I'm like, but then that's like chasing your own tail in a lot of ways because that
20:30
20% can have a big impact on imagine 20% of your recare doesn't come back. 20% of
20:36
your operative doesn't come back. You're spending that much more on marketing to make up for this 20% 10% 5% whatever it
20:43
is. You're chasing your own tail by not making sure every interaction's great. Yeah.
20:48
And maybe like in his mind he's like, "Well, that's that's just the cost of doing business." But I don't think
20:53
that's a smart approach. Well, no, because what it doesn't take into consideration is the unexpected,
21:01
right? So when you were talking about, you know, well, of course 80%, you know, that's what we should expect. But then
21:08
if we're only aiming for the 80%. We're not going to hit those all the time. And then now we're dropping even
21:15
lower. So it'd be like me walking into a test fully prepared, like, okay, we're
21:21
going to, you know, be covering chapters 1 through five and that's going to be on
21:27
the test. And I'm like, good. I only need to be in that class. I only need to be in this TA test to get an A in the
21:33
class because I've done really well, you know, the rest of the year. So, I'm going to study one through four. I can
21:39
nail one through four. I will totally get an 80% on this test one through four. But I'm not going to study for
21:46
chapter 5 because I don't need it. No big deal. And then lo and behold, I get the dang test. And you know what? Half
21:52
the test is on chapter 5. Well, crap. Now, I've I've gone in with
21:58
a plan that was faulty from the get-go. Whereas, if I would have been aiming for
22:03
100%, you know, batting a thousand is the is one of the common things is like if I go
22:09
in expecting that I have prepared for perfection in every single patient
22:14
interaction, then I know that if I swing and miss a few times, that's okay cuz I was aiming
22:21
for 100. I wasn't aiming for 80. So, I do think it's a risky mindset to go in
22:27
there cuz that's assuming you're going to get 80 out of 80. I mean, 80 out of
22:32
100 interactions you're going to get perfect because you planned for that. But what if you didn't? What if you
22:39
messed up somehow? So, to me, that's more pressure. That puts so much more pressure in my opinion because you
22:47
you're already at risk before you even start the day. So, no, I I don't agree
22:52
with that mindset at all. Um, now I think it's okay to come to the end of a bad day and to go, we've laid it all out
23:00
on the line. We have done what we can do. There's nothing more that we can do about this situation or this upset
23:07
parent or whatever. We got to just go home and brush it off and it'll all be okay. Then, I feel like that's a very
23:14
appropriate mindset because we we have to be able to let go of some things at some point. But to me, it's more on the
23:21
back end than it is on the front end. It's it's a much crummy feeling to go, "Damn it, we should have if we had just
23:28
switched Mary and Betty." Yeah. Would that have made the difference? Would I not be in this situation now?
23:34
Although, I would say I don't know that he or people like that would ever reflect on it like that anyway. That
23:41
would have just been like, "Oh, crazy patient." Mhm. But I guess to me my thought is do you
23:48
do you look at the interactions? Do you try to get feedback to go, can I make
23:53
this better? Yeah. And I think a lot of people either a don't think about it or don't have the
23:58
wherewithal to think about it or maybe think that they're limited because I only have these two staff members or um
24:05
which I'm not saying is not valid, but it's still like but okay, but you're you're going to uh play the card you
24:11
were dealt. You only have these two, but can you still be strategic? Yeah. Yeah. Or what? Okay. I've only got
24:17
these two team members and this patient hates both of them and we got to seat this crown. Okay. Well, then what can we
24:24
do to prepare to make that a more enjoyable experience? Let's think through this particular, you know, team
24:31
member team member and go, what skills could she gain in the next two weeks
24:37
that would get her prepared to deal with the rotten patient? Okay, well, let's focus on that then. And again, is it
24:43
worth it for one patient? Heck yeah, it is. I without a doubt, even if that
24:48
person is unreasonable. Now, it doesn't mean that we're going to be devastated if she still has the same experience and
24:55
it was bad, we still are going to feel good that we put the effort in and maybe we gain skills in that process that we
25:01
can use towards other cranky patients. Um, but yeah, I don't think we just roll over. And
25:08
and I'm saying this without really thinking about it, but I think when we're when we're talking
25:14
about this, I think the difference is if you're a practice owner, this is part of your job because you're
25:21
a business owner and you're always should always be strategizing to be the best, right?
25:27
If you're going to be like, "Well, there's Starbucks next door. My coffee shop just isn't going to do that well, but that's okay. I'll take the sloppy
25:34
seconds of Starbucks. I mean, you're going to have a very different outcome with with your business and your
25:39
success. Um, and if you're not really kind of going, well, it just is what it is, then
25:46
stay an associate. You're not a practice owner if you're not always trying to
25:51
be better. Yes. Be a better leader, be a better owner. So, I don't I don't know if I'm
25:57
right about that. I I guess I'm just saying it without really thinking it. I'm not trying to be offensive to anybody, but I I do think if you kind of
26:03
just like, well, it is what it is and shucks, you know? I I just don't maybe I
26:10
don't know. Am I being too harsh or unfair when I say that? No, I don't think so. I think there's a
26:19
certain quality that there's a certain drive that somebody really should have to own a business, any business, whether
26:27
it's the coffee shop or or a dental practice, there's certain drive that
26:32
really needs to be there. And I think if you're going into it thinking it's
26:38
sunshine and rainbows and easy and it'll just all be okay, man, you're going to get slapped in the face.
26:45
I mean, it's going to be a rude awakening. Yes. And I think most of us do get
26:51
slapped in the face for a while. We do. And not because we thought it was going to be easy. It's just we didn't realize
26:57
how many hands there were that could slap. You know, like we've been an associate for this long and I've dealt
27:03
with these patients and I've dealt with these staff members and I've dealt with the doctor owner and she's an idiot. She
27:09
can do it. I can do it. I've already faced all of these things. Well, yeah, you've experienced 10 of the hundred
27:14
hands that could punch you in the face. And so, you get there and I think owners
27:19
like I think we would all say that like we are like, "Oh my god, I didn't realize just how violent this could be.
27:26
I was anticipating 20, not a hundred." Um, and then it's like, okay, but how am I prepping myself for a thousand slaps?
27:33
Like, I don't want to be slapped at all. Yeah. So, and then then I guess my analogy
27:39
would be, do you mind getting punched in the face? Like may maybe that's what it is. If you're not preparing
27:45
Yeah. then you must like the abuse. You being hit in the face every time.
27:50
But for that there's no help. I'm so sorry. Just go right ahead. Get yourself
27:57
punched. I don't like being punched. I'd rather problem solve this before I get punched.
28:04
Like do I need to buy a new helmet? Should I go in there with like boots on? I'm
28:09
like, what am I doing here? Cuz last time I got my toes crushed and I don't want to wear flip flops again. Like,
28:16
what should I do? And if you're going to be one who's like, well, my flip flops, you know, most patients don't step on my
28:21
feet. Well, I lost that toe. I got nine, but it's okay. Like, where are we drawing
28:27
our line here? Oh my gosh.
28:32
Okay, so I think I've gotten us off course here. But the point was like, how much do you prepare for these patients
28:37
for the next visit? a lot. Okay. Now, you said it was a little different for like if it was a filling
28:43
patient. So, do you mind throwing in there like obviously you don't have to deal with them again. So, if it's going to be a while since they come back, hopefully
28:49
they cool and you cool and so there's no interaction. Do you do you have somebody reach out to
28:56
them a day later and say, "Hey, you know, that appointment was kind of intense. You okay? Anything wrong?" Or do you not touch that with a 10ft pole?
29:03
Do you just not touch it and inactivate them? That's what I tend to do. M um you've got so many options here and I
29:11
will say to you know at the risk of not being helpful that there's no right or
29:16
wrong on this. It depends on the doctor, the team, the patient and the scenario. Yeah. And so I if
29:24
we've done their work, we absolutely are within our power to dismiss that patient. But again, we have to dis
29:32
dismiss that patient in a proper order. they've got to have, it depends on the state, but in Texas, we have to give
29:38
them 30 days notice so that if they had an emergency pop up within that 30 days,
29:43
we would have to see them in order to um not abandon them in patient care. So,
29:50
and in Texas, there's a very specific like uh letter like components to that
29:56
letter. Um and to me, I the whole process of dismissal is to me I'm like that's a
30:01
bomb waiting to go off. Yes. And so that's not for this episode, but I'm just saying like if you decided
30:07
to dismiss, then that it comes with risks. Check check into your state laws as far as how um to do it properly. And yeah,
30:15
so there's always that option. Um which all of these have associated risks and
30:20
benefits with them. And then the other one is um okay, just inactivate.
30:26
This tends to be my go-to is just inactivate. um they turn off all their
30:33
notifications. They're not getting reminders about the need to come back for a cleaning or things like that. It's
30:38
just like poof, we're no longer contacting this person. And so that's a good option for this cuz we're like,
30:44
let's hope that she just fades into the sunset and we don't have to worry about us. Mhm.
30:49
Um so that's an option. And then the third option is okay,
30:54
I think she's the type of person, she's not normally this angry and upset. Let's give her a few days and then then let's
31:00
have our sweet team member that she loves so much. Let's have her call and check on her and just see, hey, how are
31:06
those feelings doing? Just wanted to check on you, see how things are going. Um, we don't have to mention that last
31:12
time was rough. We can let her bring that up and if she if she chooses to
31:18
I feel like in Dr. Jones's case, this woman's always like that. So, that call would have been more fuel on the fire
31:23
and just don't do it. Correct. Okay. Yeah. for him. I would have recommended
31:29
and I think this is what they opted to do is just inactivate, don't contact for any reason. And I think that's the right
31:36
move with this patient and with this particular situation. After she got the crown seated, it was like, okay, let's
31:42
let her fade off into the sunset. And I think that's the appropriate move in a lot of these situations. It's the least
31:50
risky of all of them as long as they truly are completed with their
31:57
treatment. We don't want to be in a situation where it looks like, oh, but they still had, you know, we completed
32:04
the implant placement, but she still needed to come back for the implant crown. Even though we
32:11
haven't started the implant crown, that's still a little risky to me because it's like that was all treatment
32:18
related to one tooth. Even though it's separate codes over a six or eightmonth period of time, it's still like the
32:25
whole point was to replace the tooth. So that you got to just be careful I guess with that as well. But yeah, those
32:32
would be the options. So my second question on this whole thing, if you remember back when I started this, I had two main questions.
32:38
One was how did you get that patient out the door? Did he pop back in and say, "I'm sorry for grabbing your face and
32:44
telling you to shut the hell up cuz you're an idiot." Like, you know, like what did he do or did he just disappear and not come back and assistant place
32:51
the temp and let her leave? Um, and then, you know, she comes back for
32:57
her crown and we talked about what do you do? Like, did they strategize her? We don't know what he did, how he prepared for that appointment, but
33:02
whatever. Like, got the crown seated and out the door. My question is then I
33:07
think he mentioned something about like should we should we fire this patient whether that's whichever way we're going
33:14
to do it and I think you mentioned or he mentioned something about how there was a maybe a hygienist on the team that is
33:22
like no no no this patient's always cranky but you know I can always get her through an appointment and that's just
33:28
how she is but who else is going to treat her we can do this like she still
33:33
needs care and you know, let's just kill her with kindness. I think we should keep her as a patient.
33:39
Mhm. So, how are there things that And of course, then that person wasn't involved
33:44
in this care cuz I think she was a hygienist and so she wasn't involved in the crown prep. Now, where the assistants and Dr. Dillons are probably
33:51
like, who the hell didn't fire this patient before? Oh, it was Mary the hygienist.
33:56
Yeah. Well, damn it. You're going to be in here for the crown seat next time and you're going to suction and pack the
34:01
cord because you're the one who said you could get this patient through it. And we had a miserable evening and I got
34:06
cursed out. I might have a board complaint. She maybe her husband was videotaping the whole thing and watch me be on YouTube like
34:13
Mary, what were you thinking? Why would you set your team up for failure with this loco? We can try to help everybody
34:20
but we can't help everybody. Like this is putting the entire office at risk. What were you thinking? So my question
34:26
to you is how do you navigate those like if there are people advocating to keep the patient or not who who ultimately
34:32
should kind of decide? Without a doubt the doctor. Okay. without a doubt because while
34:39
licensed individuals are at risk for some things, you know, the hygienist or even the assistant, the the the buck
34:46
stops with the doctor and the doctor is going to have to decide whether they're willing to take a risk on this
34:53
particular patient or not. And so there can certainly be team members that are advocating and I think that's precious
34:59
and sweet and I love that. But at the end of the day, if this doctor feels like he cannot handle this patient, they
35:07
have got to make that decision and not let the perspective of the team
35:13
ultimately influence. And I don't say that very often. Most of the time I'm like, let's collaborate. Let's work
35:19
together on this. But the doctor knows himself or herself enough to know I can't deal with that patient. And it is
35:26
too big of a risk to the practice to just power through and push through. Um, but I can't see your dad ever saying we
35:33
need to give up on this patient. Yeah. But ultimately then that's his own doing then. That's the bed he's making and
35:39
he's got to lie in it then. Yeah. Um I would say my team's opposite. Like the minute one decides somebody's got to
35:45
go, they're all like and I tend to be the same. I'm like, "Okay, I didn't mind
35:51
that patient, but she was rude to you." They're out. Yeah. I don't want my team having to dread
35:56
this person coming in. Yeah. Yeah. Um, I wouldn't say that's all the time because a lot of times it is like one person has a problem. I'm
36:02
like, you're kind of cranky with that patient, but this patient's not bad. This is their deal. I know you don't
36:07
agree with that, but you just stay away from that patient and we'll be okay. Yeah. Um, but I I think I it did make me go,
36:14
how do you decide when you want to fire the patient? I and I you bring up a
36:20
really valuable point here is sometimes it's the doctor that hesitates to fire a
36:25
patient and the team is overwhelmingly stressed by this patient when he or
36:30
she's on the schedule. And so that perspective is important to consider. It doesn't mean that a doctor is just
36:37
always willing to fire a patient because the team doesn't like them. It just means it goes back to us being strategic. We know that, you know, Sally
36:45
and Susie can't stand this person, but Scarlet's just fine with her. Okay. And
36:50
and the doctor's fine with this patient. Okay. Then, Scarlet, you're this person's person. You know, you're always
36:56
going to be the one that's with her. And so, we can't You're exactly right. We can't always just fire a patient because
37:02
our team doesn't like this person. As long as we have one or two people on the team that can still work with that
37:07
patient and the doctor wants to, then we can keep the patient on board. But the
37:13
risk is there that we stress our employees out so much because we have
37:19
all these bad patients that we never seem to let them go and it stresses them out and that's not good either.
37:25
I would imagine that would be more in one of those cases, two cases. One, if the doctor's like, "Well, we need the funds. Like, we can't let a patient go
37:32
because we're barely paying rent." Or if it's a p it's a doc that's like, "Everything's fine. What do you mean the
37:38
patient's fine to me?" Yeah, we're good. and not realizing that it
37:44
really is quite a strenuous burden cuz the the front desk is the one that gets reamed out every time
37:50
the hygienist gets reamed out and all she was trying to do was floss. you come in and because you're kind of a a shucks
37:56
like likable guy who's not dramatic um and the patients often don't act that
38:01
way with us the doctor and so I think just being cognizant of really trying to
38:07
feel out from your team and then ultimately it is up to you whether you can handle them or not a lot of times
38:13
though I would say if you're choosing to keep the patient how many team members are you going to lose at some point it's not not worth the risk I can think
38:20
of one situation in particular that keeps coming to mind As we talk about this, there was a client of mine that
38:27
had a older gentleman patient that was had a tendency to be borderline
38:33
inappropriate with female uh team members. And so, you know, the
38:39
hygienist had kind of punted him along to the next hygiene was like, "Oh, you can probably handle him." Well, it got
38:45
down to basically like the last hygienist that he was on her schedule
38:50
and she had seen him a couple times with no issue and she was like, I' I've got it. He's fine, you know. Well, then just
38:58
something happened where he he made a series of in one visit a series of inappropriate comments to her that just
39:08
did not sit well. She started she kept getting more and more upset throughout the visit. Um ended up at one point she
39:17
felt like he was hand a little handsy with her like nowhere violently that he
39:24
went but it was just like this I'm really uncomfortable right now. And so she went and left the appointment and
39:31
went and got the doctor, a male doc that is having to make a decision right then
39:36
and there because this has been a pervasive trend with this patient. He's been punted down the line. He's on his
39:42
last hygienist. And it really was one of those situations.
39:47
You either kick this patient out or you're going to lose teammates over this. and he had to go in right then and
39:53
there and tell that patient that he was not allowed to come back due to you know
39:58
inappropriate things. So you look at a Oh my god, I'm sweating right now just thinking about that. Poor dog, but poor
40:05
hygienist, but poor awful, right? But that's a situation exactly we were
40:10
talking about that if he would have said, "Ah, he's fine. We can handle it,
40:16
he would have lost teammates over that." And so you have to you have to think about is that patient that valuable to
40:23
me as a practice owner that I'm willing to lose two or three team members over this? and most patients aren't. So, I do
40:30
think we have to be mindful of situations like that and it needs to be overwhelming
40:36
evidence against that patient that they need to go. I'm not saying that, oh, they annoy me. Um, so there's going to
40:42
be situations like that that come up that we have to take the side of the team. Yucky. Okay.
40:49
All right. Did we get all your questions answered? Yes, but I do need to corner Dr. Jones
40:54
to figure out what exactly I I still want to know what what was going through his head and how he
40:59
navigated the situation. Yeah. And he's so positive. He may not tell me exactly. I'm going to be like, "No, no, no. You need to tell me
41:04
exactly." No, it was all fine. It was good. The patient came. No. Like how details, please.
41:09
Details, sir. Yes. Yes. Well, and he's got a really strong um office manager. My sister-in-law is his
41:16
office manager. And if if Dr. Jones is not on top of something, she is. So it
41:22
it' be also be interesting to hear her perspective on the whole thing. I don't think he could ever not be on
41:28
top of something. So I don't understand what you just said. No offense to her. I'm sure she's great. She's awesome.
41:33
Yeah, that's what I say. I don't know her, but I do know him. He is always on top of everything.
41:39
So true. Oh, awesome. Thanks. Thanks for joining the conversation
41:44
today. We hope that you are comforted in knowing that you are not alone, but we
41:49
also hope that you're walking away with some really great tips and tricks to try in your practice.
41:56
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