Patients who cost you big time

When I was first starting in practice I was desperate to be successful. I took any and every patient who came along.

“Come on in. Sit down. Take a seat! Take 2 seats!”

But, after I’d gained a decade or so of experience I started to realise that some patients cost me a lot of heart muscle and stomach lining. The emotional toll from treating them wasn’t worth it.

Here’s my own personal list of dental patients who I avoid.

1. Patients who say: “Patch it for now and I’ll get it fixed properly later.”

With such patients, later never comes. Whenever I take them on I find myself doing nothing but patchwork treatment. And, when that treatment fails, they don’t remember that I was doing it to help them out. They expect me to fix it for free because it was “only done 12 months ago”.

It’s demotivating to wrack my brains figuring out how to glue something together when I know it’s just a short term compromise like painting over rust on a car.

I’ve never found a “patch it” patient who became a good, regular member of my practice. “Patch it” patients use me when they need me and fail appointments when it suits them.

2. Patients who blame previous dentists for the disastrous state of their teeth.

Some patients come in looking like they swallowed a hand grenade: multiple missing teeth, rampant decay, abrasion, attrition, erosion and advanced periodontal disease. Some of those patients tell me that it’s not their fault and that the problems were caused by previous dentists. Two things worry me about that.

First, is that they don’t understand dental disease. The fact that their mouth is in such a bad state yet they think it’s someone else’s fault shows that they’re not in touch with reality or common sense.

Second, they never accept my advice. Even if I work out a perfect plan to fix their mouth, they continue with the same poor decision making and behaviours that got their teeth into the disastrous state in the first place.

If I treat such a patient I know that I will become the next on their list of incompetent dentists.

3. Patients who hold the mirror very close to their mouth when pointing out aesthetic problems.

Patients who are aware of tiny aesthetic problems are virtually impossible to satisfy. The closer they hold the mirror, the more they should be avoided.

I once had a lady who was convinced that the lengths of her two front teeth was unequal but I couldn’t see it. I even got a ruler out and held it across the edges of her front teeth. It was perfectly straight as far as I could tell, and the nurse too. The woman didn’t agree. Taking on such a patient is a recipe for disaster. Suddenly I’m on my third remake and totally losing the plot.

I only take on people with big, obvious cosmetic problems that I can easily see from conversational distance. Anything that I cannot see at a glance is way too much trouble.

4. Patients who move constantly and won’t keep their mouth open.

Us dentists take pride in our work. We want to do a nice job. But, some patients make that impossible:

• Within a second or two of starting work they act like they’re drowning and start flailing around, or

• They want to rinse every 5 seconds even though there’s nothing in their mouth, or

• Even though the tooth is totally numb they suddenly and without any warning pull their head away, or

• They close their mouth constantly so that you’re like a broken record saying: “Open your mouth”, over and over and over, or

• They move their head side to side and up and down constantly for no apparent reason, or

• Their tongue puffs up like a tennis ball the moment they open their mouth, or

• They won’t even let you recline the chair to 60° before they start complaining.

Such patients turn a single filling into an epic event at the end of which I’m like a wrung-out dish mop and running 20 minutes late. Life is too short.

5. Patients who regularly fail appointments.

Practice overheads are more than 60% of gross revenue. That means, if a patient turns up for every second appointment and fails the other one I’m losing money. I was once in a practice where a patient had failed 14 appointment over the course of 2 years. 14 appointments equates to over $5,000 of lost revenue. The practice would have been better off to give the patient $1,000 as a reward for going elsewhere!

The only way to convert an unreliable patient into a reliable one is to demand a deposit on all appointments. But, unreliable patients refuse to pay a deposit. I once had a lady who pleaded with me not to charge her a deposit when she’d failed her two previous appointments. She said those appointments were aberrations and she promised to turn up next time. Foolishly I relented. Guess what. She failed once again.

6. Patients who bring a companion who answers for them.

Some patients arrive with a spouse, friend, or relative who acts as their spokesperson and advisor all at once. The patient barely speaks. The companion answers every question, interrupts every explanation, and hovers over the chair like a watchdog.

I’m no longer communicating with the person receiving the treatment, I’m navigating the anxieties and control issues of the person standing beside them. It’s impossible to build rapport or gain genuine consent when all communication goes via a third party. Am I getting the real story? It’s hard to tell because every answer goes through a filter.

7. Patients who lavish me with praise “You’re the best dentist ever!”

Every now and then a patient walks in overflowing with compliments. Before I’ve even picked up a mirror they’re telling me I’m the best dentist they’ve ever had, that I’m a genius and that no one has ever made them feel so comfortable. It’s flattering, but experience has taught me to be wary.

Excessive praise at the start is often followed by excessive disappointment later. These patients swing from adoration to frustration with breathtaking speed.

The moment something doesn’t feel perfect (a slight sensitivity, a temporary crown that feels “a bit weird,” a shade that’s a tiny bit off) they forget every compliment they ever gave me. I go from “the best dentist ever” to someone who “did something wrong” in record time. I’ve learned that over‑the‑top praise is usually a warning sign, not a compliment.

8. Patients who are charming to me and rude to my staff.

Some patients are sweetness and light the moment I walk into the room, but the receptionist gets a completely different person. They snap at her, belittle the nurse and argue about arrangements they’ve already agreed to. Then they greet me like an old friend.

I take what my staff tell me seriously. A patient who behaves well only when I’m watching creates a miserable workplace. Keeping that patient in the practice tells my team that their dignity matters less than the next treatment fee. That’s a message that I definitely don’t want to send.

In conclusion

Dentistry isn’t just about teeth; it’s about people. It’s worth remembering that for every patient on this list, there are dozens of others who make you glad you chose dentistry as a career. Those are the patients worth protecting your sanity for.

The right patients make your days enjoyable. The wrong ones make you feel bad. I’ve learned that choosing who not to treat is important. If I find the hairs standing up on the back of my neck when talking with a new patient I take notice of that.

Several times a years I allow myself the luxury of deciding to not treat a problem patient.

If you'd like to improve case acceptance or work more efficiently or both, I have online courses and also offer in-office seminars. Follow these links to find out more: Case Acceptance | Efficiency.

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