Is it really an emergency?

Apr 26, 2010

Editor's note: Sheri Doniger's column, Dental Diaries, appears regularly on the DrBicuspid.com advice and opinion page, Second Opinion.

We all get them: the phone calls from patients who are in pain, have a broken tooth or restoration, or have another issue that needs to be addressed RIGHT NOW. Patients call during office hours and sometimes on our days off. Our team will triage the issues and place the patients in our schedule as soon as possible. We make all efforts to be accommodating to patients who are in discomfort for whatever reason.

In this economy -- or any economy, really -- we tend to schedule them at their convenience, not necessarily ours. Usually an emergency patient, be it a patient of record or one new to the practice, will require follow-up care that will be more than a sedative filling or a recementing of an existing fixed prosthesis. And, after all, we do want to make our patients as comfortable as possible because a happy patient is a good referral source.

There are four types of emergency patients. The first are those who are legitimately in pain and will take any time in your schedule that moderately fits into their day. These patients are very grateful for being accommodated and for the ability to be relieved of their discomfort. They understand that by slipping them into the day we potentially are changing our current patient schedule. Needless to say, these patients are so happy they are able to be seen that they will take whatever time is offered to them and make it work.

The next type are those patients who say they are in pain but will not be able to come in for a phlethora of reasons: "I have to be at the gym." "I have a manicure appointment. Can you see me a little later?" "I have lunch scheduled. Is there anything else?" These patients, no matter what you offer, will have an excuse as to why that time is not good for them. They may actually be in pain, or they may be "convenient patients" -- those who feel they "need" to come in when they "want" to come in, regardless of any preventive maintenance program you try to place them on or any attempt you make to try to schedule their most basic restorative therapies.

For the ones who are truly in pain, it is always amazing to any team that they are not as accommodating about our appointment suggestions as we would expect them to be. Personally, I love the hairdresser excuse. I know -- you never want to change your hair appointment because you may never get in at the same time again. But seriously!

Your schedule or mine?

Then there are the emergency patients who, no matter what, operate on their own schedule. You all have seen them. They need "something" -- be it a repair of a fractured tooth or a recement of a lost crown. They agree to a scheduled time, but appear whenever they show up. Some come when scheduled, some come later, and some just show up at the front door, expecting to be seen immediately.

For some reason, lately we have had a bunch of these random appointments. I do not know if it is the change to daylight saving time or just the patients' personalities. A woman recently called me on my cell phone at eight in the morning, saying she had lost her temporary. She happened to call on a day the practice was closed, which is never a big deal since our office location is quite convenient for running in and dealing with an emergency. I made arrangements to see her and immediately went to the office.

I set up the treatment room and sat down to wait. And wait. And wait. She finally arrived, 20 minutes late. Her reason? "My kids came in from out of town, and they needed a car rental. You know how those car rentals go. They take forever. I don't even know if it was a legitimate car rental place, but that is where I wanted to go, so I have been waiting there, and they finally got their car." OK ... what do you say to that? When I took her back to the treatment room and looked in her mouth, she not only had lost her temporary, she shattered it because she bit into it after it popped off. I remade her temporary and she went on her way, a comfortable, satisfied patient.

Luckily, this didn't happen on a regular day because it would have thrown off the entire schedule. Of course, this has happened to all of us. We accommodate emergency patients and try to explain to our scheduled patients we are sorry for the inconvenience. For the most part, they understand because they would hope if they had an emergency, other patients would be just as accepting.

Last but not least, there are the patients who treat emergency visits as regular appointments. They never schedule a preventive visit and only come in when something hurts, or they are years past the need for a basic restorative. Due either to their work schedule, their inability to commit to a scheduled time, or true dental phobia, we understand there will always be a small portion of patients who handle their dental needs in this manner. I had an uncle who was the nicest guy. He never made an appointment when something bothered him, he merely showed up, either for an emergency or a preventive appointment.

Emergencies will always happen. And the truth is, they are great for our practice because they potentially translate into more dental care to be done. How we triage these patients and manage their time may create more patient referrals. But dealing with patients who want to operate on their time frame -- that is a different matter. Mostly, we just grin and bear it.

Sheri Doniger, D.D.S., practices clinical dentistry in Lincolnwood, IL. She has served as an educator in several dental and dental hygiene programs, has been a consultant for a major dental benefit company, and has written for several dental publications. Most recently, she was the editor of Woman Dentist Journal and Woman Dentist eJournal. You can reach her at [email protected].

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