Sheri's Solutions: The walk-in patient

We had an interesting occurrence at the end of our day on a recent Saturday: our first walk-in. Let me preface this by saying that we are in an office building on the fourth floor. Until about two years ago, we were the sole dental practice in the building for more than 25 years.

The walk-in was an elderly gentleman who said he wanted his "tooth buffed." He told us in no uncertain terms that he had cracked off part of a tooth and did not want anything done except buffing his then two teeth. We gave him a registration form and a few other necessary forms, including consent to treat. The gentleman took the forms, sat down, and slowly began to fill them out. My dental assistant told me he also requested duplicate forms to fill out.

Sheri B. Doniger, DDS.

Sheri B. Doniger, DDS.

After about 25 minutes, I asked if I would be able to see the forms to get a little acquainted with the gentleman. On the registration form he wrote only his last name and scratched out "no" for all the dental history and medical history. He did not put down a date of birth, phone number, or contact information. He claimed that he was taking no medications.

When I asked him for his first name, he wouldn't give it to me. When I asked him to sign the forms, he wrote only "????" and his last name. Upon further questioning, he refused to tell me anything more than his last name.

As he was not a patient of record, when we told him there would be a nominal charge for an examination, he became upset. He said he used to walk right into dental offices and get his teeth smoothed down. He claimed that once I looked into his mouth I would take x-rays, do some work, and charge him more.

I tried to explain that I needed to look at his mouth and give him a professional opinion. He wanted no part of it and felt the treatment should be free. He again repeated that he used to walk into any dental office and get his teeth "buffed," but I explained I felt very uncomfortable with him not being forthcoming in giving me any of his personal and pertinent information. In the long run, he decided not to pursue any treatment and left with all his forms.

I understand in this day and age that many seniors are leery about identity theft and giving out too much information. Upon questioning, I have had some patients forget a medication or two, only to call the office with the correct name or dosage. We have also had patients "forget" to list a surgery or some other medical treatment, feeling the teeth have nothing to do with the rest of the body. As we all know, this is why the form is only a starting point to a conversation about the whole patient. But this was the first time I had ever had such blatant withholding of information by a patient.

Personally, I was highly uncomfortable with treating a patient who was not willing to share his name, let alone any other historical data. Mr. S didn't appear to have a full dentition, and the teeth I saw looked very worn down. Without looking in his mouth and not knowing what I would find (and ethically having to advise him), he clearly did not want any treatment except to smooth down a chipped tooth. This is something we might do as a favor for a patient of record, but not for a patient who walked in from the bank lobby downstairs. I understand. We all have patients who want little to no work. Obviously, dental care has changed over the years.

More recently, my dental assistant went down to the bank to make a deposit and saw Mr. S sitting alone, drinking coffee. When we left the office at the end of our day, he was still sitting in the bank lobby. We have since learned that he lives in the neighborhood and is a frequent guest to the bank. I am sure there is a back story to this whole situation, but he never wanted to share anything with us so that we could find out what it was.

As a follow-up, this person has been calling the office, periodically, asking to speak with me and then hanging up. We realize he may have some mental health issues, although he is not senile according to some conversations we have had with local police officers.

My question is: What would you have done? How would you have handled this situation?

Sheri B. Doniger, DDS, practices clinical dentistry in Lincolnwood, IL. She is currently vice president and president-elect of the American Association of Women Dentists and editor of the American Association of Women Dentists "Chronicle" newsletter. She has served as an educator in several dental and dental hygiene programs, has been a consultant for a major dental benefits company, and has written for several dental publications. You can reach her at [email protected].