Sheri's Solutions: Sticker shock

"It will cost WHAT?"

Yes, the old sticker shock when a patient hears the cost of our professional talent. We had a patient return to the practice after a six-year hiatus. Six years ago, we treatment planned for several anterior multisurface composites. After numerous attempts to schedule for the restorative and follow-up preventive appointments, she was relegated to the inactive file. She indicated that she wanted to wait to do anything since she did not have any dental benefit.

Sheri B. Doniger, DDS.

Sheri B. Doniger, DDS.

Well, we all know that waiting is not always the best policy. We received a phone call from her last week because she had some front fillings she was concerned about. She was given a standard hour appointment. After completion of update forms, review of medical history, and a limited evaluation of her problem areas, it was determined that she needed a large amount of restorative work, and she wanted it all done "today," as she was visiting her daughter in New York that weekend and wanted the fillings replaced before she left.

After determining that completing everything was not possible in the appointment time scheduled, we set our goal to the one lateral with a fractured incisal angle that had a very loose composite. Yes, this was one of the teeth we originally treatment planned six years ago. It was also one of the two she was the most concerned with that gave her the impetus to call. She wanted to know the fee prior to starting the procedure, and after the price was quoted, she said, "It will cost WHAT? That is ridiculous!"

It does beg the question: What do patients think our professional time, experience, and procedures are worth? After all, I was restoring her anterior tooth to a form and function that she would be able to eat, talk, and smile.

We judiciously mentioned that this work was recommended to her more than six years ago. We had discussed the depth and breadth of the procedures needed, as well as possible alternatives. She did remember. We reminded her that these procedure and attached fees were discussed more than six years ago, which, of course, she did not remember. At that time, she chose not to act.

Today, we had discussed fees and the investment in her overall dental health. We spent time discussing the need for routine preventive evaluations to circumvent potential problems such as this from occurring. We also spent time discussing the fact that, when she called, we had no idea of the depth and breadth of the restorative work necessary to solve her immediate chief complaint.

Finally, we decided to do one of the restorations, not many, as to keep with the schedule. As it was, we had to call the next patient to let him know we were running a little behind and to arrive 15 minutes after his originally scheduled time. I know this is not the policy of many offices. We had the time in our schedule to accommodate this emergency patient of record and without much altering of the rest of the day.

Of course, there were follow-up questions, such as "I don't eat sugar, so why do I have bacteria in my mouth?" We answered every question, and she was very satisfied when she left the office with her new tooth. She scheduled for another appointment before her trip to New York.

I never feel my work is "ridiculous." This is a woman I have seen on a weekly basis over the years, since we are at the same fitness center. Every time I see her, she says she has to get into see me but has not scheduled. She brought her husband in, who had extensive restorative needs more than three years ago, but he is too busy to get his work done. She was planning to wait until he had his restorative completed before scheduling, since she felt his was more important than hers, but realized he was not going to schedule this year.

For whatever reason, I was happy she returned. She said there was never a question of her loyalty and she had always planned on returning to the office. It was only about the money. As we all know, financing is usually available. Even if dentists do not use a specific financing group, offices will extend payments to accommodate patients.

We have all had these patients. They are the ones who schedule on a crisis-to-crisis basis. As she mentioned during the appointment, her house is falling down around her. It is in need of major rehabilitation. I mentioned, so are her teeth. We discussed the major investment she has in her mouth due to her extensive past dental restorative work. We also discussed that good dentistry, as home rehab, is not cheap or fast.

Prevention is the best policy. Let's see if she follows up.

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].

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