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Practice Profile

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Brett E. Gilbert, DDS

Brett E. Gilbert, DDS

Combining clinical excellence and compassion What can you tell us about your background? I was born and raised in Baltimore, Maryland. I attended college, dental school, and my postgraduate endodontic residency at the University...

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Randy Garland, DDS

Randy Garland, DDS

Exceeding expectations What can you tell us about your background?
I grew up in southern Orange County and earned a bachelor’s degree in biology at San Diego State University in 1983. There I met my future wife, Kim, at the...

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Scott A. Norton, DMD, MSD

Scott A. Norton, DMD, MSD

Focus on family, patients, friends, growth, and community What can you tell us about your background? For as long as I can remember, I wanted to make people smile. I always loved getting the class laughing in grade school. Looking back, I am sure...

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Clinical Articles

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Management of a tooth with a large internal resorption defect

Management of a tooth with a large internal resorption defect

Dr. Robert Slosberg facilitates accurate mapping and obturation of the resportive defect with CBCT imaging Abstract
A patient presented with advanced internal root resorption of tooth No. 9. The prominent location of this tooth...

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Pulpal diagnosis of teeth presenting with condensing osteitis prior to endodontic treatment — a retrospective study

Pulpal diagnosis of teeth presenting with condensing osteitis prior to endodontic treatment — a retrospective study

Drs. Brian Shaughnessy, Margaret Jones, Ricardo Caicedo, Joseph Morelli, Stephen Clark, and Ms. Jennifer Osborne review the occurrence of teeth presenting with condensing osteitis and their associated pulpal diagnosis over a 2-year period. Introduction Read More...

GuttaCore® system: a step forward in the evolution of endodontics

GuttaCore® system: a step forward in the evolution of endodontics

Dr. Andrei Zoryan dispels some of the common myths surrounding carrier-based obturation Carrier-based gutta percha Carrier-based obturation (such as Thermafil®, GT® obturator, ProTaper® obturator [Dentsply Tulsa Dental Specialties]) is one...

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Practice Management

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Effortless, fun, and profitable endodontics

Effortless, fun, and profitable endodontics

In part 2 of his series, Dr. Ace Goerig suggests ways to reduce stress in the practice Almost all endodontists could be completely out of debt and on the way to financial freedom within 5 to 7 years if they only knew the secret. But the secret is...

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Life after root canal — it’s not just about having enough money

Life after root canal — it’s not just about having enough money

Dr. Robert Fleisher ruminates on how to prepare for retirement There are so many articles about everything that you become pretty much overwhelmed and can never expect to read them all. So you pick and choose. You like to learn about the latest and...

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Superior customer service

Superior customer service

Dr. Roger Levin presents the 10 top ways to help create a perfect dental team With the changes brought on by the economy, top companies are bringing in the best resources they can find to evaluate where their organizations stand. They want to know...

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Dr. Robert M Fleisher describes how to handle different types of patient personalities and sticky situations

It is extremely difficult to go through your lifetime of practice without incurring some adversarial relationships. You must avoid or mitigate such incidents to protect your reputation and the integrity of your practice. Doctorswith great bedside manner have fewer incidents; however, it is inevitable that even they will not please everyone all the time. Learning how to handle adversarial relationships requires various strategies to defuse situations while maintaining your sanity.pg 110 advesarial - istock_000002421646medium

There are several areas of human interaction that are prone to misunderstanding, disagreement, or conflict. Good communication skills are necessary to both avoid and remedy adversarial incidents.
Office policy
Rules and policies must be established for an office to run properly. Policy and exceptions must be taught to your staff so you don’t have to handle every problem. Your policies should be flexible enough to show compassion without having patients take advantage of your kindness. An office that is too rigid tends to dilute the doctor’s efforts at bedside manner.

There are times when you have to give in to patient demands, but it should be an exception; and when it causes tension between you and your staff, make sure you explain to them why you gave in and hear their point of view so that you remain attuned to their feelings.

Money matters
Non-payment of bills or disagreement over fees for services rendered has great potential for adversarial conflict. Strict monetary policy makes matters worse. Many patients leave a practice because of money issues. Exceptions should be made to help a patient who has financial problems, when fees weren’t clearly explained, or when insurance companies don’t pay what was expected. Certainly, you don’t want patients to take advantage of your goodwill, but any financial policy needs to have some flexibility.

If you explain to your staff in advance those situations where payment policy may be changed, you won’t be undermining their authority at the front desk. Helping a needy patient through a difficult time may be the best booster for your bedside manner as it personifies compassion. Offering a refund for a failed procedure doesn’t have to be construed as an admission of guilt. It can be a wonderful practice booster for the patient who may not have understood the prognosis issues related to his/her (Allison—do you want to use the work “or,” or just say his/her) treatment.

Financial policy exceptions need to have limitations. You don’t want to become the neighborhood banker. Sadly, some people pay bills that must be paid and put off payment to the good-hearted doctor who doesn’t have any policy about collection of fees.

Scheduling
Coming late to appointments and repeatedly missing appointments leads to adversarial relations when you try to remedy the situation. It is important to identify those patients who are repeat offenders and utilize scheduling remedies noted in the chapter on the waiting room in Bedside Manner, the book.

Rather than sending late patients home, it may be best to have them seated and let the doctor do a cursory exam and explain why he needs them to return and be on time so he will be able to accomplish the procedure.

Doctor: “We’re lucky that today I only had to do a minor procedure. Next visit, I need much more time so please don’t be late for that appointment.”

______

From an associate endodontist working in a busy practice:

I worked for an office that refused to see patients if they came more than 15 minutes late. Since each visit was scheduled for 30 minutes, it could be argued that it was reasonable enough to reappoint patients coming that late. While sitting around reading a magazine, waiting for my patient, I heard her arrive and explain to the secretary how she waited in the storm for the bus to come, and it was running late. The secretary proceeded to tell the patient she would have to reschedule. I intervened and told the patient I would see her. Naturally, the secretary wasn’t very happy.

Had I let the secretary turn away this older woman, drenched by the storm, I would have validated the poor reputation this office developed over the years.

______

You have to have a heart and not worry so much about going to lunch late. Better yet, in your office, set up policies that prevent adversarial situations.

Patient behavior

The dictating patient
Numerous patient behaviors result in conflict. There are those who like to dictate treatment. The patient can refuse treatment, get other opinions, or not follow directions; but dictating treatment is not permitted. This doesn’t mean the doctor shouldn’t be open to patient suggestions or ideas they may have garnered in some alternative-therapy Internet search. Showing interest in their ideas makes patients feel validated in spending the time to do the research, while disregarding or mocking their efforts leads toward bad feelings.

You cannot let a patient dictate malpractice. If the patient says he/she wants you to perform a procedure in a manner that you know would be malpractice, having them sign a waiver does not remove your liability. A patient refusing x-rays is a common example. A signed waiver doesn’t excuse the doctor’s responsibility when untoward results occur from not having the proper x-rays.

The nasty patient
Truly belligerent patients should be dismissed from your practice. While you may have the temptation to tell this type of patient what you think about him/her, it is best to show kindness. Here is how you accomplish this goal:

“Mr. Smith, I am so sorry that you feel this way about… (your treatment outcome; our office policy; my staff; me, etc.). The most important thing needed in a doctor-patient relationship is trust and comfort with the doctor. I want you to have the best available treatment to help resolve your problems. With this in mind, I will do everything I can to help you find a doctor who can fulfill all of your needs. I would like to recommend… (offer the name of another doctor, or the name of a hospital-based practice.)”

If you prefer to avoid making a recommendation, you can refer patients to the county dental society to help them find a new doctor. Make sure you document all the details of these encounters in the patient’s chart. Dismissal of any patient should be followed up with a letter to the patients outlining the recommendation and the offer to see them for any emergency needs for the next 30 days (check with your licensing board to see how long you have to offer emergency care to dismissed patients). This documentation helps defend against accusations of abandonment.

It’s difficult, even for the irrational, belligerent patient, to argue with your concern for their wellbeing and effort to find help for them. You can’t please the world, and there is no reason you need the added stress of an inconsiderate, nasty patient unless you like the challenge.

Staff will often run back to warn doctors about some terribly obnoxious patient. These patients may be on antidepressants or other psychotropic drugs. They may have some personality disorder that makes them adversarial with most of the people in their lives. Make your staff aware of such personality types and how to recognize them by the nature of the patient’s behavior. Another clue may be garnered by reading their medical history and noting the medications they take. Your staff will be better able to deal with the belligerence knowing there is a medical reason for the abhorrent behavior. Quite often, antisocial patients are bipolar, depressed, or dealing with some other illness. Others may just be miserable, have low tolerance for stress, or faced with family or work problems, or they may be inconsiderate of others. Once you and your staff recognize this reality, you will not take affronts personally.

The “Let’s Make a Deal” patient
Some patients may try to bargain for services. You have the option to make deals, though that may not appear to be very professional. Hopefully, your fees are based on the value of the services rendered and should not be discounted except for financial hardship or perhaps as a discount for multiple procedures. The best way to handle a bargaining patient is to explain that your fees are the same for everyone and that if you were to offer a discount to one patient, you would have to offer it to all patients to be fair. You may want to have senior fees for the elderly who rather often ask if they are available. By offering compassionate answers to patients’ requests, you keep your bedside manner intact, even if you don’t give the patient the answer they desire.
The nasty letter
When patients make written complaints against you, your staff, or office policies, it is best to respond personally to their concerns either by phone or by mail. Avoid making incriminating statements that can be used against you in court, but don’t be afraid to defend your polices in a professional and respectful manner. If the patient’s complaint is justified, be willing to apologize for inappropriate policies, staff behavior, or personal behavior. Patients will appreciate the time you take to respond, and many times you can resolve the misunderstanding and retain a patient who becomes loyal and admiring rather than the one who makes negative comments all around town. If you don’t have the time or the ability to respond personally, have a highly competent, compassionate staff member take on the responsibility. Always document in the patient’s chart any response you or your staff makes by phone or by written communication.

Staff
Some would argue that relations with staff shouldn’t affect bedside manner; however, if your staff isn’t on your side, they can convey negativity to patients either subconsciously or overtly by making negative comments. Negativity always undermines the doctor-patient relationship by placing doubts as to why others may not like the provider.

Negative behaviors or comments by staff should not be tolerated. Most doctors who have great bedside manner are usually warm and caring to their staff, and the staff is usually very fond of the doctor. This positive relationship is conveyed to the patients either overtly or subtly in the way they show respect. A positive relationship with staff validates the patient’s good feelings about the doctor.

You have to be creative in order to please your patients and staff. You need to have them both on your side.

“The patient is always right” philosophy is a detriment to relationships with staff. No matter what the staff says regarding policy, if the patient complains and the doctor acquiesces, the staff may become furious, and justifiably so.

In cases where you let the patients have their way, they will love you. However, catering to pushy patients will invariably inconvenience others. There are times when you should dismiss from your practice adversarial patients who can’t get along with your staff and abide by your policies. A happy staff is much more important than a few happy dysfunctional patients.

Colleagues
Negative comments about other professionals are not appropriate. While some health-care providers feed upon making negative comments about colleagues to make themselves look superior, it is neither professional nor ethical. It does get some patients to assume you must be very good because you recognize the failings of the other provider, but it also undermines the profession, making patients believe other doctors are incompetent. Unless you know the circumstances of the other doctor’s relationship and treatment encounters with the patient, you cannot comment fairly.

If you find a colleague who invariably provides poor advice or treatment to common patients, you have a duty to contact this provider to make sure your judgment is valid, make recommendations, and if problems continue, consider a report to the dental board. Be courteous, professional, and friendly when you make this contact.

If a colleague contacts you in an adversarial manner, maintain a professional demeanor, listen to the complaint, and indicate you will respond to the issue after some thought. It would be best to get counsel from other colleagues if the complaint regards treatment protocol. When you get back to the provider, you can have your response and remedy well thought out and organized.

Adversarial events must always be addressed and managed in the most professional and kind manner. These tips should help you accomplish this goal, reduce your stress level, and keep your sanity.

BIO

Robert M Fleisher, DMD, graduated from Temple University School of Dental Medicine in 1974 and received his certificate in endodontics from The University of Pennsylvania in 1976. He taught at Temple University and the University of Pennsylvania and is now a member of the Affiliate Attending Staff at Albert Einstein Medical Center, Department of Dental Medicine, Division of Endodontics, Philadelphia, PA. Dr. Fleisher is the founding partner of Endodontics Limited, P.C., one of the larger endodontic practices in the United States. After retiring from practice, he now devotes his time to writing about practice management, aging and health issues, and fiction with a medical theme.

 

This article is excerpted from Dr. Fleisher’s recently published book,

Bedside Manner - How to Gain Your Patients’ Respect, Love & Loyalty

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You can read about all of Dr. Fleisher’s methods to improve bedside manner, now available for individual and institutional purchase at www.bedsidemanner.info.

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