This is one of the phrases I hear from a patient that frustrates me the most.
I hear it in response to statements such as:
“You have some decay on this tooth.”
“You have so much decay on this tooth that we’ll need to clean the nerve out to save it.”
“You have an infection and we need to clean the nerve out of this tooth to save it.”
… and so on. The patient is surprised by the presence of a dental problem and is resistant to your treatment proposal.
This stems from two possible scenarios:
(1) Lack of Money
The patient is concerned about the need to spend limited finances towards treatment that was unanticipated.
(2) Lack of Trust
The patient thinks that you are trying to take advantage of them by proposing unnecessary treatment.
The best way to help the patient understand the need for treatment is to understand the source of their resistance and tear down the barrier through education.
This is relatively easy if the barrier is the first scenario. Payment plans, insurance benefits, and other such factors can help patients who understand the need for treatment but are concerned about the financial burden.
But what if the patient doesn’t trust you? What if they have the philosophy, “If it doesn’t hurt, nothing is wrong?”
This can be a tough situation. First and foremost, you should be educating all patients by showing them their radiographs and intraoral photographs. But if they still insist that the absence of pain means they can delay treatment, here’s how I handle the situation:
Stage 1 Denial: The patient truly believes that pain is the only sign that something is wrong.
Stage 1 Solution: “I’m glad it doesn’t hurt. But just because you don’t feel any pain doesn’t mean that there isn’t disease present. I want to remove your disease before it does start to hurt you. Also, if we wait until it starts to hurt you, it will likely require more invasive and more expansive procedures to help you.”
Stage 2 Denial: If the patient is still resistant to your proposed treatment and hides under the excuse that there isn’t any pain, I believe you have an obligation to educate them about the severity of their disease. At this point, the patient may still have a lack of understanding about their condition. It’s time to bring out the big guns…
Stage 2 Solution: “It sounds like you still think the only reason to solve your problem is if it hurts. Allow me to make a dramatic example. Do you know what else doesn’t hurt until it’s too late? Cancer. I think we can agree that if your physician told you about a cancerous lesion, you would have it removed whether it hurt or not. Waiting until the disease causes pain can often lead to more invasive and risky procedures.”
Does that sound too harsh? Maybe. But I feel it is my obligation to correct my patient if they have the misconception that pain is the only reason to treat disease.
Stage 3 Denial: After you have spent much time trying to educate your patient about their disease, it can be very frustrating if they still don’t want to begin treatment. Again, if this hesitation is due to finances, I will try to find a compromise. But sometimes the patient will still resist for non-financial reasons. At this point, I feel the patient may understand what you are saying but chose to disregard it because they don’t trust you. If a patient thinks I am trying to present unnecessary treatment just to make money, we have a serious problem on our hands.
Stage 3 Solution: Depending on the situation, I may make the patient sign the chart acknowledging that they refuse treatment deemed necessary and that they “understand the consequences including, but not limited to, pain, swelling, infection (potentially lethal), and unnecessary loss of tooth, gum, and bone.”
In other cases, if I really get a bad vibe from a patient, I will dismiss them.
“Mrs. Jones, I apologize for the inconvenience, but I’m afraid I cannot allow you to continue to be a patient of this office. I have made every effort to educate you about your health problem. Perhaps you would feel more comfortable with another dentist who can better explain the seriousness of your condition.”
I’ve only had to do this once, but I still feel it was the appropriate course of action.