This is another potential problem patient that can be overlooked if your diagnostic time is too short. Frequently, this patient presents with poor dentistry or no restorative dentistry at all. Hygiene is either nonexistent or inadequate at best. They will vociferously complain about a previous dentist and staff. The major problem with these patients is they will not accept responsibility for any of their problems or faults. A typical response of a patient with extremely worn teeth may be, “I never grind my teeth,” and he or she may become agitated at you for even suggesting it. Or, “I brush my teeth six times a day,” despite the extensive presence of plaque indicating less than adequate homecare. These patients are frequently so abusive to everyone in your office, including you, that your staff will agree that no fee you may charge is worth the aggravation of treating this type of patient. This is certainly one time when a consultation with your staff about accepting this patient for treatment in your practice would be extremely beneficial. If you do decide to accept this patient, you should consider substantially increasing your fee. A doubling, tripling, or more might be appropriate.

The purpose of classifying potential problem patients here is not to dissuade you from treating them. Rather, it is to make you and your staff more aware of the potential consequences of treating certain types of patients. You and your staff should now be able to recognize better a potential problem before it happens. The chain of people who can give you information as to the patient’s personality is the receptionist, the assistant/hygienist, and then the treatment coordinator. Be sure to use the input from these key staff members before you elect to take up a patient’s esthetic treatment. Should you decide to treat a problem patient, be sure to adjust your fees accordingly.
Remember, it is not enough to just cover the cost of treatment of such patients. If you elect to dedicate the extra time, effort, and above all, stress (not only yours but also that of your staff and perhaps even your family), you are entitled to a reasonable profit for doing so. Your staff and family expect and deserve it as well. The greater is the difficulty, time, and effort required, the greater is the multiple of one’s routine fee. In the past 40 years many of the perceived “difficult” patients who elected not to proceed with my proposed treatment due to the increased fee have gone elsewhere for treatment—only to come back years later, still not happy. Now they will have to spend even more money to have their treatment redone. Incidentally, if you misjudged the patient the first time by referring when, perhaps, they might have been a perfectly acceptable patient, do not make the mistake of underestimating the amount of time, stress, and costs involved in redoing that patient’s case.

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