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Dishonest patients: Who’s at fault when the s*#! hits the fan?

July 27, 2020
Stacey L. Gividen, DDS, relays a few candid stories that illustrate the importance of receiving comprehensive medical history from patients, and what can go wrong when they leave out a few details.

If there’s one thing I despise, it’s being duped by patients who 1) don’t fill out their medical histories completely (or honestly) and 2) withhold medications they’re taking so they can get more or because they don’t think it’s important. That’s no bueno. But hey, we’re “just dentists,” right? Wrong.

Classic example—when I was a fairly new practicing dentist (I won’t say how long ago), I brought a patient in to get a simple, periodontally involved tooth extracted. It was so loose, I probably could have flicked it out. I did all the preliminary stuff—blood pressure, reviewed his medical history, etc., and we were good to go. It literally took two seconds to pull that baby, but what happened immediately afterward was like a scene from CSI—blood went everywhere. 

It was a freakish nightmare. I could not get it stopped no matter what I did, so I sent him with a huge wad of gauze to the oral surgeon ASAP (luckily, he had a driver). Come to find out, he had Von Willebrand disease, a bleeding disorder caused by a missing clotting protein. In situations such as this, it can be life threatening. Geez! That would have been good to know! Talk about a pit in my stomach and me questioning everything I ever learned in dental school. Not a good moment in my career, but suffice to say, the patient was okay and became one of my biggest fans up until a few years ago when he passed away. It doesn’t always end like that—you know what I’m talking about, too.

Just recently I had a patient come in with two lower abscessed, grossly carious canines. Exudate and mobility were the name of the game and he was clearly in pain. Health history was fairly insignificant, or so he said on his HH form. He was 55. I prescribed antibiotics and eight hydrocodone (5/325) with instructions to come back to have those teeth (or what was left of them) pulled. Slam dunk.

A week later, I received a call from the pharmacist wanting to talk with me about the script I had given him for the hydrocodone. He was just now getting those filled. Pain must not have been that bad. As an aside—I make it a point to know all of my pharmacists. They are the eyes and ears in many ways, and it’s important to establish a relationship with them. Why? Because we’re a team of health-care providers who should have each other’s backs, especially in instances like this. Anyway, back to my story… she asked, “Ummm, did you know that this patient has two monthly standing scripts given to him by two different doctors that total over 70 of the 10/325 hydrocodone?” I had her clarify. “70?” Yes, I’d heard her correctly. She was as baffled as I was because there was nothing—I mean nothing—in his health history that would indicate a need for that. I told her to not fill my measly eight-tab script and to have the patient call me if there were any issues. He and I were going to have a little chat.

Well, guess what? He conveniently didn’t show up. His reason? He was coughed on by mask-shamers at Walgreens because he wasn’t wearing a mask and he subsequently chose to put himself in house arrest (aka quarantine). You can’t make this stuff up, but then again, these days nothing surprises me.  We’ll see if he calls again to get those teeth pulled because with his Percocet pill box as full as it is, he just might be ok. Oy vey.

The point I’m trying to make is this: we’re not “just dentists.” We’re essential health-care providers who operate in a very specialized area of the body that impacts, and can be impacted by, the entire body system.  Whether a patient has allergies, sensitivities, previous surgeries or illnesses, I want to know about it. Benign or not, simple or complicated, big or small—it’s all important.

Here’s the irony: we hold ourselves to standards of honesty by doing our best every day we walk through our office doors. It’s not unreasonable to expect reciprocation from our patients. Unfortunately, many patients lack a proper understanding of what’s right and what’s in their best interest. Regardless, we, the health-care providers, somehow end up getting the short end of the stick because we’re constantly threatened with litigation, license investigation, suspension, and even revocation. How does that saying go … “The patient is always right”? No, they’re not, but in the eyes of the law and vulture-like attorneys, they are. Am I a bit riled? Yeah, you could say so. I don’t like being involved in situations where patients self-inflict potential injury or harm, or being put in the position of unwittingly contributing to someone’s drug problem because I’ve got a DEA license.

My take-home for you is this: we do our best all day, every day. We train our staff, we ask questions, we pay attention to the red flags, and when patients aren’t honest, we have a chat with them and if need be, dismiss them. I have so many amazing patients in my practice, I don’t have time, nor do I want the headache of dealing with those few who make things ugly. And those are my final thoughts.

Stacey L. Gividen, DDS, a graduate of Marquette University School of Dentistry, is in private practice in Hamilton, Montana. She is a guest lecturer at the University of Montana in the Anatomy and Physiology Department. Dr. Gividen has been the editorial director of Endeavor Business Media’s clinical dental specialties e-newsletter, Breakthrough Clinical, and is now transitioning to her new role as editorial co-director of Chairside Daily. She is a contributing author for DentistryIQPerio-Implant Advisory, and Dental Economics and serves on the Dental Economics editorial advisory board. You may contact her at [email protected].