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I think this story may be useful, not just for dentists, but even people who are not dentists to see the difficulty we face, in managing different situations. Enough time has passed now (it has been years) for me to tell this story, about how I got into difficulty by being an emotional practitioner, who was caught up and breached confidentiality. 

Some years ago, I received a self-referral. (a patient, referring themselves to me) 

I saw the patient initially and they were a reasonable case to proceed, they seemed delighted. I sent an estimate, and all was agreed and accepted. I collected the diagnostic part of the treatment that included models and a CBCT scan and went to proceed with treatment, but the patient had forgotten their cheque book at the time of the diagnostic appointment and had not paid for this part of the treatment, which amounted to some hundreds of pounds. 

After a week or two, one of my staff came to me, to say that surgery was booked, but the patient still had an outstanding account before surgery and was very evasive in contact to receive that account or to offer assurances that would be paid, prior to the surgical appointments. 

I have always had a policy in my practice only to take payment for treatment that is received and in advance, when large laboratory, bills are apparent. 

I trust people to pay their bills and I pay my bills and I think it’s a good reciprocal arrangement. 

I was working at a practice near to where the patient lived when I received a phone call off one of my team telling me that they were concerned about this account, and the up and coming surgery and the dentist I was working with that has asked me what the phone call was for. We got into a discussion about this and it turned out that, that person, knew the patient in question and knew of significant difficulties with un-paid accounts previously related to the individual patient. 

Things started to fall in to place, because the patient in question still had provisional crowns on previous other implants placed (which had not been paid for), for which we had intended to finish treatment for. The patient had told me a story about why they decided not to go back to the individual practitioner for this but, would not give the name of that practitioner. 

So, here I am about to provide very expensive implant surgery for someone who has not paid for their treatment yet, with a practice that has no policy of taking implant surgery costs in advance. 

What to do?  

Should we change our policy for this individual patient? 

I contacted the patient myself by telephone and asked if they would be able to settle the account for the outstanding diagnostic work prior to implant treatment and if they would be able to pay their implant treatment prior to coming in to surgery that day. 

The patient then said, they were having a little bit of difficulty with finance and would they be able to pay after the treatment. 

The telephone call became a little bit emotional and (stupidly) I suggested to the patient that I knew that they’ve had difficulty at a practice elsewhere. 

You can imagine what happened then… All hell broke loose. In the end the patient came to see me and sat down with me in the practice, requesting that I make a small payment to them for wasting their time and for not continuing with the treatment. I gave them their study models and diagnostics and wrote a cheque for about £45.00 and we went our separate ways. 

The alternative was a referral to the General Dental Council for breach of confidentiality. 

I realise I made a mistake here, but we’re on really difficult grounds in health care practices, where we have to take payments from patients. 

I didn’t change the policy for patients at the practice, except for large cases, where we do ask for payment in advance for the surgical phase of treatment. 

We don’t run bad debts in our practice at all, there are almost none and have hardly ever been any, because we work on a high trust basis, but it’s interesting isn’t it? It’s interesting to wonder how you might have handled the situation, had it of been you. 

Blog Post Number- 1985