Orthotown November 2015 - (Page 14)

practice management // message board What Do You Do When You Just Need to Bail Out on a Case? Townie asks for advice on how to deal with a patient whose treatment isn't going well. Orthotown.com > Message Boards > Clinical Topics > Clinical Orthodontics > What Do You Do When You Just Need To Bail Out On A Case? Str8edge Member Since: 07/17/11 Post: 1 of 7 Related Message Boards How Would You Handle Transfer from General Dentist? Handle Transfer Mean Mom: Standing Firm Mean Mom I've got this case (mid-20s female) going on in which I am just not happy with the way it is going, and I have pretty much accepted that this case is not going to turn out very well. Now I am trying to decide what to do next. There is blame to go around on both sides. In retrospect, my treatment plan was too ambitious (attempting non-surgical partial correction on an extremely gummy, vertical CL 2 open bite using TADs). I feel like I have hit the wall on this case and will not really be able to get it much better without surgery, and surgery is definitely not an option. I had recently attended a lecture where somebody showed an amazing, somewhat similar TADs case and I came back all confident, but it is just not progressing anymore and we are 2.5 years in. I told her at the beginning that she was a surgical case, and that this plan was definitely a compromise and wouldn't be ideal, but honestly I thought I would be able to achieve a better result than I have. The other side of the story is that the patient has been very unreliable and has had very poor OH. She is also delinquent on her account, which is usually consistent with missed appointments. I have a fairly high TADs success rate but for some reason her TADs keep failing, despite my trying different approaches. Of course, they have been in much longer than anticipated. On a positive note, the patient has been a nice and reasonable person so far and has accepted responsibility for her poor attendance and hygiene and always says she will do better. The other good part is that while this will definitely not be a result I will ever be proud of, I have at least made some improvements and haven't made anything worse! I have pretty much decided that we need to just bail out pretty soon before wasting more time and prolonging things. This is one of those cases that is causing some stress as well! I would like some advice on how you would handle a situation like this. Since her account is delinquent, I am tempted to just offer her a full refund because I do feel guilty that I was not able to deliver what I thought I could deliver, but I am a little concerned how that would come off in terms of liability. I'm not worried about the financial impact. I am also trying to formulate the right tone and wording for how I deliver this news and the appropriate way to cover my liability. I could post the case if people are interested but at this point I feel it's more about how to handle this unfortunate situation than the case itself. Any advice or commentary welcome. Thank you! ■ AUG 18 2015 drmac Member Since: 01/18/10 Post: 2 of 7 When in doubt, tell the truth. Set up a consult appointment, update all her records, sit down with her and review her treatment progress with her. Tell her what has progressed well (alignment) and what hasn't progressed as much as you thought it would (from lack of care on her part, her biological response, or the mechanics that were used ... it just isn't working). Then help her make the decision that is best for her, whether that is to redefine the treatment goals (head to surgery) or call it done. You will both feel better once the decision is made. ■ AUG 18 2015 14 NOVEMBER 2015 // orthotown.com http://www.Orthotown.com http://www.orthotown.com/MessageBoard/thread.aspx?a=11&s=6&f=693&t=171243&g=1 http://www.orthotown.com/MessageBoard/thread.aspx?a=11&s=6&f=731&t=234937&g=1 http://www.orthotown.com

Table of Contents for the Digital Edition of Orthotown November 2015

Orthotown.com Highlights
Embrace Progress: Congratulations, You’re Just an Orthodontist
What Do You Do When You Just Need to Bail Out on a Case?
How Would You Treat Non-Surgically?
Progressive Smile Design: Changing the Shape of Cosmetic Dentistry
Equip the Operatory— Not the Junk Drawer
The Five Key Components to Team Synergy
What’s On Your Tray? Cementation
Product Profi le: Burleson Seminars
How Pro-Bono Work Can Increase Your Sales
Effective Treatment of Class II Deep Bite in Adult Cases
Poll
A Fast-Track Guide to Selecting the Best Wires
The Airway, Breathing and Orthodontics
Imaging Guide
Ad Index

Orthotown November 2015