Compassion or Foolishness: The Obligation to Treat Everyone

By nature, dentists are compassionate professionals who feel an obligation to deliver dental treatment to everyone. In this guest post, Kerrspeak founder Dr. Wayne Kerr draws from 40 years of experience to tell us why it's okay to question this instinct.

A workshop scenario that I often present is one most of us have experienced: the emergency patient who refuses a diagnostic radiograph. After asking the question, “How do you handle this objection?” the answer is amazingly predictable. Workshop attendees immediately suggest that, by educating the patient on how safe the radiation is, the patient will agree to having the X-ray! Yeah, right!

But since we’re such compassionate caregivers, eventually someone offers the suggestion that we proceed with dental treatment without the radiograph because the patient is in pain. That it’s our responsibility to help them. Really?

According to CNA’s Dental Professional Liability Guide, “A reasonable and prudent dentist should decline to treat any patient who refuses necessary diagnostic radiographs.” And the ADA’s publication Frequently Asked Legal Questions states that, “Obtaining informed refusal does not release the dentist from the responsibility of providing standard of care.”

Why do we feel an obligation to treat everyone who walks through our door?

In other words, this management issue is clearly “My Way or the Highway,” as far as I’m concerned. And I’ve certainly dismissed more than one new patient without dental treatment over this very scenario.

Which brings me to my next point: why do we feel an obligation to treat everyone who walks through our door? I’ll never forget the morning I entered an operatory to greet a new patient. As I introduced myself, he angrily said, “You’re one minute late!” I responded by apologizing to him, and then advised him that I couldn’t be his dentist because I was never on time. Then I thanked him for coming and walked out of the operatory.

I don’t know about you, but I don’t care to spend time with folks like that.

After graduating Emory’s School of Dentistry in 1978, I was invited by Dr. Schaffer to work with the seniors in the removable prosthetics department each Friday. It was a great privilege, a lot of fun, and I learned a great deal. Soon, I received the referrals of denture patients from others in my community. One day, a gentleman appointed for a consultation presented me with a paper bag full of dentures. One by one, he proceeded to tell me precisely what was wrong with each set: this lateral incisor was poorly aligned, this cuspid was rotated, or these centrals were too small.

After listening to him talk non-stop for half an hour, I interrupted to say, “Wow! You know a lot more about dentures than I do! Sorry, I can’t help! ‘Bye!”

Why do we continue to tolerate abusive patients when we clearly have the legal option of terminating the doctor-patient relationship? We’ve all sat through a morning huddle and acknowledged the sinking feeling in the pit of our stomach when we see Mrs. Assertive's name on the day’s schedule.

We deserve the opportunity to embrace each day with joy and satisfaction in serving others

Why do we serve her, and then reappoint her for preventive care? Instead, why don’t we take the appropriate steps to dismiss her from our practice?

Then there’s the issue of dealing with a less-than-optimal employee. We can counsel, advise, educate, correct, chide, cajole and support to the nth degree, but ultimately must recognize and accept that some people simply suck the energy out of everyone and everything. They are destructive to our practice, our person, and our culture.

I’m reminded of the time I advised my (remaining) teammates early one morning that I had fired a coworker the night before. I anticipated rebellion and unhappiness as they would now be responsible for the additional workload. Imagine my surprise when everyone smiled and then screamed with delight! We had a group hug, a group cry, and a group happy dance. Clearly, I had no idea how toxic this person had become!

Compassionate care givers we are, but we don’t need to be foolish in the process. Dentistry may be our calling and commitment, but not all who seek our care or employment are worthy of our time and expertise. We, as a team, work far too hard every day to meet the needs of others. Serving our patients or working with negative people should not unnecessarily expose us to litigation. Nor should it leave us physically and emotionally spent at the end of each day.

In the end, it’s our practice, and we deserve the opportunity to embrace each day with joy and the anticipation of satisfaction in serving others. Be compassionate, of course, but don’t be foolish. Life is too short.

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