Yours Toothfully by Dr Chan Joon Yee

Romeo and Juliet died for each other. Though we know that it’s fiction, there are many real life examples of star-crossed lovers who have committed suicide because they couldn’t be together. Even in today’s “duty free” (and guilty free) society, we still come across the occasional teenager who kills himself or herself because, like Juliet, their only love sprang from their only hate.

The beauty of Romeo & Juliet (one of my favourite plays) is that the story ends when the lovers are dead. They were young, beautiful and very much in love. Today’s Capulets and Montagues, however, have a lot less influence over their children’s love lives. They can object, they can scold, they can even threaten. The modern Romeo and Juliet can ignore all the real and imagined obstacles in the tortuous path of their true love and just elope with some help from a budget airline.

A few years later, the once “ready to die for each other” couple are no longer fighting their parents. Instead, they are fighting over the house and the children. Yes. Divorce. This sort of twist in the plot can break the necks of those watching the drama unfold from Day 1; the people who have wept for the couple; those who gave them moral support when they faced disapproving glances from every direction. Now, the audience feels like it has wasted all its tears. What on earth happened?

The most witty cynic the world has known, Oscar Wilde, once said that every woman is a rebel, and usually in wild revolt against herself. Sure, Wilde was a homosexual who had something against women, but for argument sake, does the modern Juliet somehow deliberately go for a man her parents would object to because she is a rebel at heart? Then, when the fight with her parents is over, she turns her attention to her husband? It’s a chilling thought, but not a totally implausible one.

Then, on the virtual streets of Verona, Romeo opens the scene nursing his heart which was wounded by one Rosalind - the woman her loved so deeply before he met Juliet. Aha! With nasty things like the internet and online dating, could the modern Romeo still have time to cry over a failed romance when the next target could be just a click away? And with even nastier things like fast food and travelators, can the modern Juliet remain beautiful even after Romeo has grown into a dirty old man?

The questions just pile up when we think about it. Undying love is really a difficult thing to vow to nowadays even though you may think that you are ready to die for each other when the whole world is against you. Once this fight is over, another may start. Keep your necks braced for more twists in the tale.

Everyone who can read this must remember the time of film cameras, negatives and 3R prints that could cost 40 cents each. You had to bring your roll of film to the studio for processing and wait a week. Then, as more and more people could aford cameras, tiny photo-developing booths/kiosks took over the job of the studios. Processing could take just one day, then 20 minutes. I remember getting receipts from these booths that said: “Goods not collected within 6 months will be discarded”. Which is fair, considering the lack of space in the tiny little booth.

Many people don’t realise that dental clinics have their fair share of “trash” in the form of plaster models. Once the dentures, crowns or bridges are completed, these models are practically useless. The more patients we see, the faster they pile up. If we were to keep all these models from day 1, we would need to rent a warehouse to store them.

So what happens to dentures that are not collected? We call up the patient to remind them. But we can’t keep reminding them, can we? Of course not. We have better things to do. But what if the patient turns up 2 years after the denture was first made expects to collect it? You may have guessed it by now, we had one like that just a week ago.

If I were in that patient’s shoes, I would feel nervous, apologetic with only the faintest hope that the dentures will still be around. But as you may have guessed it again, this patient was angry and demanding. Insisting denture or refund of deposit. But what do people understand by deposit? Isn’t it something to protect the business in case the patient/customer abscorns, abandons treatment or dies halfway? Unfortunately, many seemingly educated Singaporeans refuse to acknowledge the fact that they have been irresponsible. They cannot blame the clinic for discarding their uncollected dentures and forfeiting the deposit.

“But I have already paid! But I have already paid!”

“We reminded you to collect your dentures. You didn’t respond”
“I was busy what”

How to make them understand? Perhaps they do understand. Could it be that just because they didn’t need or want the new denture back then and suddenly decided 2 years later that they wanted it? Yes. They could make the denture first, pay only half the fees as deposit and then collect their dentures when they are “ready”.

Isn’t it amazing the kind of service some of our patients expect us to provide? How do we manage this sort of cases? Charge them for storage?

It’s been a long while since I wrote anything about alamak patients. In fact, the following page is hardly accessed nowadays:

http://www.hougangdental.com/alamak

Moving to town really did the trick. With much fewer alamak patients to deal with, I can concentrate on providing a higher standard of treatment. But, as they all say, nothing is perfect. I soon had my first encounter with a super alamak patient at Lucky Plaza.

She’s an old lady in her 60s asking for implants to be done on the lower jaw. She had 2 standing teeth that needed extraction and I suggested a lower full arch immediate loading with 6 implants. On the first appointment, she was haggling like a Jew, asking for various charges to be absorbed by the clinic. As she was recommended by one of my A1 patients, I relented and gave her a very friendly, heavily-discounted package deal.

On the day of the surgery, I discovered that the patient’s bone was particularly dense. As a result, the xray did not show her mandibular canal very clear. Noting the position of her mental nerve upon dissection, I judged the position of her mandibular canal to be much closer to the surface than what the xray might suggest. I decided to abort the placement of implants in the molar region to avoid damage to her inferior alveolar nerve. The end result, we only managed to place 4 implants. With fewer implants and an even narrower profit margin, I was already finding it difficult to absorb the miscellaneous charges which totalled to well over $1000. The patient, however, insisted on the same number of teeth I had planned before. After a brief discussion, we agreed on a $4000 discount.

At the reception counter, she and her daughter suddenly turned around and said that they couldn’t understand why it was a $4000 discount and not a $6000 discount. Even though I was busy with another patient then, I thought the dispute was a minor issue and the patient would pay up some deposit and discuss the final amount on our future appointments.

Increadibly, they refused to pay anything and walked off with thousands of dollars worth of components in the old lady’s mouth! I quickly sent them a letter demanding at least a partial payment and informing them that I would not treat uncooperative patients. Guess what the response was. The patient’s daughter (it’s not her in the picture) demanded for a full disclosure of all every item I was charging them for.

That’s a second slap on the face. One moment, I was giving way to their bargaining and absorbing charges here and there and the next moment they are asking for full disclosure. Well, if they wanted full disclosure, I could always give them full disclosure. This would mean charging them for the extractions, the medication, the facilities, the expendable items, the disposable instruments …. ending up with a very “transparent” bill that is way larger than the friendly, discounted package that didn’t itemise the bill.

The most devastating effect of such “full disclosure” and “transparency” is that they completely destroy the trust and friendly relationship between patient and doctor. Our patient’s daughter seemed to have adopted all government recommendations without looking deeper into the more subtle aspects of human relationships.

Seeing a complete breakdown in trust and cooperation (not to mention the unacceptable financial risk the clinic is taking without collecting any substantial deposit from them), I decided to terminate the case and refer the patient to a dentist of their choice.

So when the patient turned up for review, I issued a notice of termination and invoice to them. Guess what. The patient’s daughter (the old lady has been rather passive) still refused to pay up unless I retracted my notice of termination! I asked my assistant to tell them that I would only review the case if they have paid up the cost of treatment already done. No deal. This tough lady wanted me to see her mother and continue the case before she would pay a single cent without appreciating the fact that there was already thousands of dollars worth of treatment in her mother’s mouth. Maybe she did appreciate it but just felt that she had to win completely.

I called security to make sure that they wouldn’t leave without paying. The deadlock was finally broken when the old lady relented. We finally received our long overdue payment and I agreed to follow up on her case untill the completion of the bridge. Of course, I would demand for full payment before I issue the final bridge in 2-3 months’ time. No more Dr Nice Guy for these folks.