Return Of The Alamak Patient
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.
