Dr Phillip Palmer, February 2007 - Many years ago, when I found a house that I wanted to raise my family in, I approached a good friend who was an architect, with the request that he design a fairly major renovation. After some time he came back with a design that I wasn’t happy with. So he went away and came back with revised plans – that I still didn’t like. After his third attempt still wasn’t satisfactory, I went to another architect that I had heard of but who I didn’t know socially. He designed a more expensive renovation that I liked and decided to use.
When I went back to my friend and told him I would be using someone else he was obviously disappointed and asked if he could see the new plan. On seeing the design, he was perplexed; he said ‘but Phillip, this will cost you much more than my design, I was trying to save you money.’ My friend thought he had acted with my best interests at heart and that my actions were the equivalent to a slap in the face for his good intentions. Our friendship eventually recovered but only after many years of being strained.
As dentists we sometimes fall into the same trap with our friends who are also patients. We often try to ‘be a friend’ to them and in doing so, we often actually do not act in their best interests.
Fees
Knowing what we know about our friend’s financial situation, many dentists will pre-judge the amount that our friend wants to spend on treatment and diagnose accordingly (that is exactly what my architect friend did with me).
Once, a friend came to me for the first time, as an emergency with a molar broken off with only 1 cusp left in situ.
If the patient had been Joe Public, I would have immediately suggested an indirect procedure. However, I was so conscious of my friend’s supposed financial state that I attempted a pin buildup with amalgam. It failed the next day. He subsequently requested his x rays be sent on to another dentist, who was going to do a crown- a solution I hadn’t offered due to my perception of his financial state.
Horrifyingly from my perspective, I was the ‘not so good’ dentist whose work didn’t last.
It is important to realise that:
Clinically
From time to time when I diagnosed treatment that I would normally have referred out, friends and family of mine would often ask if I could do it. Maybe it was because they trusted me. Maybe it was because they knew that I wouldn’t charge them as much as a specialist would. Whatever the reason for it, every now and then I would allow myself to be manipulated into saying “yes” and I would always regret it.
The reason I referred out that type of work in the first place was that I knew someone else could do it better. Why would I want my friends or family to have the benefit of my inexperienced specialist work when I didn’t think it was good enough for strangers. It really isn’t in anyone’s interests.
Other dentists as patients
By far the worst scenario where dentists treat and diagnose friends differently is with other health professionals, including other dentists. Dentists will come in with a self diagnosed condition asking you to do what they have decided was necessary.
As a patient, I know I once went into an endodontist friend’s surgery asking for a root canal to be done on my agonizing upper 2nd premolar. I had had a buildup of pain for about 10 days and had diagnosed what was obvious. Despite his warnings that he didn’t think it was the right tooth, I insisted.
After the root canal was finished the pain remained and it was later diagnosed (by an ENT surgeon) as a sinus infection. I had myself manipulated my endodontist to the eventual chagrin of both of us. I had forced my endodontist friend into an abnormal professional relationship with his patient-me!
The only solution with seeing friends professionally is to treat them like you would anyone else. Our relationships with our patients need to be as professional as possible and nothing should be allowed to cloud them. Especially not friends! We owe them more than that.
[Published in Australasian Dental Practice Magazine, March/April 2007]