It's been a long time since I had much to complain about with my employer, but I HAVE to share this:
I had a meeting with the boss today, and he shared with me, among other things, that we were gonna be friends for a long time, because he saved my bacon. Not long ago, I saw a young girl as a hygiene recall. Unbeknownst to me, her father is the owner of a locum tenens staffing company (does dental placement too), and he has a BAD temper. His teenage daughter has a history of bulimia nervosa, and she has had more than half of her teeth restored with composite restorations, most of them (not all) being occlusals or OLs. She had been seeing other docs at the office since 2010, and in that time they had done 2 fillings total on her.
Well, we took a new FMX on her using Dexis, her first digital set, and I don't know what the rest of you think, but digital films done with Dexis catch a LOT more than traditional films often do. Well, I saw TEN different ipx lesions from the FMX and the exam. MOST of them were in the enamel only, but were most if not all the way through, just not visibly into the dentin or DEJ line. Most of them were also tough to see, but all of them were definitely visible on at least 2 films.
It's a big problem when a patient has been in the practice a while and then suddenly you diagnose 10 surfaces of caries, especially if you are a "new" dentist either to the practice, the patient, or both. Well, this dad was IRATE! He took a copy of the xrays and supposedly showed it to 45 different dentists who supposedly ALL diagnosed 1 cavity. He was so mad that he told my boss he was reporting me to the board. My boss talked him out of doing that. He is going to restore 2 of them, and as he does so, if the caries is worse than it looks on the films or worse than he anticipates, he's gonna recommend doing the others. But he thinks I overdiagnosed them too.
I asked to see the films. I made the EXACT same calls I did the first time. I showed him the lesions and said, "You see those lesions, right?"
He said, "I do, but I don't make a big deal out of most of them. I don't overreact. I'll watch most of them and do the first two."
To which I replied, stunned, "On a teenage girl with 10 existing posterior restorations and a history of bulimia nervosa? And a total of 10 ipx lesions on the radiographs? You still watch those? You are trying to be nice, because he is a friend of yours. But I would argue that telling them the truth is the nicest thing you could do for a girl like his, and quite honestly, I would rather him not take me before the board, but if he did, I'd be more than happy to defend this one."
It's frustrating to be the one looking at the complete picture and doing what is right and being accused of overtreatment. You can look really bad if you work amongst others who ignore disease, even when they see it! It's also frustrating when doctors see the holes as the problem and not the conditions that CAUSED the holes in the first place. There is a cost to do right.
I'll try to post the FMX when I can so I can get your opinions. Don't have them yet. Sorry for the vent, but that meeting didn't go how I expected.
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David R. Boag, DDS
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