Mr. J is a patient of mine from Nepal - he is 43 years old. He has a history of Beetle Nut chewing - a habit common in that region of the world. My initial thought process was to take the photos and create the awareness. I saw him yesterday after I have been looking at these photos for the past 6 months. I brought them out during his recall visit. He has responded well to SRP and his numbers are stable. I shared this good news with him. Then I showed him the photos (again) with purpose - asking him permission if I could share some thoughts. I shared with him that I am concerned what will happen if he doesn't address the obvious wear on his teeth. After the usual back n' forth about wear - I don't chew beetle nut anymore - will this get worse - how many teeth need to be addressed - what will it cost? - I stated " I don't know. This is when I start a conversation about my specialists or (my team) and getting different opinions so we can start to get and Idea on how to "solve" this puzzle. I stopped here after the patient had left. I called the orthodontist (who is in my study club) said I would be sending some pictures over for his thoughts.

Usually as these cases progress to the ultimate decision to treat or not to - I find that I get caught up in the day to day running of the practice and I put complex cases on the back burner - then - when things slow down I get frantic that my schedule is not full and start to become more focused. Today is one of those slow days. What is missing from my discussions with patients is what could the final result LOOK LIKE. I need to use the case assistant more in my presentations to patients - but I find that most times (when I do) the patient has a hard time digesting the information - Why this is happening ( patients usually deny or seem perplexed) How can it be treated ( they look for quick fixes or don't want "crowns/caps" ) How much it will cost etc - What I have learned over the last few years is to listen, advise and allow the patient to own their condition. The things that bog me down are making it affordable to the patient - while not compromising or me feeling like I'm wasting my time and effort. How do you phase something like this. What should I charge for each segment of the process if we are phasing the case. It's hard for me to break it all down into manageable steps - especially since this gentlemen that I'm showing today could be an orthognathic case.

So my question is..... what are folks thoughts on how they approach a complex case. I'm interested in what the conversation would be like and what works well during the process of discovery and financing. Those delicate times when good financial systems and verbal skills are key. I tend to get tongue tied.

Brad

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