We spoke in detail about transfer patients from out of town on Sunday and based on the response I wanted to discuss transfer cases from other orthodontists in the same town. In town transfers are probably an even more emotionally charged subject than out of town transfers and the strength of the feelings and opinions belies the importance of this topic.
- “I won’t take in town transfers”
- “I send them back to their orthodontist”
- “They probably are behind on their payments”
- “I don’t want a trouble maker in my practice”
The above are but a few of the derogatory statements I hear from orthodontists when discussing patients who want to move to them from another orthodontist in town. If you look at these comments you can detect several assumptions made by these statements individually and as a group.
- The patient is obviously the problem
- The orthodontist is not at fault
- I don’t want to meddle in another orthodontist’s case, not because I care about the other orthodontist, but because I would be offended if they meddled in my case
- Patients who question the orthodontist are bad
- It can’t be the orthodontist who is at fault (yes, this is repetitive but so is the thinking behind it!)
There are a multitude of problems caused by our prejudicial mindset and this mindset is shared by the vast majority of orthodontists. These assumptions go unquestioned and orthodontists almost universally agree that the patients are the problem. It’s always a good idea to question anything orthodontists all agree upon. Based on my experience, let me share a few common threads and recurring issues I’ve seen when it comes to in town transfer patients:
- Sometimes the patient is behind on payments or noncompliant. This happens probably ¼ of the time so it is always a good idea to talk to the orthodontist who is treating the patient and find out the scoop. Most orthodontists assume delinquency is the case 100% of the time but that’s not realistic or logical, though it is convenient for our egos.
- Sometimes people just don’t get along. The patient can be doing their job and the orthodontist can be doing theirs but it still may not work out. This seems to be the case in about ¼ of the in town transfer cases. In these cases, the patients and the orthodontists both need an outlet and a change. You can help them both!
- Sometimes the orthodontist is unreasonable and/or takes a dislike to a given patient or parent for no good reason. This happens about ¼ of the time. I’m always shocked when it happens but, when present, this situation becomes readily apparent when you call the original orthodontist if you let them do the talking.
- Sometimes the patient or parent is unreasonable and places unrealistic demands on the orthodontist in terms of treatment, time, convenience, attention, etc. I know we would like to think this happens more often but it’s the cause of an in town transfer about ¼ of the time just like the rest of the major issues.
- I’ve also seen countless variations of all these causes combined with hygiene issues, attitude problems, family issues or tragedies, and/or freak occurrences on both both sides of the orthodontist/patient equation.
- I’ve been party to each and every one of these issues and had patients leave my practice because of every single one of them. I am as human as anyone and can lose sight of the big picture just as everyone can.
The point is that assuming the patient is in the wrong and the orthodontist is in the right whenever you see an in town transfer is wrongheaded, egotistical groupthink that has been perpetuated in orthodontics for generations. This mindset is bad for us and bad for patients.
So What Can We Do About It?
Each and every one of us can practice in the way we see fit. That’s the beauty of what we do. However, if I may be so bold, I would like to suggest a few things to help us handle in town transfer cases more effectively.
- Agree to see each and every patient who calls your office wanting to transfer or wanting a second opinion. Even if they are from another orthodontist in town. Encourage the other orthodontists in your area to do the same. It is far better to get resolution with the assistance of a peer than to force a patient to call the state board or a lawyer because they have no other option. If you don’t know the orthodontists in your area make a point to meet them.
- Take a full set of records before you see the patient or call anyone.
- Before you call the original orthodontist, meet with the patient and ask open ended but neutral questions questions like, “What can I do for you today?” or “What can I help you with?” Don’t start off with things like “What are you worried about?” or “Why are you unhappy?”. The patient will tell you what is on their mind. Don’t put your prejudices into their heads.
- Do what you can to get the patient to talk and do your best to let them do most of the talking while you listen and take notes.
- Ask the patient for permission to call the treating orthodontist to discuss the case with them. Patients/parents almost always will give permission. If they don’t then that is a cause for concern for me and if they persist in that position, I’ll probably send them on their way and refuse treatment.
- With the full set or records and your notes in front of you, call the treating orthodontist and start off by saying something like, “I’ve got ______________ here and they are concerned about ___________. I told them that you are a solid person and orthodontists and that I knew you would want to hear about this and find resolution. This kind of thing happens to all of us from time to time so I’m hoping I can help you with this case because I’m sure I’ll need your help next week or next month…” And then be quiet and let the treating orthodontist talk. Use open ended statements/questions like “Tell me more” and “I understand” and “How do you think we should proceed?” and allow the treating orthodontist to do most of the talking while you take notes.
- Based on what you hear, decide what you think the issue is (reference the reasons for in town transfers above or create your own list). Unless it is obvious what you want to do, I would tell the original orthodontist that you will call them back at the end of the day to discuss options. This can be an emotional situation for orthodontists so time is your friend.
- If it is apparent that the patient is being non-compliant, unreasonable or not paying their bill then you can discuss what you want to do with the original orthodontist – sending them back or taking over the case or whatever. You will want up-front payment for your work if it’s a payment issue without good reason. You may opt not to treat the patient. You may refer them back to the original orthodontist. OR, you might consider removing the braces at no charge and taking final records for the original orthodontist if this is something that’s been going on for some time. Resolution in these cases is a blessing for all involved. I do this often and it seems to make most people happy though I’ve had a few orthodontists get upset and say “You shouldn’t take the braces off. I won’t take the braces off until they pay what they owe me…” **I hope that those of you reading here recognize that this is an unacceptable position for an orthodontist to take. Holding people hostage for payment is unethical at best.**
- If you decide the orthodontist is being unreasonable or that the patient and the orthodontist are doing their best but just can’t get along then it’s probably best if you take over the case. You can certainly charge for doing so but I would suggest a different tactic. In cases like this I will often finish the case for free and tell the original orthodontist that I’m happy to do so and that they should keep the money they were paid and cancel the patient’s account. I make it clear that it’s my pleasure to treat the case and that I’ll send final records to the original orthodontist when I’m done. I repeat something like, “This kind of thing happens to us all from time to time so I’m happy to help out because I know I’ll need help in the future.”
Yes, yes, you are correct. Some orthodontists don’t get it and will not return the favor when one of your patients seeks them out. Yes, some orthodontists will get indignant and upset when you agree to see their patient. Yes, some other orthodontists will badmouth you when your patient goes to see them. The problem is that you can’t control any of that. All you can control is you and the way you act. Someone has to be first. Someone has to set the example. Someone has to be brave enough to put the patient first. Why not you?
We desperately need to change the way we orthodontists interact with one another and with our patients when it comes to transfers – in town or out. To do otherwise is folly. As it stands now, pride, ego and machismo rule the day when it comes to transfers of any sort and that is not good for the profession or patients. Do you have the guts to be different? Are you willing to put the needs of patients above your ego? I hope so. I hope we all, or at least most of us, are willing to do so. Otherwise, what’s the point?