Do All New Dental Patients Need X-Rays What if Your Patient Refuses - The Dental Practice Fixers

Do All New Dental Patients Need X-Rays What if Your Patient Refuses

By May 10, 2019Uncategorized

A new patient comes into your office and one of the first things she says is “I don’t want x-rays!” When questioned why not, the reason is that she simply feels that she does not need them, nor does she want the radiation. What would YOU do?  This is a question that we received, so please listen in to what Dr. Richard Madow and Dr. David Madow have to say. Then of course we do the call of the week. Since we are on this topic, we call an office asking if we could come in as a new patient and not have any radiographs taken. Listen in to see how they handle it! If you have a question that you would like answered on our podcast, please send it in to podcast@madow.com. We will do our best to get yours answered!


Do All New Dental Patients Need X-Rays What if Your Patient Refuses

Female Voice: The Dental Practice Fixers Podcast is brought to you by the Madow Center for Dental Practice Success. To find out how we can help increase the success of your practice, check out madow.com or call us at 1-800-258-0060.
 [music playing]
 Dr. David Madow: A new patient is in your chair. Everything seems great, although they say I do not want any x-rays. What do you do? We’re going to answer that in Episode 12 of the Dental Practice Fixers. Welcome, welcome, welcome. I am Dr. David Madow, along with…
 Dr. Richard Madow: Dr. Richard Madow, your co-host and fellow Dental Practice Fixer. Thanks so much everybody for being with us today. And thanks most of all for all your great comments about the Dental Practice Fixers, and going on iTunes and giving us a good rating. Feel free to do that all you like and tell your friends. Most of all, send us your questions. It may just wind up on an episode of the Dental Practice Fixers. We’ve got a great question for Episode 12. I’m just going to get right down to it. And here’s our question for today. It says, Dental Practice Fixers, I had a new patient recently. A young woman who absolutely refused to have radiographs taken. She assured me that she was not pregnant. No way in hell was her exact phrase. No way in hell. She didn’t believe in x-rays. She felt they could be dangerous and didn’t want them; she wasn’t having any problems. If her dental condition was 100% immaculate, I could maybe have let it slide. But she did have two crowns, a few restorations and mild gingivitis. I loved that. Mild.
 Dr. David Madow: Little mild gingivitis. Very mild.
 Dr. Richard Madow: Garden variety gingivitis. I told her I could not see her as a patient without x-rays, and she raised a big fuss and walked out. Loved that. Could this have been handled differently? From Dr. Amy in Aurora. Dr. Amy in Aurora, we don’t know if that’s Aurora, Illinois, Aurora, Colorado. Maybe there’s some other Auroras out there, but it doesn’t matter Dr. Amy. Great question. So after that whole scenario, let’s start by her main question and see where it goes. And that is could this have been handled differently? What do you think?
 Dr. David Madow: I’ll tell you something, from what Dr. Amy in Aurora…
 Dr. Richard Madow: Dr. Amy in Aurora or is it Dr. Aurora in Amy.
 Dr. David Madow: It could be Aurora – maybe Aurora Borealis?
 Dr. Richard Madow: Maybe Aurora Miracle. 
 Dr. David Madow: Maybe. I know it’s always limited because when somebody’s writing in a question, they don’t write a whole dissertation. They don’t know everything. But from what I heard in the questions; Rich I think she handled it right. I mean could she have tweaked the language a little bit, could she have done something? Maybe. But here’s what I’m going to say, and maybe we’re not this deep into it yet. But I’ve got a general feeling and I’ve got to let this out. I’ve got to let it out. 
 Dr. Richard Madow: Hold on, go ahead. 
 Dr. David Madow: Generally, generally speaking, a patient like this that just refuses x-rays because they say they’re dangerous. I think a patient like that is going to be trouble all along, I think, and she absolutely refused even after some education, you’re going to keep them in the practice. I’m not so sure.
 Dr. Richard Madow: Well I think that’s a really good point. And that’s the main point in this as well. And that is if a patient is trying to tell you what to do, they’re dictating how you do your diagnosis, how you treat them or whatever. Is this patient right for your practice? We’ll get to that. But I think the sidebar is, did Dr. Amy do anything to try to inform this patient? Some would say educate, that these days x-rays are incredibly not harmful. If she didn’t, she should say we use digital x-rays. It’s not like the old days. The amount of radiation is insignificant and without them, there could be cavities under that crown you have and if we don’t find those cavities, that can lead to much worse problems including a root canal or an extraction. And that’s why we like to do x-rays. That’s why we require x-rays, whatever. Could Amy have done a little more? We’re not sure about that because she’s not on the show with us today. But the way this question is phrased, it seemed like she just said, okay you don’t want x-rays, get the hell out of here. So I’m not so sure I’m a big fan of… 
 Dr. David Madow: Well again, yeah we’re not sure to the extent of what Dr. Amy did. But I think when we read a question like this and we’re only limited to the information, a lot of times we just have to go on our gut feeling. And my gut feeling, again just from what you said, is that this patient is a nutcase. And even if Dr. Amy would have explained more and more. Like, okay there’s not as much – there’s not nearly as much radiation with digital radiographs as it was in the past. I think this patient; she comes in as she’s dictating how Dr. Amy needs to do her treatment or diagnosis and treatment. I say get rid of her. If you’re a busy practice, you don’t even need to take every patient. And why deal with a nutcase that’s going to be probably problems all along when you’ve got so many good patients that are going listen to you and do what you recommend. That’s my feeling. 
 Dr. Richard Madow: A nutcase.
 Dr. David Madow: Yeah I’m going out on a limb saying this patient sounds like a nutcase. 
 Dr. Richard Madow: And so she’s an antivaxxer or a flat Earther or something.
 Dr. David Madow: So get rid of her. Get rid of her. Now look, there might be people listening to this show that don’t care if they take radiographs on a patient or not. I’m not saying that’s good, but if you don’t care and if you want to set yourself up for potential problems, then see her. But if you’ve got a good practice and you really try to diagnose properly and do the right thing. And you got somebody that comes in and telling you what to do, then what else is she going to want? There’s probably some material or some kind of impression or something that you – I don’t want that either. I think get rid of her. 
 Dr. Richard Madow: Okay that leads to two questions now. So I hope I remember both. One is I know some practices have the refusal to have x-rays for them and they say, okay well we really recommend them. If you don’t want them, you need to sign this and then we’ll go ahead and treat you. I am not a fan of that. I think that can come back to haunt you in so many ways. First of all, I think that you would get killed in court if you treat a patient…
 Dr. David Madow: Absolutely.
 Dr. Richard Madow: They’re going to have – a fantastic lawyer. I think that’s a mistake. It’s almost like saying I give you permission not to do what you need to do. Does that really count? I don’t think it counts. In a court of law, I think you’re really hanging on iffy ground there. So, now that leads to some more issues. What if you recommend treatment for patient if they say, well I don’t like that. Is there any other way to do it differently? Can you do that more cheaply? Can you only do what my insurance covers? Now we’re still talking about a patient dictating treatment here. 
 Dr. David Madow: I agree. That’s why I said, I don’t have a good feeling about this patient at all. And I still go back to what I said originally. If you’ve got a decent practice and you’ve got other patients coming in that are going to listen to you and agree and be reasonable, then those are the kind of patients you want to see all day long. And these patients that are refusing this and that and making you change your philosophy; we don’t need patients like that. I mean, Rich you and I have been preaching for a long time about how to have a more successful, a busier practice, yeah teaching, preaching, whatever. Forget the semantics, you know what I mean. I think dentists for some reason, feel that they need – a lot of dentists feel that they need to take everybody that walks in that door. I don’t feel that way.
 Dr. Richard Madow: Well I don’t either. I think that’s one of the big lessons as well. I feel like I’m saying this all the time. So maybe this is preaching: we are not obligated to see every single patient. Unless somebody is bleeding, swollen and in severe pain. That’s our debt to society, to take care of these people. In my opinion, I think you agree, whether they can pay or not. If somebody comes in and they’re bleeding or in horrible pain. It’s great to be able to help someone like that. But what about some grey areas? What if a patient has got a really destroyed tooth, missing a lot of structures? It’s just a mess. We’ve seen all these before, and we want to do a crown and we recommend a crown and the patient said can you just do a filling? Well, we could do a large filling. It might not last, it might not be a good restoration, it could cause bigger problems in the future. It’s than better than nothing. Is this patient now dictating treatment?
 Dr. David Madow: That’s a great question. I would feel better with something like that as long as if it’s a purely financial thing and they just can’t afford a crown but something needs to be done. And they’ve realized it’s not ideal treatment and you’re telling them, you’re educating; you’re documenting everything. I feel better with that because that patient is really not trying to – the way I look at it they’re not really dictating treatment. They’re just saying, hey I can’t afford the Cadillac, give me the Buick or something like that. 
 Dr. Richard Madow: But a filling is not a Buick, Tom.
 Dr. David Madow: It’s not a Buick, okay give me the Chevrolet Chevette.
 Dr. Richard Madow: Ford Pinto, is that where we’re going here? 
 Dr. David Madow: Hey I loved those Pintos, they’re great. 
 Dr. Richard Madow: Yeah I loved those Pinto Station Wagons. I know in California it seems to be very in to restore some of those cars like a beautifully restored Ford Maverick or a Pinto Wagon.
 Dr. David Madow: How about the Mavericks with like the real big bumpers? That was…
 Dr. Richard Madow: Oh yeah the JS model. 
 Dr. David Madow: It’s 1974 JS. 
 Dr. Richard Madow: They must be maintenance nightmares though and they don’t have the safety features of modern cars, but they look cool.
 Dr. David Madow: They look cool. But I feel that it was somewhere like that and they’re going into it. No, okay. I mean, you’re not doing anything – okay let’s face it. I don’t think there’s anything – there’s no malpractice there if you’re telling your patient they need a crown but you’re going to attempt the large filling. I don’t think it’s malpractice. 
 Dr. Richard Madow: I think if it leads to a root fracture, they lose they the tooth. 
 Dr. David Madow: I don’t think it’s in the same league as just saying, okay we won’t do radiographs. I don’t think it’s in the same league. 
 Dr. Richard Madow: Well I think one of the big differences is treatment versus diagnosis. And if somebody refuses radiographs, you can’t even do your proper diagnosis. So maybe that’s a line that could be drawn, kind of a demarcation there. Treatment – if you inform the patient of the best treatment they can get and they want some compromise, maybe you can learn to make that choice. I’m not a big fan of it, but maybe you can do that. When it comes to diagnosis, draw the line.
 Dr. David Madow: Agree. I would. And bottom line, I’d kick that woman out of the practice so fast. It wouldn’t be funny. 
 Dr. Richard Madow: Okay well let’s have that nutcases then. You use that phrase, that extremely derogatory phrase.
 Dr. David Madow: Nutcase. Total nutcase. I’m not PC. I don’t care. I’m not PC.
 Dr. Richard Madow: How about other nutcases?
 Dr. David Madow: Get rid of all nutcases. Give me an example. Give me example of a nutcase.
 Dr. Richard Madow: A patient that’s – okay, I don’t know if you call this a nutcase. I think we’ve all had these patients. I had them in my past practice. Patient has said I don’t want any anesthetic. Just treat me. I remember one guy who specifically – he happened to be a relative. The guy was flailing around like he was in a torture chamber. It took me five times as long. I was totally stressed out. He was totally stressed out. I don’t think I did my best work and then to make it worse I didn’t even charge them because he was a relative. If you’re watching, I doubt you are, but you know who you are. In retrospect I should have said no. I insist on treating patients who are numb and comfortable and comfortably numb. Is that a nutcase? Somebody said I don’t want any anesthetic.
 Dr. David Madow: Not necessarily. However, I would treat them up to the point where if they don’t want no anesthetic and they’re comfortable and they’re sitting back, no problem. Once they start flailing around like you just described and you can’t do your best work, I’d say it’s either anesthetic or you’re out of here buddy. I don’t care if you’re my relative or not. Get the hell out of here.
 Dr. Richard Madow: That’s not a nutcase. 
 Dr. David Madow: Not it’s not necessarily a nutcase. It’s somebody who just doesn’t want anesthesia. 
 Dr. Richard Madow: I think some people would say that 90% of TMJ and facial pain patients are nutcases. 
 Dr. David Madow: Yeah. And then what’s the other malady that people have? I think a lot of people – I’m not saying this isn’t true but a lot of people would say – what’s that…
 Dr. Richard Madow: Fibromyalgia?
 Dr. David Madow: Fibromyalgia. Is that a nutcase patient? I don’t know. I don’t know the answer.
 Dr. Richard Madow: I think before judging that, we might say a fibromyalgia patient would have inherent difficulties in treating them that’s for sure.
 Dr. David Madow: So you’re saying our practice does not accept fibromyalgia patients or TMJ patients, or any of those. 
 Dr. Richard Madow: Wow. Kind of like that sushi bar that had a big sign on the door that said no California roll, no spicy tuna roll. It’s like eliminating people that they don’t want, right from the get go.
 Dr. David Madow: Well are you going to treat somebody with many year syndrome
 Dr. Richard Madow: I don’t even know what it is. So I guess I’ll say yes. 
 Dr. David Madow: Here’s where I limit it. I would absolutely not treat somebody that came into my office that had groats disease. They’re gone. You just can’t treat groats. 
 Dr. Richard Madow: Okay. But that’s a management issue. I think more than anything else. 
 Dr. David Madow: Anyway, I’m going to say…
 Dr. Richard Madow: Before long, you won’t have any patients. 
 Dr. David Madow: I’m just not going to accept a nutcase. That’s all.
 Dr. Richard Madow: Okay, well with that said…
 Dr. David Madow: That’s the conclusion.
 Dr. Richard Madow: We’ve reached the logical conclusion, but again, I think that maybe Dr. Amy didn’t try hard enough to let this patient know how safe and important radiographs are. But at that point, if you like to use all those opportunities and your patient said no, I agree. I don’t like signing the little things like I refuse x-rays. I think you can come back and [inaudible - 0:14:08.9] big time. 
 Dr. David Madow: I’d say 30 seconds. If she can’t explain in 30 seconds, you don’t have to go into like a 5 minute…
 Dr. Richard Madow: Oh no no. No scientific. You don’t have to talk about Dr. Redken. 
 Dr. David Madow: 15 or 30 seconds if this patient still said I don’t care, I don’t want them. You’re out of here buddy. Next.
 Dr. Richard Madow: Why can’t it be any different than a patient saying I don’t want you to use the periodontal probe on me. Would you have that patient in your practice? Absolutely not. 
 Dr. David Madow: No way. Zero chance. 
 Dr. Richard Madow: Especially that you come in knowing the term periodontal probe. That’s asking for trouble. 
 Dr. David Madow: How about if patients said I don’t want you checking for fremitus? I do not want anybody here checking my mouth for fremitus. 
 Dr. Richard Madow: I think I’d want that patient in my practice. 
 Dr. David Madow. Let’s do a phone call man. 
 Dr. Richard Madow: Before we do the phone call, hey we’ve got a Masterclass coming up. It’s going to be in Baltimore. We are doing one for the first time on a Saturday. I know some people kind of complain. I can’t come to the Masterclass. I can’t take off too much work. It’s totally worth it but for you or for anyone else, go to masterclass.madow.com to see what the whole thing is about. This is no exaggeration. It really could be the most important day you’ve ever had in your years of practicing dentistry. Masterclass is for docs only, for practice owners only, looking to make some major improvements, kind of turn that corner. Maybe take your practice from good to great or mediocre to good or from downright shitty to fantastic, whatever it is. If you’re really looking for some positive changes in your practice, check it out, masterclass.madow.com. It’s a small intimate group and really, really good things happen. We’d love to see you there.
 Dr. David Madow: There you go. While we’re giving tips. Rich and I love – even the small tips are good and here’s one that’s going to change the way you’re doing credit card processing in your office and save you some money every single month. It’s very simple math. It’s very simple. We believe in our partners at Fattmerchant. Just a modern cool way – I don’t even have to go into the detail because we promise you you will save money every single month and it’s simple to switch over. We have a lot of our friends and followers and doctors that have switched over to Fattmerchant already. Check them out, we’ve set up very simple link, and I want to make sure I get it raise this time. It’s BIT.LY and if you’re watching the video, we’re going to have it right below us. BIT.LY/FATTMAD and fattmad is spelled FATTMAD. Check them out, the link right there. BIT.LY/FATTMAD. You will change your credit card processing forever in your practice and make money every month. We promise.
 Dr. Richard Madow: Alright. 
 Dr. David Madow: Do the call.
 Dr. Richard Madow: Let’s do the phone call. It happens to be thematically linked to Dr. Amy’s question. So let’s see what happens.
 Voice Recording: To serve you better, this call maybe recorded for training and quality purposes.
 [phone ringing]
 Female Speaker: Good morning. This is Amy.
 Dr. Richard Madow: Hi, I’ve got a quick question for you. I want to come in as a dental patient but I’m not sure about dental x-rays. I know that dentists usually insist on taking x-rays. Is that the way at your office? 
 Female Speaker: Have you had them anywhere else that could we kind of get emailed here so we at least have a baseline? 
 Dr. Richard Madow: Yeah I haven’t had x-rays for a while. 
 Female Speaker: What we could do is kind of take the minimum of just the T18 side and that will help him just to make it for him to do the exam. He wouldn’t want to miss any cavities. So that will help him see between the teeth. And then the rest [inaudible - 0:17:42.8] to see from looking in there. 
 Dr. Richard Madow: Yeah. Are those safe? 
 Female Speaker: Excuse me?
 Dr. Richard Madow: Is that safe? I’m just really concerned about radiation and x-rays.
 Female Speaker: Yeah. So the thing is actually digital. So when it’s a digital x-ray, it takes a lot less radiation. You can get more radiation from being outside or if you’re on a plane. So especially if you’re just taking the T18 side, you wouldn’t have any issues at all with that. Back when they were film, it took a little more radiation to expose it. But now that’s everything is digital, it’s very very minimal. 
 Dr. Richard Madow: Oh cool. What if I decide I just don’t want them at all. Is that still okay? 
 Female Speaker: It’s just – I’m pretty sure that legally you’d have to have them to do an exam, but hold on one second. 
 Voice Recording: Without metal wires or brackets. Invisalign is removable so you can eat and drink what you want while in treatment. Plus brushing and flossing are no problem. Invisalign is comfortable because it has no metal to cause mouth abrasions during treatment. And no metal and wires usually means you spend less time in our office getting adjustments. Find out if you’re a candidate. Ask about Invisalign today. We’d be happy to tell you more. 
 Female Voice: So yes he would have to have them just for legal reasons. He wouldn’t be able to do an exam and then we also wouldn’t be able do a cleaning without an exam. 
 Dr. Richard Madow: Okay. So I don’t want them maybe I’d probably – maybe she’d find another office. 
 Female Speaker: Thing is I don’t know if there would be one since that is the law in South Carolina under standard care, but yeah that’s it.
 Dr. Richard Madow: It’s actually a law. Wow, interesting. 
 Female Speaker: Yes. So what the American Dental Association requires is an exam by the dentist once a year, and you must have that before you could even have any cleaning or anything from us. And to do a proper exam, you have to have x-rays or in other words to do an exam where you’re not able to diagnose so you kind of – it’s kind of a little bit of fraud because they’re saying you’re doing an exam but you can’t really do an exam. 
 Dr. Richard Madow: Wow it’s fraud. That’s really – I mean the American Dental Association requires that? Wow, interesting.
 Female Speaker: And they actually have a website which shows all the different ones that they recommend and then also, it has a little chart on the radiation to where actually explains what x-rays are equal to, kind of like just eating a banana you get radiation from just one x-ray at a dental office. And then it’s a nice chart to take a look at.
 Dr. Richard Madow: You get radiations from eating a banana?
 Female Speaker: Yes. And then airplane…
 Dr. Richard Madow: How do you get radiations from eating a banana?
 Female Speaker: I have no clue. It’s just like a pretty chart that says…
 Dr. Richard Madow: So it’s not like a microwave banana. It’s just a regular banana. 
 Female Speaker: Yeah and I don’t know what it is, but apparently, you can get radiation from that. Just one plane ride is equal to like a full series of dental x-rays.
 Dr. Richard Madow: Yeah that makes sense. 
 Female Speaker: Yeah. So at times that shows the different – just a pretty cool chart. But now it just takes very little radiation to get an image.
 Dr. Richard Madow: Well very informative. Maybe I’ll find a dentist that’s not a member of the American Dental Association.
 Female Speaker: Alright. Thank you.
 Dr. Richard Madow: Thank you, bye.
 Female Speaker: Bye.
 Dr. David Madow: You know, I think I always say this after a call – oh my god…
 Dr. Richard Madow: But it had some twists and turns too. That’s for sure.
 Dr. David Madow: What is the story with that thing? 
 Dr. Richard Madow: I have a few comments. I like the on-hold message for Invisalign. That’s a nice touch.
 Dr. David Madow: Very nice.
 Dr. Richard Madow: Yeah. I mean, how frequently do we actually hear a good on-hold message when we do these calls? 
 Dr. David Madow: Almost never. So yeah that’s good, that’s good.
 Dr. Richard Madow: Okay she was very nice, she was pretty knowledgeable.
 Dr. David Madow: She was nice, she was cute.
 Dr. Richard Madow: She was knowledgeable. She knew what she was talking about.
 Dr. David Madow: Kind of.
 Dr. Richard Madow: I think that puts her ahead of many many people. But then she kind of started going off the deep end when she brought up that this is the law, and the American Dental Association requires that you do this, and that it’s fraud if you don’t. I’m not so sure about that.
 Dr. David Madow: Right. Let’s take it back to the beginning. What would you like to have – how should she have handled this? She got a potential new patient on the phone who wants to come to the practice but is stating that he doesn’t really want radiographs. What do you do? Do you try to explain everything on the phone or do you try to just get them into the office and do the explanation there?
 Dr. Richard Madow: Okay great question. I’m going to go back to your term of nutcase earlier. I think even you can even tell on the phone the patient is just a wacko and they’re not going to fit in your practice and just cut your losses. But I think if the patient’s really – and I sounded pretty reasonable. I just got some questions about x-rays. I think if the patient sounds reasonable, you think they might be a good fit for your practice? I agree. Let’s get them in, have them meet the doctor. The doctor can just explain a little bit about x-rays/radiographs, whatever you want to call them. It might be worth a shot. Do you agree?
 Dr. David Madow: Yeah. Because once they’re in the practice, I think there’s a better chance of a true connection. Let’s face it, when we’re on the phone, there’s not really like a true connection yet. Once you’re there, and you see these people are good and they really care and they explain a little bit about this minimal radiation. I think there’s a much better chance of somebody saying, okay I get it, let’s do it. As opposed to on the phone which she talked about bananas and fraud and the ADA. Not just it’s ridiculous. You can’t do that on the phone.
 Dr. Richard Madow: Yeah I totally agree. Again, I’m not a lawyer, you’re not a lawyer. But I think when you start to say things like this is fraud and the ADA requires that it’s done this way. I think that it’s kind of combative type talk. I didn’t care for that at all. I don’t think it’s accurate. I remember a few episodes ago somebody was saying, I can get sued if I do this. Why are you going to bring up things like fraud and the ADA requires? I just don’t – I don’t think anything good can come up with that conversation. 
 Dr. David Madow: Well you had the best comeback ever. It was hilarious. I think I’m going to find a dentist who’s not a member of the ADA.
 Dr. Richard Madow: I know, and then she said okay bye. We can’t let this go without talking about the banana thing. 
 Dr. David Madow: Right. What’s the story on the banana? I mean come on.
 Dr. Richard Madow: She said you’ll get more radiation eating a banana. I said, like a microwave banana? But I’ve never heard of that before. Have you ever heard of that before?
 Dr. David Madow: No. I’m a little bit worried because I had a banana just a little while ago. I’m a little concerned. 
 Dr. Richard Madow: I had two bananas today already. It’s one of my favorite foods. Favorite of all time. I googled it and there are people claiming and maybe this is on the ADA website. I didn’t check that out. But a small percentage of the potassium in bananas are like ionized potassium molecules. Technically they are radioactive and they enter your body when you eat a banana. But if you read a little further, you’ll see there’s no scientific basis for that because your body has a way of keeping the amount of radiation – and again I’m getting all this wrong. But essentially, the bottom line is you don’t get radiation from eating a banana. Your body has a way of regulating that.
 Dr. David Madow: I feel better now.
 Dr. Richard Madow: I know. Actually, you’re glowing a little bit. 
 Dr. David Madow: I didn’t tell you what I had a little while before we started recording. I had one banana; it might have been radioactive and I had a nice big glass of heavy water. 
 Dr. Richard Madow: Wow. How heavy was it?
 Dr. David Madow: It was pretty heavy.
 Dr. Richard Madow: You do a – I actually had a couple of isotopes. 
 Dr. David Madow: Do you know where that new restaurant called Teledyne Isotopes?
 Dr. Richard Madow: Yeah I have a friend of mine who works at Teledyne Isotopes. I ordered a few to go, Grubhub just delivered them. 
 Dr. David Madow: Sir here are your isotopes. 
 Dr. Richard Madow: Thank you.
 Dr. David Madow: Tip the driver please. 
 Dr. Richard Madow: So bottom line, I said I’m going to find a dentist that’s not a member of the American Dental Association. She just kind of chuckled. At that point, I think she probably did the right thing. 
 Dr. David Madow: I think it turned out that you were perceived as a nutcase. Let’s face it.
 Dr. Richard Madow: Exactly. 
 Dr. David Madow: She did the right thing. 
 Dr. Richard Madow: I’m not sure I want to even give her a grade. 
 Dr. David Madow: Yeah I think grading her might be difficult because there’s so many twists and turns, and then at the end you said I’m going to find a dentist that’s not a member. And so, she had to just say okay bye. So maybe she should get an A for that part. For that part at least.
 Dr. Richard Madow: Yeah I’m going to give her not bad. I didn’t like the whole fraud thing. That was kind of biased. 
 Dr. David Madow: Okay so just to summarize, I think we can both agree that she should have done everything possible. Be kind, invite you in to the office for your initial exam, even for a consultation to talk about it. And then once you’re there, that’s when they handle the whole thing. Not on the phone. 
 Dr. Richard Madow: Right. So I’m never sure if it got into the phase of maybe you should find – I want to find a dentist that’s not a member of the ADA or eating a banana, or that biased. So again, I’m going to lower her grade now to a B, maybe a radioactive B. I’ll give her a B+. But maybe it’s like a charge Ion on a B-, I don’t know. Whatever it is. Not bad though. Certainly not bad.
 Dr. David Madow: That was a fine grade because she probably did – I’m not going to give her a good grade because if she did it right, she would have gotten you in for some type of consultation or first visit to discuss in the office. I think she didn’t do it right so I’m going to have to go with a D. I’m sorry.
 Dr. Richard Madow: Okay. I think she said our office is right next to the tanning center. That maybe would have been good. Okay, well hey. Interesting stuff today. That wraps up Episode 12 of Season 2 of the Dental Practice Fixers. Thanks so much everybody for all your kind comments and ratings and all those great things. We really really love it and we hope this show is informative to you and helps your practice. So hey, I’m Dr. Richard Madow.
 Dr. David Madow: Dr. David Madow, we will see you next time. 
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