Hi Sally,
We need scripts/dialogues for patients that need x-rays/panorex and they refuse to have them. We tell them why we need them and then that at their next visit we won’t be able to treat them unless they have the x-rays. What else can we do?
Penny

Hi Penny,
I went to the management library on my web-site because I knew in the past 7 years this subject had been written about in one of my weekly email newsletters.
Below is what I found:
• Mr. Jones, I need to get your x-rays now.
• I am going to get your x-rays now as the doctor requested.
• As the doctor requested, I am going to get your x-rays now.

The hygienist will not want to ask permission. That is just saying to the patient that it is not really a required treatment but optional, and that is why the hygienist is asking permission.

Of course there will always be exceptions to the office protocol and those patients that respond back with some of the following comments:

“Will my insurance cover them?” “Mr. Jones, we cannot be sure that your insurance company will cover them. You have to keep in mind that dental insurance isn’t really insurance at all. It is actually a money benefit provided by your employer to help you pay for routine dental treatment. Most benefit plans are only designed to cover a portion of the total cost. However, many insurance companies do cover x-rays because they are considered preventive treatment. The doctor has determined that for clinical reasons we need to have these x-rays taken. Without them we will not have all of the information we need to be able to make a thorough diagnosis.”

This and many other questions are answered in the pamphlet, “My Insurance Covers This RIGHT?” (You can purchase them on my web-site here: http://www.mckenziemgmt.com/book-practice.htm#b2
Any time a patient questions if insurance will cover something it is best to educate them about why the treatment is needed and about insurance. Handing a pamphlet to them in addition to verbally explaining to the patient is a great way to approach the questioning patient.

Another scenario may be, “Mr. Jones, I am going to get your x-rays now as the doctor requested.” “Why do I need x-rays? I don’t need x-rays. My old dentist never took these x-rays” “Well, Mr. Jones, I cannot answer for your previous dentist, but we want to make sure that your bone levels are healthy, your teeth are cavity free, and that you are dentally healthy. Without these pictures we will not be able to perform as comprehensive or thorough exam.”

Penny, trying to understand why the patient is saying “no” takes on a more personal effect which could be fear of radiation or the cost or simply just not thinking they are necessary. You could just ask, “Mrs. Jones, would you share with me why you don’t want any x-rays taken?” Make sure that you document all conversations in the patient’s records.

Telling the patient that you can’t treat them on the next visit is very black and white and of course you must accept the consequences that you will lose the patient. Perhaps you could say that you’ll forego them this visit but they will be necessary on the next visit. You can also have the patient sign a release that they understand they are refusing x-rays. While the patient can refuse any treatment, the dentist is subject to liability for failing to diagnose or treat existing conditions.

I think you also have to look at your x-ray philosophy. There are 3 that we see in our consulting work, BW’s every 6 months, BW’s 1 time a year, BW’s every 18 to 24 months. Once a year is the most common. We do find those offices that subscribe to every 6 months have lower patient retention.

I hope this has been of help.

Kind regards,

Sally McKenzie