September 3, 2025 • 27 mins
Dr. Maggie Augustyn and Dr. Chad Johnson get real about the tough conversations every dentist faces; when patients push back on fees, question your expertise, or try to make their problems yours.
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Episode Transcript
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Dr. Chad Johnson (00:00):
Everybody.
This is Everyday Practices Dentalpodcast and I'm sitting talking with
my co-host, Dr. Maggie Augustine.
Here.
Dr. Maggie, how you doing?
Dr. Maggie Augustyn (00:09):
I am doing great.
And we have been in the middleof a conversation, um, a
Dr. Chad Johnson (00:13):
heated,
Dr. Maggie Augustyn (00:14):
a heated conversation, and then we
thought, you know what?
Why not, why not let, it's your listenersin on this because this is a struggle
that we are constantly having withour patients, and in this particular
podcast episode, we are going to cover.
How patients complain about payingor not paying for a service.
Dr. Chad Johnson (00:38):
We're gonna complain about complainers.
It's awesome.
Dr. Maggie Augustyn (00:42):
Listen, we've got our own, we've got our own right.
You know, people that we, that weare here to help and we all learn
from each other's experiences.
And so, um, Chad here is a little.
Hot and heavy.
So I'm gonna let him calm down for justa second because I'm gonna start us off
with a conversation about a patient.
(01:03):
Now, I I, I am completelyforthcoming and always have been.
I practice as an in-network PPO dentist.
And so, um, there's a way tomake that work a hundred percent.
And, and, and we're definitely doingthat, but I want to start us off with
a story about a patient that I saw.
Who came in for a consultation onan implant and someone had told her
(01:26):
that this implant wasn't working,and then she came in for our hygiene
visit, and these probing depths aregetting higher and higher and higher,
and she just does not know why.
And so, you know, something veryspecial happens after you've been
doing dentistry for 25 years.
It's like.
I don't know if you say that you enterthe matrix or you exit the matrix,
whatever it is, but you, there's a lotof things that kind of start to overlay,
(01:48):
and so I look at the radiograph of thisimplant and, um, well, the abutment that
was used is larger than the implant.
And so, well, why do you thinkyou're having problems, right?
These, these, this is mismatched.
And look, I'm not here tocall out another dentist.
Yeah.
Because we have all had our ownlearning experiences, but she comes
(02:12):
in hot and heavy, very hot and heavy.
This is a very difficultpatient to manage.
First thing I did is I put on mywhite coat, which I almost never do.
And the reason why I did that isbecause this particular patient
needed an air of authority.
You just kind of pick that up, right?
And then I go in and I say,this is what's happening.
You need to have surgery.
(02:32):
You need to have this cleaned out.
You need to replace the crown, and youneed to have the correct pieces used here.
Or what's going to happen is you aregoing to lose this implant, right?
You're already on the way there.
There's already threads exposed.
This is the best that we can do.
And so I have this conversation with her.
I don't know, at least an hour.
(02:54):
Now again, uh, this is a Deltapatient, so imagine how much I'm
being paid for this hour, right?
Right.
I don't know.
I'm lucky if I got paid 60 bucks right.
For the consultation and if myhourly is at $1,200, I basically
set $1,200 on fire there, right?
Right.
So then the patient comes back in andshe leaves a message and says, I do
(03:14):
not wanna hear her voice, her being me.
I do not wanna hear back from her.
What I need you to do is Ineed you to call the insurance
company and reverse the claim.
Because she didn't touchme, she didn't do anything.
She didn't fix anything.
Right.
Which of course is all completely untrue.
Um, and so what I ended up.
(03:38):
Saying, you don't wanna talk to me, fine.
I'm not gonna make you talk to me.
But what I ended up doing and, andtalking to my, to my team about is I
am in network and I have this contract.
So I can't pretend thatthis didn't happen.
I can't pretend that Ididn't give you advice and.
And so then I overheard one of myteam members talking to the insurance
(03:58):
company basically saying, look, shewants you to reverse the claim because
she didn't like what she heard.
And so here I am, um, we wouldbe grateful to lose this patient.
In all honesty, she's beendifficult from the very beginning.
But, but here's the point of the story.
We just have such difficultpatients that are so, um,
Dr. Chad Johnson (04:21):
entitled,
Dr. Maggie Augustyn (04:22):
entitled, and they're so needy.
And you know what?
You need to stand your ground.
You need to charge what you're worth.
And on patients like that,you need to cut the cord.
And if they're saying, Hey, refund methis money, or I'm never coming back,
one, I can't refund you this moneybecause I'm obligated by the insurance
(04:42):
to charge you for, for what we did too.
I set $1,200 on fire of my own productionby sitting there and talking to you.
And three, good riddance,please don't come back.
Right?
Um, and so.
I think this is, this is, you know,a great segue of, of you, Chad,
going into your story and, andhow you set this one particular
(05:09):
patient who came in hot and heavy.
So tell us that story.
Let's see how we can break it downand, and learn from it and give
our, our, our listeners here someadvice on what to do when these hot
and heavy conversations come up.
And we feel like there's no feeling,okay, we are being taken advantage of.
(05:31):
Mm-hmm.
Dr. Chad Johnson (05:33):
So for anonymity's sake, I'll call him Jerry.
And I also apologize ahead of time.
If I back the microphone awayand I'm yelling, so your, your,
your volume control might needto be on your fingertips in
the vehicle as you're driving.
Okay.
Tom and Omaha just thought I'd say hito Tom, Dr. Tom listening right now.
(05:57):
So, goodness.
Okay, here I go.
So Jerry, uh, comes in.
I'm seeing patients on a Saturday.
We get him scheduled and Icome in Saturday morning.
Um, he hasn't been in for ten-ish years.
He's got a lower denture over denturewith two locator implants that I
had placed the locator broke off.
(06:18):
Um, he's been at another dentistfor, you know, a few years
and he, uh.
Uh, has the screw broken offthe other dentist, you know,
doesn't know what to do.
So I, uh, get it out.
It probably took me 10 or 15minutes, which I was super impressed.
I told him, I was like, number one, whenwe do this, we can't be sure that it's
(06:41):
going to, you know, even work gettingthis, the, the broken off screw head out.
And if we do get it out.
Is it going to be, uh, are, arethe threads gonna be stripped on
the inside, you know, while we'remessing around with the inside?
So let's give it a try, but, you know,no promises, hate to say it, but you
know, like your only other option is toleave the implant there or pull it out
(07:03):
anyway, so, you know, no harm, no foul.
Let's give it a go.
Dr. Maggie Augustyn (07:06):
So I'm gonna short just, just small
interruption here for our Yes,
Dr. Chad Johnson (07:10):
by all means,
Dr. Maggie Augustyn: because here's the thing. (07:10):
undefined
The way to start thisconversation is to be completely
transparent with the patient.
Mm-hmm.
And say, this is the issue.
This is not my issue.
This is your issue.
As Bert Baird says, right, yourproblem, this problem is it.
This is your problem.
But here I am to solve it.
This is what can potentially happenbecause having that really honest
(07:33):
conversation upfront with our patientsis going to and inadvertently keep us
from being in trouble because had younot had that part of the conversation and
something would've happened, it would'vebeen your fault for breaking this screw.
Yep, perfect.
It would've been your faultfor this then and the other.
So communication is key.
Love it.
PDA teaches, right?
So step number one is com.
(07:54):
Be completely transparent and makesure that the patient understands
that this is not your problem.
Dr. Chad Johnson (08:00):
Yep.
You
Dr. Maggie Augustyn (08:00):
are the hero here and you are trying to
help them solve this problem.
Dr. Chad Johnson (08:04):
That's right.
So, Saturday morning, um, he'sbeen billed for limited exam peri
apical, and, uh, I don't know.
I, I just thought, uh, you know, for.
I don't, I don't know.
It's neither here nor therewhether someone else charges.
I didn't charge for the screw removal.
(08:25):
Um, why most of the time I'mnot gonna be successful and I,
uh, don't want people mad at me.
So there's that, and I, uh, 10, 15minutes later, I get the screw out.
If you're wondering how, since thisis everyday practices, I'll tell
you how, um, I got outta Cavitronand worked in a counterclockwise.
Um, and I also, uh, broke off aQ-tip and used the flat end of the
(08:50):
little wooden, uh, topical Q-tip andpushed it down in there and turned.
Uh, and then I also did a slow speed,um, uh, round burr on the top of it
and, uh, put it in reverse and use thatto, you know, kind of torque on it.
So, uh, between those threethings, I started seeing the screw
move up and got the screw out.
(09:12):
That isn't the problem.
Uh, he gives me, I'm
Dr. Maggie Augustyn (09:15):
gonna interrupt you one more time because on that particular,
on that particular instance, I think itwould've been very helpful for you to tell
the patient, Hey, Jerry, what I just didfor you is one, I charged $1,800 to open
an office, which I did not charge you for.
And two, I removed thisscrew and everybody else
would've charged you $1,500.
(09:35):
And that is my gift to you,
Dr. Chad Johnson (09:37):
right?
That would've been brilliant.
At times I'm brilliant.
At this time I was not, so, I,I mean, I was super impressed
that I got the screw out.
Let's, let's say that, but I, Iwasn't, you know, using my best,
uh, Augustine verbal skills.
So I got this, uh, screw out and,um, you know, no anesthetic, no pain,
(10:01):
no nothing out the door, you go.
I've got the little piece,uh, of the broken part.
And so I'm going to,um, order the new one.
I had it written down, um,at that point, this is dumb.
I had it written down which,uh, which size of abutment
that we had used at the time.
And so, and this was a different implantsystem too, but I found it on a website,
(10:23):
custom ordered it, um, overnighted it,it didn't show up for four business days.
He's on a Thursday now.
Um, and.
He's coming in to, uh, to get it, it,you know, says that it's, you know,
being shipped, it's getting here soonor whatever, and it doesn't show up.
Normally we get ourdeliveries, you know, 10 or 11.
(10:44):
So he shows up, um, 10minute drive from home.
It's unfortunate.
I go in and, you know, and Itell him, I'm like, um, you know,
bu deal that we don't have the.
Um, the part yet.
And so let's get you rescheduled.
And I apologize, we should have,you know, known ahead of time.
So my office manager says, whydon't we go over, um, cost estimate.
(11:08):
And so, um, she goes over the costestimate, says it's gonna be $720, that's
gonna be 600 for the abutment, uh, sixfor the new, um, uh, locator attachments.
And so then he gets all mad, whatthe f is this and this and that.
And he is all mad and stuff.
She comes in and is like,man, he's swearing at me.
He's all mad and stuff.
And I was like, I was like, uh,you know, Jerry's a uh, uh, a gruff
(11:35):
guy, so it just is what it is.
And, um, you know, but like, he's notnecessarily mad or, or he's just kind
of that way, you know, the angry.
Trucker type or something like that,you know, just like, well, well, what
in the world cost of coffee these days?
So I, uh, I go in the room, youknow, 'cause I, I hear man, he's
(11:56):
mad and stuff, so I go in the room.
Jerry,
Dr. Maggie Augustyn (11:58):
I'm going to make another small interruption.
When a patient iscomplaining about cost, yes.
Okay.
I invite them to go to fair health.org andon there is, it's a website that shows you
what is a reasonable cost for this area.
Right.
So if you're charging $680 forthis particular abutment, be like,
(12:20):
Jerry, go to fair health.org.
Why don't you look up what I shouldbe charging you and chances are
that you're, I know how you are andyour fees are probably way too low.
Um, and so then, and that's anothermind blowing thing for them, bro, I
just gifted you $3,200 on Saturday,and now instead of charging you
(12:41):
$1,200, I'm charging you six 80.
Okay?
I'm getting all riled up too, so just keep
Dr. Chad Johnson (12:46):
No.
And, you know, I, so I did.
I came in and I was like,Jerry, what's the deal?
What are you upset about?
Well, I don't know why I am, youknow, getting charged this last time
it was, you know, half the cost.
And I said, well, we've printed$15 trillion in the last five
years of, of money, so I'm notsurprised that things cost more.
And so I, I actually don't know why youaren't surprised that things cost more.
(13:09):
It just is.
I said, you go find me.
I'm gonna, this, this, I'm gonnakeep it short, not go on my full
rants of, because I was, I came in.
Unusually hot and bothered bythis, and I said, you go find
me three other cost estimates.
Go get three other cost estimates.
Do it, and you find me a dentistwho will do it $30 cheaper.
(13:29):
I'll match it because I justdon't believe that's the case.
This is a steal of a deal.
I came in on a Saturday.
I took the implant screw out at nocost because says, no, you charged me.
I said, Heather, look that up.
I could be wrong.
What happened, uh, limited exam for thismuch and a peri apical for this much.
And I said, oh, okay.
So my apologies.
You were charged.
(13:51):
You weren't charged for the screw removal.
So you're correct.
I'm correct, but let me be clear, youwere not charged for the screw removal.
You paid for the exam and thex-ray, you paid for my expertise.
There are very fewdentists that can do this.
And have done it successful, andI didn't even charge you for that.
So now you're getting chargedfor the abutment and it's nothing
(14:15):
more than what it was before.
And he says, well, it wasn'twhat I was charged before.
Office manager, what didwe charge him last time?
We look it up?
Come to find out.
We gave it to him last time at no cost.
So I said, Jerry, letme get this straight.
Are you upset that I've been moregenerous with you in the past
that I gave it to you for free?
Yes.
(14:35):
Than now?
I mean, like is thatwhat you're upset about?
Is that I've been too generouswith you in the past and.
He didn't have much to say.
He kind of like, I think he tookmy energy and was like, oh shoot,
this guy is, you know, he's legit.
Oh, and he's upset because Ithink, you know, like the goal was
I'm gonna be the upset patient.
(14:55):
Then I come in and I'm like, well,I'm the upset business owner and
you've taken advantage of me too long.
And he came back the followingThursday, which was yesterday,
and I gave him a gift card.
For a local gas station and fornot, you know, having the stuff
on time for his appointment.
And he knew about that.
(15:15):
That was
Dr. Maggie Augustyn (15:15):
kind of you.
That is actually, that works also.
That's another, that's anotherbit of information that,
um, our listeners can take.
Yes.
Think from this is like, okay, sosometimes stuff happens, and if it does
just have a bunch of those gift cards.
25 bucks, 20 bucks, gas station
Dr. Chad Johnson (15:33):
25 in Chicago, 2020 in Iowa, you know, uh, but, uh,
uh, you know, 50 in Hawaii, right?
So, um, so I, I, I just, and Igave him a legit apology too.
I was like, Larry, Hmm?
I was like, Jerry.
There was another one, Matt.
Sorry.
(15:54):
I was like, Jerry, here's,you know, here's the deal.
I am really sorry that we didn't havethe stuff on time for your appointment.
Here's a gift card as promisedlast time, because I just
don't like working that way.
And I'm super glad that that abutmentwent in today, that we got the new part
switched out, that it clicked down well.
(16:14):
Um, this is a really a win-win.
And, uh, I didn't say thisand yet I'm just like, I hope.
I hope to never see you again.
Like just move on.
And, but at the same time, I was verytransparent and authentic with him.
I think overall I was professional.
I probably had some borderline moments,but it was very cathartic to share
(16:38):
my frustrations with him and notnecessarily get bent outta shape.
Did I raise my voice?
Yes.
Um, but it wa and I told himthough at the time, I said.
Jerry, I'm not mad at you.
I am mad though that I feel takenadvantage of, that you know, that I've
got all this expertise to do what veryfew people can do successfully, and
(17:01):
it's, it's not good enough and thatthat is frustrating and I hope you can
understand that and turns out my office.
Manager's door was open.
I couldn't see anything but red.
So, um, and the whole office heard thisconversation and they were proud of me.
(17:22):
Maggie.
Yes.
They were proud of me.
They were just like, I would,
Dr. Maggie Augustyn (17:25):
had I been there, I would've been clapping too.
Yes, I would've, you know what?
I would've brought you cupcakes.
Yep.
Um, it would've been like, likewith a candle and everything.
I mean, you, you definitely,you stood up for yourself.
That's right.
Yes.
Dr. Chad Johnson (17:37):
Yep.
Dr. Maggie Augustyn (17:37):
And, and, and it's hard to do.
Dr. Chad Johnson (17:39):
Yep.
And to restore the relationship,like, you know, I don't really want
to say, but like, let's say he cameback in and then from now on he's just
chipper as ever and brings us cupcakes.
Okay, cool.
Like, but I think I needed to, tostand up for myself and my office
and my value and what it's worth.
So, for what it's worth, listeners,I'm actually, that's, you know, the.
(18:02):
Fourth or fifth iterationinto telling the story.
So now I'm, I'm kind of cooling downabout it, but, uh, probably in another
five times of me telling it, I'lllaugh about it, but right now it's
just like, oh, it made me so hot.
Dr. Maggie Augustyn (18:13):
Well, it, and it's frustrating and it was, you
know, raise your hand if you'renot driving a car, you know?
Doesn't this happen to you all the time?
Yes.
So here we are and thisis what we're doing.
We are empowering you.
Dr. Chad Johnson (18:26):
Yes.
Dr. Maggie Augustyn (18:27):
To do the hard and right thing.
Right.
It's not, this isn't easy to doand it took me 25 years of being
in dentistry before I grew, Hey,I'm just gonna say it, the balls to
say what I need to say to patients.
Now, it doesn't always work that waybecause there's plenty of really kind
(18:48):
people, and by me being so abrasive atthe wrong time, I actually turn them off
and it's a learning experience for me.
In fact, I have to make a phone call toapologize to a patient who was really
kind and I treated her with this kindof a tight grasp and I shouldn't have.
Dr. Chad Johnson (19:08):
Yeah.
Dr. Maggie Augustyn (19:09):
Um, so it's, it's a learning experience
we've gotta kind of find, um.
The balance between when to be softand when to stand up for ourselves.
Right?
And it doesn't always work out,and it's, it's, it is, it's just a
learning experience in our lives.
Dr. Chad Johnson (19:28):
Furthermore, um, Google Almighty tells us that CDT Dental
Code 6 0 5 6, uh, generally rangesbetween 400 to a thousand dollars.
Though some have, uh, fallen out.
You
Dr. Maggie Augustyn (19:41):
are welcome Jerry.
So how much Jerry didyou really get from me?
Like four grand worth.
Dr. Chad Johnson (19:48):
Right.
Dr. Maggie Augustyn (19:48):
Of free treatment.
Uh, so you know what you should do?
Um, Jerry, you should buy me cupcakes.
Dr. Chad Johnson (19:55):
That's right.
Send and send me a thank you cardfor the awesome service I just did.
Dr. Maggie Augustyn (20:00):
But you know what I, I think the universe or God or
whatever you choose to call the powerthat looks over you, or if you don't
have any power that looks over you,you know, karma, whatever you wanna
call it, this will come back to youand this will eventually bless you for
how helpful you have been to this man.
Yep.
Even if he doesn't realize it.
(20:21):
Yep.
Um.
You're, you're earningbrownie points somewhere.
Dr. Chad Johnson (20:26):
Yes.
And I do like, uh, pointing out, and thisis just a personal opinion, uh, not the
those of productive Dentist Academy, butkarma is rough because if you get what
you deserve, then that's always a goodthing when you feel like you deserve it.
Right.
You know, like you earn something.
But then sometimes we're cruddypeople and we should get what
(20:47):
we deserve in the bad way.
I'm just so thankful to Godthat it's just like that.
I don't get what I deserve attimes, and so that might sound
sanctimonious to some people.
Like I'm just, you know,spewing off stuff, but.
Uh, I'm so thankful for this professionand I, being in a, a grateful mindset
is, uh, is valuable and just being like,I really don't deserve to be a dentist.
(21:09):
I sure tried and stuff, you know, soit's not that, it's like, oh, I don't
deserve it, but it's like, listen.
Um, I'm thankful for it and I'm thankfulto be able to treat the patients.
Sometimes they are buts and they aredifficult and though it might be rare and
for some people it might be every day.
And then that just gets bold.
If you need someone to talk through,um, you can write both of us.
Dr. Maggie Augustyn (21:32):
They could do Dr. maggie@myhappytooth.com.
There you go.
R-M-A-G-G-I-E.
And that's fine.
Yeah.
Dr. Chad Johnson (21:38):
Um, you know, or chat@productivedentist.com
if you remember mine better.
And then just, I can send it alongto Maggie, or I can, or you just
Dr. Maggie Augustyn: attention more than I do. (21:46):
undefined
Dr. Chad Johnson (21:48):
Oh, no, I certainly do.
Hey, uh, listeners, thanks for, uh,you know, listening on the drive.
Hopefully that was a fun, shorter thing.
And thank you for beingmy counselor as I cathart.
Um.
You know, I don't know a betterword, barfed up my, my junk over
the last week and a half of Jerry.
Dr. Maggie Augustyn (22:10):
And listen, I'm gonna, I'm just gonna ask
you one thing that you learnedfrom this barf, cathartic barf.
Dr. Chad Johnson (22:20):
Yes.
Dr. Maggie Augustyn (22:21):
Gimme one thing.
What is your takeawayfrom this conversation?
Dr. Chad Johnson (22:24):
Um, finding a way to stand up for yourself and yet
dialing it in to where you're not.
Acting ridiculous or un whatever, justthat you're, you're also coming to
this person, treating them humanelyand you know, with decency enough, even
if there's yelling, even if there'sconsternation between the two of you,
(22:45):
to be like, Jerry, I'm not mad at you.
I'm mad that I, that I feel this way.
And, you know, just laying it out,but also setting up some boundaries.
So it was a boundaries testwithout being a ridiculous caveman.
Dr. Maggie Augustyn (22:59):
Yeah.
I love that.
And, and for me, this has a a lot to dowith looking at yourself and balancing the
energy, because I struggle with this Yeah.
Of when to go in hot and heavyand when to kind of move back,
um, because this is something thatI'm still learning about myself.
(23:19):
And then always the biggest takeawaythat I hope everybody takes from this
particular podcast and the words ofBruce Baird is, whose problem is this?
Dr. Chad Johnson (23:28):
Theirs.
Dr. Maggie Augustyn (23:29):
It's their problem, right?
You are the one that'shelping with the situation.
You're not creating the situation.
And enough is enough.
Yeah.
Patient's coming in and blaming usfor what's going on in their mouth,
that has got to stop and we're goingto do everything that we can to teach
you how to not take on that problem.
And maybe this is a great segue intoinviting back our good friend Eric
(23:53):
Wrecker, because we carry other.
People's issues with us.
Dr. Chad Johnson (24:00):
Right.
Dr. Maggie Augustyn (24:00):
Unfairly, we shouldn't be doing that.
That's not our problem.
That's their problem.
And let's find a way to, becausethat, that's, that's, that's
what creates the burnout.
We're not here to save everybody.
We're there to help them becauseultimately they're the ones that have
created these messes in their mouths.
Yeah.
I'm not saying it's their fault, it'sjust the situation, but we are not.
(24:22):
We're, we're here to help and not,not to be blamed for what's happened.
Dr. Chad Johnson (24:26):
Yep.
Maggie, great discussionwith you listeners.
Thanks for coming on.
Until next time, everydayPractices Dental podcast.
Dr. Maggie Augustyn (24:34):
See you later.
Everybody.
This is Everyday Practices Dentalpodcast and I'm sitting talking with
my co-host, Dr. Maggie Augustine.
Here.
Dr. Maggie, how you doing?
Dr. Maggie Augustyn (00:09):
I am doing great.
And we have been in the middleof a conversation, um, a
Dr. Chad Johnson (00:13):
heated,
Dr. Maggie Augustyn (00:14):
a heated conversation, and then we
thought, you know what?
Why not, why not let, it's your listenersin on this because this is a struggle
that we are constantly having withour patients, and in this particular
podcast episode, we are going to cover.
How patients complain about payingor not paying for a service.
Dr. Chad Johnson (00:38):
We're gonna complain about complainers.
It's awesome.
Dr. Maggie Augustyn (00:42):
Listen, we've got our own, we've got our own right.
You know, people that we, that weare here to help and we all learn
from each other's experiences.
And so, um, Chad here is a little.
Hot and heavy.
So I'm gonna let him calm down for justa second because I'm gonna start us off
with a conversation about a patient.
(01:03):
Now, I I, I am completelyforthcoming and always have been.
I practice as an in-network PPO dentist.
And so, um, there's a way tomake that work a hundred percent.
And, and, and we're definitely doingthat, but I want to start us off with
a story about a patient that I saw.
Who came in for a consultation onan implant and someone had told her
(01:26):
that this implant wasn't working,and then she came in for our hygiene
visit, and these probing depths aregetting higher and higher and higher,
and she just does not know why.
And so, you know, something veryspecial happens after you've been
doing dentistry for 25 years.
It's like.
I don't know if you say that you enterthe matrix or you exit the matrix,
whatever it is, but you, there's a lotof things that kind of start to overlay,
(01:48):
and so I look at the radiograph of thisimplant and, um, well, the abutment that
was used is larger than the implant.
And so, well, why do you thinkyou're having problems, right?
These, these, this is mismatched.
And look, I'm not here tocall out another dentist.
Yeah.
Because we have all had our ownlearning experiences, but she comes
(02:12):
in hot and heavy, very hot and heavy.
This is a very difficultpatient to manage.
First thing I did is I put on mywhite coat, which I almost never do.
And the reason why I did that isbecause this particular patient
needed an air of authority.
You just kind of pick that up, right?
And then I go in and I say,this is what's happening.
You need to have surgery.
(02:32):
You need to have this cleaned out.
You need to replace the crown, and youneed to have the correct pieces used here.
Or what's going to happen is you aregoing to lose this implant, right?
You're already on the way there.
There's already threads exposed.
This is the best that we can do.
And so I have this conversation with her.
I don't know, at least an hour.
(02:54):
Now again, uh, this is a Deltapatient, so imagine how much I'm
being paid for this hour, right?
Right.
I don't know.
I'm lucky if I got paid 60 bucks right.
For the consultation and if myhourly is at $1,200, I basically
set $1,200 on fire there, right?
Right.
So then the patient comes back in andshe leaves a message and says, I do
(03:14):
not wanna hear her voice, her being me.
I do not wanna hear back from her.
What I need you to do is Ineed you to call the insurance
company and reverse the claim.
Because she didn't touchme, she didn't do anything.
She didn't fix anything.
Right.
Which of course is all completely untrue.
Um, and so what I ended up.
(03:38):
Saying, you don't wanna talk to me, fine.
I'm not gonna make you talk to me.
But what I ended up doing and, andtalking to my, to my team about is I
am in network and I have this contract.
So I can't pretend thatthis didn't happen.
I can't pretend that Ididn't give you advice and.
And so then I overheard one of myteam members talking to the insurance
(03:58):
company basically saying, look, shewants you to reverse the claim because
she didn't like what she heard.
And so here I am, um, we wouldbe grateful to lose this patient.
In all honesty, she's beendifficult from the very beginning.
But, but here's the point of the story.
We just have such difficultpatients that are so, um,
Dr. Chad Johnson (04:21):
entitled,
Dr. Maggie Augustyn (04:22):
entitled, and they're so needy.
And you know what?
You need to stand your ground.
You need to charge what you're worth.
And on patients like that,you need to cut the cord.
And if they're saying, Hey, refund methis money, or I'm never coming back,
one, I can't refund you this moneybecause I'm obligated by the insurance
(04:42):
to charge you for, for what we did too.
I set $1,200 on fire of my own productionby sitting there and talking to you.
And three, good riddance,please don't come back.
Right?
Um, and so.
I think this is, this is, you know,a great segue of, of you, Chad,
going into your story and, andhow you set this one particular
(05:09):
patient who came in hot and heavy.
So tell us that story.
Let's see how we can break it downand, and learn from it and give
our, our, our listeners here someadvice on what to do when these hot
and heavy conversations come up.
And we feel like there's no feeling,okay, we are being taken advantage of.
(05:31):
Mm-hmm.
Dr. Chad Johnson (05:33):
So for anonymity's sake, I'll call him Jerry.
And I also apologize ahead of time.
If I back the microphone awayand I'm yelling, so your, your,
your volume control might needto be on your fingertips in
the vehicle as you're driving.
Okay.
Tom and Omaha just thought I'd say hito Tom, Dr. Tom listening right now.
(05:57):
So, goodness.
Okay, here I go.
So Jerry, uh, comes in.
I'm seeing patients on a Saturday.
We get him scheduled and Icome in Saturday morning.
Um, he hasn't been in for ten-ish years.
He's got a lower denture over denturewith two locator implants that I
had placed the locator broke off.
(06:18):
Um, he's been at another dentistfor, you know, a few years
and he, uh.
Uh, has the screw broken offthe other dentist, you know,
doesn't know what to do.
So I, uh, get it out.
It probably took me 10 or 15minutes, which I was super impressed.
I told him, I was like, number one, whenwe do this, we can't be sure that it's
(06:41):
going to, you know, even work gettingthis, the, the broken off screw head out.
And if we do get it out.
Is it going to be, uh, are, arethe threads gonna be stripped on
the inside, you know, while we'remessing around with the inside?
So let's give it a try, but, you know,no promises, hate to say it, but you
know, like your only other option is toleave the implant there or pull it out
(07:03):
anyway, so, you know, no harm, no foul.
Let's give it a go.
Dr. Maggie Augustyn (07:06):
So I'm gonna short just, just small
interruption here for our Yes,
Dr. Chad Johnson (07:10):
by all means,
Dr. Maggie Augustyn: because here's the thing. (07:10):
undefined
The way to start thisconversation is to be completely
transparent with the patient.
Mm-hmm.
And say, this is the issue.
This is not my issue.
This is your issue.
As Bert Baird says, right, yourproblem, this problem is it.
This is your problem.
But here I am to solve it.
This is what can potentially happenbecause having that really honest
(07:33):
conversation upfront with our patientsis going to and inadvertently keep us
from being in trouble because had younot had that part of the conversation and
something would've happened, it would'vebeen your fault for breaking this screw.
Yep, perfect.
It would've been your faultfor this then and the other.
So communication is key.
Love it.
PDA teaches, right?
So step number one is com.
(07:54):
Be completely transparent and makesure that the patient understands
that this is not your problem.
Dr. Chad Johnson (08:00):
Yep.
You
Dr. Maggie Augustyn (08:00):
are the hero here and you are trying to
help them solve this problem.
Dr. Chad Johnson (08:04):
That's right.
So, Saturday morning, um, he'sbeen billed for limited exam peri
apical, and, uh, I don't know.
I, I just thought, uh, you know, for.
I don't, I don't know.
It's neither here nor therewhether someone else charges.
I didn't charge for the screw removal.
(08:25):
Um, why most of the time I'mnot gonna be successful and I,
uh, don't want people mad at me.
So there's that, and I, uh, 10, 15minutes later, I get the screw out.
If you're wondering how, since thisis everyday practices, I'll tell
you how, um, I got outta Cavitronand worked in a counterclockwise.
Um, and I also, uh, broke off aQ-tip and used the flat end of the
(08:50):
little wooden, uh, topical Q-tip andpushed it down in there and turned.
Uh, and then I also did a slow speed,um, uh, round burr on the top of it
and, uh, put it in reverse and use thatto, you know, kind of torque on it.
So, uh, between those threethings, I started seeing the screw
move up and got the screw out.
(09:12):
That isn't the problem.
Uh, he gives me, I'm
Dr. Maggie Augustyn (09:15):
gonna interrupt you one more time because on that particular,
on that particular instance, I think itwould've been very helpful for you to tell
the patient, Hey, Jerry, what I just didfor you is one, I charged $1,800 to open
an office, which I did not charge you for.
And two, I removed thisscrew and everybody else
would've charged you $1,500.
(09:35):
And that is my gift to you,
Dr. Chad Johnson (09:37):
right?
That would've been brilliant.
At times I'm brilliant.
At this time I was not, so, I,I mean, I was super impressed
that I got the screw out.
Let's, let's say that, but I, Iwasn't, you know, using my best,
uh, Augustine verbal skills.
So I got this, uh, screw out and,um, you know, no anesthetic, no pain,
(10:01):
no nothing out the door, you go.
I've got the little piece,uh, of the broken part.
And so I'm going to,um, order the new one.
I had it written down, um,at that point, this is dumb.
I had it written down which,uh, which size of abutment
that we had used at the time.
And so, and this was a different implantsystem too, but I found it on a website,
(10:23):
custom ordered it, um, overnighted it,it didn't show up for four business days.
He's on a Thursday now.
Um, and.
He's coming in to, uh, to get it, it,you know, says that it's, you know,
being shipped, it's getting here soonor whatever, and it doesn't show up.
Normally we get ourdeliveries, you know, 10 or 11.
(10:44):
So he shows up, um, 10minute drive from home.
It's unfortunate.
I go in and, you know, and Itell him, I'm like, um, you know,
bu deal that we don't have the.
Um, the part yet.
And so let's get you rescheduled.
And I apologize, we should have,you know, known ahead of time.
So my office manager says, whydon't we go over, um, cost estimate.
(11:08):
And so, um, she goes over the costestimate, says it's gonna be $720, that's
gonna be 600 for the abutment, uh, sixfor the new, um, uh, locator attachments.
And so then he gets all mad, whatthe f is this and this and that.
And he is all mad and stuff.
She comes in and is like,man, he's swearing at me.
He's all mad and stuff.
And I was like, I was like, uh,you know, Jerry's a uh, uh, a gruff
(11:35):
guy, so it just is what it is.
And, um, you know, but like, he's notnecessarily mad or, or he's just kind
of that way, you know, the angry.
Trucker type or something like that,you know, just like, well, well, what
in the world cost of coffee these days?
So I, uh, I go in the room, youknow, 'cause I, I hear man, he's
(11:56):
mad and stuff, so I go in the room.
Jerry,
Dr. Maggie Augustyn (11:58):
I'm going to make another small interruption.
When a patient iscomplaining about cost, yes.
Okay.
I invite them to go to fair health.org andon there is, it's a website that shows you
what is a reasonable cost for this area.
Right.
So if you're charging $680 forthis particular abutment, be like,
(12:20):
Jerry, go to fair health.org.
Why don't you look up what I shouldbe charging you and chances are
that you're, I know how you are andyour fees are probably way too low.
Um, and so then, and that's anothermind blowing thing for them, bro, I
just gifted you $3,200 on Saturday,and now instead of charging you
(12:41):
$1,200, I'm charging you six 80.
Okay?
I'm getting all riled up too, so just keep
Dr. Chad Johnson (12:46):
No.
And, you know, I, so I did.
I came in and I was like,Jerry, what's the deal?
What are you upset about?
Well, I don't know why I am, youknow, getting charged this last time
it was, you know, half the cost.
And I said, well, we've printed$15 trillion in the last five
years of, of money, so I'm notsurprised that things cost more.
And so I, I actually don't know why youaren't surprised that things cost more.
(13:09):
It just is.
I said, you go find me.
I'm gonna, this, this, I'm gonnakeep it short, not go on my full
rants of, because I was, I came in.
Unusually hot and bothered bythis, and I said, you go find
me three other cost estimates.
Go get three other cost estimates.
Do it, and you find me a dentistwho will do it $30 cheaper.
(13:29):
I'll match it because I justdon't believe that's the case.
This is a steal of a deal.
I came in on a Saturday.
I took the implant screw out at nocost because says, no, you charged me.
I said, Heather, look that up.
I could be wrong.
What happened, uh, limited exam for thismuch and a peri apical for this much.
And I said, oh, okay.
So my apologies.
You were charged.
(13:51):
You weren't charged for the screw removal.
So you're correct.
I'm correct, but let me be clear, youwere not charged for the screw removal.
You paid for the exam and thex-ray, you paid for my expertise.
There are very fewdentists that can do this.
And have done it successful, andI didn't even charge you for that.
So now you're getting chargedfor the abutment and it's nothing
(14:15):
more than what it was before.
And he says, well, it wasn'twhat I was charged before.
Office manager, what didwe charge him last time?
We look it up?
Come to find out.
We gave it to him last time at no cost.
So I said, Jerry, letme get this straight.
Are you upset that I've been moregenerous with you in the past
that I gave it to you for free?
Yes.
(14:35):
Than now?
I mean, like is thatwhat you're upset about?
Is that I've been too generouswith you in the past and.
He didn't have much to say.
He kind of like, I think he tookmy energy and was like, oh shoot,
this guy is, you know, he's legit.
Oh, and he's upset because Ithink, you know, like the goal was
I'm gonna be the upset patient.
(14:55):
Then I come in and I'm like, well,I'm the upset business owner and
you've taken advantage of me too long.
And he came back the followingThursday, which was yesterday,
and I gave him a gift card.
For a local gas station and fornot, you know, having the stuff
on time for his appointment.
And he knew about that.
(15:15):
That was
Dr. Maggie Augustyn (15:15):
kind of you.
That is actually, that works also.
That's another, that's anotherbit of information that,
um, our listeners can take.
Yes.
Think from this is like, okay, sosometimes stuff happens, and if it does
just have a bunch of those gift cards.
25 bucks, 20 bucks, gas station
Dr. Chad Johnson (15:33):
25 in Chicago, 2020 in Iowa, you know, uh, but, uh,
uh, you know, 50 in Hawaii, right?
So, um, so I, I, I just, and Igave him a legit apology too.
I was like, Larry, Hmm?
I was like, Jerry.
There was another one, Matt.
Sorry.
(15:54):
I was like, Jerry, here's,you know, here's the deal.
I am really sorry that we didn't havethe stuff on time for your appointment.
Here's a gift card as promisedlast time, because I just
don't like working that way.
And I'm super glad that that abutmentwent in today, that we got the new part
switched out, that it clicked down well.
(16:14):
Um, this is a really a win-win.
And, uh, I didn't say thisand yet I'm just like, I hope.
I hope to never see you again.
Like just move on.
And, but at the same time, I was verytransparent and authentic with him.
I think overall I was professional.
I probably had some borderline moments,but it was very cathartic to share
(16:38):
my frustrations with him and notnecessarily get bent outta shape.
Did I raise my voice?
Yes.
Um, but it wa and I told himthough at the time, I said.
Jerry, I'm not mad at you.
I am mad though that I feel takenadvantage of, that you know, that I've
got all this expertise to do what veryfew people can do successfully, and
(17:01):
it's, it's not good enough and thatthat is frustrating and I hope you can
understand that and turns out my office.
Manager's door was open.
I couldn't see anything but red.
So, um, and the whole office heard thisconversation and they were proud of me.
(17:22):
Maggie.
Yes.
They were proud of me.
They were just like, I would,
Dr. Maggie Augustyn (17:25):
had I been there, I would've been clapping too.
Yes, I would've, you know what?
I would've brought you cupcakes.
Yep.
Um, it would've been like, likewith a candle and everything.
I mean, you, you definitely,you stood up for yourself.
That's right.
Yes.
Dr. Chad Johnson (17:37):
Yep.
Dr. Maggie Augustyn (17:37):
And, and, and it's hard to do.
Dr. Chad Johnson (17:39):
Yep.
And to restore the relationship,like, you know, I don't really want
to say, but like, let's say he cameback in and then from now on he's just
chipper as ever and brings us cupcakes.
Okay, cool.
Like, but I think I needed to, tostand up for myself and my office
and my value and what it's worth.
So, for what it's worth, listeners,I'm actually, that's, you know, the.
(18:02):
Fourth or fifth iterationinto telling the story.
So now I'm, I'm kind of cooling downabout it, but, uh, probably in another
five times of me telling it, I'lllaugh about it, but right now it's
just like, oh, it made me so hot.
Dr. Maggie Augustyn (18:13):
Well, it, and it's frustrating and it was, you
know, raise your hand if you'renot driving a car, you know?
Doesn't this happen to you all the time?
Yes.
So here we are and thisis what we're doing.
We are empowering you.
Dr. Chad Johnson (18:26):
Yes.
Dr. Maggie Augustyn (18:27):
To do the hard and right thing.
Right.
It's not, this isn't easy to doand it took me 25 years of being
in dentistry before I grew, Hey,I'm just gonna say it, the balls to
say what I need to say to patients.
Now, it doesn't always work that waybecause there's plenty of really kind
(18:48):
people, and by me being so abrasive atthe wrong time, I actually turn them off
and it's a learning experience for me.
In fact, I have to make a phone call toapologize to a patient who was really
kind and I treated her with this kindof a tight grasp and I shouldn't have.
Dr. Chad Johnson (19:08):
Yeah.
Dr. Maggie Augustyn (19:09):
Um, so it's, it's a learning experience
we've gotta kind of find, um.
The balance between when to be softand when to stand up for ourselves.
Right?
And it doesn't always work out,and it's, it's, it is, it's just a
learning experience in our lives.
Dr. Chad Johnson (19:28):
Furthermore, um, Google Almighty tells us that CDT Dental
Code 6 0 5 6, uh, generally rangesbetween 400 to a thousand dollars.
Though some have, uh, fallen out.
You
Dr. Maggie Augustyn (19:41):
are welcome Jerry.
So how much Jerry didyou really get from me?
Like four grand worth.
Dr. Chad Johnson (19:48):
Right.
Dr. Maggie Augustyn (19:48):
Of free treatment.
Uh, so you know what you should do?
Um, Jerry, you should buy me cupcakes.
Dr. Chad Johnson (19:55):
That's right.
Send and send me a thank you cardfor the awesome service I just did.
Dr. Maggie Augustyn (20:00):
But you know what I, I think the universe or God or
whatever you choose to call the powerthat looks over you, or if you don't
have any power that looks over you,you know, karma, whatever you wanna
call it, this will come back to youand this will eventually bless you for
how helpful you have been to this man.
Yep.
Even if he doesn't realize it.
(20:21):
Yep.
Um.
You're, you're earningbrownie points somewhere.
Dr. Chad Johnson (20:26):
Yes.
And I do like, uh, pointing out, and thisis just a personal opinion, uh, not the
those of productive Dentist Academy, butkarma is rough because if you get what
you deserve, then that's always a goodthing when you feel like you deserve it.
Right.
You know, like you earn something.
But then sometimes we're cruddypeople and we should get what
(20:47):
we deserve in the bad way.
I'm just so thankful to Godthat it's just like that.
I don't get what I deserve attimes, and so that might sound
sanctimonious to some people.
Like I'm just, you know,spewing off stuff, but.
Uh, I'm so thankful for this professionand I, being in a, a grateful mindset
is, uh, is valuable and just being like,I really don't deserve to be a dentist.
(21:09):
I sure tried and stuff, you know, soit's not that, it's like, oh, I don't
deserve it, but it's like, listen.
Um, I'm thankful for it and I'm thankfulto be able to treat the patients.
Sometimes they are buts and they aredifficult and though it might be rare and
for some people it might be every day.
And then that just gets bold.
If you need someone to talk through,um, you can write both of us.
Dr. Maggie Augustyn (21:32):
They could do Dr. maggie@myhappytooth.com.
There you go.
R-M-A-G-G-I-E.
And that's fine.
Yeah.
Dr. Chad Johnson (21:38):
Um, you know, or chat@productivedentist.com
if you remember mine better.
And then just, I can send it alongto Maggie, or I can, or you just
Dr. Maggie Augustyn: attention more than I do. (21:46):
undefined
Dr. Chad Johnson (21:48):
Oh, no, I certainly do.
Hey, uh, listeners, thanks for, uh,you know, listening on the drive.
Hopefully that was a fun, shorter thing.
And thank you for beingmy counselor as I cathart.
Um.
You know, I don't know a betterword, barfed up my, my junk over
the last week and a half of Jerry.
Dr. Maggie Augustyn (22:10):
And listen, I'm gonna, I'm just gonna ask
you one thing that you learnedfrom this barf, cathartic barf.
Dr. Chad Johnson (22:20):
Yes.
Dr. Maggie Augustyn (22:21):
Gimme one thing.
What is your takeawayfrom this conversation?
Dr. Chad Johnson (22:24):
Um, finding a way to stand up for yourself and yet
dialing it in to where you're not.
Acting ridiculous or un whatever, justthat you're, you're also coming to
this person, treating them humanelyand you know, with decency enough, even
if there's yelling, even if there'sconsternation between the two of you,
(22:45):
to be like, Jerry, I'm not mad at you.
I'm mad that I, that I feel this way.
And, you know, just laying it out,but also setting up some boundaries.
So it was a boundaries testwithout being a ridiculous caveman.
Dr. Maggie Augustyn (22:59):
Yeah.
I love that.
And, and for me, this has a a lot to dowith looking at yourself and balancing the
energy, because I struggle with this Yeah.
Of when to go in hot and heavyand when to kind of move back,
um, because this is something thatI'm still learning about myself.
(23:19):
And then always the biggest takeawaythat I hope everybody takes from this
particular podcast and the words ofBruce Baird is, whose problem is this?
Dr. Chad Johnson (23:28):
Theirs.
Dr. Maggie Augustyn (23:29):
It's their problem, right?
You are the one that'shelping with the situation.
You're not creating the situation.
And enough is enough.
Yeah.
Patient's coming in and blaming usfor what's going on in their mouth,
that has got to stop and we're goingto do everything that we can to teach
you how to not take on that problem.
And maybe this is a great segue intoinviting back our good friend Eric
(23:53):
Wrecker, because we carry other.
People's issues with us.
Dr. Chad Johnson (24:00):
Right.
Dr. Maggie Augustyn (24:00):
Unfairly, we shouldn't be doing that.
That's not our problem.
That's their problem.
And let's find a way to, becausethat, that's, that's, that's
what creates the burnout.
We're not here to save everybody.
We're there to help them becauseultimately they're the ones that have
created these messes in their mouths.
Yeah.
I'm not saying it's their fault, it'sjust the situation, but we are not.
(24:22):
We're, we're here to help and not,not to be blamed for what's happened.
Dr. Chad Johnson (24:26):
Yep.
Maggie, great discussionwith you listeners.
Thanks for coming on.
Until next time, everydayPractices Dental podcast.
Dr. Maggie Augustyn (24:34):
See you later.
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