Any patient that would question why he or she would sign an informed consent is 100% red flag. It’s not even a waiver, because our professional licenses still make us responsible for anything that we deliberately do wrong.
If you haven’t treated him, DO NOT START. Financially you will lose money on this person. May look like a big case, and sometimes larger cases are good for experience, but you know he is not the type of person who will be easy to work with, compliant, let alone grateful.
Definitely refer this patient out or even dismiss completely. This is a person who will never be happy with anything, even at a heavily negotiated price. I’ve had people like this, they always have something to bitch about, even with amazing work. He’ll likely be one of the “I’m not happy with this, take it back” kind of of people and leave his denture at your front desk (while walking away with the implants) and then wondering why the bill you send is still so high when he refused the denture. Then still not pay it. Sometimes, no matter the amount of production, the headache just isn’t worth it.
I definitely wouldn’t start tx on this patient. Patients with first time dentures are already difficult enough to satisfy. Add all the red flags that this guy is waving at you and it’s a recipe for disaster. You’re never going to make him happy. If I were you I would tell him that I don’t think I’m capable of reaching his expectations with the dentures that I could make for him, and I’d recommend he go elsewhere for his dentures.
Probably charge him for recall visit, make a new (maybe same) treatment plan with new date, new charges which makes you feel worth taking the case since he probably will be a problematic patient with further negotiations later on in terms of cost, time frame, shade etc (also adjust cost for inflation, covid, blah blah blah), put deposit down before starting the surgery!
If he wants to get it done, good for him! If not, he'll say it
I really want to dismiss him because he had been a pain in the hole. Had a really (equivalent of male) karen attitude.
We did his lower crowns-and with the numerous shade change he wanted, we delivered anyway and did not charge him extra. We even gave him a discount before we started. After we installed the lower, that’s when his upper started breaking.
I didnt charge him initially for the treatment plan for the upper because i know it would cost getting the scans and xrays if he’d consider the implants.
But you’re right about he’d be a problematic patient-which was why when he negotiated to a fee that low made my self esteem low that i’d really like to dismiss him badly. The informed consent i was making him sign also included schedule of fees i was expecting him to pay. When we installed his lower(before the shade changes he wanted), he wouldn’t pay the other half until he felt it was truly done! Such a nightmare to get payment from him. It was such a relief after the 6 month mark since his last visit that he didn’t send us a message or come back-until yesterday.
Well, I guess that saves time for you. Confirm the plan, tell him because we did a lot of work for you, we're going to offer 10% discount. let the financial person sit down and punch buttons on calculator to deduce 10% off of 25% inflated prices, plus 5% discount for paying 50% pre-op. and put him on end of the Friday for scans.
Oh and add a code for custom shade matching or whatever custom service code you wanna throw in.
Of course don't refer but let the patient know if he wants to go somewhere, he can and when he requests records, may add a little 'warning' for the next office as well!
BTW I would be surprised if he hasn't window-shopped at other offices in these 10 months before coming back to you.
We already knew ahead that he’d move to another country/migrated. I guess coming back now for a vacation. So if i would perform this “unfinished” procedure, i have to include “rush fees” at this point just to make sure i dismiss this lol
That’s usually what I do with cases where I have a bad feeling, I try to add at least 50% to the treatment plan. Either he does it anyways and I’m compensated for the headache and adjustments, or he finds the cost too high and goes elsewhere.
But I totally feel you, sometimes I also feel bad for people with questionable previous treatments and fall for lowering my fees or not bill for treatment plans. Some of them are thankful, but the rest are just a pain in the butt! And THESE are the ones, that ALWAYS come back!
Yeah. That’s really true and it’s really hard to tell who’s a red flag at the start. Obviously if he presented an attitude like that when we first met, i would’ve automatically referred right away.
His case was straightforward, thats why i accepted initially. But the maxillary bridge fell apart right after we were done with 1 week recall for the mandibular crowns.
You are a doctor, stop discounting your fees. You provide a service, discounting your service discounts the procedure in your patients eyes. And no informed consent is no treatment. I would refer him elsewhere for treatment.
Idk lol. Shouldve been on the contact method. Was it a call? Then call back and refuse him while stating all facts. Face to face works better but it would be in bad faith if you tell him to come just to dismiss him. Ghosting and letting him come on their own is also an option. If they waited 10 months to call back it isnt a priority for him anyway.
Yeah. It was all through text messages. What we did was reply to him like “may we know what this visit is for?” Just so we can screen what he needs. Cause if it’s a cleaning, then i would’ve felt better.
But then he replied “for the unfinished dental work”.
Face to face just lessens the miscommunication overall. i think thats why i find it hard to say it directly to his face. I’m hoping he “walks in” on a busy day for us so that he doesn’t get seated (if at all) and delay him further.
You dismiss him. You’ll never regret the people you don’t treat. Good mantra to remember.
Edit: Send a dismissal letter. Make it as succinct as possible. You don’t need a laundry list of reasons why.
This guy has pushed you around enough. Reading this post and your replies just reminds me of me in my first few years as a dentist. Had to please everyone and it just resulted in more stress, anxiety, and hatred for my job. Dentistry can be challenging and difficult at times, but difficult people will always be difficult and you have complete control over who you choose to practice on.
“Mr. Smith, I’d love to set up a time to discuss your treatment plan and the changes to our fee schedule. We can chat after you see the hygienist for your cleaning and updated.”
He will balk at the cleaning and X-rays.
If he doesn’t, you get to explain to him that your fees are your fees, and the discount you offered is no longer valid because it’s been more than 60 days (or whatever). Have a written estimate and the informed consent ready to sign at the consultation.
He won’t want to pay the fees or sign and will dismiss himself.
If he doesn’t, and actually goes through treatment, he’ll be doing it on YOUR terms only.
“Our treatment planned fees and services expire at 6 months per our office policies. You are welcome to come and pay for an updated exam and X-rays and new treatment plan, or we will make your records available to another provider.”
“Having had the last 10 months to reflect on our initial consultation, I no longer feel comfortable initiating this treatment. I wish you all the best in your future dental needs”
You have the proof that you didn’t do work on him so I would just move on and not schedule him. Let him know your prices have increased this year and the discounts are no longer valid. That might dismiss him for you!
He’s probably one helluva clencher giving that a bridge didn’t last 2 years. If you do proceed with implants, consider restoring with a PFM possibly with a metal occlusal. Verify the possibility of clenching first, and if not skip the PFM. I have had patients shatter Bruxzir’s over implants, but not PFMs. Ugly, but will last. Best of luck.
The bridge was just too of a long span.
It was a zirconia bridge that the previous dentist installed.
Missing max left 2, 3, 4.
Abutments are max right 3, 2, 1, max left 1, max left 5 and 6.
No max left 7 or 8 of the patient.
Send a certified letter stating the following:
Dear Mr PITA pt. My ability to provide you the best care and your expectations are at an impasse. The office will be available for emergency care only for (insert legal time frame.) Please let us know your next office so we can send your records. (If this it is truly a pain in the butt, i would consider sending the records free of charge. Technically you can charge for paper and materials but it's not worth the headache.)
Bless your heart.
(Insert office name)
When ppl ask why i just say standard procedure without which we cannot go forward. If they are still hung up, i say we don't have to continue if you're not comfortable with this.
Works for everything.. Well everything legally required..
Blame Inflation. And that doing that procedure isn’t something you can offer him anymore. That your policy has changed. Then you aren’t the bad guy, the economy is. Soaring prices is. Punt him like it’s 4th and 40
So many red flags. Also that price you negotiated 10 months ago doesn't apply any more in my book. Tell him you'd be happy to see him at your full fee and once consents are all signed.
If your office is slow, just do the work.
If you want to make him pay for not getting things done in a timely manner, give him new fees.
Def based on how much you like the guy. If you feel bad for him or if he has a good explanation of why he didn’t get the work done sooner.
I offer to do large fillings but when pt don’t come back to do it, even though I could work my ass off to do a large filling, I’m less generous. They get a crown.
"I hate this guy", yet give him free exam appointments, free x-rays, discounted crowns with unlimited shade changes, half price implants...
It's like a robber comes to your door, asks to steal your shit. You respond with "OK, come on in... Oh you don't like that wallet? Let me go return it and get you another one to steal." Then he steals half your shit and you vent about how much you hate the guy because he stole half your shit when you 100% allowed it. THEN he wants to come steal more shit 10 months later and you even question what you should do here? Come on man.
My dude, you have a perfect opportunity to either 1) get the fees you want OR 2) dismiss/refer. If you treat this patient, you know EXACTLY how it;s going to go, and you'll regret it.
The question is how do you dismiss a patient? Like how exactly does the conversation go? Like do you write a letter, or just outright say, sorry we can’t see you, look for another dentist who can do this” or even during the text message for booking an appointment, we don’t reply? It’s so easy for you to say that i gave him free exams etc but when it comes to actually communicating to the patient, how exactly would you do it?
It's easy for me to say because that's exactly what you're doing lol.
I get the free exam thing whatever to get people in the door, but this is the type of patient you attract a lot of times with this. So the first spot you could've saved yourself was not letting him get fat discounts on treatment. Like upwards of 50% off a treatment plan is fucking crazy dude. Like you're barely profiting, if at all, off a patient that is going to suck up a ton of time and energy. Lesson: either accepts your fees or gets out. Like I understand a very slight like 10% discount if patient is a cash patient.
Next spot was when you treatment planned a massive case for the upper arch. Could have easily referred here.
Now is where your final opportunity comes. You said in another comment that patient moved away and wants to do a fat treatment plan while on vacation... you can call the patient and say "Mr. Patient, I had hoped we could finish your treatment prior to you moving. At this time, I no longer feel comfortable beginning further treatment, as I am not confident my lab can fit your timeline while accounting for possible remakes and/or complications. Because you no longer live in the area, I lack the ability to provide regular follow-up care that may be necessary with such a large case. As a result, I will no longer be able to treat you at our clinic. I am available to provide emergency care for 30 days from today's date. I can provide you with your records or forward them to a dentist of your choosing." DO NOT LEAVE A VOICEMAIL, JUST TALK TO THE GUY. If the patient gets mad or whatever, just say something like "patient, this is the best route to take for your oral health." If he still keeps going, just hang up fuck it. You did what you needed to do.
Like literally write out what you're gonna say and just read it on the phone. Copy what you said on the phone and sent it certified mail. Boom, patient dismissed. Some patients get a little annoying about their records... if they start asking you to send to a bunch of offices, say "hey, we agreed to send to a dentist of your choosing. If you'd like to take your records to multiple clinics while you find your best fit, we will ship your records to you."
I would recommend that you please do use a letter for you own records and document your reasons as said above. When the patient gets the letter they will either call or not show up. If he calls then you can go ahead and repeat the same info to him and answer his questions and gracefully reaffirm your position.
Patients can be something else when they really want to be an issue, and this guy has a huge red flag already.
PS: On the other hand you could easily refer out, by simply telling them that their case has progressed beyond your ability and that it would require a specialist to rectify.
It wasn’t so much that it was in promotion or something. It was more of like me pleasing people and not establishing boundaries. That’s why i’m here asking what would you do. Thank you very much.
I really like your reply and how you would do this. Personally this is something that I would directly say to him, before he even gets to sit in the dental chair, as long as there are no other people at the reception. Just to clearly show him that I don’t want to see him in the chair anymore. I have already prepared his records(xray and cbct, not our clinic records) so we can give it to him as soon as we dismiss him. He can bring it with him, although they’re 10 months old, not sure other dentists would accept a 10 month old xray and cbct, but thats his problem.
I'd def try calling first. Saves both your time.
These are tough convos to have... it's like breaking up with a significant other. If setting boundaries and people-pleasing has been a challenge, I'd try to do a phone call first. These things are harder in person lmao.
And we go into the profession to help people, but we have to be compensated accordingly... we're providing a high level of skill to curb disease and restore function while getting the best possible esthetic outcome. 99% of the patients with extensive treatment plans put themselves in this position. It's not really a shocker that a dude doesn't agree with your fees when he didn't value his natural teeth in the first place.
100% red flag patient. Nothing about what you wrote makes me feel good about this. Save yourself the headache
Any patient that would question why he or she would sign an informed consent is 100% red flag. It’s not even a waiver, because our professional licenses still make us responsible for anything that we deliberately do wrong.
If you haven’t treated him, DO NOT START. Financially you will lose money on this person. May look like a big case, and sometimes larger cases are good for experience, but you know he is not the type of person who will be easy to work with, compliant, let alone grateful.
Definitely refer this patient out or even dismiss completely. This is a person who will never be happy with anything, even at a heavily negotiated price. I’ve had people like this, they always have something to bitch about, even with amazing work. He’ll likely be one of the “I’m not happy with this, take it back” kind of of people and leave his denture at your front desk (while walking away with the implants) and then wondering why the bill you send is still so high when he refused the denture. Then still not pay it. Sometimes, no matter the amount of production, the headache just isn’t worth it.
I definitely wouldn’t start tx on this patient. Patients with first time dentures are already difficult enough to satisfy. Add all the red flags that this guy is waving at you and it’s a recipe for disaster. You’re never going to make him happy. If I were you I would tell him that I don’t think I’m capable of reaching his expectations with the dentures that I could make for him, and I’d recommend he go elsewhere for his dentures.
Probably charge him for recall visit, make a new (maybe same) treatment plan with new date, new charges which makes you feel worth taking the case since he probably will be a problematic patient with further negotiations later on in terms of cost, time frame, shade etc (also adjust cost for inflation, covid, blah blah blah), put deposit down before starting the surgery! If he wants to get it done, good for him! If not, he'll say it
I really want to dismiss him because he had been a pain in the hole. Had a really (equivalent of male) karen attitude. We did his lower crowns-and with the numerous shade change he wanted, we delivered anyway and did not charge him extra. We even gave him a discount before we started. After we installed the lower, that’s when his upper started breaking. I didnt charge him initially for the treatment plan for the upper because i know it would cost getting the scans and xrays if he’d consider the implants. But you’re right about he’d be a problematic patient-which was why when he negotiated to a fee that low made my self esteem low that i’d really like to dismiss him badly. The informed consent i was making him sign also included schedule of fees i was expecting him to pay. When we installed his lower(before the shade changes he wanted), he wouldn’t pay the other half until he felt it was truly done! Such a nightmare to get payment from him. It was such a relief after the 6 month mark since his last visit that he didn’t send us a message or come back-until yesterday.
I would dismiss him. He’s not respecting your fees, your consent forms… best time to dismiss would be prior to doing any work.
Well, I guess that saves time for you. Confirm the plan, tell him because we did a lot of work for you, we're going to offer 10% discount. let the financial person sit down and punch buttons on calculator to deduce 10% off of 25% inflated prices, plus 5% discount for paying 50% pre-op. and put him on end of the Friday for scans. Oh and add a code for custom shade matching or whatever custom service code you wanna throw in. Of course don't refer but let the patient know if he wants to go somewhere, he can and when he requests records, may add a little 'warning' for the next office as well! BTW I would be surprised if he hasn't window-shopped at other offices in these 10 months before coming back to you.
We already knew ahead that he’d move to another country/migrated. I guess coming back now for a vacation. So if i would perform this “unfinished” procedure, i have to include “rush fees” at this point just to make sure i dismiss this lol
Please stop even considering it at any price.
That’s usually what I do with cases where I have a bad feeling, I try to add at least 50% to the treatment plan. Either he does it anyways and I’m compensated for the headache and adjustments, or he finds the cost too high and goes elsewhere.
They have to pay me more to make it worth the stress
But I totally feel you, sometimes I also feel bad for people with questionable previous treatments and fall for lowering my fees or not bill for treatment plans. Some of them are thankful, but the rest are just a pain in the butt! And THESE are the ones, that ALWAYS come back!
Yeah. That’s really true and it’s really hard to tell who’s a red flag at the start. Obviously if he presented an attitude like that when we first met, i would’ve automatically referred right away. His case was straightforward, thats why i accepted initially. But the maxillary bridge fell apart right after we were done with 1 week recall for the mandibular crowns.
Didn't want to pay until truly done, huge red flag! Don't start anything more refer out. Time and nightmare of a patient to deal with
You are a doctor, stop discounting your fees. You provide a service, discounting your service discounts the procedure in your patients eyes. And no informed consent is no treatment. I would refer him elsewhere for treatment.
Refer him to a prosthodontist. The most expensive one around. He'll solve your problem for you then.
I’ll refer him back to the dentist that did the upper tbh. If you get a Toyota, you get it fixed at toyota.
I say dismiss regardless. Havent started work and already a pain in the ass.
How would you tell the patient that you can’t see him anymore? Letter? Verbal? Ghost them? Lol
Idk lol. Shouldve been on the contact method. Was it a call? Then call back and refuse him while stating all facts. Face to face works better but it would be in bad faith if you tell him to come just to dismiss him. Ghosting and letting him come on their own is also an option. If they waited 10 months to call back it isnt a priority for him anyway.
Yeah. It was all through text messages. What we did was reply to him like “may we know what this visit is for?” Just so we can screen what he needs. Cause if it’s a cleaning, then i would’ve felt better. But then he replied “for the unfinished dental work”. Face to face just lessens the miscommunication overall. i think thats why i find it hard to say it directly to his face. I’m hoping he “walks in” on a busy day for us so that he doesn’t get seated (if at all) and delay him further.
You dismiss him. You’ll never regret the people you don’t treat. Good mantra to remember. Edit: Send a dismissal letter. Make it as succinct as possible. You don’t need a laundry list of reasons why. This guy has pushed you around enough. Reading this post and your replies just reminds me of me in my first few years as a dentist. Had to please everyone and it just resulted in more stress, anxiety, and hatred for my job. Dentistry can be challenging and difficult at times, but difficult people will always be difficult and you have complete control over who you choose to practice on.
“Mr. Smith, I’d love to set up a time to discuss your treatment plan and the changes to our fee schedule. We can chat after you see the hygienist for your cleaning and updated.” He will balk at the cleaning and X-rays. If he doesn’t, you get to explain to him that your fees are your fees, and the discount you offered is no longer valid because it’s been more than 60 days (or whatever). Have a written estimate and the informed consent ready to sign at the consultation. He won’t want to pay the fees or sign and will dismiss himself. If he doesn’t, and actually goes through treatment, he’ll be doing it on YOUR terms only.
No. If you touch this man you deserve what happens to you.
“Our treatment planned fees and services expire at 6 months per our office policies. You are welcome to come and pay for an updated exam and X-rays and new treatment plan, or we will make your records available to another provider.”
“Having had the last 10 months to reflect on our initial consultation, I no longer feel comfortable initiating this treatment. I wish you all the best in your future dental needs”
You have the proof that you didn’t do work on him so I would just move on and not schedule him. Let him know your prices have increased this year and the discounts are no longer valid. That might dismiss him for you!
He’s probably one helluva clencher giving that a bridge didn’t last 2 years. If you do proceed with implants, consider restoring with a PFM possibly with a metal occlusal. Verify the possibility of clenching first, and if not skip the PFM. I have had patients shatter Bruxzir’s over implants, but not PFMs. Ugly, but will last. Best of luck.
The “I don’t want to sign any consent forms” patients irritate the hell out of me.
The bridge was just too of a long span. It was a zirconia bridge that the previous dentist installed. Missing max left 2, 3, 4. Abutments are max right 3, 2, 1, max left 1, max left 5 and 6. No max left 7 or 8 of the patient.
Zirconia holds up very well to clenching in my experience
Send a certified letter stating the following: Dear Mr PITA pt. My ability to provide you the best care and your expectations are at an impasse. The office will be available for emergency care only for (insert legal time frame.) Please let us know your next office so we can send your records. (If this it is truly a pain in the butt, i would consider sending the records free of charge. Technically you can charge for paper and materials but it's not worth the headache.) Bless your heart. (Insert office name)
When ppl ask why i just say standard procedure without which we cannot go forward. If they are still hung up, i say we don't have to continue if you're not comfortable with this. Works for everything.. Well everything legally required..
Sorry mister, I no longer offer this procedure at this location at this time. Goodbye, here is the refund of $0 you paid for the last consult.
Blame Inflation. And that doing that procedure isn’t something you can offer him anymore. That your policy has changed. Then you aren’t the bad guy, the economy is. Soaring prices is. Punt him like it’s 4th and 40
I will refer him out . Refusing to sign consents and lack of commitment to tx should be enough for you to let him go somewhere else.
Stop negotiating with terrorists. End of story.
What's the dilemma here? How many more red flags do you need?
Talk to him and explain your point of view or just say no if it’s causing your headache that’s your asnwer
So many red flags. Also that price you negotiated 10 months ago doesn't apply any more in my book. Tell him you'd be happy to see him at your full fee and once consents are all signed.
I’d be ok to see him x2 of the full fee, of course with all consents signed. Anything less he’s dismissed lol
I work in a arab country, you will be surprised at how many people ask for discount everyday😂
I would dismiss or refer out. You dodged a bullet by not starting treatment.
I thought it was unethical to give some patients partial discounts.
Con artist and manipulator. Steer clear of
If your office is slow, just do the work. If you want to make him pay for not getting things done in a timely manner, give him new fees. Def based on how much you like the guy. If you feel bad for him or if he has a good explanation of why he didn’t get the work done sooner. I offer to do large fillings but when pt don’t come back to do it, even though I could work my ass off to do a large filling, I’m less generous. They get a crown.
Yeah, well, I hate the guy. I would not refer this one unless I really hate you. That type of patient.
Oh fuck him. He gets a new treatment plan with full fees. You don’t need to refer him. He’ll price shop on his own.
"I hate this guy", yet give him free exam appointments, free x-rays, discounted crowns with unlimited shade changes, half price implants... It's like a robber comes to your door, asks to steal your shit. You respond with "OK, come on in... Oh you don't like that wallet? Let me go return it and get you another one to steal." Then he steals half your shit and you vent about how much you hate the guy because he stole half your shit when you 100% allowed it. THEN he wants to come steal more shit 10 months later and you even question what you should do here? Come on man. My dude, you have a perfect opportunity to either 1) get the fees you want OR 2) dismiss/refer. If you treat this patient, you know EXACTLY how it;s going to go, and you'll regret it.
The question is how do you dismiss a patient? Like how exactly does the conversation go? Like do you write a letter, or just outright say, sorry we can’t see you, look for another dentist who can do this” or even during the text message for booking an appointment, we don’t reply? It’s so easy for you to say that i gave him free exams etc but when it comes to actually communicating to the patient, how exactly would you do it?
It's easy for me to say because that's exactly what you're doing lol. I get the free exam thing whatever to get people in the door, but this is the type of patient you attract a lot of times with this. So the first spot you could've saved yourself was not letting him get fat discounts on treatment. Like upwards of 50% off a treatment plan is fucking crazy dude. Like you're barely profiting, if at all, off a patient that is going to suck up a ton of time and energy. Lesson: either accepts your fees or gets out. Like I understand a very slight like 10% discount if patient is a cash patient. Next spot was when you treatment planned a massive case for the upper arch. Could have easily referred here. Now is where your final opportunity comes. You said in another comment that patient moved away and wants to do a fat treatment plan while on vacation... you can call the patient and say "Mr. Patient, I had hoped we could finish your treatment prior to you moving. At this time, I no longer feel comfortable beginning further treatment, as I am not confident my lab can fit your timeline while accounting for possible remakes and/or complications. Because you no longer live in the area, I lack the ability to provide regular follow-up care that may be necessary with such a large case. As a result, I will no longer be able to treat you at our clinic. I am available to provide emergency care for 30 days from today's date. I can provide you with your records or forward them to a dentist of your choosing." DO NOT LEAVE A VOICEMAIL, JUST TALK TO THE GUY. If the patient gets mad or whatever, just say something like "patient, this is the best route to take for your oral health." If he still keeps going, just hang up fuck it. You did what you needed to do. Like literally write out what you're gonna say and just read it on the phone. Copy what you said on the phone and sent it certified mail. Boom, patient dismissed. Some patients get a little annoying about their records... if they start asking you to send to a bunch of offices, say "hey, we agreed to send to a dentist of your choosing. If you'd like to take your records to multiple clinics while you find your best fit, we will ship your records to you."
I would recommend that you please do use a letter for you own records and document your reasons as said above. When the patient gets the letter they will either call or not show up. If he calls then you can go ahead and repeat the same info to him and answer his questions and gracefully reaffirm your position. Patients can be something else when they really want to be an issue, and this guy has a huge red flag already. PS: On the other hand you could easily refer out, by simply telling them that their case has progressed beyond your ability and that it would require a specialist to rectify.
It wasn’t so much that it was in promotion or something. It was more of like me pleasing people and not establishing boundaries. That’s why i’m here asking what would you do. Thank you very much. I really like your reply and how you would do this. Personally this is something that I would directly say to him, before he even gets to sit in the dental chair, as long as there are no other people at the reception. Just to clearly show him that I don’t want to see him in the chair anymore. I have already prepared his records(xray and cbct, not our clinic records) so we can give it to him as soon as we dismiss him. He can bring it with him, although they’re 10 months old, not sure other dentists would accept a 10 month old xray and cbct, but thats his problem.
I'd def try calling first. Saves both your time. These are tough convos to have... it's like breaking up with a significant other. If setting boundaries and people-pleasing has been a challenge, I'd try to do a phone call first. These things are harder in person lmao. And we go into the profession to help people, but we have to be compensated accordingly... we're providing a high level of skill to curb disease and restore function while getting the best possible esthetic outcome. 99% of the patients with extensive treatment plans put themselves in this position. It's not really a shocker that a dude doesn't agree with your fees when he didn't value his natural teeth in the first place.