Mentor Advice ForumRadiographs
Ann Cote asked 2 years ago

I have dealt with a few very rude patients who decline the routine BWX x-rays. They don’t want the “speech” and just decline them. After myself and the doctor highly recommend them to the patient due to many high risk factors for decay, the patient still declines and are just down right rude. Any advice? 

3 Answers
Lucinda B. McKechnie, RDH, BS Staff answered 2 years ago

After 46 years of clinical dental hygiene, I have encountered the situation you describe many, many times. Quite honestly, if the underlying reason is financial concerns (and I know I have had patients who are embarrassed by not being able to afford “extra” treatment like radiographs so they blame it on risk concerns), our office tends to take the radiographs anyway, at no charge because they are so necessary. In cases where the, “risk” is of concern according to the patient, our hygiene team will bring up a panoramic or bws (anonymously) and describe the rational for taking the radiographs and point out the details of what we are assessing on the radiograph with the patient looking as well. Once the patient sees issues on the anonymous pan or bws, and, listens to our concerns, the patient may be more willing to accept (and we never say, “xray” we instead say, “radiograph” and if the patient does not get it, then we say, “xray” but always start with, “radiograph”). Ah yes, then there is the patient who does not want to hear the, “speech” as you stated. For those rude patients, we have them sign a consent form, stating they declined radiographs as well as making a note in their chart. Some patients are offended by the form, but, if a treatment arises that could have been ameliorated with radiographic detection, then that form gets you, “off the hook.” Tough situation I know. . . there will always be those rude and non-compliant patients who ruin your day. Smile and move on. . . after they sign the form. And if they refuse, we have dismissed those patients from the practice which is totally acceptable.

Nancy Kiehl, RDH, MS Staff answered 2 years ago

That’s a tough one. It’s good that your dentist is involved and helps you. Ultimately, it is the patient who decides what he or she will and will not do. Your office has the right to decline treatment to patients who don’t follow the recommended advice of the dentist. On that note, your question includes the words ROUTINE BWX. Even though insurance companies will pay for routine radiographs, that doesn’t mean you should take them as often as insurances will pay. Hopefully, each patient is being assessed for his or her individual need for radiographs and given personalized care. There shouldn’t be standing orders from the dentist stating that without exception, each patient must have BWX at a set time. Patients have specific needs and those needs can and do change. Some patients at high risk will require radiographs every 4- 6 months and others at low risk might need them every 3-5 years.
You could also try asking the patient about his or her reason for objecting to radiographs. Some don’t want the radiation and knowing this can lead to a discussion about the reduction in radiation with digital radiographs, if you have that technology. For others, it is the increase in cost that they object to and perhaps your office could offer Care Credit or another payment plans so that patients have options to pay for treatment.
It’s easy to get upset and take it personally but I hope you will keep the channels of communication open with patients and try to understand it from their point of view. Even if you work on commission, extend a genuine concern for the patient’s feelings and thoughts and perhaps trust will develop and maybe next time the patient will have the radiographs taken.
Good luck and thanks for asking!

Darlene J. Swigart, RDH, BS Staff answered 2 years ago

This is such a difficult situation to face. We know taking radiographs is essential for a complete diagnosis. I have dealt with this problem in the past. It helps if the office develops a policy on radiographs. Many offices require new patients to have a FMX or pano with bitewings on the first visit or provide one taken in the previous 3 to 5 years. Having a set policy works if the front office staff team informs new patients what will take place on the first appointment. The policy for recare patients should be based on dental caries and periodontal disease risk, and an evaluation of the patient’s health history.
We always want to base our decisions on individualized person-centered care and not on a set routine interval. My first step was to work on developing a rapport with patients and using reflective listening. I would ask them the reason they did not want radiographs and tell them I needed to document the reason in the chart. Interestingly, it wasn’t always about the radiation exposure. Sometimes it was money. Sometime it was about wanting to get out of the office ASAP because they hated being in a dental office. Sometimes they said they didn’t have time, so I could tell them how fast I could take them. We need to ask the reason, so we can address it.

If the reason was about radiation, I would reassure them that I also wanted them to get the least amount of radiation possible. Informing the patients of the reduction in exposure with the use of digital radiographs was also helpful. Patients generally liked the challenge of reducing their risk for dental caries and periodontal disease when it meant a longer time between radiograph exposures. I was very upfront with patients and told them what could not be seen without radiographs. I was usually able to negotiate with patients and allowed them to extend the time between radiograph exposures. The patient had to sign a statement each time radiographs were recommended and the patient refused. The statement included the complete risks including an undiagnosed infection that goes systemic, loss of teeth, undiagnosed bone loss, etc…
In some states, a signed refusal does not hold up in court because the patient does not have the knowledge and understanding of their risks of refusing radiographs. A patient might be able to sue for damages.