Treatment Doesn't Always Succeed—Now What?

The procedure works out great... until it doesn’t. I don’t care what they tell you—implants don’t have a 100% success rate. Patients also don’t show up for all their recall appointments. In fact, most don’t. Only 15% actually do.

So what do you do when things don’t go well? Whose fault is it? Is it your fault? The patient’s? Your team’s? God’s? Because things do happen.

The Truth About Informed Consent

We talk about this a lot: informed consent. When you tell someone in advance, that’s informed consent. When you tell someone after, we’re just making an excuse.

I try to give informed consent with every one of my new patients and every patient before we go through surgery—or really, any procedure. But oftentimes, patients don’t hear or realize what they’re signing. Later they say, “You never told me this was going to happen.”

Well, we did. And it’s not really the patient’s fault—it’s my fault. Because if I told them and they didn’t hear it, whose fault is that? I didn’t communicate clearly enough.

Communication Today Is More Complicated Than Ever

Everyone will say today, “I left you a voicemail,” or “I sent you a text.” But did the other person actually read it? Listen to it? Understand it? Take action on it?

We receive hundreds of pieces of correspondence every day—emails, texts, voicemails, spam, junk mail, people yelling out their windows as we walk by. It’s overwhelming.

One of the biggest problems we face as humans today is communication. We think we communicate, but often we don’t.

One-Way Communication Isn’t Enough

I have an expression: if you send me an email or a text, that’s just one-way communication. But people think they’ve done their job.

People are so busy that they think if they just call you back, they’ve done their job. But if they call you and you don’t connect, now it’s your turn to call them. That’s not real communication.

In my practice, that kind of breakdown can be dangerous.

Taking Responsibility When Patients Say “I Didn’t Know”

When a patient says, “I didn’t know,” it’s probably my fault. Maybe the patient came in on a day I wasn’t there, got a CBCT scan, and was scheduled for surgery without me reviewing the scan—because nobody on the team told me the patient was in that day.

We see anywhere from 20 to 50 patients daily—sometimes more—with multiple hygienists and periodontists. There are a lot of people coming and going. I'm surprised more things don’t go wrong.

The only reason they don’t is because we have protocols in place for everything we do—and we try to follow them. One of those protocols is to provide informed consent: tell the patient in person and have them sign it.

Phone Consults Don’t Work—Here’s Why

When we try to give informed consent or a treatment plan over the phone, it doesn’t work as well.

For example, I got a call from a patient about 25 minutes ago. He was supposed to show up for a post-op check. We were going to treatment plan him for a mandibular overdenture. He lives 90 minutes away and has Parkinson’s disease. He called and said, “I can’t make it today; my Parkinson’s is acting up.” He wanted to do the consult over the phone.

We started talking, and I realized he needs a couple more teeth out, two or three implants, and we’re planning a full implant overdenture. That means I need to manage the prosthetics, surgery, aesthetics, extractions, and a medical consult. And he wants to do all this on the phone?

I’ve done this before—and I won’t do it again. I refuse to schedule someone for surgery over the phone unless I’ve seen them in person, unless it’s an absolute emergency.

The Risk of Cutting Corners

Things get lost in translation. After 10 minutes on the phone—with his wife in the background—I told him: “It’d be best if you come in.” Now it’s spring, the weather’s nice, and the drive is scenic. I said, “Find a time when your Parkinson’s isn’t acting up, come in, let me take a CBCT scan, a series of X-rays, and a digital scan. Let me work up the treatment plan appropriately.”

Sure, I’d prefer to do it over the phone. It’s easier. I don’t have to see the patient. My schedule is full—booked four months out. But that would be a disservice.

Sometimes We Have to Save Patients From Themselves

Patients often want to do the wrong thing. One of the things I say all the time is: “I’m here to save you from making a decision that’s not in your best interest—even if it’s the decision you want to make.”

If you have children, you know what I mean. It’s 4:00 PM, and dinner’s at 5, but they want ice cream. You say, “We’re eating dinner soon,” but they insist. “I want it now!” Sorry. I’m the adult. You’re the child.

With patients, we’re the adults. They’re not children, but we’re responsible for guiding them toward the right care.

When Things Go Wrong, Look at Yourself First

So next time something goes wrong, look at yourself first. Realize it probably comes down to communication.

As Brené Brown says (and we’ll talk about this more in a future video):
"Clear is kind."

There’s too much confusion in the world today—and that’s where most of our mistakes happen.