Sunday Dental Thread: Treating the Wealthy Edition
For purposes of this thread, I will stipulate that the term "wealthy" applies to those worth, in my estimation, over three million dollars. In fact, compared with many of my clientele, these individuals would be considered middle-class a la McCainesque classification, but we know better.
Now of course, this applies only to dentistry, since I don't practice medicine, but it may be a bellwether of behaviors practiced elsewhere. I have discerned these tends over 35 years of practice and I want to state for the record that they are generalities only and not applicable to many, and all of these generalities in toto apply to almost no one individually, although there are about three people who fit the profile entirely.
1. There is an implicit statement at the outset of the therapeutic relationship that the practitioner needs to understand that it an "honor" to be selected to treat the individual. Chosen out of hundreds of others, the doctor is the Chosen One. The upside is that it is seemingly flattering. The downsides are legion: that one can be fired at any moment, that every movement is watched, that every syllable is analyzed, and that every appointment is critical to success, to efficiency, and to professionalism.
2. There is an implicit statement that if the case works out well (read: perfectly) other extremely wealthy and influential people will be referred. The upside is that it's flattering and theoretically munificent (more on that later)', the downsides involve more pitfalls than a trip to the Inferno. What that means is that every nut case, psychiatric, obsessive, and quite possibly insane character within the rich person's purview will be referred and the worst part is: they will come. They will come because they are afraid of the rich person casting aspersions upon them if they don't come, to wit, "I told her to see you but she's still seeing that other dentist who is ruining her mouth. Plus which, he's really expensive." Which brings us to...
3. These people attempt to not pay and it is a magnificently honed skill set. Since they have millions, there exists an assumption that they'll pay the going rate in a timely fashion. Wrong on both counts. They pay pittances during the treatment and imply that they'll await the result before paying the complete bill. Yes yes, I know, the practitioner needs to be firm. These people or their spouses negotiate billion dollar deals and know exactly how to push all the right buttons at the right time. In addition, they all have dental insurance which requires the explanation that there is an annual maximum almost universally (BTW, Philadelphia schoolteachers have no annual maximum, the only indemnified group in the city where that is the case to my knowledge) and they don't generally buy the concept of a maximum. Of course it is bad enough that we have to lower our fees to the allowable charges, but those are the rules, and Lord knows, we follow the rules, especially for the wealthy, since they know every rule which is to their advantage and conveniently forget those which are not. They are particularly adept at the escape via the bathroom routine. When completed, they walk to the front desk and immediately ask for the bathroom key, they return it quietly, say that they'll call for the next appointment and walk out the door, usually when the staff member is occupied with someone else. It is clever technique because you can't stop someone who needs to run to a rest room, and you can't insist upon giving an appointment to someone who preempts you by stating that they cannot make the appointment without his or her secretary or aide de camp. And these folk move fast, I mean like The Flash fast. I called one guy Barry Allen and he actually got it and changed his behavior...miraculously, since he's famous for ducking bills all over town.
4. Wealthy people referred by other wealthy people are often troublesome. One has to figure that by the age of 65, living in the same place for decades, an individual would have finally found someone who fits their profile and their needs. There are many reasons why that wouldn't be the case, such as dentist retiring or getting weird with the patient, which happens a lot. The are many stories which would be great for another thread or my book in progress, but you can only imagine. Psychodramas are de riguer and the complexities of their lives are beyond comprehension unless one has a net worth of eight figures. The worries involving their eighty-seven foot boats and crews are incomprehensible to me, and the amazing aspect of all this is that they speak of this in the same breath as their complaints regarding the cost of groceries when their children visit the Homestead, or as I like to call it, Versailles. I actually say these things and they laugh, because we have come to an understanding that they can say what they want, but they aren't fooling me. They are rich beyond comprehension and that is that. One guy whose name is plastered on buildings all over Philadelphia told me that he was on a "fixed income". I asked him if his previous dentist had known this, and he said that she had. I asked him if he'd ever seen The Godfather Part II, and since he had, I reminded him of the Meyer Lansky character who said that he was a retired pensioner with a fixed income, even though he had made millions at the pinnacle of his organized crime empire. We were off to a good start. I didn't do the case, the guy who did got stiffed big time, as your former VP would say. I know this because I had to send the radiographs to his office and ran into him in the elevator a few months later. His buddy who had sent him to me told me later that the guy was well-known for stiffing practitioners and I asked him quite frankly why he would foist this guy on me. He just laughed that dismissive laugh they have an waved me away, so to speak.
5. Lastly, rich people are powerful and dangerous when maddened. Yeah, you can crow all you want about your lawyers, the judicial system, and your influence, but all these guys have to do is make one phone call and your life may never be the same. Professional Review Boards, newspapers, local politicos, national politicos, all are beholden to the power of certain individuals and sometimes you deal with these people. You had best better ensure that they have no axe to grind, or believe me, your life can be a living hell. I won't be too specific, but a dentist in town here thought he could milk this one case for a lot of money over about nine years. The lady, a wife of a very influential and extremely wealthy man, came to me and I completed the case in six weeks. This other dentist was verbally attacked unmercifully by both she and her husband for years since they lived in the same building in Rittenhouse Square, and what they would do, is if there we a social occasion, invariably the topic would turn to where the other person was getting their full mouth reconstruction completed, and they would both go off on how this other dentist was a bastard, and worse. It was embarrassing because they would use my name and the dentist thought that I had something to do with it. He actually stuck his fat finger in my chest. I offered to break it if he didn't take it off my chest. Things actually escalated from there. He's dead now, in case you're interested, from a massive stroke, not from anything weird or unholy.
So when I read here about how the rich just walk into hospitals and don't have a concern about the bill or the administration of medical care, think again. They are involved to the umpteenth level and do not miss a trick. The fact that they can afford health insurance and deductibles and private care and experimental drugs and techniques places them at a level where we cannot even begin to fathom the potential. But in fact, they have their ways around much of what you and I expect that they would "have" to do as "paying patients". As my father of blessed memory used to say, "they have more tricks that you have hair on your head."
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Also, it's nice to get your perspective on this. 
So what're ya doin' Friday Night? 
