Pitfalls of Being a Patient Record Pack Rat

Copyright 2003 Robert E. Horseman, DDS

There are many reasons to look about our office with pride. Our collection of used diamonds, for example, is second to none. The 3M Company has recognized us as being the most innovative users of yellow Post-It notes in the Dental Offices Under 1,000 Square Feet Division. The Southern California Edison Company has often publicly marveled at the number of extension cords we have emanating from a single power outlet.

Yet, there is one area that threatens to erase the smugness of these accomplishments. It is the disposition of patient records. Our custom over the years has been to simply decamp from our venue when patient records reached the point where they occupied 68 percent of the total office space, leaving the next tenant the task of disposal. Nomadic tribes used to do this when their accumulated refuse gave even the most tolerant of them migraines. The heady feeling of the chance to start over with a clean slate is admittedly attractive but can interfere with the continuity of treatment. This does not mean you shouldn’t move just beyond the limit that lower denture patients are willing travel to seek you out.

So we came up with Plan B: a simple solution, really, involving the removal from our files of all the patients who had not visited during the past 10 years. Although this has the desirable effect of thinning the herd, so to speak, it has also produced an inactive file approximately 100 times the size of the active file, and that’s why we can’t get the car in the garage anymore.

Even more depressing is the discovery that we are facing what appears to be thousands of individuals who, because they have not been in for 10 years or more, force us to ask ourselves “Why?”

What immediately comes to mind, of course, is the distinct possibility that the work we did for them was so good they will never require any more dentistry.

We concede that some may have moved out of the area or to that ultimate “beyond,” but what about those who didn’t return because we hurt them, we didn’t live up to their expectations, we were too expensive or, worse yet, too cheap? Were we too old, too hairy, too pushy, too wishy-washy, too fat, too emaciated or so totally lacking in charm and ordinary social graces that wild ponies couldn’t drag them back?

Write this legibly on a yellow Post-It and stick it on your forehead: DON’T GO THERE! Analysis of one’s shortcomings is an exercise best left to one’s spouse. Instead, work on getting your active files, now purged of all these missing hordes, into some sort of recognizable alphabetical order. “Alphabetical” is the keyword here. Sometimes temporary staff has innovated a filing system involving first instead of last names, or hair color, thus ensuring themselves an indispensable position as the only employee able to find anything.

You realize that all these missing people were the recipients of your recall cards, the ones with the charming little first molar brandishing a toothbrush and asking that they call your office RIGHT NOW for an appointment because it has been six months since their last visit and you are worried sick that their oral health will be endangered if they procrastinate a minute longer. These are the cards that cost 23 cents apiece to mail and carry the same imperative impact that other unsolicited junk mail delivers.

There is a theory that the surest way to see a long-absent patient suddenly reappear is to place his or her records in an inaccessible place, perhaps in an incinerator. This is an unreliable ploy at best, vying with the recall card in results, but cheaper.

The law states that patient records must be maintained for a minimum of seven years. Why seven instead of five or eight, nobody knows. Why are there seven days in a week, or why can a soft drink with a name like 7 UP be bought at a 7-Eleven? It never came up for a vote.

One of the enduring characteristics of dentists is that they never throw anything away. That’s why their cupboards are full of stuff for which they have no earthly use. If it weren’t for assistants who daringly give the heave-ho to vast quantities of this junk when the doctor is on vacation, the whole profession would grind to a halt for lack of space. We don’t need a law to tell us to keep all these records, we would just keep them with all the other useless stuff anyway. We can’t help it. But really, who cares what we did on Joe Blow 10 years ago? We can’t even read our writing. What we want to know is what are we going to do with Joe right NOW.

Which brings us to Plan C. All the dentists in your town who are speaking to one another gather up all their ancient records and anything else they are willing to relinquish. We stack all this impedimenta in a huge pile after getting the proper permits from the City Council, the Fire Department, the EPA and the ACLU, and torch it.

The act of culling, of purging, of expunging can be a liberating experience. Deny yourselves no longer!