I’m at my wits end with some patients
Pt came in complaining of severe pain in UR. Radiographs show caries on 3 teeth breaching pulp. I tell him his options endo or ext. He wants whatever’s cheaper. I recommended ext as most affordable, short term “fix” but also consider replacement options. He then says he doesn’t want them pulled because he can’t think straight right now. That’s understandable, so I recommended sending him to the endodontist for RCT so he can get out of pain and buy these teeth some time. He also declines that referral and says he “only want a local”. I tell him I don’t routinely admin local anesthesia for exams and also his BP was over 170/110. I offer to prescribe him Ibuprofen/APAP combo. He declines and says that won’t work. Ok now I’m thinking, my pt population thinks antibiotic is miracle juice but for some the placebo effect works, so I offer Amoxicillin. He still declines and insists he “just want local today.” I reiterate the definitive options to send him to the OS for ext or endo for RCT and I’ll try to call to can get him in today. He declined both tx options, started berating me about how he wasted his time coming here and can’t get local, then walked out??
Was there something else I could’ve done differently? Do you guys give pts local anesthesia on exams like this? I feel for the guy but when he declined every options we offered what do you do?