This may be going a long way to prove a point but...
We have a patient who I have seen for about 25 years. She is a professional, reasonably well educated, above-average in appearance, presently single with some children. I have had nothing but difficulty on and off with her over the years but I am one of those people, like an idiot, who thinks that if I get through a situation then it won’t happen again. I do that because i’m a moron.
In my new practice where I’ve moved, she managed to find me and needed some work done. On her first visit, she acted out terribly using four letter words and shrieking in a complaining fashion. I told her she had to keep her voice down that they were other people around, and she negated my entreaties, but did in fact quiet down a bit. After her visit, the office manager called her told her that we wanted to keep her here but did that behavior was unacceptable. The woman apologized 50 different ways and promised that she would not do it again. When I came into the office the manager informed me that she had had this conversation and I replied to her that no we really don’t want her in the practice because this is a never ending issue with her. The manager disagreed with me, which I fully understood, and stated that the patient said that she would behave herself from now on. I thought to myself “yeah right”.
Two weeks later the patient came in to complete her dental work and was more or less fine in the chair, and I knew what was coming. When she went to the front she headed out the door and the manager said excuse me, we have to settle your bill. At which point the woman started screaming at her that she wasn’t going to pay anything and how dare we ask her for money after we had been so rude to her via the phone call, and stormed out the door. Out of curiosity immediately we did a little research and found that she had received the check in full from the insurance company and was thus participating in the theft of services scheme which in Pennsylvania is a felony over a certain amount of money.
I then told the manager that I knew this was going to happen and that was exactly why I had stated that maybe it would be best if she had let her go, by dismissing her from the practice, after that last visit filled with obscenities. Almost unbelievably, the manager said that she would work it out with her and she was sure that she could get her to pay the bill and behave yourself in the future. I then said to her this more or less:
“Your tolerance and acceptance of her inappropriate behavior is exactly why we had Donald Trump for four years and God forbid that have them for another four years at some point. People in general do not know how to deal with severe mental illness and give credence to what these people say as though it means something and that they will “get through to them“. It doesn’t work that way. She set us up to steal the dental services and is daring and defying us to seek retribution. I saw it coming, I understand that you did not see it coming, but you didn’t listen to me and you did not take my word for it nor did you give me credence having known her for 25 years, and then we are now the victims in every way of this woman’s Lunatic behavior once again. Those of us in the population who were screaming when Trump was running for president that there was a basis of dementia and insanity here were nixed by those who “knew better” And are self-judging “better” judges of character.”
Then I went on to say that the manager needs to take my judgment seriously in the future because in all these years of practice, I have never been sued by a patient, nor if I had a complaint to a state board about my behavior. This is because I anticipate for the most part bad behavior and compensate for it a priori. Those of us with good judgment screaming during the entire presidential campaign in 2016 to no avail with so many and now we have a crisis of chronic insanity/fascism pervading the country in extremis. I know that I have not heard the end of the situation with this lady in my office as we have not yet heard the end of the situation with the former guy.
Over my many years I have had to deal with people who were called quirky, eccentric, a little bit wifty , and the like, but in fact these people have some degree of treatable (in most cases) disturbance and are listed in the DSM, sometimes in multiple categories.
Many many years ago when I was a student, we had a class member who was an “odd duck” as they used to call them and I was always very careful to minimize my contact with him even though we shared a similar background and upbringing as well as commonality of religious institution belonging. One day I came back from vacation to find that he had been hospitalized by a law-enforcement agency in another state when he was driving back from seeing his parents because of his grossly inappropriate behavior to the police officer who stopped the car. He had shown me the report of the officer and I believed every single word of it given what I knew with him and he spent some fair amount of time in hospital, was released back into the school and had a reasonably successful career,with ongoing therapy, from which he is now retired. I don’t know why people don’t recognize the seriousness of disturbed behavior, perhaps because it’s easier to simply chalk it up to casual observance so it’s not to become terribly involved. Again in extremis we see this with child abuse such as we witnessed this week with The remarkable and heartbreaking testimony of those four brave women who had been so terribly abused and ignored by law-enforcement. It is to the detriment of society that this occurs and we need to do something about it as soon as possible, for we may be facing a greater catastrophe then we know how to handle.
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