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Casual Toothday- I mean Tuesday

Just another day at the office:

I assisted today while Doc was removing #25 and 26. (Those are lower front teeth in case you’re not a dental person.) While taking out #25 the tooth broke with a snapping sound. The crown of the tooth flew up and hit the ceiling with a click and then landed on the bib on the patient’s chest.

Me: <—just trying not to laugh

Doc: “Well, I don’t think that’s ever happened before.”

Patient: ? (He was fine.)

Change is… good?

We have a new dentist in the office where I work. We’ve only worked with him for a couple days and already our workplace feels like it has been turned upside down. Or, maybe it’s more accurate to say that it feels like an alternate universe. Like, is this really happening? I don’t mean to be so dramatic, but this is a huge change for us all. I’ve worked there nearly nine years and I’ve been a patient there since I was four years old. Everyone else has worked there even longer than me. It’s located in a small town and it definitely feels homey and laid back. Well, at least until recently.

We all know that we need to produce more to keep the practice going and be more successful. But, I think my coworkers feel something similar to what I feel: will reaching for his stated production goals come at the expense of patient relationships? Our schedule generally has one operative chair column with another for work-in patients or to help catch up if we get behind and one (sometimes two) columns of hygiene patients. Obviously we need to grow. He would like three columns of operative and three columns of hygiene. My first question: are there even enough potential patients in the surrounding area to fill these chairs? My second question: if we do actually fill a schedule like this, how will the doctor develop and maintain good patient relationships? Our patients are used to having a dentist who remembers their parents and/or their kids and asks how they are doing. They are used to having a dentist who often has a conversation with them while waiting for the anesthetic to kick in, not one who numbs and runs every time.

I think we all fear that our office is going to turn into a factory. I can’t help but picture patients on an assembly line.

I hope I’m worrying for nothing and we’ll end up with a more modern and successful practice that patients will recommend to their friends and family. We’ll see.

Any comments you have on this will be appreciated.

Do you trust your doctor?

I’ve had a casual but persistent interest in the doctor-patient relationship since an assignment I had in dental hygiene school. We had to write a paper on a healthcare topic of our choosing. I chose defensive medicine. Basically, this occurs when a doctor’s fear of litigation drives their decisions: unnecessary tests may be ordered, for example. Or, a doctor may give up some part of their practice altogether, such as obstetrics.

Long story short, I learned that a good doctor-patient relationship can reduce the likelihood of litigation. If a patient trusts his or her doctor, he or she is less likely to sue. Of course, this is not the only reason to have a good relationship with your healthcare provider. With trust and respect, you are more likely to follow your doctor’s instructions and be healthier as a result.

This goes for dentistry, too. Let’s say your dentist tells you that you need a crown while you’re flat on your back with the light in your eyes and then leaves the room. You might think he just wants to make a payment on his Lexus, and you’re probably going to tell the front desk that you’ll schedule it later, and then you probably never will. Now let’s take that same tooth, but change the dentist’s behavior towards the patient. This time, he raises chair back up, pulls his mask down, and shows you a photo and/or x-ray of your tooth. He explains why he wants to crown this tooth and what might happen if you choose not to. Now, you might still be thinking about his Lexus, but I would bet that you would have a much better relationship with this doctor now. And if you went ahead and got that crown, you might save yourself from breaking the tooth, exposing the pulp chamber (where the nerves are), and needing endodontic treatment (a root canal) or extraction (pulling the tooth).

All of this came to mind because of this video of the author of Cutting for Stone, which I recently finished and recommend.

Abraham Verghese: A doctor’s touch

Modern medicine is in danger of losing a powerful, old-fashioned tool: human touch. Physician and writer Abraham Verghese describes our strange new world where patients are merely data points, and calls for a return to the traditional one-on-one physical exam.

In our era of the patient-as-data-point, Abraham Verghese believes in the old-fashioned physical exam, the bedside chat, the power of informed observation.