What all dental personnel must know to insure good patient care

Lisa Newburger, LISW-S
February 26, 2013

“You need an implant.” Imagine your horror if you heard your dentist spit that out. He dropped the other shoe. “It will cost you about $5,000.” I thought, He has got to be kidding, right? But what choice did I have? This is the latest “development” in the saga of my dental life. There isn’t going to be anything left in my will for my kids when all my hard-earned money has been put into my mouth. Is there some way they can repurpose my teeth after death? (Okay, lame attempt at humor – but that is how I cope.) This odyssey is really a customer service story. You’ve heard those stories before, but look at it from the patient’s perspective, not the dental professional’s perspective.

Two weeks later, I was seen by my peridontist to start the fun of removing my tooth. (Where is the tooth fairy when you need her? More importantly, how much can I get for a “lost” tooth as an adult?) It’s revealed that I have an infection. It wasn’t there two weeks ago, but that isn’t anyone’s fault.

(My husband had offered to use some string and a door handle to save on cost, but I chose not to be so frugal.) My periodontist started the injections, but uh-oh! He can’t numb my mouth. He gave one injection after another, and another. It goes on and on. But, no results. (Maybe I have superhero powers, but who would want those?) I don’t want to feel anything. At this point, I had identified that there was epinephrine in the shots and I was starting to shake from all that was in my system. When I identified the drug, they switched the injections to ones without it. Too late. I asked them to call my husband, as I knew I wasn’t going to be able to drive. A half hour has passed. “Lisa, I don’t know what to do.” (Hey, he is the expert, right? I am not going to make this decision.) Finally, he decides to send me to the oral surgeon.

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They sent me downstairs. Their first mistake was sending a patient out of the office unattended. Tip: If you know that the patient’s husband is on his way in and the patient is doing weird stuff like shaking and maybe having a reaction to the drugs, don’t let them leave. Stupid me didn’t take the elevator down. I wanted the exercise to burn a few calories, so I walked down a couple flights of stairs. They knew me at the oral surgeon’s office. My reputation precedes me. Actually, they knew me from my kids having had wisdom teeth out. The receptionist, Mary Beth, sees that somehow I am “off” (more than the usual). She was alarmed, but my husband was entering the building and joined us. At this point, I turned and almost fell down. Mistake number two: They didn’t have me sit down and let the drugs wear off. But, liabilitywise, this surgeon didn’t do this to me, it was my periodontist upstairs. They give me a date of four weeks for the next available appointment for the surgery. Now I am shaking like an earthquake.

We walk out and I tell my husband, “We are going back up to the other doctor.” Stopping at the bathroom, I wash my hands and look in the mirror. My head is now whipping back and forth getting my lipgloss caught in the hair. I can’t seem to stop. My neck is going to kill me tomorrow. Am I about to have a seizure? This time, Bruce and I take the elevator to the periodontist’s office. We get there and tell the staff what the date of the appointment was and asked for a referral to a different oral surgeon. They said they don’t refer to anyone else. Mistake number three: They didn’t have a backup plan for referrals. It turned out the oral surgeon was meeting with my periodontist and gave instructions for us to go back down to his office and wait. He would come shortly.

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Back downstairs I tell my husband to tell the staff why we are back. He says, “No reason to,” but I insisted on it. (He might have been afraid of me with that look of pure exhaustion and my head whipping all over the place.) He tells Mary Beth and we wait – and wait. Finally, Mary Beth checks on me. Another receptionist pipes up that the oral surgeon had called. At this time, I am a little stressed, as I don’t know what is going on with my own body. My response was, “I am going to wait in this waiting room as the doctor said, even if it takes all day.” (Okay, I was getting a little irritable.) She clarified that he called since I had returned. She decided to let me calm down before letting us know the outcome. I started to cry. I didn’t mean to, but the medication was doing weird stuff to me and I was annoyed. Mistake number four: They didn’t keep the patient and family informed. I just wanted to go home and had been delayed by having information withheld.

I get scheduled for sedation three weeks from that day. Exhausted, I am not sure if my head is going to snap off from this epinephrine. It should have worn off by now, but we didn’t know if I was having a reaction to the drug. We leave and go back upstairs. My periodontist meets with us and is stumped. I ask again for another referral. He doesn’t know who to refer me to. I am stunned. He said, “If you get into trouble with pain, call me and we will figure something out.” I left at this point. When I got home, the surgeon’s office called and made an appointment for two days later. The surgeon decided to change his lunch to fit me in.

The surgery went well and everything was resolved.

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I am telling you this because even though I adore both of these doctors, it was horrifying to think that they would allow a patient who was in obvious physical distress to walk alone in a medical building. They knew my husband was on his way and should have had me wait for him in the waiting room. What if I had had a seizure? What if I had been in that stairwell alone? My husband would have taken the elevator, but after not finding me in two offices, and my car still being outside, he would have searched the stairwells. But, if I fell on the concrete steps, it wouldn’t have been good.

Do not let a patient who is having an obvious problem leave your office. There could have been serious consequences. I am not talking about your legal liability, but just plain compassion. You have no idea how just listening and voicing concern meant at that time. I was not strung up on drugs. I was not combative or hostile. I was having a reaction to medication that was put into my body by a professional. That happens. I encourage you to talk to your patients. Listen to your patients. And for goodness’ sake, don’t let us walk out of your office in an altered state without a safe plan of action. That is what makes good patient care.

Lisa Newburger, LISW-S, a.k.a. Diana Directive, provides humorous ways to deal with difficult topics. Check out Diana’s webpage at www.discussdirectives.com.