Wednesday, September 12, 2012

Sorry About That

Well, if you didn't notice, we were off last week. I hope you missed us.

I want to talk about the “Sorry” patient. This is not a patient who apologizes to you. This is the patient you have to apologize to. I want to talk about the appointment that should be easy but just doesn't go so well.

Let’s say a patient comes in for 18 occlusal. I have 20 to 30 minutes in my schedule. I want this patient in and out and thrilled when he is done. "Wow, I didn't even feel that. That was so easy. Thanks." This is not even a blip on the radar for either of us.

I greet the patient and tell him that he has a cavity on the back tooth that is right in my wheelhouse. It is my bread and butter and I do it all the time. I tell him we’ll get this tooth numb and he will be out of here in a jiffy.

I usually will not do a block here. For one posterior in the mandible, I will try to use the Paroject injection system (an interligamentary injection) and put Septocaine all around the tooth locally. I want this to be a fast appointment and I don't want my patient numb for two to three hours for a 10-minute procedure.

When we begin, I tell the patient to let me know if he feels anything. I start in on the tooth and he jumps, so I back off. Did I not give the anesthetic enough time to work? Do I cut bait and go for a block? I grab the Paroject again and pump more anesthetic in and around the tooth. (For the record, the Paroject system works about 95% of the time. There are times it doesn't work, but it has been very successful for us.)

I start again. Have you started to sweat yet? You know how this is going to go. I am starting to sweat just telling you about the story, because I know what is coming up.

Almost immediately, he jumps. "Hmm," I say out loud. “Sorry about that. I guess we are going to have to give you a block." My assistant, who saw this coming, has already gotten out the Lidocaine in a syringe, and I give the patient a block.

Now I am 25 minutes into my 30-minute appointment. Oh, and it never fails that I have already had a pretty crappy day, so this is just piling on. But all is not lost. I can get the patient numb and get this thing done, right? Not so fast. The patient is numb in the back, but there is no tingling on the lip or tongue. My assistant already has another injection ready. I inject again, this time higher and lower and farther back and farther up. I have lost a bit of discretion because I just want him numb.

I don't wait this time and go right in with the handpiece. The patient can handle it, so I take the old filing out and see the decay. I touch the tooth and he jumps. He is starting to get a bit impatient. "Just go ahead; it is not that bad."

I go a little bit more and he is trying hard not to move, but I can tell he is feeling it. I am now officially running late and don't even have the patient numb yet. I tell some jokes to pass the time then go check on hygiene because all the hygienists have been loitering around the door for the last 10 minutes. I come back with a renewed sense of calm, ready to get this done and get him out of here. Feeling confident, I ask him how the numbness is. When he says he thinks his lip is a little tingly, we try again.

I start again and I am able to go a bit more, but I know that if I try to get all the decay that I can see, it is going to hurt. I tell him that I have this one spot to get and it is going to take just a couple of seconds. He understands, but meanwhile, I might see a tear or sweat on his forehead.

I officially hate my job. I hate doing fillings and I hate products that don't work. I am sweating. I yell for someone to turn the freaking air conditioner down. Nasty thoughts are running through my head. How many more years do I have to do this stuff before I can retire? I somehow get this procedure done.

AND the filling doesn’t even turn out well! How could it? I am under duress. I am 25 minutes behind and three of my next patients are here and waiting. Then I have to go to the front and charge him. UGHHHH.

At the end, I apologize that it didn’t go very well. You know what he says then. They always say this. You know what he is about to say. "Man, I am SOOOO numb now!!!!"

I try to continue on with my day, but it lingers. I try to put it out of my mind. And just when, after a day or so, I have officially chalked this up to having a bad day, I get a phone call. In the back of my mind, I know who is on the phone. He is calling to tell me that I suck so bad I can't even get a guy numb. He has been in quite a bit of discomfort from all the injections and now can't open his mouth more than about an inch.

No, I don't suck as a dentist. Yep, it happens. It happens to me and it probably happens to you. It sucks though. If it hasn't happened to you, be prepared. It is going to happen to you.

Hope this makes you feel less alone and puts a little smile on your face. Yes, it happened to someone else.



Dr. Andy said...

Amen bro

Christiaan Willig said...

"Yeah, you are right, Mister Patient, we should have just let that mushy carious lesion fester under that restoration you had placed during the Reagan administration. Root Canals are way more fun for both of us!"

Anonymous said...

If I only have 30 min for a carious lower 7, the patient gets 2 maybe 3 blocks to ensure we don't go late. If that is not enough, judging by feeling Endo Ice before we start, then and only then do I use ligmaject. If Ice is still plus, then I go intraosseous. That pretty much always works. There is no time for optimism with anesthesia for a short appt. Go big or go home.

I usually try to avoid this as I have pretty much catalogue all my patients' anesthesia profiles. Lowers we record the needle type and depth measured off the 7 according to the PAN and how many carps on site once at the target and then ligmaject or intraosseous as needed. If we ever need to reenter the quad we jump to what worked in the past without horsing around. Just another way to try to harness the most variable variable. G


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