Monday, May 16, 2016

Looking for Answers

Have you ever had one of those patients describing a combination of symptoms who leaves you wishing you’d gone into accounting instead?

“Doc, the pain shoots from my nose to my left toe and back around to the tip of my tongue, but not every day, just on humid days, and only if there’s a waning moon. But it’s not a tooth pain.”

We (and by “we,” I mean “I”) like a little more certainty than that. We (I) like problems to be clearly defined and properly diagnosed so that we can provide effective treatment. Give me a shadow on a radiograph with a little cold sensitivity, and I’ll restore that puppy and move on. Large amalgam with biting sensitivity that can be isolated to a single cusp? Let’s get a crown on there!

I like the boring stuff. I like it when things fall within defined limits. But how often does that happen? How do we (I) react when things are a bit less certain? Frustrated? We don’t want to admit we don’t know the answer. We say those things are idiopathic. Theologically, I’m totally comfortable with uncertainty. Dentally, it makes me feel frustrated.

I mention this because in the past few years, I’ve had the tables turned, and I’m the one seeking answers, and I’m the one being told “I don’t know.” And I can’t tell you how bad that feels.

In the next few blog posts, I’ll tell you about my diagnosis and my journey to find an answer. I’ll tell you about how the inability to get a definite answer from a health care provider can perplex an otherwise intelligent, scientific-minded dentist. It’s pretty illuminating to see to what lengths people will go to seek an answer when conventional wisdom fails them.

One of my patients presented with what turned out to be lichen planus. We diagnosed it based on clinical observations and confirmed it via biopsy. Topical treatment was recommended with Lidex rinse. The appearance hasn’t changed, but the symptoms seemed to improve slightly.

Months later, I was listening to Mississippi Public Radio’s call-in medical show. The host doctor welcomed a woman caller, and when she started speaking, I instantly recognized her distinctive drawl. She described her condition and the treatment she received to the doctor — who agreed that that was exactly what he would’ve provided her. It sounded like she was disappointed that she hadn’t found a better answer when she hung up. But I felt great because our decision had been corroborated! Aren’t we great?

Well, I don’t think she felt so vindicated.

To be honest, it was nothing more than a patient seeking a second opinion. I encounter those patients all the time, so I understood.

That’s what we as humans do: We solve problems, and we seek answers to questions. And some of us look outside the box of common knowledge for those answers. And there’s a lot of uncommon knowledge out there.

So, stay tuned to this same bat channel on this same bat station, and I’ll fill you in on my search for answers.

Bruce M. Scarborough, DMD, FAGD

2 comments:

Ed said...

Interesting post. I find myself being extremely conservative when the problem is not black and white. I'd rather do no harm than start work on an area that wasn't the cause in the first place. That's a good way to avoid a malpractice claim! Frankly, in the medical field, I've found that procedures = money and people above the GP scale are quite happy to cut, remove, suture, and do whatever they can suggest to generate treatment. Even when the problem is not clear, they definitively state what it is and move forward. I frankly appreciate when a specialist can look at a problem and say, "I don't know what's going on here, but this is what we can do to narrow it down or figure it out." Those words are farther removed from their vocabulary as the level of complexity of the specialist increases.

Niddrie said...

Very interesting post and love your blog.

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