Hey all,
At the Gammichia house, we are all going in different directions. Luke and Madison were both at different sleep-away camps last week. Noah was at Boy Scout day camp. Our house was pretty quiet, I have to admit. This week is a regular ol’ week, but next week we are taking a little vaca back to the mountains.
Yep. You know how much I loved the elevation and the clean air of the Smoky Mountains. We are going to Beech Mountain. My friend has a house up there and he and his family are going. We decided that maybe we shouldn't cramp their style and we should get our own place. If we rented a place 4 doors down from them, do you think that is still cramping their style? Well we will see, because that is exactly what we did.
We are thrilled. It has not been oppressively hot here this year yet. The highs and lows are about 74-94 right now. But the beauty of where we are staying is that it is 57-76 right now. Beautiful during the day and maybe even cool enough in the evening to have roasted marshmallows and wine by a bonfire. Biking, golfing, white water rafting, maybe a drive into Asheville... Oh my gosh. I am excited. I will post pictures.
I had an issue last week that I want to talk to you about. I do all the root canals in the office. I see my patients and my father’s patients for root canals. So sometimes I do not know the people that I am working on.
This fact is so important sometimes. When I first got out of school on the first day of the first continuum at Pankey, I heard, "Know your patient." And I think it is also important that the patient know you. That is going to be in the first continuum at the (not so famous) Gammichia institute.
My assistant and I are a different breed. We find that "the show" involves us talking all the time to each other. (If you don't know what I mean by "the show," it was an old blog entry. Every time we walk into the clinic area, we are putting on a show. If you are in a bad mood, if you are swimming in debt, if you are fighting with your staff, squelch it all. When you are in front of a patient, you are working. They want your best.) We both feel that the more you distract people from what is going on in their mouth, the less anguish they feel.
Maybe we argue about 50 Shades of Grey and the erosion of society, or whatever. We could talk about office politics. We could talk about my buyout of the practice. Anything I am thinking of or anything she is thinking of. Nothing is off limits. Patients know this about us from the first appointment. During the new patient experience here, we banter to get people used to the way we are. So they kind of get to know us.
Back to this incident last week. This patient has been referred by my father for me to do a couple of root canals. We had a few hours scheduled for the appointment. We exchanged the normal pleasantries. "Hi, how are you doing? Nice to meet you. We are going to be doing a couple of root canals, so let’s get started."
The first one went without incident and took about 45 minutes. The next one was very calcified and very tough, and it took forever. Now, there is only one thing more boring than doing a root canal and that is assisting a dentist doing a root canal. (I say that, but I don't really think they are boring. I actually like doing them.) My assistant got bored, so we were doing a lot of talking, joking, and stuff like that. Our usual.
This patient is missing a bunch of teeth and kept asking about the anterior bridge that she is getting. I told her that I don't know anything about it, but when she gets to the front we can get scheduled for this. When the 2 hour and 15 minute appointment was finally over, the root canals looked great. I was thrilled because they were so hard.
The patient went up to the front desk and asked about the anterior bridge. Nothing was in the chart. This is not usually a big deal, but my dad was on vacation and so was his assistant. No one knew what was next for this patient. She was not happy and stormed out, even though we told her that the doctor is on vacation and we would call her first thing Monday.
I called the patient the next day and left a message on her voicemail at home and at work, just to see if she was doing okay. Then the next day there was an email about how she is taking their records and going somewhere else. We replied to tell her we were sorry to hear that and is there anything we did or anything we could do to maybe rectify the situation.
She was angry about a bunch of things. First, she had already paid about $3,000 she still has spaces in her mouth. No one knows what the heck is going on with her bridge. She is in pain and Dr. John said she was not going to be in pain (not true: I don't tell anyone they are going to be without pain). And she had to sit for 2 and a half hours listening to Dr. John and his assistant talk about people and work and all that stuff. "No, you can't stop me from going somewhere else and no, there is nothing you can do to make this situation better."
Well, I have to admit that this stuff really bothers me. I want 100% satisfaction. But when I think about it, I know I can't please everyone. I know my style is not for everyone. My assistant and I have angered people in the past with our "chitter chatter."
I am not going to change. I think that people like me. I think our banter puts people at ease. At least it makes it more fun for me. Is that selfish? Heck yeah, it is. Can we be better at communication for treatment plans? Heck yeah, we can. And we will be, after this incident. Can we communicate cost to patients better? Heck yeah, we can. And we will.
But changing how we do things? Probably not. I mean, I can't tell you how many people tell us that we are great, that we made their visit so easy. So many people tell us how nervous they were and how we made it just a little more tolerable.
I listened to this patient. I apologized for not being everything that she needed. But I was not going to apologize for our efforts. As a professional, I have to realize that not pleasing everyone is going to be okay. I know I have written this in past, but you all have to hear this. It is okay for people not to like you. Do the best you can. Have fun (this is important). And treat people the way you want to be treated. That is the best you can do.
What do you think?
Have a great day.
john
I think that having fun in your profession is one thing, and abusing a patient with self-indulgent chat is another. If you've ever been at the receiving end of a doctor's treatment, only to find that your doctor was focused on everything else BUT that treatment, you would go somewhere else, too. Never forget that your patient has entrusted you with their most precious gift, and you should not abuse that trust. Your responsibility is primarily to your patient. If your assistant get's bored during a long endo session, she should be reminded of that, too.
ReplyDeleteGreat comment.
ReplyDeleteThanks for that.
Have a great weekend.
john
I have to agree. Our office policy is that any conversation while in the presence of a pte has to either include them or be pertinent, never idle chit chat that makes the pte feel like an outsider. Silence or background music is better.
ReplyDeleteI guess it could become too much for some people, but I'll err on the side of having as much fun as our staff and patients can while being as attentive to our patients as possible.
ReplyDeleteI think most of our patients would prefer the distraction. I am aware of many of the interests of my patients and will converse on this if possible.
I can't stand it when the check out person at Wal-Mart is chit chatting with the other check out person, I can't imagine how upset it would make me if it was my dentist or doctor doing that!!! The patient is king, the patient is king, the patient is king. Make me feel like you are lucky I came in to your office today. Instead of asking your assistant about her vacation and her kids, ask ME about ME.
ReplyDeleteI once had a dentist replace a filling and perhaps it was just idle chit-chat with his assistant, but to me it seemed like major flirtation. It made me want to throw up, which wouldn't have been a bad idea since I wasn't able to say a word. I walked out of there and promised myself I would never see that dentist again. Then I got home and looked at the filling and realized that he had spent too much time talking and not enough time concentrating on my filling. It's one ugly filling and every time I look at it I remember that disgusting conversation.
ReplyDeleteBut the worst experience I've ever had was a dentist who kept telling her assistant to "be careful". I wanted to scream "YES, BE CAREFUL!" but it was impossible to talk because of the way my mouth had to remain open. At the end of the procedure the dentist told me that "the suction got too close to the sinus" and made a hole. It has been 2 years and the problems from that procedure have not ended.
So, "BE CAREFUL" what you say in the presence of your patient! What you think as harmless chatter might be raising his/her anxiety level beyond anything you can tell. A simple explanation to the patient that things are going well and how far along the procedure is may be all they really want to hear. Believe me, I know!
I am going to have to agree with the patient as well. If my asst and I are talking, its only acceptable if it is including the patient. I'd rather have them distracted with music or tv than listen to me and her talk. If I were the patient, I would feel that the dentist is really giving the procedure the concentration and effort that he/she should be. Just my two cents.
ReplyDeleteHere's a suggestion: Tape record your next long session with a patient. After it is all over, have someone strap you in that same chair, open your mouth, anesthetize your lower jaw, fill it with dental instruments, then turn on that recording. Don't speak until it's over. See if you enjoy the "fun" banter in YOUR office from a patient perspective.
ReplyDeleteSome people don't mind you talking and others don't like it - usually easy to work out. I even try to match patients with different specialists.
ReplyDeleteOne excellent surgeon can appear quite arrogant but my arrogant patients love him.My hypersensitive patients get the lovely teddy bear who fusses over them more than their own mothers would. Sending a sensitive patient to the arrogant surgeon has on the few cases when it has occurred just got me very upset patients
Let's get back on point here by starting with that title, "Have Fun, No Matter the Cost". Whose cost? Why should the patient pay the cost? "We both feel that the more you distract people from what is going on in their mouth, the less anguish they feel." Is that right? Patients are not coming to be distracted. A patient undergoing endodontic therapy is under duress, because root canal is a metaphor for all that is bad in the world. And your response to the patient's fear is-- to put on a show? Patients need to know that you empathize, that you know their fears, and that you will demonstrate that their fears are unfounded. You do that by focusing on the patient, their comfort, and by allaying their justifiable expectation that they might encounter disinterested and distracted care. If you must have a conversation, have it with the patient, about him,his family, and what is important to HIM, and not you. Turn off your cell phone, stop singing with the radio, because you won't be giving up your day job for show biz. Your patient needs to know that his welfare and the outcome of his treatment are your only concerns while he's in your chair. Moving one's focus from narcissistic introspection to caring for others is part of the process of becoming a responsible adult, and an absolute necessity for becoming a responsible dentist.
ReplyDeleteWow John,
ReplyDeleteSome harsh word from your peers - I am like you - I like to chit chat with my assistant of 15 years in front of the patient - usually telling the patient and her jokes, talking about kids, politics, etc. I DO make it a point to ask the patient or include them and the funny thing is most patients will tell me that they really enjoy our comraderie and that it DOES put them at ease. I have only had ONE time in 15 years that a patient has complained to me about our chitchat and that was about 10 years ago! I find patients definitely appreciate levity and humour when they are stressed, especially when it is accompanied by thoughtful care and gentle touch.
Keep on talkin'!
KenJ from Toronto
Thank you Ken,
ReplyDeleteIt doesn't bother me when people have different opinions then me.
It only bothers me when they disagree and tell me about it in a way that makes it sound like the way I am doing it is wrong or unprofessional.
We all have different ways of doing things and that is okay.
You and I will hopefully treat the people that feel comfortable in a talking environment.
And the people that like quiet will hopefully be treated by a dentist that fits that style.
I have been successful doing my thing for a long time and a couple of comments on my blog is not going to change me or the way that relate to my patients.
Talk to you soon,
j
"I have only had ONE time in 15 years that a patient has complained to me about our chitchat and that was about 10 years ago!"
ReplyDeleteDr Ken J-- do you really think all your patients are going to come to you with a critique of your chairside manner if it offends them? If they feel their needs are not being well served, they are going to go somewhere else. But what you don't know won't hurt you, eh?
Dr. J-- Perhaps your inability to see my point is one of perspective; maybe you're too young to have sought as much medical service as I have. I don't expect you to change just because your comportment is in my opinion unprofessional. But the next time you go to a doctor for something serious-- for example, brain surgery or heart surgery (from the patient's perspective, root canal can be almost as daunting, believe it or not)-- see if you appreciate "sitting for 2 and a half hours listening to Dr. John and his assistant talk about people and work and all that stuff." You are certainly entitled to cultivate the kind of practice you want, but don't confuse self-indulgent banter with empathy and kindness, because I can assure you that your patient's won't. And I'd be willing to bet that despite your prideful boast that you just won't change, I suspect you're not too old to learn to improve yourself and the image of dentistry you portray to the public.
Seem like everyone is polarized on this; I am on your side John as I said before - good thing we all have our OWN practices - different strokes for different folks - I would hate to be worked on by a cold and sterile clinician that made no effort to put me at ease - I much prefer an extremely competent but personable caregiver than someone who is coldly professional, especially for a procedure I am awake and participating in - unlike say brain or heart surgery.
ReplyDeleteDr. Borfeld - this is not brain surgery or heart surgery - don't kid yourself - no patients have ever died in my chair. Maybe the reason root canal treatment is a metaphor for all that is bad for the world is because historically the treating doctor made it worse by not helping the patient relax through a long and boring procedure. I have had more patients than I can count tell me they didn't mind the root canal because they were enjoying the conversation, movie, etc. Practice the way that you want - but don't tell me my chairside manner is any less professional than yours.
KenJ
KenJ, your attitude is a bit frightening. As a health care provider I'm always aware that anything I do or provide for a patient "could" harm or even kill them. For you to say that you're not doing brain or heart surgery, that none of your patients have died in your chair, and that your procedures are boring makes me think that you are setting yourself up for that one big time when things DO go wrong. Face it---some patients DO die in the dental chair, you COULD make one little mistake that causes a patient to NEED brain surgery, complications DO affect heart health, and the procedures you label "boring" ARE stressful to your patients.
ReplyDeleteDr. B was pointing out that professionals who take their craft seriously are willing to change to meet the needs of their patients.
The fact that Dr. John wrote about the topic at all tells me that he has had second thoughts about his "performances" in the office. If he's unwilling to change, he should be willing to lose a few patients. The choice is his.