Thursday, December 4, 2008

My patients are trying my patience.

27 weeks today-- I should put up a belly pic, but I am too tired to change out of my scrubs and figure out the new camera Tyler and I bought each other for Christmas. (We figured we should be ready take pictures of the baby with something a little better than our iPhones!) I guess this means I'm in the third trimester now... this is all going so fast!

I have something on my mind today that might offend some people who read this blog, because I know it's a lot of pregnant women, many of whom are all about the birth plans. So, I apologize in advance if it does.

This morning, I had a new patient come in for a treatment planning session, where we do a thorough exam and make a plan for all the treatment they're going to need to fix up their mouth. She's a really sweet older lady, I've seen her before on an emergency basis (in fact, she was my first extraction), but today was the day we were going to figure out everything she needed to get done and get approval from all the different departments. After I did her exam, I told her she had moderate periodontal disease and was going to need scaling and root planing (sort of a deep cleaning procedure) in addition to a few fillings and some crowns on her front teeth. She told me she didn't want any sort of gum therapy, she doesn't like to have her teeth cleaned, and she doesn't want crowns-- she just wants this one filling in a front tooth replaced. I tried to explain that at the school, we have to give our patients comprehensive care, and the faculty won't let us place restorations of a type that are likely to fail, and we can't do any kind of restorative work in a mouth that doesn't have a good periodontal status, because essentially it's a waste of the patient's time and money. Anyway, our goal is to get people to have healthy, functional mouths rather than teeth that look okay from the outside but are secretly falling apart. But she just insisted that she had come to the school to get this filling replaced and that was all she wanted. So I had to let her go.

And you know, it's something I've seen with other patients too, although I can usually get them to see my point of view (and they want to stay with the school because the care is so inexpensive). I think it's a really unfortunate trend these days, that patients think they can and should dictate what care they receive. I get that dentistry is a business, and patients are customers to an extent... but the clinic is not a store, and you can't just come in, sit yourself in my chair, and inform me that I'm going to do this filling and nothing else, and furthermore I'm going to put a pin in it because that's the only kind of filling that will stay in your teeth. I mean, seriously?? Why would you even come to me for treatment if you know better than me, and you know exactly how it should be done and I'm just there to do it for you exactly as you specify? What the hell am I going through all of this school for if my patients are going to expect me to do as they say and forget everything I've learned? The irony is, we definitely spend 90% of our time in dental school learning about diagnosis and treatment planning and the "why" of things... and the remaining 10% is spent on physically learning how to do the procedures. And then patients come in with expectations like that. It's really frustrating.

In my opinion, it's a similar situation with the birth plans that pregnant women write to express what they'd like to happen before, during, and after their labor and delivery. Don't get me wrong-- I have certain expectations and wishes for my delivery. I don't want a C-section or an episiotomy. I want an epidural and I want to breastfeed as soon as possible after birth. But you know what? I picked a group of doctors that I trust, who are against unnecessary interventions unless the baby or I are in danger. Beyond that, I'm satisfied to let their superior education and experience be the guide as to what happens to me and my baby. I'm not going to walk into that hospital and and hand everyone a sheet of paper telling them how to do their job.

Patients should have a choice as to what happens to their bodies, that's definitely a basic human right. But there needs to be some kind of limit to that, and that limit seems to be getting pushed further into ridiculous territory as patients get more "empowered" when it comes to their care. If a doctor or dentist caves into a patient's demands even though they know deep down that it's not best for the patient, they are doing that patient a disservice because they went to school so that they would know better.

Anyway, that's what's been on my mind today... I can tell this is going to be an issue for the rest of my career, so that's pretty frustrating to me.


Jessa said...

i usually lurk on your blog, but this post deserves a "hear, hear".

MJS said...

You know, I'm a law student and actually just finished a final exam regarding (in part) just what you are talking about. To a certian extent you are totally right legally as well. As I'm sure you've learned as a medical professional, you and other care providers actually have a duty to patients to at least inform them of treatment options and risks of getting (and for example in CA, NOT getting) treatment. As a fellow fledgling professional, I agree with you that there should be a certian level of trust for those providing services that we have spent so much time and energy becoming experts in so that we can help people. Obviously it is a collaborative thing between provider and client/patient, but we also have a duty as professionals not to do things that would actually harm the patient (um, hippocratic oath, right?). Anyway, I agree with you and think you are doing great with everything. As Jessa said, "hear, hear!" Keep up the good work, we're rooting for you! :)

Anonymous said...

I am an NICU nurse and there's kind of a joke on our unit about birth plans. If you have one your baby ends up in the NICU. I also understand what you are saying and a lot of people now look online and diagnose themselves and feel like they are now educated and can make their own decisions. There is a lot of stuff online that is just plain untrue, and there is a lot that people misdiagnose themselves/babies as having. You are so right and when I go to the dentist I trust their expertise. When I go to the OB/GYN I trust what they know, even though I feel like I have a very good understanding of birth and human anatomy. I'm a nurse and I don't try and be a doctor. I understand your frustration!

Anonymous said...

I think the purpose of the birth plan is not so much about taking the care into your own hands but to have an idea of what interventions you prefer. It makes more sense with your second birth (or third and so on) when you have more of an idea of what is going on. I think it is for woman who end up saying afterwards, "that isn't what I wanted at all and no one asked me or explained what they were doing." You don't always have a choice but if you have a choice then the mother should be part of team deciding. I guess I don't feel it is that similar to your job. I agree with what you are saying in terms of dental work but I think births are different. The doctor is more passive, it is the mother doing the work. The doctor is there to deliver and to help if something needs to be done. That is why they are different.