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.