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‘Whoever did this didn’t do a very good job’

By Mike Briddon | Friday, August 3, 2012

No one likes the dentist. No one looks forward to a dentist appointment. I’m no different. But as I walked through Harvard Square to this particular visit last week, I had a little bounce in my step. Why? One word: flossing. For whatever reason (maybe it’s my adoption of the idea of “small tests of change” in my life), I’d made flossing a habit in the last six months. So, I … was … confident!


Before we get to the visit, though, let me back up for a moment: When I started working at IHI a little over a year ago, I couldn’t define the term “patient-centered care.” I’d heard it in passing, but it didn’t mean anything to me. In fact, I thought it had something to do with balance or equilibrium.


Since I just passed my one-year anniversary as an “IHIer,” I wanted to take a couple minutes and reflect on something I’ve learned about. And last night, I decided that something would be patient-centered care. Now, I’ve learned a lot about patient-centered care in the past 12 months. We added a course about it to the IHI Open School. And I’ve had the pleasure of soaking up teachings from our internal experts (folks like Jim Conway and Martha Hayward). But I decided to reflect on patient-centered care because of what happened to me at the dentist. On to the story:


The visit started just fine – small talk, I got married, yada, yada. My hygienist commented on my improved flossing (“Yes!”) and that she saw some nice improvements. But then she noticed an area in the back (“It’s always in the back!”) that had a lot of bacteria. It was hard for her to get to it because there was a filling in the way. There was, as she called it, an “overhang.”


She called the dentist in to take a look. “I might be able to sand it down,” he said. “But most likely I’m just going to have to replace the filling.”


“Really? Are you sure? I just got the filling replaced about a year ago. That doesn’t seem right. I had my first filling for 15 years,” I explained.


“Well, whoever did this one didn’t do a very good job,” he said.


Immediately, my mind raced back to an appointment a year earlier with my old dentist. And immediately, I got a bad feeling. He was a nice enough guy, but I never felt comfortable with him. He’d answer serious question with jokes and spoke in a very condescending tone.


“Oh, I need to get a filling replaced?” I asked. “When do I need to get it done?”


“Well, it’s not going to get better on its own,” he joked.


“Right …”


During the appointment when he replaced the filling, he left his dental tools on my chest because it was easier for him. At the time, it made me uncomfortable. I didn’t speak up, though. I just wanted to be done. The visit was rushed and somewhat painful, but dental work, I thought, wasn’t supposed to be fun. Just deal with it.


Fast forward back to the present. Looking back, I know my care wasn’t patient-centered. I was a spectator. And I should have spoken up. I should have said I didn’t feel comfortable. I should have said … something.


Now, more than likely, my tooth will be fine. And since I’m fortunate enough to have dental insurance and a flexible work schedule, it’s not an enormous inconvenience. But it’s still time, money, and energy that I’d rather not spend at the dentist. (Again, no one likes the dentist.)


As health care professionals who are torn between the bottom line and spending extra time making patients feel comfortable, I understand it’s not easy. There is pressure. The pace is fast and getting faster. Systems are not perfect.


But everyone has time for a question. If you sense something is wrong in an appointment or if you’re about to do something (really, anything) to a patient, just ask: Are you comfortable? As a patient, I think those three words can make all the difference in the world to us – and make us feel like we’re at the center of our care. 

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