I have always prided myself in looking after patients to the best of my abilities. At dental school there is a certain standard to deliver exemplary treatment, after all one usually has a tutor behind you watching your every move. As a student, I couldn't wait for the day where I could do what I wanted to do, provide the course of treatment I wanted to without fear of reproach from clinical teachers or maybe even leave that bit of caries at the ADJ......
First complaint on my second day
It's strange though what actually happened. I found myself caring more once I had graduated. I don't particularly know why, perhaps once the training wheels are off it is a worrying thought that one's skill level might decrease if self-regulation does not occur. It's predictable really, that this rational anxiety becomes translated into tangible action. So on this basis, you can imagine my horror when I received my first complaint on my second day.
Now I know what you're all thinking, that I must be a dreadful dentist to get that kind of review so soon into practice. Well, if you are sitting comfortably, then I shall tell you what happened and why, so you can avoid the same trap.
New patient examinations
So there I was, second day in, with a morning full of new patient examinations. The patient in question came into the surgery; she had a quiet and withdrawn demeanour. This made me suspicious as to what stresses she had in her life. She revealed that her new baby was not well and was currently in hospital. After the exam, the only treatment she required was a very small buccal composite to restore a slightly carious pit on a lower wisdom tooth. In an effort to save her extra hassle coming to appointments, I offered to do the filling then and there. Now I certainly got consent, but what I forget is exactly how I got it. It could have been a case of, "You need a small white filling on your back tooth, shall we do this now?" or "You need this small white filling, let's do it now." Such phrasing at first glance may seem irrelevant, but the more keen reader will notice that one is a question; the other is rather less of a choice. Either way, I gained her consent, that makes it fine doesn't it?
From the clinical appearance the lesion in question looked as if it was going to go into dentine. In other words, it was local anaesthetic time. I didn't feel that subjecting the patient to the rigours of an ID block would be particularly kind, so I infiltrated with articaine. Unfortunately as sometimes happens, this failed to numb the area and I had to go the whole hog and give the ID block. One fantastic composite (though I say so myself) later, the patient left with numb lip warnings and a recall date for six months time.
Unhappy with treatment
I think you will agree that from my perspective that was a good and, just as importantly, a thoughtful treatment. So you might imagine my surprise when she rang the next day complaining that she had an infection and was unhappy with the standard of treatment. When she came in to discuss her issue, she presented with a grossly swollen lip. It was obvious that she had bitten her lip. When she was asked what it was about the standard of her treatment she was unhappy with, she stated that she only was expecting an examination that day and she didn't understand why she needed two injections. She thought that my administration of two local anaesthetics meant I had made a mistake. I explained this was not particularly unusual and that it wasn't the cause for her swollen lip, it would have been numb with just one nerve block. I also explained to her that I was trying to be kind by completing her treatment in one visit, giving consideration to her social circumstances. Once I had said this, the patient was very understanding and, just as my perspective of the treatment given was changed, so was hers.
What did I learn?
So what did I learn from this? I learnt that in this case my perspective of how I treated the patient was wildly different to what she perceived. What should I have done to prevent this happening and how can I prevent this from happening In the future? Well subsequently I have always asked patients on the first appointment what they would like me to do for them and what they expect. We are always taught at dental school to judge patients expectations for extensive and cosmetic treatments, but I would extend this to all treatments, even examinations. I should have explained more comprehensively the ramifications of the articaine infiltration failing so that she would not have lost confidence in my abilities. I initially found this experience upsetting, but after reflection, I am glad to be able to have learnt from this and I hope that you may find this useful reading.