Our Patients' Problems Are NOT Our Problems

Imagine the scenario: You go for ACL surgery and the doctor tells you not to eat after midnight before your procedure. You arrive at the outpatient surgery center and the nurse asks you when you last ate and you tell her: “2 hrs ago. I was hungry for breakfast and I just couldn’t skip it.” The nurse is exasperated. The doctor is upset. The surgery needs to be rescheduled . You think they’re a little uptight and overreacting.
The surgery went well and they give you a course of oral antibiotics and yet your knee begins to swell, discolor and itch a couple of days later. When you show up for your 1 week post-op check, the doctor tells you that you have an infection which is weird, because the antibiotic should have taken care of that. You reply that the pills made you nauseous so you stopped taken them after the first dose. The doctor seems miffed and says: “Here’s a different antibiotic but you have to take it all. Can you do that?” and you say “I’ll try my best”. You go home, take the first 2 of 20 pills and forget the rest.
Eventually, after IV antibiotics, you get the infection under control but skip all suggested physical therapy because it’s just too much work. 4 months later, the graft has “taken” but you walk with a noticeable limp and the joint is stiff all the time with limited range of motion. When you ask him why your knee always hurts, he says: “Yeah, you’ll walk with a limp the rest of your life, but the graft was a success. Look, you didn’t take the antibiotics the way we told you to, and the infection caused damage. You refused to go to physical therapy, which we told you about before the surgery, so the range of motion is now limited due to scar tissue. I’m sorry, but there is nothing more I can do. Unless you want to redo the surgery and we can do that, of course with a full charge to your insurance which won’t pay any of it a second time.”
It’s clear to you that your doctor placed the burden of pre and post-operative responsibilities on you. Medicine has been extremely good at separating the patient’s responsibility from the procedural outcome. The patient has to play a role in the outcome or it will be compromised-and it’s not the doctor’s problem.
Orthodontists have chosen-by and large-to take an opposite approach. We tend to accept the patient’s problems as our problems. If a child doesn’t want to brush, we choose to buy all sorts of medicaments, sealants and machines to create a work around for the issue. If they don’t want to wear rubber bands, we come up with appliances and gadgets to solve the issue, even though it costs us lots of money, time and effort. There are very few orthodontists who will walk up to a mother and father and say: “Your child refuses to play a role in their own health, so I am removing the appliances today.” And this is all for a non-acute, optional set of procedures.
We give multiple chances, work on “motivation”, education and for many clinicians, continue at the risk of their own emotional well being all to try and make up for a lack of participation from the patient.
How often have you seen a Class II adult patient say: “I’m sorry but I simply can’t wear elastics during the day and I won’t use any other appliance”?  How many orthodontists can sit that patient up, eye to eye, knee to knee and say: “OK, then I’m sorry I can’t give you the outcome we discussed? Where do YOU want to go from here?”
Imagine a restorative dentist seeing a hygiene patient who has periodontal disease and been through perio surgery come to a 3 month check and say: “I haven’t flossed once since I saw you and I brush occasionally.” They have deep perio pockets and pus everywhere. Does the GP say: “Hmmmm, let me figure out a solution that I can do for free and not make you upset at me”? Or, does the doctor say: “Well, if you don’t help, your perio disease is going to get worse and you’re going to lose your teeth. Oh, BTW, we need to see you every 3 months for a scaling for which you’ll pay $250/visit.”
Having come from the restorative side for 20 years, I have been really interested in seeing how differently orthodontists treat the patient responsibility portion of treatment and how many of my peers have taken that burden on themselves. While I won’t ever do that, I am kind and gentle when explaining that to patents and their parents.
Always remember that when it comes to any dental problem, including orthodontics, it’s THEIR problem and your goal is simply to help THEM solve it. It’s NOT your problem…unless you make it yours….
Best wishes,
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If you want to come to learn more about an amazing business meeting for orthodontists, simply visit OP2018.com . We’ve got a world-class lineup of speakers, amazing food and an ambiance that will make you want to come back year after year. You can always email me at Glenn@OrthopreneursRD.com or message me on Facebook. I’m here to help.
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