IMPRESSIONS
Welcome to My World
By Dr . Bruce R . Terry Editor
Did you ever have one of those days ? Of course you have ; look whom I ’ m talking to . Well , I had one of those days yesterday . You know , the kind that starts out O . K . when you wake up and nothing is sore . You eat breakfast , read the paper and go to the office . That ’ s where the fun begins .
They don ’ t teach this stuff in dental school . My first patient reported that her dentist tried to start root canal treatment the other week , but she didn ’ t get numb . She is afraid that she will have the same problem in my office . After a 25-minute lesson in local anesthetic chemistry and human physiology I thought we were ready to go . We agreed that she would benefit from some nitrous . I got her going at 25 percent as my receptionist dropped me a note saying that a patient of my associate ’ s demanded that I call back immediately . I gave Mary , my receptionist , the look . You know , the one that says , “ Really ?” Then I told her that I would have to call later . Just as Mary was leaving , my patient began crying uncontrollably . At that moment I wondered why they call this stuff “ laughing gas .”
I turned down the nitrous and converted to 100 percent oxygen , but she wouldn ’ t stop crying . My assistants are very good at calming my patients . It seems that despite my calm demeanor I ’ m not the calming type .
My assistant Jennifer tried to calm our patient . As we were nearing the end of the box of tissues the patient has gone from crying to a gentle whimper . She said she was sorry and she was ready to get started when I explained that it had been
55 minutes and we would have to reschedule . Her face turned dark red and the tears started again . She was now angry with me . As I was thinking about why she was angry with me , she was raising her voice in defiance telling me that she had taken the morning off from work , and why that ’ s not so easy and she has lost a half day ’ s pay , and her tooth hurts her and she can ’ t wait . So , in my calmest voice , and remember I have been told that I do not exude calmness , I explained that I have other patients to see today and it ’ s simply not fair to make everyone wait . She got up from the chair , grabbed her coat and purse and stormed out saying “ you suck .” I hadn ’ t even had a cup of coffee yet .
Mary , bless her heart , reminded me about this patient I ’ ve never seen but demands to speak to me . I told her I was going to get the next patient numb and then call the impatient patient . I introduced myself to the next patient and asked him if he was having any pain . He told me that he had been in pain for several days and his tooth felt loose . When I examined him it was clear that tooth # 5 was vertically fractured . I explained that I wouldn ’ t be able to perform root canal treatment because of the fracture and he would need an extraction . He told me that he didn ' t understand . So , I got out my 3D models and spent the next 20 minutes explaining how we couldn ’ t save his tooth because we can ’ t seal fractured teeth . He asked why not , and that consumed another 10 minutes when Mary came by and mimed like she was talking on the phone . I nodded to her and continued to discuss my patient ’ s options . He agreed to have me extract his tooth when I realized that he was on Coumadin . I told him that I would need to contact his physician and see what modifications in medications were needed before we could extract his tooth . I had Jennifer escort him to the front desk with instructions to
contact his cardiologist .
I got back to my office and I began to call the patient that had been waiting for me to return his call . The phone rang twice when Mary stormed into my office and told me to come quick , the nice old man is having a heart attack in the waiting room . I hung up the phone and ran out to the waiting room . As I make my way to the waiting room I regret not having the emergency situation practice drill . This was certainly going to be an emergency . I told Jennifer to get the AED and the oxygen . I told Mary to call 911 . I knew that $ 1,600 AED would come in handy some day . When I got to the patient he was sitting in a chair . He is white and sweating . I asked him to lie down and he refused . He said he was just not feeling well , but didn ’ t want to lie down . I told him that he didn ’ t look very good and he might have a problem with his heart . He looked up at me and threw up all over me and the magazines in the waiting room . I still haven ’ t had that cup of coffee . We got him cleaned up as the ambulance arrives . They started to examine him . They hooked him up to an EKG and took his temperature . The paramedics turned to me and said he ’ s not having a heart attack , he had a stomach virus and a fever of 103 .
Luckily , I have another pair of scrubs in the office for just such an emergency . I changed so that I could see the next patient . I was now about one hour behind and I have not produced $ 1 in production for the day . Can you bill for a nervous patient or a patient that vomits in the waiting room ? What exactly is the code for that ?
The next patient spoke very broken English and Mary warned me that she was difficult to understand . I asked her what her problem was and she pointed to a tooth on the lower left side . I looked in and there was a large hole in the occlusal of # 19 . I explained that I would need to do root canal treatment after looking at
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