So, what ever happened to Mel? You remember Mel, don’t you? I told you his unhappy tale in the last article: The Case for a Dental Escort Service. I was wary of Mel’s initial choice of dentists. Some of the finest clinicians in the world work in the Northwest, where Mel lived, and I know most of them. I had no reason to believe Mel’s dentists were anything other than well-qualified, but I had a high level of confidence in others with whom I had worked. From the first time Mel told me his plans, I implored him to let me organize at least a second opinion with clinicians of high clinical reputation who also had an excellent patient care orientation. Following the last straw experience with Dr. Martin, Mel asked me to help. I enthusiastically agreed.

 

 

My first choice was to introduce Mel to my friend, Dr. Michael Cohen, a periodontist specializing in implant dentistry and founder of the Seattle Study Club network. [The names of Mel’s first dentists are fictitious, of course. I am, however, using the real names of the dentists with whom Mel finally chose to work.] I knew Michael to be a superb clinician, a gentle and understanding human being, and a master at working collaboratively with other specialists. I called the office and asked Kim for an appointment to evaluate Mel’s dental condition and discuss how and with whom he might receive the best care. I let her know I would be joining Mel. I also spoke with Michael and reviewed Mel’s experiences, preparing him for Mel.

 

I accompanied Mel to the appointment and we were both greeted with anticipation. They expected us and were pleased to see us. After Mel completed a medical history, we were escorted to an examination room by Rhonda, Michael’s long-time surgical assistant. She looked at Mel’s radiographs and copies of his dental charts. She told Mel she would like to begin making note of the current condition of his mouth, focusing on missing teeth, existing restorations, tipping and crowding and other basic findings. She asked lots of questions about how he wanted to be treated and what triggered his anxiety. He was responsive and she made notations for others to read.

 

Once completed, Michael joined us. He rolled his chair back and adjusted it so that he was knee-to-knee and eye-level with Mel. In his warm voice, he introduced himself and asked how Mel was feeling right now. “I feel very secure and comfortable with Sandy here and what has been done so far is just fine.” “Good,” Michael responded. “So, Mel, tell me this. What will be different for you once we have finished? How will you be different walking out of our door than you were when you came in today?” [This is one of the most effective and superb ways of asking about Outcome that I have ever heard. If Outcome is not a concept with which you are familiar, please contact me for more information about this foundational piece. It is the cornerstone of a relationship-based practice.]

 

Mel hesitated not one minute. “I have avoided smiling for almost ten years because I was embarrassed about not having any teeth in the back. That would be changed, and I would be proud to laugh in front of friends. My teeth have hurt for over ten years; the pain would be gone. I can’t eat many foods because I don’t have any teeth to chew on. I want to be able to eat the way normal people do. And I’d feel good about myself, with confidence that what I had done would last and not make any more problems for me.”

 

Ca-ching! Mel was clear, precise and obviously very committed to each of these outcomes: appearance enhancement, comfort, function and peace-of-mind. Although Mel will likely have root canals, braces, implants, reconstruction, and possibly orthognathic surgery, he is buying the freedom to laugh with friends; he is buying relief from pain; he is buying the ability to chew and eat; he is buying peace of mind — appearance, comfort, function and peace-of-mind. I know Michael Cohen will never forget this and that the other dentists with whom he works will not either.

 

Michael then asked Mel if he could have a look around, and, with Mel’s permission, lowered the chair and completed the examination and charting. He alerted Mel to what he would be doing before he did it and explained everything in lay language. When he completed the exam, he raised Mel’s chair and invited us to come to his office for a discussion. As we sat around a round table, Michael share his thinking. And it was just that – thinking. He had several thoughts and began to share them with Mel. He wasn’t entirely sure about one thing or another, and he said so. He wanted the opinion of two other clinicians, both with which he felt Mel would feel safe and comfortable. He suggested Mel’s next step was to meet Dr. Ward Smalley, an orthodontist who is double Board Certified in Prosthodontia and Orthodontia, and whose opinion Michael greatly valued. In addition, he wanted to introduce Mel to Dr. Fred Ebsworth, a general dentist of significant clinical skill who has a gentle style just made for Mel. I was thrilled at Michael’s suggestion of these two clinicians, both with whom I have worked and for whom I have the highest respect. Michael’s staff handled coordinating the appointments and Michael wrote a thorough letter of introduction to both Ward and Fred, ensuring that Mel’s particular situation, both clinically and emotionally, were clearly conveyed.

 

I was traveling the day of Mel’s initial visit with Fred, so he went alone. Although I had no concerns about Fred’s ability to work someone like Mel, I called in advance and spoke with Rose, who assured me that Mel would receive the utmost of consideration. Indeed, he did, and Mel subsequently returned for a minor procedure. Fred scheduled it at the end of the day with no competing patients and was prepared to take his time. There were no problems at all. That afternoon, Mel called, excitedly reporting, “Fred was just exactly what I needed. I’ll be his patient for life.” Ward and his staff were equally wonderful. I’ll continue to be his dental escort as long as he wants me to, but I think Mel is well on his way to dental independence.

 

There are many takeaway lessons to this true story and most have to do with avoiding relationship failure. My hypothesis is that significantly more failures are the result of relationship breakdown than clinical error. My guess is a safe one considering that patients control many of the most important variables which determine the success or failure of a clinical strategy.

 

How do you examine your failures? Most people just want to move on and forget their mistakes, but there is much to learn from these experiences which will help you plan to avoid problems in the future. It is humbling to reveal your mistakes and omissions, yet it is encouraging to learn that even the best clinicians may overlook an important factor or undertake a strategy without success.

 

I provide the following questions as a structure for the review of your own relationship failures. Please involve your team in this project.

 

   Relationship Blues Case Study

 

Please choose an example of a relationship (not clinical) failure you have experienced. The following questions will help you provide details about the situation.

 

I hope you take the time to work on this exercise and learn from it.