Of Mall Medicine and Mangled Molars

22 Oct

When I was a small kid, we had one doctor. Doctor Tecson (or Doc Tec, as he was lovingly called) went to our house and gave us shots and endorsed us to specialists, when needed. He also played basketball and donned his funny Knights of Columbus hat with my dad on week-ends. Doc Tec remembered us by the ailments he treated us for. For me: “O, ikaw yung nagka-H-fever (old school name for dengue). Yung maraming kagat ng lamok sa binti.”  He was confident and firm — we trusted him.

My grandfather was a dentist who opened his clinic in Tondo, Manila in the 1930s. Lolo had this scary chair with a drill, powered by a manual foot pump — reminiscent of “My Little Shop of Horrors”. My uncles, tita, cousin — dentists all. In my childhood, we preferred my younger Tito to do extractions because he had a swift, strong hand; while we preferred Tita to do fillings because she was deliberate and gentle. At every visit, we knew what we were in for.

Sleepless nights and a puffy face from a botched tooth surgery yesterday triggered an introspection on how the concept of healthcare has changed so much today —  in an era of franchising and brand syndication of medical services and in relationship-building practices hedged on social media and text blasts.

The healthcare that my children have experienced has been very different — especially after they “graduated” from their pediatrician, who we have been loyal to in the early years. For them, it has been a series of HMO doctors and mall dentists, who would never remember their names, much less know their medical history without pulling out their charts from large metal filing cabinets. Very soon, cognitive computing would be able to help doctors make better cancer diagnosis and treatment and even understand the genetics of autism.  Maybe in the future, my grandkids won’t even be talking to doctors at all — they would just get scanned and get their diagnosis in an email.

The evolving delivery model around healthcare makes sense to achieve scale and quality; but I pray, never at the expense of the well-being of the patient.  I am sharing this cautionary tale below, relayed in an excerpt from a letter that went out today to a proprietor of a popular family-owned chain of mall-located dentist clinics.

The top of my 20-year old filling broke over the week-end; and I was keen on getting it done quickly, so I went to the mall nearest our home. My quest to fix the tingle I felt in my molar, ended badly and painfully. Cue the quotes on the ills of haste.

I appreciate you sending the surgeon from your Manila branch. She was able to credibly explain to me how proceeding with the extraction yesterday would mean intense pain, as anesthetics won’t work with the pus surrounding the tooth; and that waiting for the inflammation and infection to subside would be the best way forward. Sadly, that was a conversation I had only two hours before, in the same office, in the same chair; but I got a very different answer.

I am sure the staff had given you their reports. Please allow me to share my observations from yesterday and, with your kind indulge, my sentiments:

1. The dentist knew fully well that I came in thinking I was just getting my filling redone. Pushing for the surgery, despite my willingness to postpone (if the pus found meant that anesthetics won’t work), showed that the dentist had a cavalier attitude, with little or no empathy for what the patient may feel. When she said, “Pwede pa naman po”, I had assumed she had the technique and technology to ensure she could execute successfully.

2. After tugging on my tooth, triggering intense pain, I started crying. I endured this for 10 minutes or so until a point when my breathing became labored. Telling someone to “Stay calm” or “Relax” or petting them like a cat without clearly articulating a pain management plan is not reassuring — not to mention very annoying. Aside from administering mefenamic acid, someone walking me through other pain management techniques would have helped me through the worst part of the 1.5 hours of waiting for a competent surgeon. Instead, I was left to cry it out.

3. The team yesterday had poor presence of mind, questionable creativity and fleeting empathy. When the pain triggered my hyperventilating, they all scattered to make phone calls and left me alone in the room. I felt, someone should have tried to help me control my breathing — giving me a bag to breath into or something. I had to ask for someone to take my BP (they did not do this on their own volition) — but when I saw the arm band, I told them it would not fit me. They went through the motions; but finding it could not fit, no other action was taken, so my vitals was not taken at all. Two people came in on separate occasions to open the electric fan, not looking at me long enough to see that my jaw was chattering uncontrollably, because I was so cold. I was left in consistent pain for an hour and a half. I had to text my driver to come in from the parking area, in case something happened to me.

4. There was no leader. The dentists all seemed to have spent a lot of time making calls to various senior members of your team in other branches — all of them were running around. After an exchange, they would go out and make phone calls again instead of completing an adult conversation with me. They stayed in the secluded dentists’ area most of the time instead of talking to me or at the very least, sitting with me. Considering I was hurt and in distress, they should have sat with me and just took in what I had to say — instead, they ran away like they were scared of me. If someone was credible and decisive enough to talk to me, and to convince me of the way forward, your Manila-based dentist could have saved a trip.

5. Dr. MR lost all credibility when the surgeon’s recommendation was opposite to what she had decided to execute. As I was waiting for the bill in the waiting area, I saw that she just graduated last year and just got her license only a few months back — not even a year. I am filled with regret for not asking about her experience first and reminded of the rationale why even the salon across the hall would clearly advise clients if a junior or senior stylist was working on them. Before I left, she handed me a prescription for pain medication and antibiotics — no instructions on post-trauma care, no schedule for a follow-up consultation and no apology for inflicting unnecessary suffering. I walked out your front door, crying from pain more intense than I had felt when I first came in, and feeling violated.

6. Adding insult to injury, I got a text this morning: “We would like to inform you not to chew on the left side to avoid further trauma. Take your antibiotics on time. There may be also swelling.” The worsened condition of my tooth and gums was your dentist’s handiwork, and pain, swelling and inability to eat were already very obvious to me. I am still in constant pain and could not even go to work today, so I did not appreciate an impersonal text with a delayed post-procedure instructions and a condescending message. Protocol in these emotionally charged situations need to be thought out, as it affects your business and your brand.

Please consider making operational improvements to address these observations. I would not wish for anyone else to go through what I had gone through.

This experience reminds me why my parents never used doctors who were not their friends. I am motivated to reconnect with old friends who have their dental and medical practices now. They may not be in a nearby mall; but they would give me and my family the healthcare that they deserve — one that need not be accompanied by a waiver at every turn. I am off to find a network of new Doc Tec’s for me and my kids.

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