A specialist's patient-centered care: He won't do one

Throughout his career John Rossi has improved medical care, as an industrial engineer by training.  He's the best, and I was privileged to learn clinical quality improvement from him. -Ken

John's story:

My work makes me hypersensitive to flaws in any system I encounter.  I'm naturally curious about those things; I can't restrain my curiosity.

A few years ago I had pain of uncertain origin that my regular dentist couldn't find.  He referred me to an endodontist, saying "If you don't need a root canal, he won't do one."  Some people in that business will just do the root canal and that's the end of the story.

I was able to get in quickly as a new patient.  From the beginning, the experience was as good as you can make it in those circumstances.  I arrived in pain.  The initial paperwork was easy and brief.  They knew exactly what to do with my insurance.  They had already received my information from my dentist, so I didn't need to do any paperwork.  They told me exactly what it would cost me.  

When I first talked with him, he said, Here are the options, in simple terms about what was going on with the tooth.  I had had a root canal years before, and that experience was very different.  They just got in there and started doing the procedure.  Instead, he said, I can pull the tooth, but you'll have a gap that your dentist can fill; that's the other option.  Or if you want to keep the tooth, I can do that with a root canal.  

Having options is always good when you're dealing with a specialist.

He prescribed pain medicine because he couldn't do it that day.  The pain was kind of bad so that helped.

The next visit was for the procedure itself.  He was able to do the first one in one visit.  That was important because you're in the chair for a long time, with your mouth open wide.  That's not painful in itself, since you have lots of novocaine to block the nerves, but it's irritating to sit there for that long; your mouth gets tired.  An earlier root canal with another endodontist had taken three visits.

He explains what he's doing in advance, and as he's doing it:  how this works, and what he's doing.  He has technique that's very good, that's not difficult to tolerate.  He has an assistant, a surgical technician who passes instruments so can move things along very rapidly.  

He explains the aftermath, and if there's to be a second procedure, he'll explain that, telling me, This will take about this amount of time.  He predicts accurately.  And he'll say, If you have pain later, this is how we'll deal with it.  If I need an antibiotic, he gives it to me.  

I've never had any complications.  

For subsequent times, he can see me quickly, because our relationship is established.  There's no barrier to going there, even though in practices like this, it's not self-referral.  I get in there pretty quickly.

His assistant has already worked out an arrangement with the insurance company so they know what balance I owe, as my insurance only pays a certain percentage.  So she says, When you come back, come with a check in this amount, and we'll send you a check back if necessary.  I usually get a little rebate check. This is expensive stuff, ranging in the thousands, even after insurance.  It adds up pretty quickly!

They're making everything as painless as they possibly can:  the procedure itself, the lead up to it, the check-in process, and the settling of accounts at the end. 

The bedside manner is right there.  He's obviously an excellent technician, with a modern setup.  That's the stuff that's hard for the consumer to judge, other than the lack of pain during the procedure.  His manner is very gentle and calming even when you're in pain.  He brings down the anxiety level by explaining.  He'll do some small talk around the edges to bring the anxiety down, because they know people in this situation are usually in considerable pain.

It's a nice contrast.  Some surgeons are very abrupt with their patients, just saying, We're all set, all right, let's go.  That's not easy for patients or their families.  It's a very different experience with this man.

Overall, it's a collection of things, not one thing. It's all of what they do that meets those patient-centered ways of doing things.  I don't expect it as much of the office staff about the making of appointments, arrangements with insurance, the paperwork, and so forth, but they also make that painless.  While I don't like writing a big check of $1,000 or more, I'm not surprised.  It's not, We'll submit this to the insurance company and see what comes back, like with other dentists.  If I've made an overpayment, they'll pay me back.  It's all done smoothly for the patient.

I've had four root canals with this doctor, and the office process and the dental care are amazingly consistent at this high level of patient-centered care.

I give them a lot of credit for that.  If I do have to have more work done, that's where I'll go.  They've made the experience that good.  That has gotten back to my dentist; that's why he'd told me he had no reservations about sending me there.

Ken's Advice: In talking with a specialist, be sure to learn your options.  (John adds:  "If you perceive a lack of options, alarms should go off.  Be assertive, patients!")

Read a story of a dentist's patient-centered care.