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.

Run, do not walk: A dentist's errors

Patti's story:
In 2002 I was referred to a dentist by my family physician. The dentist insisted he perform a full mouth oral reconstruction and he was the "best" for the job. My dentist told me a panoramic X-ray would be taken before recon but later I found he had no such machine. He also told me I would be given antibiotics...knowing I had a heart condition.

Immediately all my veneers broke at one a month as my dentist tried to patch them with a yellowed crackled substance. Later my front teeth had to be filed down and capped. I also learned other patients of this dentist had veneer failures.

In 2004 my recon was still not complete. My dentist ignored facial pain, numbness, swelling, infection and inability to chew solid food. His response was, "shut up, you're losing weight." My dentist also told me to "shut up" or, I'll take back your reconstruction...you don't deserve my reconstruction. I didn't know what that meant.

After my veneers failed a newly crowned molar broke due to improper load force. My dentist angrily slathered a rough substance over my molar with visible debris still under the slathered crown.

Later four unsuccessful root canals were performed, all necrotic, all with no antibiotics. My dentist stated I could become immune to a plaque if given antibiotics. I lost my crown and learned of crown replacement guarantees.

After one of my past root canals I confronted my dentist about sedating me without my knowledge or consent. He was leaving me to drive home alone under the "influence." His response to my sleeping was, "You were wasting costly chair time." I told him to never do that again.

During an appointment for final impressions for that "free" replacement crown my dentist sedated me again without my permission. He was verbally and physically abusive. He drilled for two hours through the "sole" of my molar. He stated in my file I would lose that molar.

I sought the best of dentists including periodontists and prosthodontists for sectioning. But my dentist destroyed everything above the gum including his own crown lengthening and gum surgery which he told me would be done by a periodontist. Another one of my dentist's lies.

I also found out from those dental specialists I had TMD from an improperly positioned reconstruction.

Weeks later with no antibiotics and what was left of a severed necrotic molar sealed in silver amalgam I was admitted to a hospital with septic shock, hemorrhaging internally. I was put on life support with renal and respiratory failure. My insides were repaired as best they could. My family was told I would die. At 5' 7" I was left weighing 83 pounds.

Due to malnutrition I lost my hair and fingernails. My surgery also failed leaving my stomach and intestines to flip over one another. My colon protruded out my navel. All my internal organs relocated outside my body. I was left to suffer ileus (vomiting my own feces) and ongoing renal failure.

Again I sought the best...only, this time I was looking for the best abdominal repair surgeon. No surgeon could make such a huge repair and without repair I was to die.

Two years later in 2006 my incision reopened spewing pus from an intra-abdominal abscess.

I found a renowned surgeon at Chicago's Northwestern Memorial Hospital to repair me...the largest repair he has performed. I am told I am lucky to be alive.

The most disturbing fact about my dentist is that he held no current controlled substance license at that time. I have also found my dentist claimed specialized dental fields without even passing a simple written test. My dentist's Chicago Dentistry Society profile states TMD as one of his specialties. My dentist denied any knowledge of TMD when confronted with my failed TMD reconstruction.

I was told by dentists to demand a free crown replacement. I was told by a prosthodontist to demand a properly placed reconstruction.

Patti's Advice: It's our duty to check our dentist's licensure through our state's department of professional regulations. Don't be afraid to ask questions!

Run...do not walk from a dentist like this idiot!!!

Read a story about a much more competent and compassionate dentist. Thanks to Patti DePaola for sharing her story.

Reluctantly, he said the dentist had done a good job: Medical tourism

When Josef Woodman's father decided to fly to Mexico for a few months to have some restorative dentistry done, his son was horrified, and took the trip with him out of fear for his father's well-being, as well as to satisfy his own curiosity.

"My dad had isolated three clinics in the area of Puerto Vallarta that performed the procedure he needed, and had eliminated two of them rather quickly. At the third, a board-certified dentist performed work that, here in the States, would have cost about $24,000, for $11,000 including accommodations and traveling costs for a month."

"I've traveled for my own procedure – a $4,000 root canal that, in Cost Rica, cost about 25% less. There were many Americans in the waiting room. Upon returning home, I had my dentist check the work. Reluctantly, he said the dentist had done a good job."

The Joint Commission International (JCI) a US-based accrediting body that evaluates medical facilities overseas with a particular focus on state-of-the-art technology, has been accrediting hospitals overseas for about 10 years, and in 2002 there were less than 40 accredited hospitals. Now, there are more than 130.

Singapore alone receives 400,000 visitors a year as part of medical tourism, and most speak English. It seems to be a growing trend; about 200,000 Americans, and even more Canadians, travelled abroad for medical care last year.

Upon their return, Mr. Woodman had a new smile – and his son had a new focus for his writing. Now Josef has written a book, Patients beyond Borders [which I haven’t read yet] about medical tourism.

Advice to underinsured people needing expensive care: In considering medical tourism, do your homework about the quality of care.

Browse for related stories in the index at the very bottom of this page, or read another medical tourism story.

Thanks to Jaclyn Stevenson for the source article in the March 2008 issue of The Healthcare News of Western Massachusetts.