Bay Area Dentist Serving San Francisco, Berkeley, Piedmont, Oakland
Archive for January, 2012
Monday, January 16th, 2012
Four years ago, I had a skin cancer removed from the very edge of my lower eyelid. The surgeon who removed it was/is widely regarded as the best surgeon in the area for this type of procedure. At the time, I was not quite as impressed as everyone else was. Her bedside manner was abrupt, she was rough, and seemed uncaring. During the procedure I actually woke up from the IV sedation feeling the pain of sharp surgical instruments, which should never happen with the right combination of local and IV anesthesia. While I was recovering, aside from looking like I had seen the business end of a boxer’s fist, I felt like I had a small pebble in my eye for 2 weeks from a suture she had tied in such a way as to irritate my eye. When it came time to remove the sutures–a procedure generally regarded as painless–she was so rough that I asked her to stop, and I went to my office and removed the last sutures myself–painlessly.
When a recurrent lesion developed in the same exact spot this year, I was again referred to the same specialist. My consultation with her reminded me of all that went wrong last time, with one additional consideration–she didn’t remove all the cancer. Despite my reservations, my doctor assured me that she was the best in the area, that “these things happen,” and that I should proceed. When the specialist’s office took a month to get back to me to schedule the surgery, I had already asked my doctor if there was someone else I could see. With a few emails, my doctor arranged for me to see 2 top specialists at Stanford Medical Center.
The two experiences were as different as could be. The Stanford Dermatology Center made me feel like a VIP. They arranged things so that the cancer surgeon and the plastic surgeon would coordinate their procedures on the same day. I didn’t feel a thing during the procedures or after. And I didn’t look like Joe Frazier after the “Thrilla in Manila.”
These 2 episodes remind me that there are often local professionals who have become the go-to experts, not because they deserve it, but because they have a local niche, skillful marketing, a confident disposition, or because they have managed to ride on an old reputation rather than consistently excellent performance. One of the wealthiest, most successful orthodontists in our area is like this. He boasts about his international reputation, his keynote addresses at national meetings, and his published articles. I have had the uncomfortable experience of explaining to some of his patients, without disparaging him, why they now have headaches and jaw joint noise that they did not have before his treatment. Another local dentist described the orthodontist like this, “If he were half as good as he says he is, he would wouldn’t be half bad.” One time he called me on the phone to complain that when his patients come to my office that they never come back, and he had a collection of articles in front of him to support why they should. Not being someone to criticize another dentist’s work because I never know the whole story, I didn’t really have a good explanation for why his patients didn’t come back except that “It’s certainly not my communication skills, so maybe my treatment approach simply makes more sense to them.”
There is another local “expert” in implants I used to refer patients to before I received my own training in implants. When one of his implants failed on a patient of mine and I asked to meet with him about it, he came into my office angry and hostile, unwilling to entertain the thought that he had made a legitimate, understandable mistake that my patient wasn’t going to tolerate.
Who says that these people have to remain the go-to experts? As far as I can tell, my reputation is only as good as the last painless injection I gave, the last bite problem I solved, or the last toothache I cured. Everyday, it is incumbent upon so-called “experts” to re-earn their reputations with solid results on real, live patients. No amount of published articles, patient referrals, or keynote addresses can compensate for clinical failure. Clinicians are not perfect. We all make mistakes. This is why every day we have to balance confidence with humility, professionalism with humanity, reputation with performance.
As patients and as consumers, we do not have to tolerate sub par professional care by local “experts.” To me, it is worth it to travel as far as necessary to get the best possible care from a real expert. When my mother was diagnosed with ovarian cancer, traveling to the Mayo Clinic in Minnesota gave her 3 years she might not have otherwise had and allowed her to see 2 grandchildren born that she might have never known. When I needed my own teeth and bite addressed, I traveled to one of the top dentists in the country who not only fixed my teeth but cured me of my lifelong migraines and relieved me of the debilitating vertigo that I believe was caused by our “expert” local orthodontist. And now I know that Stanford has far more competent specialists in skin cancer and plastic surgery of the eye than the highly regarded local expert.
In some instances, the best professional may be just around the corner, but when it comes to your health, it is worth the minor inconvenience to travel to a real expert.
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