The TRUE Face of Health Care Reform

You hear the horror stories of a surgeon operating on the wrong leg, or side of the body. So far, I’ve had at least two dentists look at the wrong side of my mouth. The first really seemed to be sleepwalking (are the rumours of self-anesthetizations for dentists true?) Right after examining me, he ordered a dental x-ray-- on the wrong side.

The second time a dentist examined the wrong side of my mouth happened recently (2006). On a follow-up visit, after an extensive discussion of my RIGHT upper molar, the dentist re-examined the x-ray taken in his office, clearly spelled out “Right” and “Left.” He proceeded to talk about how the root canal had not been done well, and then pointed to the LEFT side of my teeth. First, I have had only, thanks be to the Holy Lord God, one root canal. Second, the tooth had been extracted, and had a clear area of greater lucency, as well and area of bone atrophy where the tooth had been. Third, he had just examined that tooth.

Flashback to a renowned Oral Maxillary Facial surgeon, a dentist at a top medical center. (As an indication of the demand for him, the dentist accepts only cash payments.) After multiple visits, it was decided to just extract the tooth. This decision came after the initial root canal, and:

A. the crown broke the next day;

B. the crown was removed two days post placement;

C. three endondontic procedures where a hole was dug in the middle of the tooth again; and

D. two apicoectomies* when a hole the size of a dime was made to my upper jaw, two times because the dental surgeon ignored the root from which the infection was coming. In short, I had had a raging infection about three inches from my brain for the last 7 years!

Back to the tooth extraction. The dentist jiggled and wiggled the tooth, and I wondered if this was part of the standard process. Finally he said, “I’m just trying to get this crown off.” I replied, “There is no crown.” The dentist had been pulling at the wrong tooth.

Another caveat from the same dental surgeon was during the initial visit when he prescribed the antibiotic Clindamycin, until Computer Assisted Tomography or CAT scans of my tooth could be taken. I asked him how long I should take the medicine, and he replied, “as long as the tooth hurts,” clearly differing from the recommended lengths for efficacy and reduction of resistant bacterial strains. As an explanation, he stated that pretty much the “teeth heal by themselves.” I wondered why I was in his office.

*Apicoectomy: A dental procedure in which the roots or apices of the tooth are removed. It was explained to me by a dentist that root canals are not able to reach all the way to the tips of the roots.

THE STATE OF OUR HEALTH CARE

Most people would agree with the statement that our medical care is in need of reform. The high costs, unsatisfactory service, and the loss of human interactions can be seen throughout the industry. As a physician and a patient, I know. I had lived with a raging infection for 7 years in my face--an area that somehow fell between anyone’s expertise. The M.D.s said it was the domain of the dentists. A top oral surgeon said, “most things in the teeth heal by themselves.” Yet as attested by the lucrative salaries that dental surgeons derive from procedures, the oral surgeon’s opinion doesn’t seem to be the opinion of most dentists’, judging from the multitude of dental procedures performed.

I would like to propose a new way of looking at Health Care. As a physician, I must rally for the practitioners with the central knowledge and practice to be Executives or captains of the medical care ship. Health care may be viewed through many lenses, but is it logical to have attorneys steering the ship? Would the seamen or medical administrators who make up seaway codes, tucked away in their offices, be the best captain for conditions of storm? How about the medical academicians? Would they be able to judge the best route while at sea or while in the laboratory? Who is the Executive that has the experience of hands-on weathering of storms and complications, with the help of her crewmen (nurses, technicians, therapists)?

Our American history contains the seeds of wisdom that our ancestors established in creating the balance of powers for our governmental system. We have the Executive branch, which is represented by our President. The Legislative branch gives form to the wishes of the people in the structure of laws. The Judicial branch interprets the laws when there are times of disagreement. We can recapture the wisdom of this system by applying the concept of a balance of powers to the medical system.

A second misconception of roles is that Health Care has become “consumerized.” Health care has become a commodity, as if Health were the same as a pair of shoes or a new flat-screen TV. While this may work for material objects, the crucial part of the healing process has always been the Patient-Physician Relationship. In fact, many people try to romanticize inanimate objects, referring to cars/boats/planes as “she,” in order to fulfill the universal need for relationships.

In any relationship, there are times when two or more people have differing opinions. The differing opinions may be handled differently depending on the roles and the context of the group. Is the primary role the a patient-physician relationship? Is it the differing opinions within in a medical team? Is it differences due to the differing goals of the Executive, Legislative, or Judicial branches of medicine?

Which leads us into the murky waters of conflicts of interest,

and the TRUE Face of Health Care Reform…