Thursday, September 08, 2005

Kids are...Fun.

So, today I got to yell at a 7 year old. I am a mean, evil dentist. I am like Dr. Mengele, DDS. oh yes.

Nice little girl; we'd done 2 fillings and three crowns on her; just a couple weeks ago, she was reasonably tolerant when we did back-to-back pulpotomy/crowns on teeth A and B. So no worries.

Anyway, we brought her back cuz one of her earlier fillings (mine, I fear) had gone south....it's hard to do a two-surface filling on a first baby molar, cuz the durn thing is like 80% pulp anyway, so good luck not hitting it.... So I did. Shoulda done the pulpotomy on it the first time, but noooo....

So we bring her back, and I'm trying to subtly distract her whilst sneaking up w/ the injection, but she's too smart for that, having been there before. So, she starts whining and crying, "I want my mommy" etc etc ad nauseum. So I use my happy Dr/Mr Rogers voice and explain very very gently how we don't WANT to hurt her, but you see, if we don't get those nasty ol' tooth bugs OUT of the tooth, (which I might add, IS currently sporting a deligtfully pus-filled parulis!) why, you might get sick and have to go to the hospital! Your face would swell up and look REALLY silly and it would really hurt! You don't WANT to go to the hospital, I don't want you to go to the hospital, and you see, that's why Mommy brought you here, cuz SHE doesn't want you to go to the hospital.

"I don't want to be here!!!! waaahh!"

Why? "It's going to hurt!!!"

What's that in your ear, sweetie? "huh?" The hole...in your earlobe. Are your ears pierced? "Uh-huh." Did that hurt? "Just a little..." Well, there you go..... no, just open... "I want my mommy!!!"

At that point she jerks her head dangerously close to appoaching syringe, therein threatening myself, my assistant AND herself w/ acutal serious injury. At that point, you can send her home, or get tough. It's no different that Super Nanny or Dr. Phil. Stop, lower voice, speak a little louder and quite sternly. "Jenny. It is VERY important that you sit still, or someone could get really hurt. Now, I know that you don't act this way at home. I know you are a big girl, but right now, you are acting like a four-year-old. We have four-year-olds that don't even behave like this! This is OUR office and you need to follow our rules."

A much subdued "Jenny" then opens and barely notices the injection. Was that so bad? [sheepishly] "no...." after that, easy procedure. 10 minutes.

So. Nothing new there, I get one or two of those every week. However, THIS time, I'm later pulled aside by a nurse I work with who really felt that I was too loud, too mean, and inconsiderate to the terrified little girl. Why didn't I let Mom back with her? Sometimes that helps them calm down. I should recognize that a lot of people have different anxiety and pain thresholds etc etc. She said that she TELLS her patients when she's injecting so they know what to expect. Also, as a mom, she felt bad for the little girl.

I seriously have the deepest respect for this woman, and I admit that I don't know everything. I further concede that "you're acting like a four year old" may be a little inappropriate. However....

1. Mom is in the waiting room with two other girls, 5 and 2. She can't hold "Jenny's" hand and watch the other girls. Further, I don't want them seeing the sister upset. The odds are, if no one hears horror stories from older siblings, they're just fine no matter what I do.

2. Having Mom in the room, more often than not, induces the child to act out. They "perform," knowing full well if they yell enough, Mom will scoop them up and carry them away. Lovely, but it doesn't help anyone in the long run. Additionally, having a parent there sends the child a message: "I don't trust this doctor, so if they hurt you, I'll take you away." The kid is then more apprehensive. Mom doesnt' stand at the door the whole day at school. Why? Because she trusts Ms. Applebottom, and Jenny can trust her too. She should trust us as well.

3. Nurses have the luxury of being able to inject people and turn them loose. All done! see ya! -I- have to keep them "on my side" for 30 min or more. If it were just about a quick stick, hey, no worries.

4. She didn't hear the entire exchange. Obviously, I didn't start OUT yelling at the little girl! You start out with lovey-dovey, of course....

5. Lastly, I KNOW this patient. This girl LIKES me and had never given us problems. Sometimes you need to step up and be a little intimidating to let them know "Hey, this is my house. You are not going to play that game." Now, if it's a four year old or a brand new patient, sure, you have to play it by ear.

Regardless, I still feel TERRIBLE for raising my voice and scaring a little girl who may just have been having a bad day. And, admittedly, I'm 6'2 and for all I know Jenny doesn't have a father figure, or even she's had one who is nothing but abusive. I don't know. So I feel bad. My assistant said I handled it "perfectly as usual" so that was gratifying..... Can't help feeling bad...Especially because I really like and respect the Nurse.... She knows her stuff, so I'm torn about to what degree I should have used a different approach....

Thoughts?

10 comments:

Anonymous said...
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David Loewinger said...

It sounds like you did the right thing to me. I know that the first couple of times that I got impressions taken (I believe it was in elemntary school for a lip bumper and night brace) I was a terrible patient - and it was my own dad treating me. I didn't refuse to do let him do anything but the first several times my mouth seemed to automatically close - not good considering his hands were in my mouth. I found that after my brother and I asked him to tell us what he was doing while he was working or even beforehand it helped hugely to reduce my anxiety. Also, repeated visits and just plain getting older and more mature pretty much got rid of all the anxiety so that when he used circular diamond saw blade to open up space in between some of my teeth I was pretty calm. Of course the kind of work you do with needles and drills probably looks scarier than anything in an orthodontists office.

Don Wallick said...

Nate, you can give my children shots anytime. And you can yell at them, too. Never works for us, but maybe for you ...

Perhaps you could have shown her your personal darts set: "See these? One of these sure would hurt, if I PLUNGED IT INTO YOUR TOOTH wouldn't it? Instead, you get this needle and it isn't nearly as big as this dart..."

Seriously ... those are no win situations. If you came out of it still having her respect and her tooth got fixed to boot, then I call it success. Sometimes a kid needs the adult to firmly set a limit. Crikey! That sounded like Dr. Phil! Noooooooo.......

Don Wallick said...

Yes I used the word "crikey."

Jeanie said...

Nothing wrong with 'Crikey'. I'm from the land that invented 'Crikey' and it's still a cool word... until Steve Irwin contaminated it...
As for the kid,I think you did the right thing. Esp. if you knew her well.
But my lecturer says you should reward the kids afterwards- stickers and stuff. Actually she said you should use 'pedo-talk' (not the M. Jackson type) but talk in a soothing voice blah blah. Personally I think I'll just refer the lil blighters on. I'm too impatient to take the time to calm them down.

Dr Nate said...

I was hoping Jeanie would catch the Crikey... lol....

My new fave is "wicked." As in "The Sox ah wicked good this yea-ah." "Or, Doctuh, my tooth huhts wicked bad." Well, what other kind of bad is there?

It's funny; as tempting as it is to refer all kids, you'll find most of them are better than many adults.... I've worked on 3,4 year olds who I honestly believe I could remove tonsils without anesthetic, and they'd just be sittin' there...chillin.

Actually, there's a few that make no sound at ALL, which can kind of creep me out...They get a vacant stare and I worry that they've perhaps been abused and they just automatically tune out.... But many are just peachy. la.

WindowShopper said...

Besides general dislike of other people's bodily fluids, I think having to control my annoyance with fussy patients would really hinder me as a medical professional. I guess that's why I chose engineering, where I'm almost expected to be socially inept.

jfmiddmd said...

Hey Nate,
Great job of Voice control. I use it all the time too. You handled it perfectly and the nurse is way off base in not being in there, and not having full Hx of trtmnt. Dont compromise your gut instinct. I'm impressed.

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evelyn said...

Reading this made me all nostalgic about my dental adventures with Dr. Achber (retired, perhaps deceased - if you're still around, I love you, man!) in Laconia, NH; he never really believed in painkillers. Talk about a rapid lesson in "grace under pressure." I didn't dare make a fuss in his chair even if there was spurting blood, in case he DID get my mother. He was like Christopher Lee in Willy Wonka - scary visage with a big heart inside.

Back then Mom would whup my butt with the hairbrush if I disrespected any adult or if I got all whiney.

I've enjoyed checking out your blog; it's too bad I already have a dentist, one I met on the chairlift at Loon Mtn. I'll be back.