Let me preface that yesterday was hell…that is 3 hell days out of the past five. The highlight yesterday was one of our employees being threatened by a patient and a restraining order being filed. That was in the midst of about everything else going wrong.
Who or what causes this..so called hell? We have one doctor that sees all the Orofacial and chronic pain patients with TMJ issues (jaw) in the state…with a few exceptions. In addition we service a number of out of state patients because of poor coverage or care in their area. It is said that 25% of the people in the US have an issue with TMJ at some point in their lives. Their care can increase the cost in comparison to other patients by over 50%. (these stats are off the top of my head and I am not as sharp as I use to be…my point is they add a significant burden to the overall cost of healthcare and are a prevalent patient population). In our practice and nationwide the vast majority of patients with TMJ issues are women (due to a combination of abuse, genetics, habitual, trama and stress issues). This is why we consider it a women’s issue and in that context it is also why we were able to make significant changes in the law in our state (presented this way to Gov. Dean’s wife a doctor the law began to take shape and be implemented). TMJ is covered under medical issuance in our state, but currently is only treated in this context by one dentist , ours. Why medical? Because it involves a complex combination of teeth, bone, disk, ligament, muscular, nerve, brain, psycho/social issues. So why a Dentist? Because traditionally dentist have always treated TMJ, because the medical community has not wanted to deal with it, discriminated against it and dentist have been happy to treat it in a system that is a pay out of pocket fee for service system for a issue that has had very little research around it. With medical insurance involved…well it takes a certain type of doctor to want to tackle the complexities of treatment and business hurdles, ours…who happens to be a dentist. There is only one other state in that nation that has the type of coverage available in our state. So every other state has a huge underserved community of patients that are being bounced around from doctor to doctor, primarily being treated and diagnosed incorrectly and costing the health care system even more. If they are treated and it is covered they go directly to surgery…only 5% of our patients need surgery. But we are a small family run practice so despite some recognition nationally, most people who make real decisions about healthcare coverage, treatment and diagnosis…do not know that we have solutions here. There also is a great number of dentists and doctors who can not see past their experience and knowledge in order to treat patients as efficiently as we do…this is why we only have one doc in the state that does this…along with a shrinking dentist population over all. I do not boast this fact…it is actually a tragedy. If you want to be seen as a new patient you are waiting 6 months (many with acute chronic debilitating pain); treatment begins over a month after that. If you are an existing patient we can schedule you 5 months out. Our call list for new patients is 200 people. The call list does help (for all types of visits). Because just as many people have acute issues (meaning it is there and then it goes away) as chronic issues. They typically cancel their appointment, because we can not get them in while there is an issue and they assume it is over. A significant number of these patients we see some other time when things are worse and more chronic, missing the opportunity to help them more preventatively.
All of the above contributes to making the “hell,” but what stresses us most is a significant portion of our time is spent/wasted dealing with people who lack common decency, ethics ect… Pain is a motivator for patients to be seen, it is also what makes them miserable people to deal with. We recognize this happens in people who are generally good people. Pain changes you…so I am not talking about these people. I am talking about a more complex case. It may have started with pain and then they did not have the life tools to navigate these set backs…eventually their lives become so unwieldy that they abuse and are aberrant by nature. They do not show up to appointments (time that could have been spent with a patient who needed to be seen). The are argumentative, harassing, they lie, they manipulate, the threaten, they are violent, they are accusatory, they don’t listen, the are unempathetic ect… Who are these people, stereotypically speaking? Drug seekers, people who milk the system (Medicaid ect…), Criminals, Wimpy men, the uneducated, the unethical, the thoughtless, OCD’s, egotists, people with poor dental hygiene, the week, the lazy, the angry, the self righteous, hypochondriacs, unethical zealots, self righteous naturalists and the liars ect…
So why do this job!?! Because for everyone here in Vermont that causes you a head ache (pun intended) there are; farmers who work every day of their lives in pain, single mothers who have escaped abusive relationships and drug dependency to find themselves in school and moving on for themselves and their child, there professionals who do good work and can do better work if they were not in pain, there are teachers who do not use their profession as an excuse, the person who finally feels relief after seeing 7 doctors and been through years of misdiagnoses, along with, misjudgment, the intellectual who can finally think, and the person who appreciates what you have done.
Can we and will we do this forever? No. At some point we are going to retire from this profession. We hope and work at recruiting someone to take over. No real takers yet…time is running out. Over 10,000 people that we know of will be in trouble if no one takes up our offer. In light of the new administrative change we hope they have the foresight to find out that state mandates can provide a vital service to a community. We hope that Obama is serious about resisting the temptations of Arisa. We would be overjoyed if someone other then people already in the know came to our small little office and realized…TMJ needs to have conservative const and medically effective treatment covered in all states under all medical insurance plans. We hope that the system begins valuing and paying for diagnosis on par with procedures, so there is incentive for doctors to get it right the first time. If these things happen, medical insurance cost will go down, people will be properly effectively ethically and cheaply treated. Peoples efficiency as contributors to our society and economy will improve and we will find another method to help us out of the current economic and social climate we find ourselves in…perhaps those people who don’t get it and contribute to out “hell” will see how to behave. Or perhaps we have to bottom out first. I just hope it happens before our doc retires.
The End.
PS much of the above…well all of it is off the cuff…in the midst of battle. Those who work with me can correct any error or add on. For those of you who do not…please let me know what you think, or if you find similar issues in your life. This office is a bubble sometimes.
Who or what causes this..so called hell? We have one doctor that sees all the Orofacial and chronic pain patients with TMJ issues (jaw) in the state…with a few exceptions. In addition we service a number of out of state patients because of poor coverage or care in their area. It is said that 25% of the people in the US have an issue with TMJ at some point in their lives. Their care can increase the cost in comparison to other patients by over 50%. (these stats are off the top of my head and I am not as sharp as I use to be…my point is they add a significant burden to the overall cost of healthcare and are a prevalent patient population). In our practice and nationwide the vast majority of patients with TMJ issues are women (due to a combination of abuse, genetics, habitual, trama and stress issues). This is why we consider it a women’s issue and in that context it is also why we were able to make significant changes in the law in our state (presented this way to Gov. Dean’s wife a doctor the law began to take shape and be implemented). TMJ is covered under medical issuance in our state, but currently is only treated in this context by one dentist , ours. Why medical? Because it involves a complex combination of teeth, bone, disk, ligament, muscular, nerve, brain, psycho/social issues. So why a Dentist? Because traditionally dentist have always treated TMJ, because the medical community has not wanted to deal with it, discriminated against it and dentist have been happy to treat it in a system that is a pay out of pocket fee for service system for a issue that has had very little research around it. With medical insurance involved…well it takes a certain type of doctor to want to tackle the complexities of treatment and business hurdles, ours…who happens to be a dentist. There is only one other state in that nation that has the type of coverage available in our state. So every other state has a huge underserved community of patients that are being bounced around from doctor to doctor, primarily being treated and diagnosed incorrectly and costing the health care system even more. If they are treated and it is covered they go directly to surgery…only 5% of our patients need surgery. But we are a small family run practice so despite some recognition nationally, most people who make real decisions about healthcare coverage, treatment and diagnosis…do not know that we have solutions here. There also is a great number of dentists and doctors who can not see past their experience and knowledge in order to treat patients as efficiently as we do…this is why we only have one doc in the state that does this…along with a shrinking dentist population over all. I do not boast this fact…it is actually a tragedy. If you want to be seen as a new patient you are waiting 6 months (many with acute chronic debilitating pain); treatment begins over a month after that. If you are an existing patient we can schedule you 5 months out. Our call list for new patients is 200 people. The call list does help (for all types of visits). Because just as many people have acute issues (meaning it is there and then it goes away) as chronic issues. They typically cancel their appointment, because we can not get them in while there is an issue and they assume it is over. A significant number of these patients we see some other time when things are worse and more chronic, missing the opportunity to help them more preventatively.
All of the above contributes to making the “hell,” but what stresses us most is a significant portion of our time is spent/wasted dealing with people who lack common decency, ethics ect… Pain is a motivator for patients to be seen, it is also what makes them miserable people to deal with. We recognize this happens in people who are generally good people. Pain changes you…so I am not talking about these people. I am talking about a more complex case. It may have started with pain and then they did not have the life tools to navigate these set backs…eventually their lives become so unwieldy that they abuse and are aberrant by nature. They do not show up to appointments (time that could have been spent with a patient who needed to be seen). The are argumentative, harassing, they lie, they manipulate, the threaten, they are violent, they are accusatory, they don’t listen, the are unempathetic ect… Who are these people, stereotypically speaking? Drug seekers, people who milk the system (Medicaid ect…), Criminals, Wimpy men, the uneducated, the unethical, the thoughtless, OCD’s, egotists, people with poor dental hygiene, the week, the lazy, the angry, the self righteous, hypochondriacs, unethical zealots, self righteous naturalists and the liars ect…
So why do this job!?! Because for everyone here in Vermont that causes you a head ache (pun intended) there are; farmers who work every day of their lives in pain, single mothers who have escaped abusive relationships and drug dependency to find themselves in school and moving on for themselves and their child, there professionals who do good work and can do better work if they were not in pain, there are teachers who do not use their profession as an excuse, the person who finally feels relief after seeing 7 doctors and been through years of misdiagnoses, along with, misjudgment, the intellectual who can finally think, and the person who appreciates what you have done.
Can we and will we do this forever? No. At some point we are going to retire from this profession. We hope and work at recruiting someone to take over. No real takers yet…time is running out. Over 10,000 people that we know of will be in trouble if no one takes up our offer. In light of the new administrative change we hope they have the foresight to find out that state mandates can provide a vital service to a community. We hope that Obama is serious about resisting the temptations of Arisa. We would be overjoyed if someone other then people already in the know came to our small little office and realized…TMJ needs to have conservative const and medically effective treatment covered in all states under all medical insurance plans. We hope that the system begins valuing and paying for diagnosis on par with procedures, so there is incentive for doctors to get it right the first time. If these things happen, medical insurance cost will go down, people will be properly effectively ethically and cheaply treated. Peoples efficiency as contributors to our society and economy will improve and we will find another method to help us out of the current economic and social climate we find ourselves in…perhaps those people who don’t get it and contribute to out “hell” will see how to behave. Or perhaps we have to bottom out first. I just hope it happens before our doc retires.
The End.
PS much of the above…well all of it is off the cuff…in the midst of battle. Those who work with me can correct any error or add on. For those of you who do not…please let me know what you think, or if you find similar issues in your life. This office is a bubble sometimes.
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