Notes from a consumer of medical and dental services
My family doctor is a member of the medical team at Bloor Medical Clinic in Toronto. Along with being highly impressed with the quality of care at this centrally located clinic, I’m also impressed with the fact the clinic has a lot of space. There’s a seating area in the middle, with lots of room for people to sit. Physicians’ offices are spread out along one side. There’s a reception area as you walk in off the street and another reception area toward the back of the open space. It’s a relaxed setting. The space is beautifully organized. There’s a feeling of ease.
I previously was a patient at a clinic elsewhere in the Greater Toronto Area. The clinic was in a tightly confined space. A bench across from the reception area was where patients sat waiting to see the physician. This was a fine physician, but the setting was akin to a busy train station. There was a feeling of time pressure. Other than how the office was arranged, I was impressed with the quality of service, the quality of care, at this clinic. Not being keen about the confined space, however, after some thought I decided to move on to another medical practice namely the Bloor Medical Clinic.
In recent years, a routine blood test at the latter clinic gave rise to a convincing explanation for some minor, recurring symptoms dating back many years. In this case, thanks to a team of physicians utilizing a standard protocol for blood tests, I was able to access information that put my mind at ease. Until then, I had been in the dark, always seeking an answer but never finding it.
Secondly, a word about dental practices. For some years, I was a patient at a specialist clinic in the Greater Toronto Area where on one occasion, I had to wait five or six weeks with an abscessed tooth before it was attended to. After that experience, I moved along to another dental practice. If you need to wait more than a week or two to get an abscess looked after, it’s time to move on.
I’m now a patient of Dr. Jerry Vasilakos at Planet Dentistry in Toronto. Some years ago, a dental hygienist at Planet Dentistry gave me a splendid set of instructions (the time that was required for this was covered by my dental insurance) on how to properly clean my teeth. I found that really useful and highly recommend learning such details.
Another thing I’ve learned is that it’s a great idea to find a dentist who is not going to carry on an extended conversation with a dental assistant while you’re having a tooth implant procedure performed on your jaw. I will close with a story about one of my experiences many years ago at the dental practice where I had to wait five or six weeks before an abscessed tooth was attended to.
I recall a dental-implant procedure from many years ago. As the dentist was drilling into my jaw, he was engaged in a non-stop, animated conversation with a dental assistant (who was helping with the procedure) about a day, a few days previous, that they had spent on a lake in Muskoka north of Toronto. I still remember visual and other sensory impressions that arose in my mind during the conversation. All the details about this power boat and that power boat, and who went where and who did what.
The fact I was under local anesthesia, possibly combined with the stress of the dental procedure, has meant the story I heard about the waves and splashing water in Muskoka have stayed in my mind forever. The story has been firmly planted in my brain, ready for playback any time. Despite the fact the dentist actually did a great job with the implant, I’m pleased I’m no longer a patient at that particular dental practice.
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It’s been really interesting to think about the dynamics involved with different arrangements for all manner of things.
For example, the matter of how space is used in medical settings brings to mind the Humber Fitness Centre in Long Branch in Toronto where I worked out for many years. The way that space, in this case at a particular fitness centre, is arranged is spectacularly effective. There’s space to move around, you don’t end up running into people, and yet the atmosphere is friendly and supportive. The centre is architecture and space design at its best.
Frequency of dental visits
At the specialist dental clinic that I attended for many years, before moving on to the dental practice that I now attend, I was scheduled for dental hygiene visits every three months. I was regularly berated for not doing well enough in keeping plaque at bay but received no instruction regarding how to get better at this task. The backstory here is that the more frequently a person comes in for such appointments, the more income a clinic generates.
As well, because it was a specialist clinic, I was charged more per visit than otherwise. My dental insurance covered the regular amount for such a visit and in each case I paid out of pocket for the extra amount. I did not in fact receive any extra value for money for the extra fee.
As well, my insurance after some years (as I recall) covered only three dental hygiene visits per year; the extra visit per year that I was charged for I paid out of my own pocket (if I recall this point correctly).
Thus we had a situation where the dental practice had a business model that generated large amounts of income (the practice in question had more than one clinic, and the clinics were busy); such a model worked well for the dentist but did not work as well for a patient such as myself.
A corollary to this story is that when I found a new dental practice to sign up with, I received detailed instructions on how to properly clean my teeth. At the specialist clinic, the concept of teaching patients how to go about cleaning their teeth was just not in the cards. Once I had learned to keep plaque at bay, through diligence by way of flossing, toothbrushing with an electric toothbrush, and all manner of other (for me, highly interesting) details, my scheduled cleanings occurred at four-month intervals, rather than every three months as before. This has worked out much better for me. I much appreciate being at a dental practice where such matters are addressed.
Technical competence and/or (as the case may be) respect for patients
The dental specialist whose practice I have described did top-quality work. The dentist was very capable at performing dental-implant procedures, for example. That said, the respect for patients was not equally top-notch. I’ve described a dental-implant procedure where I was subjected to an animated, non-stop conversation between dentist and dental assistant; under the effects of local anesthesia and the stress of the procedure itself, I ended up with near-total recall of a conversation about a topic I had nothing to do with and in which I had no interest.
The same conditions tended to apply at the dentist’s clinics, where large numbers of patients would be undergoing dental hygiene procedures. The conversations between the dentist and each dental hygienist were non-stop and conducted under conditions where the patients were pretty much out of the picture. The presence of patients in their capacity as human beings was to a considerable extent ignored. The main thing that appeared to register for the dentist, from what I could pick up, was that he was in the presence of endless sets of teeth.
There’s much to be said for having conversations; there is so much we can learn and so much to enjoy from engagement in them; that is not the issue. The issue is the choice of time and place. There’s also a distinction, in the kind of setting I’ve described, between a bit of pleasant conversation here and there, versus the kind of driving, relentless dialogue that never ends.
There are several ways to look at the story. In the larger scheme of things, a choice is made between maximizing profit and largely ignoring everything else, or maximizing profit but at the same time taking other things (such as the well-being of the typical patient) into account. What matters, from the patient’s perspective, is that we as patients have a choice in some cases at least, regarding where we go for medical or dental services. I’m pleased I have a choice.
The second matter is: How do we characterize situations or people? I prefer to avoid simple characterizations. I have the sense that much of what occurs in life is multi-causal with many things – brain wiring, formative experiences, the milieu of a given place and time – coming into play. Many factors and influences come into play, when a given professional chooses a particular business model. It’s not my task to judge what’s at play when such decisions are made. What matters is that I have a choice. I can shop around, compare notes and demonstrate agency with regard to those things over which I have control. That’s the most, and the least, that I can do.
For over a half-century I’ve had some benign medical symptoms which mimic the symptoms associated with having a cold. The symptoms gave rise to many medical tests over the years but nothing turned up – until, that is, when I had signed up at the Bloor Medical Clinic a physician, in writing up a requisition for a blood test, specified that a particular condition should be checked for. The results of the test, as it happened, indicated that I indeed had the condition (benign as it was) that the test was designed to detect. What a revelation that was! Since that time, just from knowing what was at play, the symptoms have never bothered me again.
Over the years, nothing had turned up, in test after test. At times I felt perhaps a little foolish, like I had been imagining something that wasn’t there. The point of the story is that in some situations just knowing what’s what is a great way to ensure a person’s peace of mind.