When the inevitable happens…

It’s your last day at the office before your vacation, and you are eager to meet your family at the airport for a flight to paradise. Just as you shut off your equipment, a desperate call comes in from Mrs Wenger. Her daughter, Valerie, is complaining that her mandibular lingual holding arch is “pressing into the gum, and there’s bleeding.” You will not be able to board that flight with a clear conscience unless you address the problem, so you ask your receptionist to have Mrs Wenger bring Valerie in immediately. Your clinical staff has already left for the day, and you realize that you’ll be cutting it close to boarding time even if remediation of the problem is quick and easy.

Valerie’s holding arch has fractured, and the lingual bar is impinging on her gingival tissue. The remedy is to remove the appliance now and then replace it when you return. In your haste to remove the mandibular left first molar band, your debanding plier catches Valerie’s gingival tissue and lacerates it. She is a stoic girl and barely flinches. But you need to compress the tissue with gauze to stop the gingival bleeding. At that moment, Mrs Wenger enters the operatory to assess her daughter’s welfare. With minutes remaining before you have any chance of making that flight, you must decide whether to tell Mrs Wenger of the mishap or hope that Valerie will never mention the incident.

All practitioners, regardless of intellect, experience, and level of manual dexterity, have misadventures. An instructor of mine once told me that the only way to avoid mistakes is to refrain from practice. How true. Professionals are frequently reluctant to admit their misadventures, possibly out of fear of retribution for the consequences, or to avoid being viewed as incompetent. Moreover, they often lack role models who have demonstrated that mistakes occur, even to consummate clinicians. Few respected authorities are eager to use their own failures as learning tools in lecture material.

As dentists and orthodontists, we are programmed to seek perfection. We represent ourselves as authorities in our profession. Inferred from our educational process is that an error is a sign of a character defect, as if our effort was inadequate. We also view the role models who have educated us to be infallible and nearly incapable of error. Our aspiration is to equal their level of expertise. We yearn to be viewed as constantly in control. And when things don’t work out as planned, we strive to identify some external reason for our failure, such as unfavorable growth or lack of cooperation.

Physicians apparently suffer from the same insecurities. In a survey of 338 physicians designed to evaluate their frequency of error, 17% admitted their failures to report minor (nonlife threatening) errors, and 4% admitted their neglect in admitting major (lethal) errors. Yet, 84% of the respondents conceded that reporting errors or mishaps improves future levels of care. The study indicated that although a physician may see value in reporting an error, disclosure is often omitted.

In another study of over 3100 physicians and surgeons, over 60% reported anxiety about their potential for committing future errors, and 44% reported loss of confidence and reduced job satisfaction after committing an error.

Health practitioners must realize that to err is human, and committing an error is occasionally inevitable. Mishaps should be followed by a sincere apology and coupled with reparation if possible.

Mrs Wenger needs to know what happened, even if you mention the incident only briefly before you depart for your vacation, followed by future amplification when time permits. Her trust in you depends on it. After all, an explanation now is far better than an excuse later.

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Apr 6, 2017 | Posted by in Orthodontics | Comments Off on When the inevitable happens…
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