Is the Doctor right or do you know better than them?

I fell unconscious today at my friend's clinic. It's extremely hot in Karachi, and on my way back from the hospital at 3 PM, I stopped at my friend's clinic for my scheduled hair PRP treatment. I had traveled there on my motorbike in 38°C heat.

For PRP, my friend needed to draw my blood. I have a specific phobia about having my blood drawn, despite having performed numerous surgical procedures involving blood and sharp instruments. Since childhood, this has been a consistent issue for me.

I informed my friend that it’s extremely difficult to find a vein in my right arm. Historically, locating a vein there has been problematic. Today, however, none of the doctors could locate a vein in either arm, so they had to use the cephalic vein on the dorsal side of my hand

While my blood was being drawn, I tried very hard not to look. Suddenly, I experienced symptoms of vasovagal syncope. I started hearing a whistling sound in my ears, my chest felt heavy, cold sweat appeared, and then I passed out. I have never been unconscious in my life before. Despite having donated blood many times, today was different. It might have been due to working 7 hours straight or the extreme heat, but my friend had to lay me down and cancel the PRP procedure.

After about 30 minutes, I felt better and insisted on continuing the procedure, but my friend refused and told me to go rest and revisit him next week. Now, this post really isn't about me falling unconscious rather about the decisions of doctors. I am going to narrate stories of two of my patients whom I encountered last week, you be the judge. Let's begin:

Patient #1

A 43-year-old female patient visited me on June 4th for the first time, complaining of sharp, radiating pain in her wisdom tooth. I recommended that she get an X-ray done. One important aspect to know about the hospital where I work is that nearly 99% of our patients cannot afford any dental treatment. The cost of an X-ray here is $1, equivalent to 3-4 steem.

Upon reviewing her X-ray, I discovered that she had curved roots and a significant infection. Given this diagnosis, I immediately advised her to have the tooth extracted. Extraction seemed to be in her best interest, particularly considering the severe infection and the complexities associated with treating such a tooth. However, she was adamant about saving the tooth despite my recommendation.

Our hospital operates with substandard materials and outdated machines, which presents a significant challenge in delivering high-quality dental care. Performing a root canal treatment (RCT) on a wisdom tooth under these conditions is fraught with difficulties. As a responsible healthcare provider, my primary concern is always the well-being of my patients, and I would never recommend a treatment that could potentially harm them.

Despite explaining the risks and challenges involved, the patient persisted in her desire to save the tooth. The discussion turned into a long and heated argument. She was very insistent, and despite my reservations, I ultimately decided to respect her wishes and proceeded with the root canal treatment. This procedure cost her $1.2, only slightly more than the X-ray, and thus began the arduous task of performing an RCT on her wisdom tooth.

For those unfamiliar, wisdom teeth are notoriously challenging to treat with a root canal. The reasons are multifaceted: their position at the back of the mouth makes them less accessible, and their anatomy is often more complex than other teeth. Curved roots, in particular, pose a significant challenge in ensuring that the canals are thoroughly cleaned and sealed.

The infection in her tooth was substantial, making the procedure even more complicated. Our limited resources further compounded these difficulties. The equipment and materials we have are not up to the standards found in more affluent dental practices. Nevertheless, I was determined to do everything possible to save her tooth.

The X-ray was blurry, and I lacked an apex locator to determine the length of the canals, further complicating the situation with the curved roots. Despite these challenges, I began cleaning the infected tissue inside the tooth. However, the pain was so severe for the patient that even the local anesthesia wasn’t effective. I applied formocresol to her tooth and scheduled a follow-up appointment for a few days later.

When the patient returned for her follow-up visit, I attempted to continue the root canal treatment on her tooth. However, the procedure proved to be impossibly difficult. Recognizing the need for additional guidance, I consulted with a senior dentist without initially informing him that I had already started the root canal. Upon examining the X-ray, he immediately advised extraction due to the tooth's complex anatomy.

I then spent 30 minutes counseling the patient, explaining the necessity of extraction and the reasons why it was the best option given the circumstances. Despite her initial reluctance, she eventually agreed to proceed with the extraction. I performed the procedure, successfully removing the problematic tooth and ultimately relieving her of the intense pain she had been experiencing.

This experience highlighted the complexities and challenges associated with dental treatments, especially in a resource-limited setting. It reinforced the importance of professional consultation and patient communication in ensuring the best possible outcomes. Despite the difficulties and initial setbacks, the patient’s well-being was ultimately prioritized, resulting in a successful resolution of her pain and infection.

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Patient #2

Dear Lord, last week presented one of the toughest experiences late A young woman visited me on June 15th, just a day before Eid, with an urgent plea for help. She was looking skeptical and annoying from day 1. I'm sorry if it sounds rude to you but I'm only a human. She was a 26-year-old bride-to-be, scheduled to get married on June 21st, which is today. She was deeply concerned about her appearance because all her anterior teeth were carious. She sought an immediate solution to ensure her teeth looked aesthetically pleasing for her wedding.

Understanding the urgency and significance of her situation, I scheduled an appointment for her on June 20th, as the hospital was closed from Monday to Wednesday for the Eid holidays. Today, as promised, I seated her in the dental chair and prepared to address her concerns.

I started by applying the rubber dam kit to isolate the teeth and maintain a clean and dry working area. The procedure involved three main steps:

• Removal of Caries: The first step was to remove all the decayed portions of her anterior teeth. This required precision and care to ensure that all carious material was thoroughly eliminated while preserving as much of the natural tooth structure as possible.

As I began removing caries from her anterior teeth, she was unresponsive from the very start. I tried my best to calm her down and, with great care, started removing the caries using my bur. However, as I continued the procedure, she motioned for me to stop, touched her front tooth (from where I had removed the caries), and shrieked in surprise. She began shouting, accusing me of breaking her tooth and expressing her panic about her wedding the next day.

I was taken aback by her reaction but patiently listened to her concerns. I explained that the removal of caries was a necessary part of the procedure and assured her that I would fill the tooth, which would leave her satisfied and happy with the results. Despite my reassurances, she remained upset and continued to blame me.

Finally, I proposed a compromise: I would finish treating the teeth from which I had already removed the caries, but if she did not want to continue, I would not touch the other teeth. I then proceeded to fill the prepared teeth with the best composite material I had, restoring them to a fresh and healthy appearance, while leaving the other two teeth untreated and still carious.

When she saw her smile in the mirror after the procedure, she was visibly impressed, and I could see a hint of regret on her face. However, she spoke to me in a demeaning manner and demanded that I now fill her other two teeth as well. I politely refused and asked her to leave. She departed, cursing me, and I was unable to take a picture of the fillings I had completed

These two experiences in a span of a week made me ponder something. Why do people not trust doctors when they have already shown some level of trust by visiting the hospital? The doctors there must have accomplished something in their lives and earned qualifications to be in their positions, right? So why not fully trust doctors when they genuinely want the best for their patients? This reminded me of a post I read from @soulfuldreamer about her encounter in the hospital with her son.

As a doctor, it is very disheartening when people behave this way towards us. Do they think we want harm to come to them? Logically, which doctor would want their patient's treatment to fail, risking their own reputation and standing? Yes, doctors can make mistakes, but no one deliberately wants to harm their patients.