Portal de Periódicos da CAPES

Lost in translation

2021; Elsevier BV; Volume: 159; Issue: 2 Linguagem: Inglês

10.1016/j.ajodo.2020.11.012

1097-6752

Peter M. Greco,

Child and Adolescent Health

You were under the impression that treatment for young Molly was going smoothly. Molly's mother is a dentist, and the family lives quite a distance from your office. Yet this dentist and mother trust you implicitly with Molly's care, so her trip to see you is worth her effort. Molly's malocclusion is complex: a Class II brachyfacial pattern with a deficient mandible, short lower facial height, and proclined maxillary incisors. Her facial presentation strongly resembles her grandmother, according to her mother. The dentist-mother is opposed to maxillary premolar extractions right from the start and assures you of optimal cooperation levels throughout treatment. About a year later, you have corrected the Class II relationship via fine cooperation and favorable growth. But the dentist-mother greatly objects to the anterior spacing that has resulted during treatment. You repeatedly assure her that you intend to close the spacing and resolve the overjet as soon as possible. A week after your last visit with Molly, your receptionist tells you that Molly's dentist-mother wants copies of all of the records. You gladly send them to her but receive no communication from her until you receive her frantic phone call several days later. She says she brought Molly to one of the orthodontists near her office, who told her Molly's case is out of control and poorly handled. After more than an hour of in-person consultation that follows, including an analysis of a progress cephalogram, you convince her that her daughter's facial pattern is familial and that the case could not be treated more effectively without surgery. She finally grasps your input and asks, “Then why did the other orthodontist make the comments he made?” You look down, bite your lip, and mutter, ”I don't know.” Sometimes we are our own worst enemies. What we say often influences a patient's or parent's attitude about our treatment, and at an extreme, might even instigate litigation for no sound reason. Every child knows the game of Telephone when one's statement is misconstrued by the time it reaches the third child in line. It is no different in our arena, except we are in a far more vulnerable setting where serious repercussions can occur. The tendency to critique ongoing treatment is ingrained in our clinical psyche. Moorrees1Moorrees C.F. Gron A.M. Principles of orthodontic diagnosis.Angle Orthod. 1966; 36: 258-262PubMed Google Scholar defined therapeutic modifiability as a “critical appraisal” of treatment as it progresses. We should do this every time we see our own patients, so it is an appropriate habit. But we need not editorialize about another doctor's treatment, especially without discussing our observations with the other doctor first. A 2013 article reports an experiment in which actors posing as patients with advanced lung cancer were seen by 20 oncologists and 19 family physicians.2McDaniel S.H. Morse D.S. Reis S. Edwardsen E.A. Gurnsey M.G. Taupin A. et al.Physicians criticizing physicians to patients.J Gen Intern Med. 2013; 28: 1405-1409Crossref PubMed Scopus (14) Google Scholar Recordings of the doctors' comments pertaining to care were classified as either supportive or critical. Fourteen of the total 34 patient visits included 42 comments made by 1 doctor regarding the care level of the other. Sixty-seven percent (28 responses) were classified as critical, 29% (12 responses) were supportive, and 4% (2) were neutral. The critical comments were made without communicating with the preceding physician, which can certainly affect the patient's satisfaction with the level of care and confidence in the original provider. No comments about another's treatment should be offered until you have explored the whole story, including but not limited to cooperation levels, previous disclosure of treatment options, and the restrictions thereof. If we perceive therapy as deficient, the treating provider should be approached in privacy. In the meantime, any comments to the patient must be made with respect for our colleague. After all, there are often many ways to treat a case. But there's usually more to the story than that. You feel compelled to call the other orthodontist, and you do so with Molly's mother's permission. The orthodontist assures you that he never made the disparaging remarks she listed in her account of that visit. And knowing his fine reputation, you believe him completely. It feels like a game of Telephone once more.