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Re: Interconnectedness

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  • William
    ... I was always fearful of killing a patient. As time went on dentistry became a more multidiciplinary effort. The old days of just having a do it all dentist
    Message 1 of 6 , Jan 6, 2013
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      --- In existlist@yahoogroups.com, "Mary" wrote:
      >
      > Bill,
      >
      > This is interesting because an argument for a speculated gums-heart connection occurred to me as an example of interconnectedness. Do statistics show that antibiotics are more likely to cause a fatal reaction than prevent heart infection and failure, and was the fear of causing a death your deciding factor? Isn't there also the danger of topical anesthetics causing heart failure if they hit the wrong blood vessel? How is malpractice determined if either withholding or administering is traumatic?
      >
      > I ask because it's interesting how we make close calls. Sometimes it's simply knowing what we can or can't live with, the awareness of how we have responded in the past to difficult decisions and consequences. I can't really apply the concept of responsibility to these choices, because who could possibly know the outcomes except statistically? They do seem more about freedom when 50/50 applies, with responsibility being solely that of having to make a choice, not the choice itself.
      >
      > Mary
      > Mary, The periodontal disease allows a bacterimia that can literally infect heart valves. The actual treatment may use antibiotics to kill bacteria especially during calculus removal ,debredement procedures. Before such procedures a very careful evaluation of each tooth to ascertain if it has the bony support to remain viable in the mouth must be done. If it is not it is extracted. Once the calculus and septic teeth are removed meticulous oral hygiene must be maintained. The periodontist makes the decision on which antibiotic,dose and duration of medication. The idea is to get rid of the local factors and keep the antibiotic exposure to a minimum. With patients with antibiotic sensitivities this can be quite a chore. Also those with bacterial endocarditis these parameters change. The various regimines changed many times over the years.
      I was always fearful of killing a patient. As time went on dentistry became a more multidiciplinary effort. The old days of just having a do it all dentist became fewer. By the time I retired I referred more work than I did myself. Those extra eyes,brains and hands surly saved my record. Probably the greatest reason I left was because my team was retiring. The relationship you enjoyed with the specialists you referred to was very important.You had to know what to expect from them and they had to know where you were headed. We were all just wearing out and bringing a new person into the extended treatment team was trying. The specialists I had the honor to work with were supurb practitioners. As they left I felt too many open flanks. The lease was up and the equiptment was worn out. All these factors combined to make the decision very clear.
      As to our discussion of interconnectedness each of these team members proceeded according to their view of the best course and I certainly never overruled a specialist . I do not remember having any controversy. I knew what they could do and they knew what I would do.The system constantly improved over the years with more checks and balances inherant in the system. I am sure it will continue to improve as some new kind of specialists are coming out. My last oral surgeon was a double degree man who was also a MD. Educating such a specialist is a very long process and when people howl at the rising cost of health care they might consider what it costs to put such super practitioners in the game. They save lives and I know some of my patients were in that group. Bill
      > --- In existlist@yahoogroups.com, "William" wrote:
      >
      > >mary, Indeed, I do not ask you or Eduard or Dick to agree with me. As you probably notice I read you closely , self defense has always been a part of my life. I learn from you people and you have changed the trajectory of my tenure. I just watched tombstone for the tenth time. I begin to see my romantic attachment with guns and the old west. Of course there is Doc Holiday . Now that I am out I have completed a life goal. When I came in there was a fifty fifty chan ce a dentist would kill someone during their practise life. It may have been raw luck but I made it. I think of that almost every day and I feel good at my good fate. I know collegues who lost patients and it caused trauma to more than the patient. I know a senior fellow who prescribed an antibiotic and the patient died of massive allergic reaction from an oral dose. For the last twenty years of my practise I did not prescribe ,endodontists were always on call to open and drain septic teeth. We quit prescribing and patients quit dying. In a strange way the AIDS epidemic brought down our risk. We gloved and masked and used harsh sterilisation measures. We killed a lot of the bugs and it cost a boatload of money .I gloved fifteen times a day for better than twenty five years.I developed an allergylike many to latex and turned to the more awkward vinyl gloves. It is like working in boxing gloves but we didnt spread the virus. So Doc killed many and I killed none. Im happy. Bill
      >
    • Mary
      Bill, I see how your group of specialists reduced risk for both themselves, each other, and their patients. The advantage of having practitioners as members of
      Message 2 of 6 , Jan 7, 2013
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        Bill,

        I see how your group of specialists reduced risk for both themselves, each other, and their patients. The advantage of having practitioners as members of the same business seems that of close communication among themselves and immediate knowledge of the patient.
        This also benefits the patient.

        I recently read about the Temnothorax rugatulus ant which demonstrates the problem of 'cognitive overload' and how when critical tasks are distributed among members of the colony, catastrophe is reduced and success rates are higher. If only one scout ant is responsible for finding a new home, the results are less effective than when several are.

        Mary


        --- In existlist@yahoogroups.com, "William" wrote:

        > --- In existlist@yahoogroups.com, "Mary" wrote:
        > >
        > > Bill,
        > >
        > > This is interesting because an argument for a speculated gums-heart connection occurred to me as an example of interconnectedness. Do statistics show that antibiotics are more likely to cause a fatal reaction than prevent heart infection and failure, and was the fear of causing a death your deciding factor? Isn't there also the danger of topical anesthetics causing heart failure if they hit the wrong blood vessel? How is malpractice determined if either withholding or administering is traumatic?
        > >
        > > I ask because it's interesting how we make close calls. Sometimes it's simply knowing what we can or can't live with, the awareness of how we have responded in the past to difficult decisions and consequences. I can't really apply the concept of responsibility to these choices, because who could possibly know the outcomes except statistically? They do seem more about freedom when 50/50 applies, with responsibility being solely that of having to make a choice, not the choice itself.
        > >
        > > Mary
        > > Mary, The periodontal disease allows a bacterimia that can literally infect heart valves. The actual treatment may use antibiotics to kill bacteria especially during calculus removal ,debredement procedures. Before such procedures a very careful evaluation of each tooth to ascertain if it has the bony support to remain viable in the mouth must be done. If it is not it is extracted. Once the calculus and septic teeth are removed meticulous oral hygiene must be maintained. The periodontist makes the decision on which antibiotic,dose and duration of medication. The idea is to get rid of the local factors and keep the antibiotic exposure to a minimum. With patients with antibiotic sensitivities this can be quite a chore. Also those with bacterial endocarditis these parameters change. The various regimines changed many times over the years.
        > I was always fearful of killing a patient. As time went on dentistry became a more multidiciplinary effort. The old days of just having a do it all dentist became fewer. By the time I retired I referred more work than I did myself. Those extra eyes,brains and hands surly saved my record. Probably the greatest reason I left was because my team was retiring. The relationship you enjoyed with the specialists you referred to was very important.You had to know what to expect from them and they had to know where you were headed. We were all just wearing out and bringing a new person into the extended treatment team was trying. The specialists I had the honor to work with were supurb practitioners. As they left I felt too many open flanks. The lease was up and the equiptment was worn out. All these factors combined to make the decision very clear.
        > As to our discussion of interconnectedness each of these team members proceeded according to their view of the best course and I certainly never overruled a specialist . I do not remember having any controversy. I knew what they could do and they knew what I would do.The system constantly improved over the years with more checks and balances inherant in the system. I am sure it will continue to improve as some new kind of specialists are coming out. My last oral surgeon was a double degree man who was also a MD. Educating such a specialist is a very long process and when people howl at the rising cost of health care they might consider what it costs to put such super practitioners in the game. They save lives and I know some of my patients were in that group. Bill
        > > --- In existlist@yahoogroups.com, "William" wrote:
        > >
        > > >mary, Indeed, I do not ask you or Eduard or Dick to agree with me. As you probably notice I read you closely , self defense has always been a part of my life. I learn from you people and you have changed the trajectory of my tenure. I just watched tombstone for the tenth time. I begin to see my romantic attachment with guns and the old west. Of course there is Doc Holiday . Now that I am out I have completed a life goal. When I came in there was a fifty fifty chan ce a dentist would kill someone during their practise life. It may have been raw luck but I made it. I think of that almost every day and I feel good at my good fate. I know collegues who lost patients and it caused trauma to more than the patient. I know a senior fellow who prescribed an antibiotic and the patient died of massive allergic reaction from an oral dose. For the last twenty years of my practise I did not prescribe ,endodontists were always on call to open and drain septic teeth. We quit prescribing and patients quit dying. In a strange way the AIDS epidemic brought down our risk. We gloved and masked and used harsh sterilisation measures. We killed a lot of the bugs and it cost a boatload of money .I gloved fifteen times a day for better than twenty five years.I developed an allergylike many to latex and turned to the more awkward vinyl gloves. It is like working in boxing gloves but we didnt spread the virus. So Doc killed many and I killed none. Im happy. Bill
        > >
        >
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