What I learned from my root canal.

I hate dentists. I hate making the appointments, taking work off to see them, paying them, laying in the chair, the bright light, the pokes, the prods, the paper bib, the drool, trying to answer questions with fingers in my mouth, and flossing (because it reminds me of some dentist telling me to floss more). This is completely irrational because my loathing actually stems from my experience with an orthodontist (not a dentist), but imagine my annoyance at needing a root canal.

Some people have not had the pleasure of having a root canal, like my friend Jessica. Our conversation on the subject went something like this:

Jessica: What's a root canal?
Me: You know how you and most normal people go to the dentist every six months.
J:Yeah
Me: And every once in a while you have a cavity, but it never really hurt and the dentist fills it, and its no big deal.
J: Yeah
Me: Well if you don't see the dentist often enough the cavity goes all the way to the root, where the nerves and blood supply to the tooth get infected and it hurts like hell.
J: Oh.
Me: so they have to drill out the center of the tooth and pull out all of the nerves and blood supply in the root of the tooth, fill it all back in, and put a crown on it. It's a big pain in the butt and really expensive.
J: So let me get this straight. You have to have all of this work done mainly because you didn't see the dentist every six months?
Me: Right.
J: And its dentists you hate?

Ouch.

So here is what I learned from my root canal:

• My problems are my own fault.
• Seeing the dentist every six months is not a scam
• My dentist has every right to talk to me like I'm an idiot.
  
• When the dentist says "don't chew on the right side," don't chew on the right side.

This is just one of many occasions where I suffered great pain to learn a simple lesson. What have you learned the hard way? (tell me in the comments.)

By the way, If you need a Dentist in Kalamazoo, Dr. Allen and Dr. Wilson are both terrific.

Photo: Betsssssy

Correcting Errors Early: Source checks, Self checks, and Successive Checks

The Lean Healthcare Exchange has an excellent article about source checks, self checks and successive checks. This concept needs to be incorporated into standard work procedures in healthcare whenever other error-proofing methods are not in place. And that would be most of the time.

The need for these checks stem from the fact that there is so much opportunity in healthcare to cause great harm from simple mistakes: fat fingering a medication order in the EMR, transposing two numbers in a lab result or medication dosage, or confusing left and right when performing a procedure on a patient. Smart people can easily make these kinds of mistakes. Source, self, and successive checks prevent these errors from harming the patient.

The classic example of this is the surgical time-out. The nurses, surgeon, and anesthesiologist stop what they are doing and review the procedure and location on the consent. This successive check ensures that they are doing what the patient and physician intend.

Unfortunately this assumes that everything leading up to the written consent is correct. The recent example of a surgeon removing the wrong kidney from a patient illustrates the problem with this. It turns out the wrong kidney was reported as cancerous in the medical record. Lets look at how source checks, self checks, and successive checks can help prevent this type of error.

• The radiologist performs a self-check to ensure the film is not backward before reading it.
• The radiologist reads the film again (source check) just prior to reporting the result.
• The physician double checks the radiology report before ordering the surgery (successive check)
• The physician looks at the film himself before ordering the surgery (source check)
• After ordering surgery the physician compares what he just ordered with the radiological report (self check)
• The surgical team checks the consent before starting surgery (successive check – this is standard practice, and is what the team did)
• The surgical team checks the original film before starting surgery (source check – this is the new procedure instituted at the hospital in question)

All of this checking and re-checking seems like wasted activity. But eliminating the defect early on is much less costly than letting the defect get to the customer. This is true in manufacturing, and it is even truer in healthcare.