Yours Toothfully by Dr Chan Joon Yee

It happens often enough in any dental practice. A patient walks in to have a new denture done. He tells you all the horrible things the old denture is doing to him. He wants those things rectified. You faithfully design a different denture that addresses all his concerns.

Patient’s Denture Wish List
1. Teeth that look new
2. Teeth that look real
3. Whiter teeth
4. Teeth with more bite
5. Sexier teeth

When the new denture is ready, the patient, spits it out, can’t tolerate for one second and start comparing the “merits” of old denture with the demerits of what you’re just done. It doesn’t matter if you pull out that wish list written in the patient’s own handwriting and signed against “sexier teeth”. They think the new teeth you’re giving them just ain’t sexy.

Most dentists will reel from the shock of seeing a happy, enthusiastic patient walk in for the first visit, only to be entertaining a critical and uncooperative one at the end. Can these cases be spotted at the beginning and weeded out before taking the case? I find it difficult. During initial examination, the dentist may be able to establish how the patient felt and what the patient wanted at that point in time. They may feel that their old denture had teeth which were too short. They wanted longer teeth, bigger teeth, whiter teeth… Even if the dentist could read their minds at that point in time, he would have seen that they wanted longer teeth. But once the longer teeth are issued, they begin to sound funny, feel funny and chew funny, they may decide to take issue with their new dentures in the most unexpected ways, saying that it’s uncomfortable, unstable and just not right.

The vast majority of dentures do require some adjustment before issue. Nothing is perfect - especially a set of new dentures to which the patient is not accustomed. In the vast majority of cases, patients are satisfied after adjustments are made. If the new dentures are significantly longer, larger or thicker than the old ones, then a period of adaptation (with 100% patient participation and cooperation) is required. Only in rare cases are redoing the denture necessary. If the patient is agreeable to a redo of the denture, this time without such a great departure from their old set of dentures, then, an amicable conclusion is still possible. And it usually ends up amicably. Even if the patient is unwilling to bear the cost of the redo, the dentist would still be in the position to end off with a satisfied patient - something more important to the dentist than making a profit out of every single case.

Just for the sake of job satisfaction, many dentists are willing to redo dentures. But not all patients allow the willing dentist to redo. What if the patient declares that he has lost all confidence in the dentist even before wearing the denture for any reasonable length of time (less than an hour)? He is not asking for a redo. He is asking for a refund.

Reading their minds now, the dentist may see a totally different patient from the very nice and accommodating one on the initial visit. So mind reading doesn’t help. What might help, is a third eye that can look into the future and predict trouble and unpleasant responses from initially nice and friendly patients. How I wish I can do that.

“OK, Dr Chan, here’s the $1,000,000 interest free loan you’ve asked for. We are not in the position to judge if your business plan is scatter-brained, but we rule that it’s not scatter-brained anyway. Here’s the money ….”

Ouch! Who woke me up?

So what’s new? We’re going to save 2 cents on public transport, drivers are going to save 3 cents on petrol, so why not I give my patients 10 cents discount for every time they come see me for scaling. The more often they come, the more they save. Fortunately or unfortunately, people are not stupid, but their intelligence isn’t of much use when they don’t have a choice when it comes to public transport or pump prices.

Over in Malaysia, BN and PR are engaged in a battle so hot that it turned steamy. Until now, the game of musical chairs was played only by Thai politicians. It’s amazing that it took so long for the game to reach neighbouring Malaysia, but it eventually did with such spectacular drama that those who are not familiar with how quickly Thai politicians and lovers can switch loyalties might think that it’s a Malaysian invention. Pity Elizabeth Wong. An ex-boyfriend might have traded pics of her half-naked and sleeping body for an indecent amount of money. But we all have to get naked to take a shower, don’t we? Would she have to quit her post if some voyeur caught her in the shower?

Judging from online postings, virtually 100% of those who spoke out felt that Ms Wong had done no wrong. Some even suggested that Anwar should exploit the current situation to help the PR win even more votes. Can Ms Wong’s enemies’ plans backfire? Maybe not. First of all, judging from the online postings, the sympathetic responders were obviously, open-minded and intelligent individuals. In any society in the region, these people form the minority of the population - even for Singapore. To judge public sentiment from the vocal minority would be a mistake. Not too long ago, Singapore also had a politician who confessed about his interest in artistic nude photography. He was almost instantly rejected by the electorate because of his unusual hobby.

Why would Ms Wong want to quit just because her private pictures leaked out? Because I think if she didn’t, the blackmailer might have warned that even jucier pics would appear on the mobile phones of some lucky or unlucky Malaysians. Ms Wong would certainly be a liability to her party then.

Our ministers are going to take home only $1 a month until the economy recovers…

Ouch! Who woke me up. So it was just a dream. But little could I imagine that the kaypoh topic http://www.newagedentists.com/?p=163 I discussed not too long ago would resurface not in Hongkong, but here in Singapore.

A female teacher had confessed to having sex with her student. Apparently, she realised her mistake and tried to end the relationship, but the boy threatened to harm her and her family members. A case of Fatal Attraction or did they prefer to believe in Yang Guo and Xiao Long Nu’s story?

Regardless of whether it’s Andy Lau/Idy Chan or Christopher Lee/Fann Wong’s version, Condor Heroes 神雕侠侣 tells the same story of a boy who fell in love with his female guardian. He even called her gugu or “aunt”. Everybody loved the story that shot Andy Lau to fame. It didn’t do very much for Christopher Lee and Fann Wong, but nobody was ever disgusted with the story.

Ouch again. We’re not only talking about real life, we’re talking about about a married woman and vulnerable teenager. It’s not just against the law, it’s an open target for desperate housewives whose sex lives are not half as exciting. What if this teacher were not married? What if everything went smoothly until the boy reached 18 and nobody threatened anybody? Would the public and the court be more forgiving towards the teacher?

Touching on this topic on Valentine’s Day holds a special significance. Legend had it that Roman Emperor Marcus Aurelius Claudius passed a law that forbade the marriage of conscripted young men. A priest went against this law and secretly conducted marriage ceremonies for young soldiers. When Caludius found out about this, he had the priest beheaded. Over in Asia, eloping couples who were caught have been drowned in pig cages. Why celebrate Valentine’s Day? To show that nothing can stop people from falling in love? Not even the law? No even if it means risking our lives?

Our poor teacher. Was she just a horny, impulsive slut exploiting a boy’s curiosity or was she a believer that age difference and the teacher-student relationship should not pose any barrier to true love? Was she prepared to wait for the boy to grow up and bear the consquences if their affair was discovered prematurely (pun intended).

The days of drowning in pig cages, arranged marriages are long gone. Valentine images are cute and richly adorned. Out on the streets today, young lovers are sparing no effort or money to show how much they mean to one another. The clothes, the shoes, the hair, the accessories … But can all this be counted as true acts of sacrifice in the name of love?

“I spent $1000 this Valentines Day.”

“I spent $2000 OK!”

Sure, money is hard to earn, but what about the courage to take risks on partners who are not fully compatible in the eyes of the public? How many of these love birds actually sized up their lovers and determined that they were safe, uncomplicated, marriageable and have good prospects before taking the plunge? I know for a fact that many fellow Singaporeans do that. Would anyone spend $1000 or $2000 on someone whom they may have no chance of marrying? Isn’t it ironical that people who celebrate the courage of those who have been beheaded or drowned for love take careful steps to avoid complications before investing their time and money?

Don’t get me wrong. I’m all for prudence and I don’t like dangerous complications and emotional dead ends either. But I think it would be utterly inappropriate for all the pragmatists out there to celebrate this day. Only lovers caught in difficult situations have the right to celebrate the courage of those who have suffered or died before them.

Two months ago, if a patient needed general anaesthesia, I could have booked a session with Day Surgery International at Paragon, called my anaesthetist and had the surgery completed without much waiting. Besides that, the facility fees at the day surgery centre were much lower than that at the hospitals. Surgeons and patients could have benefited from the lower costs and convenience. For a moment, it seemed that the couple who came up with the brilliant concept were on their way to buying up their very own private island in the Bahamas. Except that business wasn’t brisk for almost 2 years.

Late last month, it was reported in the news that the day surgery centre at Paragon has folded along with the other centre at Camden. The failure of the centres was attributed to high operating costs, slow business and the relative novelty of facilities devoted to day surgery. Most of the procedures the centres offered are normally handled in hospitals and doctors were slow to refer patients. Even good ideas may not work out when put into practice. Why? Let’s begin with me.

I have my own clinic and I’m already paying rental for it. If I have a surgery, I would certainly prefer to do it under sedation in my own clinic. In the case of children who must undergo general anaesthesia, I may have no choice but to use the day surgery. Apart from these rare cases, I wouldn’t need the facilities at the day surgery.

What about surgeons who routinely operate with their patients under GA? For the minor surgeries, they can certainly consider using the day surgery centre, but many patients who need surgery under GA happen to be cases serious enough to require hospitalisation post-op. The day surgery would not be suitable in these cases. If we trim all these cases down, the percentage of each surgeon’s patients suitable for treatment at the day surgery centre may actually be quite low. What seemed like a good idea initially turns out to be not so hot when one goes into the details.

I remember that not too long ago, another doctor has the brilliant idea of bringing medical specialists into the heartlands for the convenience of heartlanders. A polyclinic of sorts was set up. Instead of GPs, specialists like endocrinologists, cardiologists, ENT surgeons, onchologists, orthopaedic surgeons …. waited to see patients who not only knew exactly what was wrong with them but also knew which specialist they ought to see. It was like a consortium of medical specialists sitting in a neighbourhood mall, waiting for patients who knew who to see to pop in.

The originator of this concept assumed that heartlanders are well-educated enough to be able to walk directly into the correct specialist’s office and get treated. The centre recruited an impressive “menu” of specialists. Many people who passed by the neighbourhood mall and read the menu were very impressed. They were equally lost.

“Got stomachache see who huh?”

The receptionists may be able to get him into the right consultation room, but can the ailment not be easily and quickly treated at the much more user-friendly GP clinic downstairs? Traditionally, specialists get their cases through GP referrals. Successful specialists often have a very good rapport with GPs. Yet recently, more and more specialists have been trying to get walk-in patients direct from the streets. Some have been very successful. Apparently some wannabe thought of skipping the “middleman” too. Sounds good to the specialists, sounds good to the patient, but when the latter needs a doctor, he is almost certain to start off with a primary healthcare provider. The only exceptions could be gynaecologists and paediatricians.

Not surprisingly, that consortium of specialists failed miserably. There are many lessons to be learnt from others’ mistakes. It’s better than to make them yourself. In these difficult times, I need to keep reminding myself not to get too ambitious and carried away by another “brilliant concept”. Between success and failure, it’s not too bad to just stay put until the storm is over and directions are clearer.