The same old song and dance

Inefficiencies everywhere

This past week while taking my youngest to the dentist, I observed a scene that I can't quite get out of my head. No, it was nothing traumatic, nothing of that nature, this was just a casual interaction between a dental assistant, a dentist, and a 16-year-old boy.

But I'll get there in just a second.

There are so many times in life where we watch things happen around us unsure as to what actions to take. I've written about this here before, and many of you may recall the science around the "bystander effect." Basically, the bystander effect is this phenomenon where individuals are less likely to intervene in an emergency situation when others are present, often due to diffusion of responsibility and a perceived expectation that someone else will take action. Sure, there's a tendency a lot of us have to avoid confrontation and assume others will step up and help, but what most often happens is that no one ends up doing anything.

Back to the dentist.

As the dental assistant was cleaning this young man's teeth, something occurred where his retainer came off. I am not a dental expert so cannot get into the nuances here but could tell immediately that something had gone wrong with his visit. The young man, while not visibly distraught, knew better than anyone that something was off. The dental assistant immediately motioned to the dentist to come over, which was the equivalent of waving a massive red flag to the entire office that something was wrong.

What happened next is a master class in inefficiency.

The dentist, seeing the problem, did what they thought they could do to address the issue. Needless to say, it wasn't enough. The problem persisted and the young man sitting there was really unable to do anything.

Standing next to the dentist, the dental assistant was trying valiantly to problem solve the situation only to be told repeatedly by the dentist that her solutions wouldn't work. In what happened likely in a matter of seconds, was now going to take this young man days to fix. You see, their end solution was to have this teen go and see the orthodontist. While that seems like a relatively simple request, when one factors in taking off school, rescheduling, co-pays, and so much more, it gets a lot more complicated. What's even more troubling for me is that the orthodontist is literally right next door to this dental office; in the same building, on the same floor. I bet you the dentists even have lunch together.

For whatever reason, which I am sure there are many, the dentist could not help this young man out. But what I couldn't get past is it all he needed to do was to go next door and get someone to come over and see this kid. Sure, there are schedules and workflows and all kinds of reasons why this shouldn't happen, but it would have been the right thing to do. It would have actually helped this kid immensely to have someone fix this problem so that he could go back to school and not have the inconvenience of a loose wire in his mouth. But no, this didn't happen. Referrals were made. Schedules were disrupted. Distress came to visit.

This stuff happens all the time in health care. All the time. What's even worse, is when it happens, it’s in those areas where you know that more could be done, but no one does anything.

Part of the reason why I am such a outspoken advocate for integrating mental health into the places that people are, is so that we don't have to deal with this referral and discontinuity problem. We actually bring mental health to where you need it so that in those moments that you actually do need it, it's there. There's no waiting. There's no referrals. There's no miscommunication between staff or providers. No, this is about a team doing what a team should do which is take care of you.

I used to talk a lot about the fragmentation of the system and how fractured it is in being able to take care of our health. And while I still do that, I've just begun to default to reminding people that the system is giving us exactly what the system is designed to give us. And yes, that's fragmentation. But we shouldn't be surprised anymore.

Yet, here I was, in a totally different office environment, watching the same thing occur that happens to countless people every day in health care.

I don't want to fall victim to the bystander effect. I don't want to become desensitized to how bad it is to not be outraged when I see things occur. Yet here I was, an expert in health systems and policy, unable to even say something. Maybe it was the setting or maybe it was my lack of surprise.

What’s frustrating to me is that we know the solutions. We know what works!

We must champion interdisciplinary collaboration within health care settings, particularly in environments as interconnected as dental and orthodontic offices or primary care and mental health offices. Imagine a scenario where the dentist, the orthodontist next door, and their respective teams operate not as separate entities but as a cohesive unit dedicated to patient care. By fostering a culture of open communication and mutual support, these professionals can address patient issues swiftly and efficiently, without the red tape of referrals and the added stress to families. This kid would have been taken care of in that moment.

This integrated and collaborative approach not only streamlines the process of resolving unexpected problems, like retainer issues, but also ensures that the person’s needs are met with the least amount of disruption to their daily life. Implementing protocols for quick consultations between specialists in the same building, and even establishing a shared responsibility model for patient care, could transform a patient's distressing experience into a testament of seamless, patient-centric care.

By embracing interdisciplinary collaboration, we're not just solving a logistical problem; we're reimagining a health care model that genuinely prioritizes the well-being and convenience of those it serves. It's about breaking down the silos that have long dictated how care is delivered and moving towards a more integrated, empathetic approach to health. This is the kind of systemic change that can bridge the gaps in our fragmented health care system, ensuring that no one’s care is compromised due to procedural inefficiencies. It's a step toward not just treating health as a series of isolated incidents but as a more comprehensive journey requiring collaborative stewardship.