Exhausted and Alone
Written by: Dr. Maggie Augustyn, FAGD, FICOI, FIADFE, FAAIP
I’m exhausted. I have found myself recently, patient after patient, clinician after clinician, in conversations complaining about participating in a broken system. I take care of patients who are sick. They’re not just sick, they are getting sicker, year after year. Patients whose need for polypharmacy complexifies not just treatment planning, but also complications, recovery, predictability, and the long-term success of healing.
I feel alone fighting a battle of educating patients about the relationship between heart disease, stroke, Alzheimer’s, diabetes (and more than 40 other conditions), and periodontal disease.
I am exhausted watching the faces of patients whose mouth disease is so expensive and treatment so expansive that they cannot afford anything past scaling and root planing and periodontal maintenance, let alone addressing abscesses, occlusal disease, fracture lines, and partial edentulation.
I listen to patient after patient disclose to me their unaddressed dental traumas, which have kept them from seeking care. Traumas that we, as dentists, are undereducated about, and stresses that we do not know how to handle in our dental population.
I find myself, so often, wanting to scream and weep and cry, not for myself, but for my patients.
I have officially entered the era of my dental career where I am tired of working within a broken system.
Today, I refuse to be chained to that feeling. I want a way out. I want to fix things. Yet, with each word I speak to my patients, each tear I shed in private, I am reminded that I am just one person. And what can one person do to change a system?
PLAYING A RIGGED GAME
The system within which we operate as healers is broken at so many levels. Some days, it feels like there are those who have dedicated their lives to keeping it off the rails; they purposefully keep it broken because it builds wealth for themselves and their progeny. This is solely my own opinion, but I’d consider certain insurance company advocates and executives to be in that category. Admittedly, there is much I do not understand about running a multi-billion-dollar company. But the optics of watching CEOs take home many millions of dollars, or $30,000 to $187,000 per day, while my patients’ necessary periodontal care, which correlates with their diabetes and heart disease, gets denied, is unjustifiable.
Here is an example of a clinical appeal that I was part of not too long ago, advocating on behalf of my patient. As the consulting dentist was presented with findings of a patient with comorbidities of diabetes and hypercholesterolemia, calculus present subgingivally, intraoral photos of inflammation, bleeding on probing, and the probe buried into tissue up to 7 mm in some areas, the scaling was denied. The answer I was left with, per the consultant, was that there wasn’t enough bone loss. Hearing this infuriated me to the point that my anger was difficult to hide. As rage at his answer grew, so did my advocacy for my patient. I abruptly asked the dentist what he, as a clinician, recommended for this patient. My loss of respect for him was palpable at that point, as if he’d chosen to work for the enemy. He was calm and collected, making it known he’d heard my reaction many times before, maybe even earlier that day.
“You’re doing everything right,” he spoke softly. “Your diagnosis is on point. This patient needs scaling and root planing. I don’t disagree with you. The insurance company won’t cover it because of the limitations of this plan.”
I was speechless, with nothing else to say. My eyes darted around the room as I considered whom else to blame. Could I have blamed the HR person who picked the plan? The insurance company representative who recommended the plan? What if there was no one person to blame? Well, no one immediately, no human to blame. Just the system, designed by many humans. A system in which we all participate. A system that is now so broken it feels like it can never be fixed.
That phone call was the first time that I felt, or maybe knew in real time, that I was playing a rigged game. A game that I was never going to win, and that my patient was never going to win. Ultimately, it was the patient who lost the most. They lost the opportunity to have their care covered. They lost confidence and trust in our office for estimating insurance costs. And most tragically, they lost faith in the system.
In that moment, and in many others, it felt as though designing an insurance plan to deny care for diseases that affect systemic conditions was simply a way to pad those multimillion-dollar CEO salaries. It’s an age-old trick: sell patients hope in an insurance plan, then leave the rest of us to deal with the fallout of its failure.
UNHEARD ADVOCACY
Educating patients about the relationship between their dental care and their health is another major hurdle I have found myself complaining about over and over. I see patients who are put on bisphosphonates and say they’ve never been told to see a dentist before starting treatment.
Now, mind you, I am not naïve. I understand that sometimes patients will not always be honest about what physicians suggest to them. And with an aging population, they might simply not remember. Further, they might have been told to see someone, and because they didn’t or chose to ignore the advice, they feel ashamed and now blame someone other than themselves.
Be that as it may, carrying the weight of potential consequences in treating such patients presents burdensome challenges today more than ever before. Those consequences might be mild, such as not being able to choose an implant, or far more severe, such as ending up with jaw resection. But even the milder effects for these patients can be life-changing, especially when they weren’t given a choice or weren’t prepared for such news.
I’m tired of seeing new patients who struggle with managing diabetes, have rampant periodontal disease, and have never been told to see a dentist by their endocrinologist. I’m tired of seeing patients with no space in the back of their throat who snore through procedures, walk around half asleep and exhausted, have metabolic syndrome under physician care, and have never had a sleep study. And I think what is most frustrating is that, as I attempt to educate my patients on the oral-systemic connection, 20 years after it’s been established in the literature, I am still met with comments such as: “Stay in your lane,” or “My doctor never said that, so I must be fine.”
The reason why all of this is so hard to take is that my advice to patients has always come from a place of education and care for their overall well-being. And to be the best possible clinician, I’ve spent weekends and evenings piling on continuing education credits to understand these factors, attempting to make patients healthier out of sincere concern.
There are many more examples of heaviness in my workday that I could build a paragraph around. I very much doubt that your days are much different than mine. The point of it all is that complaining about others’ misdemeanors and watching a broken system take a toll on me became exhausting. I’d complain every evening, and I didn’t want to do that anymore. I also understood that the chances of my fixing the system or the people within it were basically nil. That’s the argument I often hear when it comes to recycling at my house: “Why should I recycle this one piece of paper? It makes zero difference.” So, I refused to make zero difference. I began fixing things. I began moving the world in the right direction, one patient at a time.
FIXING A BROKEN SYSTEM: ONE PATIENT AT A TIME
There is a young man who has been a patient in our practice for several years. He is in his early 20s. He lives on his own and has a job at a local grocery store. Well, that’s just one of his three jobs. He works 12-hour days, seven days a week, almost every week. He comes in mostly when a tooth hurts. And that’s because, despite his “insurance,” he can only afford one emergency exam, one tooth treated, and a filling or two before the annual benefits run out. A year goes by, and he’s at a point where he needs another root canal or three, if I’m being honest. Each year, he chooses extractions rather than root canals due to cost.
He is a fairly closed-off and somber young man, one who seldom makes eye contact, his hair covering his eyes, maybe for that purpose. His head is down even as he walks from the waiting room to the operatory. He wears predominantly black clothing, and his hand is never away from his phone.
I was alerted to his consult after my partner in our practice had done the initial evaluation. The patient had requested an extraction again, and that happens to be my lane within Happy Tooth. I was told to be cognizant of the fact that his mood significantly deteriorated after hearing he’d lose another tooth.
The young man was so emotionally detached he barely acknowledged my presence, not even when I reintroduced myself. With arms crossed over his chest, his head hanging down, he stared into the black of his pants. He appeared almost frozen.
I explained his options to him again: root canal, bridge, extraction, implant.
Still no movement. No words spoken. Silence.
“Tell me what’s going on. What are you thinking?” I asked softly, gently, quietly.
“I’m just tired,” he uttered, though he didn’t break from his stance or stare. I was genuinely taken aback to receive a response.
“This is never going to change,” he continued so quietly that I could barely hear him. “I am never going to make any headway. It takes me a year to pay off each tooth, and when I do, I need another one, and another, and another worked on. I’m never going to catch up.”
Then something strange came over me. I can’t explain it. I breathed in hope and happiness and goodness as an antidote to his loss. In complete astonishment to myself and Yesica, our assistant in the room, I said: “What if I told you that we’d just take care of you?”
“Huh?” he responded with confusion.
“What if I told you that your dentist and I would just treat you for free? We’d do all of your treatment, the bridges or root canals or fillings, for free. We’re talking close to $30,000 worth of treatment.”
He finally looked up at me. I could see his eyes light up from beneath his oiled bangs. He was shocked, amazed, and most of all cautious in receiving the news. I thought I saw his eyes well up, but maybe I just wanted to see that.
“Why would you guys do that?” He shook his head in disbelief as he spoke.
And then I felt my own chest fill with love and light and a power that a human might possess if they only choose to acknowledge it. In a moment I will never forget, I said: “Because we can.”
I really needed to hold back my tears. I felt the power I had, the power we had as a team within the practice. For me, it would be a few hours of work and a few extra hundred dollars in overhead. For him, it was a life-changing miracle.
“We own this practice. We answer to no one. We want to gift that to you. You live a difficult life, and we see that.”
There were three of us in the room: me, the patient, and our assistant. And my guess is that we will remember this encounter and its lesson for the rest of our lives.
Yes, I am romanticizing this, but I am also calling it what it truly was.
Human.
Life-changing.
Possible for each one of us to give.
To.
Give.
And as we give, we gain.
We gain so much.
The more I thought about that encounter days later, the more I realized I had just found an antidote to the complaining I’d been doing over the last few months. I had been focusing on the wrong thing. I had been looking for the ways the system is broken, and my job all along was to find ways to fix it, no matter how small.
And that patient became one of many whom I have since treated at no charge. Large cases. Suffering humans. Sick people. Broken spirits. All helped because of what we can do as a team. Sure, the bottom line could have been higher had we charged them. But their spirits would not have been restored, not in the same way.
And the question becomes: did I fix them, or did they fix me?
I do not suggest you adopt this as a business model. I am not advocating for you to resort to my type of solution full-time, though I do hope you give it a try if you can.
Since I treated that patient, I have had dreams of winning $320 million in a lottery to establish a nonprofit center where all we do is provide high levels of care to patients who have lost hope in the system. And I wonder if it’ll remain just a dream. But I will tell you, providing that care and reliving that moment in my head, bringing it front and center in my memory, has set me free in the moments I’ve needed reprieve from a difficult day.
I have spent most of my 40s attempting to make as much money as I could, proving myself worthy. And I have found that more money doesn’t make you happier; it chains you to wanting more money.
I live a great, comfortable life, as this profession has afforded me. I began as an HMO and public aid dentist, almost bankrupting our practice. I am not looking to go back to those roots. I am not ignorant of the need to remain profitable within the practice. However, if I have an opening in my schedule and the overhead is already taken care of, I will reach out to patients who have lost hope and trust, and I will take care of them at no cost.
The benefit of that, as opposed to scrolling social media or mindlessly shopping on my computer during downtime, is insurmountable for every single human involved.
Again, I am not ignorant of the fact that I am lucky to have been in that position as a practice owner. I am lucky to have learned to perform surgical extractions, and I am lucky to own a Glidewell IO mill that can create long-lasting provisional restorations and three-unit zirconia bridges, lowering my overhead. That’s what we used for the young man mentioned above. And I will toot my own horn, proclaiming I do this all as an in-network PPO dentist.
Not everyone’s circumstances match mine. So, if yours are different, here are some other ways you can give:
- Get involved in organized dentistry. You can make a difference by bringing attention to the laws and regulations that affect how we practice. One of my favorite contacts for this would be Dr. Spencer Bloom. Please email me at the bio address below so I can connect you two.
- Volunteer at nonprofit clinics. You can narrow some of these down through your local state societies. Some might be within driving distance. Some might need volunteers weekly, while others might need them once a year for large events.
- Volunteer abroad. I have done this multiple times in my youth. It is eye-opening and transformative on so many different levels. I have traveled with Global Dental Relief to Nepal and Guatemala. For more information, please get in touch with Kim Troggio or visit: https://www.globaldentalrelief.org/
There were many years in my career when I really needed someone to see how profitable I was, what my hourly production was, and how healthy our overhead was. And those things are still very important in running a business. But I paid so much attention to them that I had forgotten about being a good human. I’d forgotten about giving without the expectation of receiving anything in return.
This world can be exhausting, unfair, and broken. And much of that simply depends on what we look for and what we focus on. It’s called confirmation bias. My bias for months was to participate in a broken system. I looked for evidence of that, and it kept me exhausted.
That bias has changed for me since then. I now look for confirmation that we live in a world where we can all participate equally and build something beautiful, fair, and loving. I truly do hold proof that recycling that one piece of paper makes all the difference in the world, especially when we all choose to participate in that kind of solution.
ABOUT THE AUTHOR
Dr. Maggie Augustyn, FAGD, FICOI, FIADFE, FAAIP, is a Dawson-trained practicing general dentist, owner of Happy Tooth, author, and inspirational keynote speaker. Featured on 4 dental magazine covers and recognized by Dentistry Today as one of the top 250 leaders, she inspires others through her writing, helping them find healing and connection. Dr. Augustyn serves as the national spokesperson for the Academy of General Dentistry. She contributes monthly to her “Mindful Moments” column for Dentistry Today and AGD Impact and writes for other publications as well.
With unwavering compassion and a dedication to excellence, Dr. Augustyn addresses audiences ranging from a few dozen to thousands, guiding them toward fulfillment and meaningful impact. To contact her, email [email protected].
FEATURED IMAGE CREDIT: Dragon Images/Shutterstock.com.
