Meet Jolene, 27 years old. She has been dental nursing for the past ten years at Dr Bentley’s practice. He occupies a special place in her heart and she in his. With his encouragement, she has succeeded in attaining her dental nursing qualifications despite some socio economic difficulties. She is the true backbone of the clinic, organising everyone and everything in a quiet, controlled and indispensable manner. From the team, she has the strongest bond with the greatest number of patients. Jolene remains composed when faced with challenges, she takes everything in her stride.
I still see your shadows in my room
Can't take back the love that I gave you
It's to the point where I love and I hate you
And I cannot change you so I must replace you (oh)
Easier said than done
I thought you were the one
Listening to my heart instead of my head
You found another one, but
I am the better one
I won't let you forget me
(Lucid Dreams, Ju!ce World)
Jolene breezes into a room, a breath of fresh air, lifting the challenging and oppressive atmosphere of impending doom that has befallen her colleagues. Derek and Maya consider carefully how to deal with the attack that they are sure will come from a long standing patient, Christine Craig. The two dentists eye one another and weigh each other up, assessing each other's weaknesses and vulnerabilities.
Derek had taken Jolene under his wing when she started her career as a trainee dental nurse all those years ago. He had encouraged her and supported her to reach her potential. She had surpassed both their expectations, becoming an indispensable member of his team. They had many mentoring sessions until eventually she became the strong spine that led a fantastic clinical team, delivering quality dental care to multiple patients over many years.
Jolene had the ultimate respect for Derek and saw him as her boss, her teacher and confidante. He went above and beyond the call of duty to care for her professional needs as well as support her in her personal life which often troubled her. Outside of work, Jolene had her fair share of dramas and narrow escapes. Her romantic partners had not always been picked for the right reasons and her family life was tumultuous to say the least.
Somehow she perpetually achieved status as a castle of calm, nestled in a self built sea of tranquill, clinical sterility. She loved the contrasted respite to her personal life that work offered her. She rejoiced in making sure that everything was ‘just so’. Everyone loved Jolene, patients looked forward to seeing her and staff respected her for her positive impact.
Jolene would offer solutions to problems that staff hadn't even anticipated, rejoicing in celebrating collective advancement and healthcare gains. She celebrated people’s achievements no matter how big or how small. A nurse might gain a radiography qualification or a cleaner might clean out a fridge. All achievements were worth acknowledgement in Jolene’s eyes.
There was one quality that above all others was the glue, the foundation underpinning the team’s motivation. Jolene thanked every member of the team before they left the building, at the end of every day for whatever they had achieved. Every member of staff came to realise that they were appreciated and acknowledged , no matter who they were or what role they fulfilled.
Jolene would be the first one to arrive in the morning and the last one to leave at night, making sure that on the rare occasions she was not present, clear instructions had been left the previous day so everyone knew exactly what to do and what should be occurring.
Jolene surveyed Maya and Derek eyeballing each other and reflected on how Derek had changed over the past decade. Derek had been a realistic idealist. He had showcased such excellent interpersonal and technical skills, the combination of these had wowed her into stunned admiration for the man he once was. Even though she was his biggest fan, she couldn't help but feel disappointed that his presence had recently become latently dormant. She felt so upset seeing him as a shell of the dentist he once was. He had been gradually beaten by the relentless flow of patients, increasing compliance and now to top it all off: a patient complaint!
Jolene considered carefully how she could play a helpful role. She noted that Maya had felt threatened by her position of authority and responsibility. Jolene thought back to the many occasions, whilst Maya had been inducted into the beginnings of her professional life. Jolene’s vast experience had been invaluable in helping her to learn the ropes. Though she sensed that Maya didn't like her, Jolene had sacrificed niceties in favour of clinical efficiency in order to help Maya succeed just like Derek had done for her all those years ago. Clinical support was a harsh mistress for a dentist still wet around the gills like Maya but would certainly pay off in the long term.
Jolene was attuned to the silence that followed the engine stopping in Christine’s car as it pulled up outside the clinic. There was no knock at the door or any sound of Christine exiting her vehicle. Jolene knew that Christine was sighing heavily, still seated, anticipating the awkward conversations that were to follow after her letter of complaint to the practise.
Bentley said to Craig "Let her have it Chris"
They still don`t know today just what he meant by this
(Let him Dangle, Elvis Costello)
Jolene looked across at her two colleagues and was reminded of the three flies she had recently cleaned from the surgery light fitting. She felt that she was bearing witness to a frozen conversation regarding litigation avoidance. She darted her glance from face to face and registered the worried and defensive stances of both her colleagues in relation to each other.
Derek and Maya were engaged in studiously scouring clinical records. They were trying to ascertain and assign responsibility and liability to their various interactions with Christine. Each one was blaming the other for the subtle ambiguities in their writings. Hindsight lent assumed additional insight into the motivations and judgements behind the clinical decision making that was documented in the clinical notes.
The one true conclusion was that neither of them had done anything particularly wrong to give substance to Christine’s complaint. However they were both running on adrenaline and cortisol, ruled and influenced by the potent chemical allure of defensiveness and stupidity. They were drowning in a steady stream of stress hormones, Jolene decided to help them draw breath. She could see a clear solution that they could not as they couldn’t look beyond their blinkeredness.
Derek and Maya concluded that even though Christine had suffered a tooth bereavement, their only crime had been to devalue her as a patient. Derek had fleetingly accused Maya of contributing to the adverse outcome but Maya had countered by saying that had she stood in front of a quorum of her peers, she had done what the majority of them would have done anyway. Derek accepted that Maya had not been at fault. This brought them no closer to a successful resolution of Christine’s complaint.
1.To find out what happened and why
2.To receive an acknowledgement, acceptance of responsibility and an apology
3.To enforce accountability
4.To correct deficient standards of care
(Hiivala et al 2014 - Top 4 reasons for making a complaint)
Jolene greeted Christine with her customary confidence. She acknowledged the obvious anxiety and nervousness that Christine displayed with empathy and concern. Empathy to Jolene wasn't necessarily trying to walk in someone else's shoes. Instead she skillfully repeated the content of Christine’s concern and reflected the emotion that she clearly displayed. Her empathic paraphrase visibly comforted Christine, who realised straight away that she had been heard and understood on an emotional level.
Christine seemed like she wanted to unburden herself, let out the pressure of a repressed hurt. Jolene asked if she would like to sit down together and have a cup of tea in the office. Christine agreed and they companionably followed the corridor to find some privacy together. When Christine was seated comfortably, she became a pressure cooker letting off steam, offloading the yoke from her shoulders to an engaged and receptive Jolene.
Jolene nodded and made encouraging noises, interjecting only with ‘tell me more’ and short empathic paraphrases until Christine’s shoulders relaxed and the pent up pressure had been dissipated. Jolene was reminded of the poor man behind the airline desk that she had complained to, after having a disastrous flight where the food was late and the seats had been cramped last year. She knew that with the release of pressure, Christine would be more receptive to a productive disucssion together.
Whilst Christine explained to Jolene that she hadn't really wanted to complain about Dr Bentley, she felt that she had no other option. It had seemed to her that Derek no longer cared about her and preferred to palm her off to a younger dentist. This was unfair as Derek was ‘her’ dentist. She had noticed a steady decline in Derek’s professional countenance and wished for her complaint to be a kick up the backside for him to re- engage. She felt that she owed it to her mother, on her behalf, she was trying to help Derek. She had never intended to cause any trouble.
Jolene inwardly breathed a sigh of relief. She asked Christine how she would like this matter to be resolved. Christine said that she would very much like to see Dr Bentley, once again become the Dentist she once knew. However, she realised that this wouldn't be possible.
Jolene asked her if seeing Maya might be a viable alternative. Maya was an excellent dentist and her modern approach might renew Christine’s confidence.
Christine agreed to give Maya a fresh chance and withdraw her complaint. ‘Please pass on my apologies to Dr Bentley, i realise now that maybe i should have talked to you first, instead of venting my anger in a letter form’ Christine capitulated.
Jolene smiled a genuinely warm smile, knowing that another day had passed successfully. Christine left the building knowing that her future smiles were in safe hands.
Before Jolene rejoined her colleagues, she breathed a sigh of relief. She entered the room to be confronted with puzzled and worn looks from the two frazzled Dentists. She explained that Christine had wanted to be listened to and feel the care and attention that had become more lacking in recent years. Jolene thanked Maya and Derek for their involvement in the resolution and threw a knowing smile and a wrinkle of her perfectly freckled nose over her shoulder at the relieved dentists.
Jolene has left the building.
This story comes from the collective experiences of over two decades of being a dentist, talking with dentists and their teams. It’s important to be able to talk about the difficulties we might experience and how to overcome them. Morale in dentistry is at an all time low and I hope that this 4 chapter story will help people explore their daily professional experience of themselves, their angle of daily discomfort.
Comments