Day 23 - Hoonah, AK Day 2

I had an early wake-up call this morning because our first patient at the clinic was at 7 AM. Pat was upstairs bright and early cooking breakfast. She prepared eggs, sausage, and pancakes this morning. She loves to cook so, as long as you sit at the table, she’ll continually feed you juice, coffee, and breakfast. I told her I had been looking forward to the French toast so she promised that it would be on the menu tomorrow morning.

The walk to the clinic took about 5 minutes. I interviewed the first patient in the waiting room and then headed to my makeshift office to organize some things for the day. At the beginning of each day I have to update my list of people to call for my telephone survey. I go through Eaglesoft and look for patients with the 09130 code next to their names. I can then sort them by clinic and isolate the ones from the four clinics I am calling – Prince of Wales, Haines, Sitka, and Juneau. The list is growing quickly (25% missed appointment rate adds up!) and I am getting a bit behind because some of these patients are hard to get a hold of. I am in a precarious position because I don’t want to keep pestering patients who don’t answer, however, if not enough patients answer to take the survey the results will not be as meaningful. Good thing I am here for another month and a half.

The rest of the morning in the clinic ran really smoothly. I interviewed each patient as they came into the waiting room. I am getting some really great responses. One of the questions on the survey is an open-ended question that allows patients to tell me what dental information is most important to them. The responses have been quite surprising. Most don’t really care about anything more basic than how often to brush, when to make appointments, or whether or not flossing is important. Sometimes it’s hard to believe that this is the mindset of some patients in the United States in the 21st century.

Cindy, Dr. Nascimento, and I headed to a local restaurant for lunch. The restaurant is known for their halibut pizza so I tried a slice. It was actually pretty good. It must be hard to serve bad fish when it’s caught fewer than 50 feet away. During lunch I had an interesting conversation with Dr. Nascimento about the scheduling process for these clinic trips. Since the dentists obviously cannot see every patient every time they are in the clinic there is a bit of a rotating schedule. Ideally, the patients should rotate through the system to give everyone an equal opportunity to see the dentist at least once per year, however, it often does not work that way. The dentists are met with a lot of opposition from the full-time staff at some of the smaller clinics. There is a combative mindset between the dentists and the administrative employees in places like Angoon, Hoonah, and Haines. Many in these smaller villages appreciate what the dentists do for their communities, but others fell upstaged by the dental village trips. As a result, the front desk does a poor job of scheduling appointments for the most urgent patients. There is a lot of favoritism and discrimination by the administrative workers as they prepare the clinic schedules. This turns out to be unproductive for everyone as the most critical needs of patients are not met and the minimal time the dentists are spending in the clinics is not used efficiently.

I also learned about treatment planning today. There is simply no penalty for patients who skip out on appointments and that leads to a lack of commitment from the patients towards the dentists. There is little the dentists can do as the patient base is covered under the Indian Health Services and Medicaid programs, however, the one way in which dentists can fight back is through treatment planning. The dentists often start with the back teeth and work their way towards the front of the mouth. The patients, frustrated by the aesthetics of their front teeth that are visible when they smile, are forced to come back to get treatment on their back teeth. Dr. Nascimento agreed to fix a black decay spot on a front tooth for a patient only after the patient agreed to let her fix an infected tooth in the posterior of the mouth.

I just got back from the clinic and am about to go on a run. Cindy is going to meet me at the Historic Canner and we are going to grab a burger and watch the Zipriders from the beach. There are two cruise ships in port tonight so the area should be busy and fun.

Tomorrow is my last day in Hoonah and then it’s back to Juneau for the rest of the week. I have my first OB survey day on Thursday and a boatload of phone interviews waiting for me on Friday. Things are really starting to pick up and get exciting…