Thursday, October 13, 2016

My dentist is such a caring dude... or, HIPAA is not a thing in Germany.

Yesterday, Bill and I went to the dentist for our cleanings.  Over the past year, I've gotten to know the guy somewhat.  He's very good at what he does.  He's probably the best dentist I have ever had.  No-- scratch that-- he definitely is the best dentist I've ever had.  But culturally speaking, he's different than your typical American dentist.  My dentist is a product of American and German parents.  Therefore, he spent some years in the USA and many more years in Germany and Switzerland.  While you can talk to him and feel like you're speaking to one of your countrymen, after awhile, it becomes very clear he's not like your typical American.  He does some things that, frankly, could get him in some trouble in the United States.

One thing that may be difficult to get used to if you're an American visiting a German dentist or doctor is that HIPAA-- that is, the Health Insurance Portability and Accountability Act-- is not a thing in Germany.  There's actually a lot to HIPAA, but the one thing that most Americans know about it is that it protects a person's privacy.  In the United States, most medical professionals are required to be very cognizant of a patient's right to confidentiality.  It's quite a strict rule and violating it can land healthcare professionals in hot water.  As someone who has had to work within the confines of HIPAA, I will say that it's a mixed bag.  HIPAA can make some things about patient care difficult because it makes sharing information more difficult.  On the other hand, as a patient, I can see where it's a good thing.

My awesome dentist has a habit of talking to Bill about my dental care.  Although I don't usually care much about that, yesterday, he went further than usual.  Let's just say that what he said was kind of embarrassing and inappropriate and it made me feel uncomfortable.  I left his office feeling shocked and upset.

Ever since my dentist did my implant, he's ribbed me about being nervous around doctors and dentists.  He came in yesterday, after I'd had my teeth cleaned and had been sitting in the chair for about twenty minutes waiting, and immediately gave me a hard time about my nerves.  The hygienist who did my cleaning seemed a bit less experienced than others who have cleaned my teeth, so I was feeling a little perturbed about that.  She'd left the suction device in my mouth forever and used tons of product to clean my teeth, so it wasn't a very comfortable experience.  She did, at least, get me a hot scented towel for my face afterwards, which was nice, but then she left me sitting alone in the chair for a really long time.

We'd been in a massive Stau on the way to the dentist's office and were a few minutes late, so I was a little on edge for that reason (mainly because Bill was cussing the whole time).  And I had been waiting awhile, needing to pee, and wanting to get out of there ASAP.  I get annoyed when I'm bored, but healthcare stuff generally makes me uptight.

When the dentist finally came in to see me, he checked out my teeth and said my other baby tooth was looking okay, but a small piece of enamel had fractured off and left a space in my filling.  He said the pulp in the tooth is obliterated, but he might be able to eventually put a crown on it.  He doesn't want to redo the filling (which was redone in 2013 after 18 years of having a big chip in it), because he's afraid the tooth will fall apart.  Apparently, doing work on a baby tooth makes the roots reabsorb.  I figure he'll eventually do another implant on me, but I prefer to wait awhile if I can.  Luckily, this one would not be as involved as the first one, because I have plenty of bone in my lower jaw and we don't have to worry about my sinuses being in the way.

Then, he said it looked like my hair was longer.  If it is, it's not by much.  He asked me if I was also nervous about visiting hairdressers.  I said I cut my own hair and haven't been to a hairstylist in six years.  He was kind of shocked by that and wanted to know how I do the back.  I said I've practiced so much that I can do it myself.  I used to have a horse, so I learned how to do things like trim hair, shave whiskers, and French braid (which I had to explain to him-- he thinks it's the same as cornrows, though).  

After saying it looked like my hair was longer, the dentist gave me the usual bullshit about being "tense" and nervous.  Apparently, the hygienist told him I was "tense".  I didn't think I was unusually tense yesterday, but maybe I seemed that way.  I'm sure he's seen people more tense and anxious than I am, but for some reason, he likes to kid me about it.

I told him that I get nervous about visiting medical people.  I haven't been to a doctor in six years, either.  That comment earned me a sound chastising.  I got a full on lecture about how important it is to get cancer screenings (which I know, because despite avoiding doctors myself, I actually have an advanced degree in public health).  I was very embarrassed and not really sure what to do, as he told me horror stories about some other woman he knows who got ovarian cancer at age 35 and will never have children.  I told him that I'm 44 and have no children.  I didn't explain it wasn't due to my choice because he was busily telling me off about how I am at risk for chronic diseases.  Yes, I know...  I know all too well.

Then he made some comment about how I wouldn't even look him in the eye.  The truth is, despite popular opinion, I am kind of shy around people I don't know well.  It takes me awhile before I feel comfortable meeting someone's gaze.  I am especially uncomfortable when I'm being browbeaten about my personal healthcare choices by my dentist.  He thinks I'm being cavalier about my health and need to be nagged about it.  What he doesn't know is that visiting medical professionals is a terrible challenge for me.

I know it sounds ridiculous, but I have tremendous anxiety about visiting physicians.  I'll do it if I have to, but it takes a lot for me to go in.  And visiting gynecologists (which was what he was lecturing me the most about) is a huge deal for me.  I have to find someone I can trust implicitly who I know won't hurt me and make my problems worse.  Of course, since what happened to me to cause this anxiety was traumatic and humiliating, I couldn't explain to him why I don't see doctors.  He's thinks it's because I'm reckless and neglectful, but it's really because of anxiety and what I think is an actual phobia.

He went on and on about how I need to visit a regular doctor immediately and promised that the next time I see him, which will be in the spring if my other baby tooth doesn't fracture, he's going to be up my ass about it.  Then, he went in to see Bill and gave him a talking to about how important it is that I see a doctor.  He mentioned that I wouldn't "even" look him in the eye as he was "calling me out".  Maybe he sees that as shame, but to me, it was more shock and humiliation that here I am, 44 years old, and being lectured by my dentist about my reproductive health in front of a bunch of other people.

The dentist was still talking about my lack of doctor care in the hall, in front of his other patients.  While I appreciate the concern and know where it comes from, it was embarrassing for me.  I know his concern is genuine, but he kind of made me feel like a child.  I also felt like the whole conversation was inappropriate because, really, it's none of his business and not appropriate for him to be going off on Bill about how I neglect my health.  On the other hand, maybe that's just how things are in Germany.  People here listen to their doctors and Germans, in general, tend to be very blunt about a lot of things.  In the United States, though, what happened yesterday would be considered very unprofessional.  Of course, I probably should learn to shut up about such things as my personal health, anyway.

At another time in my life, I might have started crying in his office.  Or I might have gotten really pissed off.  As it was, I tried to laugh it off and told him it was time for wine, which Bill and I immediately got after we left his office.  I had to take a few minutes to simmer down.  Wine is good for that purpose.  His promise to be on my case next spring, though, will do wonders for my nerves.  

Privacy is different in Germany than it is in the States.  Germans tend to be extremely respectful of privacy in some situations.  That's one reason why it's so rare to find public WiFi in Germany.  Germans who work together are private about their personal lives.  But in other ways, there is less privacy, especially in healthcare settings.  Nudity is not a big deal here, so if you go to a doctor or a hospital, you may or may not be asked to disrobe and you might not be given anything to cover up with.  I don't even want to think about the horror of seeing a German gyno.

Anyway... it was definitely an unsettling and weird experience for me.  I'm not sure why the dentist gives me a hard time about such things like being nervous.  Hasn't he encountered other nervous patients?  He even ribs me about bringing Bill with me.  I told him that he comes with me because afterwards, we usually go out to dinner.  But regardless, why is it an issue?  Can't he just stick to taking care of my teeth?


  1. I solemnly vow that when I am licensed to practice medicine, I will never berate a patient for failing to seek medical care for himself or herself. i might politely offer an opinion of what is or isn't in a person's best interests, but I won't try to make the person fear coming back. When medical care of a child is involved, the stakes are a bit different, but I still wouldn't berate the child's caregiver. If it was a situation that needed to be reported right then, I'd make the report. If a parent or caregiver needed to follow through in a certain manner, I'd state such matter-of-factly and with clarity. If the child were then properly cared for , great, If not, I'd report it to the authorities, and the authorities could choose to berate the person if they so desired, but in no situation will I ever berate a patient.

    1. I wouldn't say I was berated because I honestly felt like he was trying to be caring. It was very strange, though. Bill said after he'd been waiting 20 minutes or so in the chair, the dentist came in and said hello, then he said "I'm trying to talk your wife into seeing a gynecologist."

      Weird, weird, weird!

  2. P.S. Regarding privacy or lack thereof, I think I told you about a family friend's parent-teacher conference in Slovakia. If not, tell me and I'll tell you. It's wild.


Comments on older posts will be moderated until further notice.