Kicking and Screaming for Bedside Manners

From Wikipedia regarding Bedside Manner:

"The quality of the patient-physician relationship is important to both parties. The better the relationship in terms of mutual respect, knowledge, trust, shared values and perspectives about disease and life, and time available, the better will be the amount and quality of information about the patient's disease transferred in both directions, enhancing accuracy of diagnosis and increasing the patient's knowledge about the disease. Where such a relationship is poor the physician's ability to make a full assessment is compromised and the patient is more likely to distrust the diagnosis and proposed treatment, causing decreased compliance to actually follow the medical advice."

I recently went to an Oral Surgery rotation and disliked the experience.  I have been to OS before and I had a good time watching extractions done on patients in pain.  They were all relieved to be getting teeth pulled so they would no longer be in pain.  This time in OS, however, was different.  I got there a few minutes before my scheduled time and waited around for patients to be seen.  I probably waited for 15-20 minutes before any patients were seated in chairs and someone was there to see the patients.  I watched two extractions - those being the most common procedures I have seen in OS so far.  The second was for a young girl with a rotting 2nd molar that had broken mostly down to the gingiva.  She kept telling us she was scared because she had never had an extraction before.  The dental student (very) briefly went over the procedure and began with the anesthetic injection.  The girl was scared of needles and began crying and wailing as the injection was given.  This proceeded for about 10 minutes while the medecine set in.  She was sweating and crying and very obviously scared.  I was very nervous for her and the student giving the injection.  After the rest of her procedure, I was asked to assist in another room where another woman was getting two teeth extracted.  The resident gave her the anesthetic injection and began pulling her two decayed molars out.  She was obviously anxious too, and had tears running down her face as the resident yanked out her teeth.  He abruptly left when he had finished and told me to read her the aftercare instructions.  Once he was out of the room, the woman started crying and told me that, "he's an a--hole, I hate him."  I was startled to hear her say that and tried to say something to calm her while not saying anything negative about the resident.  I couldn't think of much to say.  I tried to be as friendly to her as I could as she sat there quietly crying.  I wanted to hug her but I didn't think it would be appropriate for some reason.  I always start to tear up when I see someone crying (even on TV) so it was really hard for me to read her the aftercare instructions without choking up myself.  Once she left, a new patient was assigned that room.  He was left there for awhile while the resident and student were attending to other patients.  I was pacing through the hallway, waiting for another patient to help with when I heard the worst screaming and commotion I have ever heard that didn't involve a horror movie script.  I listened to these blood curdling shrieks coming from behind the door of the room across the hall.  I looked back over to the room with the waiting patient, who looked at me and said, "If it's going to be like that, I'm having second thoughts!"  I tried to talk to him and assure him that was not normal and that he would be completely numb so there would be no pain.  We chatted for a minute, then I walked back over to the room of horrors.  The yelling began again.  Obviously, the woman behind the door was scared and in pain.  I cannot comprehend why no one ever thought to give these patients a topical anesthetic to numb at least a little of the pain before stabbing a needle into painfully diseased gingival tissues.  As the screaming increased, I heard the resident yelling over the top of her voice to "BE QUIET!"  I was shocked at this.  I wasn't in the room so I can't say what was going on inside, but from where I stood, the situation was a bit out of control.  I walked over to the nurses who were chatting by the water cooler and asked them if they ever used nitrous or anything and they told me, "shhh, don't say that too loud, we don't want everyone coming in here asking for nitrous.  It wouldn't help her anyway since she is so wound up.  If they did anything, it would be IV sedation."  Wow.  First of all, why shouldn't these patients be given the option of nitrous if they need it?  Is it more expensive?  Is the clinic losing money when they use it?  Secondly, why didn't they give the screaming woman IV sedation?  (They never did)  I heard the resident speaking brusquely with the woman while he extracted her tooth and biopsied some tissue.  This guy beats all I've seen before.  Everyone in the clinic that day seemed to have no regard for the patients they treated.  The resident needs to take another course in bedside manner because he is grossly lacking in that skill.  I was really astonished with the staff in OS on this occasion.  I tried to make up for their lack of caring by visiting the rest of the patients I could and talking with them to keep them calm and distract them from what was to come.  This experience really made me want to be an advocate for the patient.  It made me want to improve my communication skills so I can soothe some of my patients' anxiety in the dental chair.  I want my patients to have the best possible experience I can give them with the least amount of pain and anxiety possible.  I want to have a great bedside manner.