What would you like??

Hi all,

Help me out with some research please? Being a dentist, I already know what I should do during a patient examination! (that must be reassuring!) But I would like your input too. btw this means you! no lurking in the shadows here! What you post could make a big difference to others. and we are, to some extent, in this together

From start to finish then, ie first contact via phone or whatever, dentist greeting you in the waiting room through to the actual examination and then making further appointments. is there anything that has worked particulary well for you? Things you would like changed? Something you wanted to happen that just didn't...

It'll help me refine my practice, and may also become part of my diploma work at UCL. Which may help to influence how others practice in the future. I can also give you feedback on any issues you may have during the examination appointment and perhaps explain why dentists do what they do, and perhaps how you can help to train them the way we want them to be!

Thanks in advance.

Pars

Please allow me to be the first to reply to you. I have been waiting for the opportunity to tell a dentist what to say to a phobic patient. this only applies to me so it may not apply to anybody else on these boards but I will get right to the point.
Before the patient comes to your office, communicate via e-mail if you can. some people do not even like talking to the dentist over the phone. So if you do e-mail, this would be a wonderful beginning. let the patient ask questions and when you answer, keep it simple and state the following in your reply: "Above all, the comfort of my patient is my utmost concern". "I will not cause you pain, there might be discomfort but I use only the latest equipment and dentistry has come a long way".

And if you don't use the Wand GET IT!!!! It means the world of difference to a phobia patient, believe me.!!!! Tell the patient in the e-mail that you use the wand. Explain about it. Assure the patient again.
Then when that patient feels comfortable, have your staff make an appointment.

If the patient needs to take a xanax (or something to calm them) then tell them to do this. many phobics just can't walk into a dentist's office and just plop themselves in the chair and let you go to work. My husband can do this. BUT HE'S NOT PHOBIC!!! I AM!!!!
Keep the waiting room in nice soft colors. No jagged paintings on the wall. No display of open mouths, before and after smiles. nothing with teeth. don't have any instruments displayed. I once had a dentist who had a big cartoon on the wall of an old time dentist with a big wrench in his hand pulling out someone's tooth. I know this might seem funny but to a phobia patient, it only brings apprehension.
the staff should be very friendly and very caring. No abrupt talk, and whatever they do, never make the patient think she(or he) is stupid for not being able to come in sooner. the patient is scared out of their mind and the patient needs to be treated with kid gloves. EXTREME KID GLOVES!!!

My phobia dentist has hot tea or coffee on a table. He also has a fridge with all fresh juices. But if you can't do this, at least have a fountain with hot water so the patient can make themselves a nice hot cup of soothing tea. That did wonders for me.

when the patient sits in the chair, don't have any instruments around. keep them separate. Don't push the chair all the way back down just yet. let the patient get accustomed to the surroundings. My doctor has candles lit and the aromatherapy is very soothing. Just talk to the patient. The most important thing you can do is LISTEN to why the patient has a phobia. Let her tell you what happened when he or she was young. Then tell her you understand, that the previous experience should never have happened and assure her again that dentistry has changed.
Now comes the time for the x-rays. If you can, get the new digital x-ray. It's a laptop with a probe that simply goes into the mouth and all of a sudden all the x-rays come up on the laptop. It's not uncomfortable and there is no paper in the mouth to bite on.
Now when you see what is wrong with the patient, don't hit them all at once with "oh you need two extractions, a root canal and deep cleaning.ETC. ETC.
Do one thing at a time. For example, say "okay, you need a cleaning, but don't worry, you will have numbing gell put on and our hygenist is the best in her field.
If the patient needs extensive work, ask the patient if it's okay to talk in detail about her mouth. Talk about a payment plan. Make it possible for the person to actually have her teeth fixed without waiting months for an appointment. Be fair in your pricing. Phobics need a break believe me. their life is tough enough without having to pay thousands of dollars for dental work.
if you can do a fair payment plan and you can assure the patient that you won't cause them discomfort, AND IF YOU ARE HONEST AND DON'T HURT THEM!! you will have a patient (and all her friends and relatives) for the rest of your practice.

Believe me I know what I'm talking about. Years ago, I went to my first phobia dentist (who no longers practices, she only teaches). Every time I went to her I looked her in the eye and said the following sentence: "please assure me you won't hurt me". the first time I did that, she looked amazed and replied "of course I won't hurt you" AND SHE DIDN'T!!!Every single time I went, I asked her the same thing before she began. And every time, she would say "don't worry, melody, I understand and I won't hurt you". And she didn't..

do you understand the point I am making? In the past, dentists have been abrupt, have hurt us, have never understood out feelings. Our moms just put us in the chairs and just left us in the office to be treated so badly by unfeeling dentists. There isn't a child alive who would willingly, smiling all the way, sit in a dentist's chair and see a big needle and say "oh goody". It obviously doesn't work that way, so why would a dentist expect anybody to just sit in a chair, look at a big needle and say "oh goody, I'm getting my tooth worked on today".
Our minds don't work like that. We need assurance, assurance and more assurance.
There are many of us who have even more special needs. Like sensory issues, for example. some patients can't stand the smell of the dentist's office. If you can understand one thing, understand this: Years and years ago, dentistry was not advanced like it is today!!. If you want to make a phobic go to your office, make your office, your staff, your demeanor, appealing to the phobic person.
A person is not born phobic. Things have happened to that person earlier in their lives to make them feel the way they do. Your job is to make them feel safe, to make them know in their souls, that you are not out to hurt them. Then, once you prove this to them, as they continue to come to you, they will feel easier and easier.
Yes, they will need a xanax (or similar) to come in for treatment. Maybe some day they won't. But when you begin a practice you will see more and more people like us. Nice people. people who would go out of their way to help others. But people who need a break. You need to be there for this type of person. I hope I have made you understand the mind of a phobic.
Sincerely,
Melody

OK here goes - this is from my experience both before and after 'the avoidance years' :

This might be rather long !

(1) The receptionist is usually the first point of contact so they obviously need to be aware that not all patients are *that* keen on visiting the dentist (<--- euphemism for completely terrified!) and need to treat people as they would wish to be treated themselves if they were in that situation. Some (but not all!) receptionists can be total 'jobsworths' at times and this attitude really doesn't help if you've just plucked up the courage to make that first call. A recent example would be my last trip to the dentists. As I was sat downstairs in the waiting room, one of the receptionists was on the phone to a patient and she was so rude to them to the point where she was actually shouting down the phone! Yet at the other end of the scale, the woman who was sat next to her is really nice. So, as a patient it's pot luck whether you get Mrs Nice or Mrs Nasty on the phone if you call.

If you're trying to let the person who answers the phone know that you're scared and you are made to feel stupid, then obviously the dentist is going to be awful as well (even if s/he isn't).

(2) It might sound stupid but when talking to patients, make sure you're facing them and making eye contact (even if they're not). As a patient, even though you're completely terrified and you'd rather be anywhere but sat in the chair trying to talk to the one person you fear the most, it can be very un-nerving if you can't see them. Until my last appointment, I didn't realise what my dentist actually looks like because due to the room layout and him hiding behind the chair all the time, I'd only seen the top of his head and his hands before. Although his 'appearance' in front of me caused me to go , it was better than him going as usual.

(3) Sounds/noises. I suppose this one depends on whether the person likes to know what's going on or not. I know that a lot of the sounds are unavoidable, but some are e.g. slamming drawers and cupboard doors. If you're the kind of person who would rather know exactly what's going on (i.e. you're not sedated), then the chances are that you're very sensitive to all the noises and could probably hear a pin drop. I usually close my eyes the minute I sit in the chair (an attempt to prevent flashbacks) so every time I hear a drawer slam shut, it can really make me jump (and look like a demented star fish lol! But there isn't a smiley for that...).

(4) When talking to a patient, even if you think they know it already or you think you're repeating yourself, go over everything that they need to know including answers to commonly asked questions. I realise that dentists aren't mind readers but some people find it very difficult or impossible to speak, let alone ask questions. I've lost count of the number of times I've sat there with loads of questions in my head but I haven't been able to speak due to complete terror. Later on, when I've recovered and I'm my usual effervescent self , I'm left wondering what on earth happened at the appointment and what was it all about anyway. That's probably one of the reasons why the questions section on this board is so popular!

Well, that's it for now (until I can think of some more ).

Just my humble thoughts, hope it helps .

Great topic, Pars. I echo an awful lot of what vicki and melodyl have written.

First contact: I was able to email my current fab dental team and got a reply within 12 hours. This was followed up by a phone call from the counsellor/nurse - she was fantastic and did a lot of listening to all my fears and experiences. This gave me the courage to make my first visit. I had to have a chance to talk to someone before making that first appointment.

Welcome: I agree totally with vicki about receptionists. I'm so lucky now that as soon as I arrive at my practise, they know who I am. I know this is helped by the fact that it's a single handed practice, so there aren't two or more surgeries on the go at a time. But being greeted with a smile and my name is really great.

Chain of information: Sharon said she's pass on all I'd said to my new dentist AND SHE DID. This meant that I didn't have to start all over again when I arrived for my appointment. I'd asked to see no instruments, not to see my teeth or any x-ray results and Douglas knew all of this and understood. He also knew my version of my dental history before taking his first look.  

Taking things at my pace: every small step taken adds to my sense of trust in my dentist...he said when I first met him that he would take treatment at my pace and he hasn't ever let me down. Even now, after two big sets of treatment, he asks if it's okay to do a quick polish or an exam.  

Understanding shame: this was a biggy for me. My teeth were in a dire state and I was so ashamed on my first appointment that I cried. What I got was kindness and reassurance...this was immeasurably important. This applies not only to my dentist but to his two nurses as well.

Not waiting around: (although this is scarey as well!) I'm a bit of a punctuality freak, and always arrive about 10 mins ahead of my appointment time (when the tubes allow). I don't think I've ever had to wait more than five minutes to see Douglas. And he always comes out into the reception area, shakes my hand and says hello before leading me into the surgery.

Giving information: I had to have a lot of treatment (root planing, extractions, partials fitted) and Douglas wrote it all down in a long letter, and read it out to me. This gave me time to digest what he was proposing, and ask questions. Although I didn't need to, he said he was happy to have me ring him with any further questions. And I know I can always email and get a quick response.

Knowing I'm not bad or strange: every time I've been to my dentist, I get the strong impression that this is the normal way he practises. So I'm not a saddo phobic but a person in my own right, and the attitudes my dentist has don't have to be altered because it's me he's seeing. I've been to so many dentists in the past who have know I'm utterly frightened, but have not taken this into account once treatment has started. So I've ended up feeling like a set of teeth on legs rather than me (if you know what I mean).

Sedation: not possible for every practise, I know, but I don't think I would have got through my treatment without IV sedation.

I think that's it for now...hope it's useful, Pars.

Hey everyone thanks very much for your replies so far. There's lots for me to work on there! Seems like a team approach is very much the way forward. If there's anything else you can think of, no matter how trivial, I'd be interested to know and learn from you all.

Thanks again

Pars

I'm back again... Had a few more thoughts ...

Adverts for tooth whitening and other cosmetic work on display throughout reception/waiting areas: it could imply that you should have the same flashy smiles as displayed which would mean loads of work and that all they're interested in is your money. The same goes for products such as toothbrushes, toothpaste, mouthwash etc being on display (you can quite often buy exactly the same products in a supermarket or other shop for less money anyway). Interesting or calming pictures would be much nicer and less intimidating. Alternatively, if it has to be dental related, maybe info about maintaining good oral health would be a better option.

Magazines/newspapers in the waiting room: I don't know if maybe it's just me, but by the time I'm sat waiting, I'm so terrified that I can't concentrate enough to look at the pictures let alone read anything. So maybe some other method of distraction would be better. Big comfy chairs instead of small hard chairs all in a row (a bit like you're on a conveyor belt) would be more welcoming as well.

Also maybe consider what it sounds, smells and feels like to be sat waiting for your turn. All the sounds coming from the other side of 'the door' really do make things a whole lot worse so your imagination just runs wild (even though you know on a rationale level that it's only noise).

If someone is obviously terrified or panicking, no matter how shocking, surprising or un-nerving it may be, it's really important to stay completely calm about the whole thing and not get stressed or mad about it. Trying to stop a panic attack can be like trying to stop a runaway train with no brakes sometimes and it really isn't something that a person would do if they had the choice.

Well, there you go - some more to add to your list!

Hope it helps .

Positive reinforcement (i. e. praise for even the smallest baby steps) can be another biggie, I think. Then again, I like a frequent pat on the back . Don't know if others might find it condescending though!

I agree with you lets, when i went for my last treatment two weeks ago I remember saying to helen  "I'm really getting nowhere - am  I". The reply from all in the room was " you're not as bad as you were, you're doing really well"  I felt from the tone of their voices that they were being truthful with me.

The one thing I didnt like last time, was that they put the cover/bib around me just as helen was inserting the IV. For a couple of seconds, I wondered what I'd let myself in for (amazing just how much can race through your mind in such a short time!)

The first appointment I had was made via the dental helpline, who had informed the practice how scared i was. My appt was  just before lunchtime and there was only me and one other person in the waiting room. The receptionists were really nice and told me that the dentist i was seeing that day was really nice. I still stood by the exit until a panic attack took hold and i gingerly sat down. The receptionist saw me and disappeared........ and came back with the dentist, who sat down and spoke to me quietly and calmed me down. Then he asked me if it was ok to sit in the treatment room even if not in the chair. I manged to let him see the infected tooth and was prescibed antibiotics and given a referral for IV sedation. This was sooooo different to my previous appt which was over 20 years ago, again for extractions under iv.....i walked in the room and  said " i dont think I can do this" and was told   "your decision, stay or go"
Anyway, I went to this special needs clinic within a hospital, and have managed to have 3 appts so far. I like the fact that I'm always the only one in the waiting room. I have never known anyone being treated at the same time so there are no noises. I know this cant be done at every practice tho. Helen always discusses things with me in the waiting room, therefore as soon as I go in THE room they can just get on with things....no time to look around etc.

I have been lucky so far, even to the point that I went on my own by taxi for a check up. I was freaking out on the journey and telling the driver how scared I was. He ended up escorting me to the treatment room to make sure I was ok and actually went in lol.

Now I'm ranting, and have probably gone right off the topic .............feel free to edit as much as you like lets  

Ok....To start  with, the  office staff demeanor/lack thereof  -in alot  of cases makes or breaks  it for the phobic patient. Point  #2.....Dont push  the patient  into ANYTHING theyre not ready for .Communicate ...DONT LIE #3    Absolutely NO playing games  with  billings , advocating unnecessary  procedures ,ect . to p lay  fast/loose  with that  invites disaster .#4 .irrespective of what your personal feelings/opinions   may be regarding a patients  phobias  -keep them  to yourselves . I  myself happen  to be  needle phobic - allit took was ONE -note that -ONE - incredibly insensitive -ill timed comment (made in an attempt  to try to defuse an already tense situation - in the chair ) on that that totally backfired .it took quite a bit of time to straighten that row out -it got straightened  out eventually --only because the  manager of that practice  risked her job in order to act as a go between -  in order to negotiate  a solution . 5 If you screw  up- admit the  mistake -and  then correct it -immediately -irrespective  of time  or cost .   6  recognise /respect that  phobics have difffering needs   -and have the flexibility -and the additude -to  meet-within reason- those needs ., Your Additude demeanor- and that of the staff -goes a LONG way here  .THAt is crucial  to ones sucess /or failure -in treating the phobic .7) Be  honest, open, empathic  and compassionate when treating the phobic  pt.....we can sense -at least I can ...whether youre coming across as genuine  /real ...or not ..We dont wan to be in there as it is -half the battle is just getting us in the freaking door 8) i- use whatever  pain control method works for the  pt -even  if it   means eating  part of  it-on occasion- in order  to do that work.Screw  up on pain control - and youll likely  lose that pt .Over the long haul-things tend to level out  on that issue any way.Pain control  has come a long wayin the last 25 years -use  it to  both your - and  your pts-advantage . 9)use whatever pain  control  methods  work  for that pt - cutting corners even once  invites problems 9)If issues arise -deal with/address it right then-unless the clinical situation at that time (ie ..dams, impressions)precludes/dictates otherwise...then address it before the patient departs . and be open, transparent , and honest about it -while  ensuring /protecting the dignity /privacy  of the patient .Lie -or  be deceptive with a patient  once -if that patient knows/figures it out ....theyre likely gone -.you just destroyed  your reputation  with that pt.Dont play ego games  -itll bite  you every  time .Occasionally -review the oath YOU took when you first hit med/dental school---with your staff-"First- Do the patient no harm"You- and your staffs actions -can cause /create immense healing -or immeasurable harm to a patient Remember -it takes years to build up your reputation in the community  as a reputable clinician  -and  mere seconds for you -your staff-or a pt  - via your behavior -to destroy  it .   Hope this helps you out.There are a few  other  observations that id  like to make -should  be addressed  in a PM ,Parsnip.Again -hope this helps the learning curve  Keith2

Ok, here's my two cents worth. I will probably repeat what others have said, but than you know that those are really important

First- Introduce yourself when meeting the patient face to face for the first time. I went to a specialist last week, who never introduced himself and didn't even make eye contact when he entered the room. He just went straight to the wall where my x-rays were and talked with his back to me

Second-Communication between the office staff (receptionists, assistants, and the dentist) is VERY IMPORTANT!!!!!!

Third-A little reassurance goes a long way. I agree with "Lets" here, a gentle pat on the back, or a reassuring rub of the shoulder really helps to calm me down.

Fourth-Eye contact is also very important. Sometimes just an understanding or reassuring look goes a long way. I have never had the courage to tell the dentist just how nervous I am, but I know he is fully aware just by the reassuring looks that he gives me.

Fifth-Find out how much detail the patient wants regarding a procedure. Some people do not want to know step-by-step what is happening, while others would feel much more comfortable if they knew (because there would be no surprises)

Sixth-Schedule enough time for each appointment (communicate with staff) If you are rush the patient will feel it and that will raise thier anxiety level.

Last (for now at least, I'll probably think of more lol) Choose your words carefully when discussing procedures. Sometimes when you say "We need to do a deep filling" the patient hears " we have to do a PAIN, PAIN, PAIN, blah blah blah, PAIN

"T"

Wow It really great to know that you are trying to find out how to make your patients more comfortable. Many time dentists and doctors, for that matter, don't take the time to understand the fears that thier patients have. I worked for many doctors who were oblivious to the fears that thier patients had. Congrats on not falling into that trap and thank you from phobic everywhere

Great list by freakout there... another thing which occurred to me: one thing I personally found helpful was that my dentist reacted as if it was no big deal, not in the sense of brushing my fears aside, but rather that my behaviour was in no way unusual or troublesome, that I would do just fine. I suppose placing trust in your patient or having belief in your patient, really.
I don't know if that's just me though, others might feel differently about this.

I have to agree with all the input above, and just would like to add some things I noticed in my last appointment which I really appreciated. First off, they gave me a blanket which helps quite a bit- it adds a psychological shield between you and what's about to happen. Secondly, my dentist had these goggles stuck to his glasses which eliminated the need for that blindingly bright light that I always remember hanging over the chair. Third, I found that the headphones and tv on the ceiling helped me relax and take my mind off the procedure while it was happening.

The disturbing bits were the sounds of drilling from other rooms (I wish they had closed the doors or something) and the smell of the drilling in my own mouth- I don't know if anything can be done about that, but it really is one of the most unpleasant things about being there.

I agree, the TV is a great thing. My dentist has current movies playing on them all the time. I don't think I can watch, because I am so nervous, but before I know it I am totally engulfed in the movie that is playing lol. I even remember when I had my top teeth extracted and was on nitrous, Top Gun was the movie playing on the TV. If I focused on that and not what was going on in my mouth, I knew I would be OK.

Great points by everyone! I do think that teamwork (receptionists, nurses, dentist) is a key issue.
Wow, freakout, Top Gun! Tom Cruise in a jet when he was a babe...must tell my dentist to get that in My dentist has Radio 2 playing, which is a good distraction; I agree with vicki that magazines are useless to take my mind off the possible terrors that lie in wait.
Totally agree with happy about the calm demeanor of the dentist - vital in building trust.

gumgirl said:

Great points by everyone! I do think that teamwork (receptionists, nurses, dentist) is a key issue.

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I'm gonna be the odd one out here, but personally, I find I can only concentrate on one person at a time... (i. e. the dentist). Of course, it's important that the receptionist is not nasty (as has happened occasionally on this board) or that there are no miscommunications, and that the team members get on well with each other and have a good working relationship. It sets the tone for the practice/office. But on the other hand, I personally find it annoying if I get too much attention... one person is enough... that's probably just me though!

Totally agree with happy about the calm demeanor of the dentist - vital in building trust.

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I'd have to agree there. Maybe this is due to the fact that someone who appears calm also appears more confident in their (and your) abilities?

One other thing (that's also been mentioned by other posters in this thread) is the importance of putting the patient in control. For me, that was a key issue.

My dental phobia was started by a bad child hood experienc with a dentist who was not very good at comunicating with patients, and attempted to drill a tooth without giving me a local anaesthetic. I preffer to be treated by a female dentist I find them to be more sympathetic and reassuring and more approachable. I find I need the dentist to speak to me and reassure me. I need them to talk me through the appointment explaining each step. I find having eye contact and being able to see my dentist helps put me at ease. She is really good at speaking to me and reassuring me. I listen to a relaxation cd on a cd walkman if I need any treatment that involves drilling I find this helps me to relax and drows out the sound of the drill. My dentist always tells me when the driling is finished and assures me there is no more drilling. My current dentist and previous dentist (both female) have been very caring, their surgeries are modern and well designed with instruments like the drill kept well out uf sight. Having relaxing music playing in the waiting room so you cannot hear the sound of the drill. As a child I went to a school / comunity dentist (early 1980s). Even for this era the surgery they had was very old and dated with a belt driven drill hanging in clear view of the patient and a switch with high / low (i presume speed of the drill) clearly visable in front of me - this really used to freak me out even when I did not need any drilling done. When sitting in the waiting room I could always hear the drill this would unnerve me even if I didn't need treatment.

hi pars
well im crap at explaining things and very down at the mo but here goes.
this is what my friend (the dentist) does to help me.
1. he always calls me by my first name which makes me feel like friends not just patient
2.he always comes into the waiting room to get me and is always smiling.
3. he always takes the time to see me i realise its not always possible but even when he was in the middle of a sedation clinic at the old practice he took the time to talk to me when i came in upset
4. he always phones me back himself if i have a prob which i really apreciate
5.little praises go a long way
6. he always asks me if im ok when he is doing the work
7. some people say that the receptionist doesnt matter but for me they do mine isnt that nice bit better than she was but not great when i first met her it was awful and it put me straight back to square one.
8. as freakout said,A little reassurance goes a long way.

Hi Pars
I agree with everything everyone else has said and Harper's list is particularly good for all patients - phobic or not. There's only one thing which no one has overtly stated which I think really helped me, at my first appointment after a really bad experience. *

Bad Experience: At the age of 10 (1972) a sadistic associate dentist at a 'modern' practice did 8 fillings (4 at each of 2 appts a week apart ) and refused me anaesthetic - most were extremely painful * but somehow I just gripped the chair arms and put up with it - silent tears etc. which he wiped away from time to time...sinister eh?

Friends at school and my Mum's best friend who used the same practice, assured me I should have been given injections. I waited for him to leave before going back but promised myself I would not ever let any dentist *do that to me again.

The thing which really helped me was that the replacement Associate dentist I saw 12 months later was completely different. I was 11, he chatted to me about school, made an attempt to put me at ease, was gentle and smiley.

The key thing: at the end when he had to break the news that I needed a few more fillings, he said the magic words: 'This is nothing for you to worry about' and then *explained about bonjela, local anaesthesia and that it would not be painful. And it wasn't. This is without me saying anything about my previous bad experience but I suppose its just possible he could have guessed it from the records and my waiting a year to come back. This was just what I needed. *

I stayed at that same practice and saw many Associate dentists over a period of 20 years - all of whom were fine.....so why am I on this board?....because I moved to a foreign country, had a couple of bad experiences and realised I was actually only comfortable with painless dentistry and that it was important for me to be made to feel at ease and not treated like a set of teeth.

So after breaking the news about treatment...offer some reassurance and explanations...it could make all the difference to your patient keeping the next appointment *.
Cheers
Brit

Geraint said:

 As a child I went to a school / comunity dentist (early 1980s). Even for this era the surgery they had was very old and dated with a belt driven drill hanging in clear view of the patient and a switch with high / low (i presume speed of the drill) clearly visable in front of me - this really used to freak me out .

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Geraint
That's unbelievable for the 1980s - I last saw one of those in the 1960s, oh and in the Science Museum recently in London at Easter! The standards in Community dentistry are generally high.

One thing I have noticed in modern EU surgeries (and probably elsewhere too) is that the 'handpiece' stuff is sort of built into the chair all over again and really in your face even though the drill bits are not attached. Personally I prefered the low level wheely trolley thing at the side of the chair which was much easier to ignore.
Designers honestly - they'll bring that horrible ceramic white circular tray thing back next which used to swing across you and hem you in!  
Brit