Phase five: Case presentations

July 1, 2001
In our continuing series on the transition to Diagnosis-Driven Hygiene, we now address the communication skills necessary to inform patients about their examination results.

by Beverly Maguire, RDH

In our continuing series on the transition to Diagnosis-Driven Hygiene, we now address the communication skills necessary to inform patients about their examination results. We understand the patient's periodontal status, but until the patient understands what's happening, we will continue to clean and "watch" the disease.

Communication skills are integral to a successful transition. I am amazed at how dental professionals are frightened of telling patients the results of their periodontal examinations. Fear of not being liked, fear of patient skepticism, fear of "abandonment," and just plain old fear of change! It affects all of us; I've yet to see a practice escape it altogether. It essentially comes down to being committed enough to our patients to accurately diagnose and inform them of the findings, whether or not they will be pleased with the information. We are ethically bound to do so.

It is essential that the entire staff supports the periodontal philosophy promoted in the office. We must do the groundwork to establish treatment protocols for the four types of periodontal disease, using the AAP Parameters of Care. Once probing and charting become routine for all patients, the diagnosis process can get underway. Hygienists gather all of the pertinent data; they then can share the results with the doctor and inform patients about their options.

I recently completed a transition in a Denver general practice. The doctor would routinely tell the patients, "Now, let's not shoot the messenger!" Patients somehow pick up on our need to be liked and often push their limits with us, implying that we are making the problem up or are even causing it by pushing too hard with the probe! In any case, how we handle patient concerns and comments will make or break the transition process. Any question the patient brings to us is fair game. Patients have every right to be concerned, disheartened, or disappointed; they also have the right to more information. It is very helpful to do some role-playing ahead of time and be prepared for these predictable questions.

"Doctor, did this just happen overnight? Nobody told me I had a problem last time I was here."

"Of course I'm bleeding! You're pushing too hard with that thing!"

"Did my cleanings pay for that Mercedes?"

Without some preparation, professionals will retreat to their comfort zones and continue to do "hygiene as usual" after the first or second patient confrontation. Unfortunately, telling patients only what they want to hear isn't an option. We have an ethical and professional responsibility to accurately diagnose and inform patients of their status and options for care.

The interesting thing is, patients accept the truth! They want to take good care of themselves and, when given the option, will do so 99 percent of the time. Yes, a handful will opt out of the practice during this transition; roughly five patients will call concerning fees for some of the procedure codes used. However, it is far less of a problem than you might believe!

Once again, time invested in staff discussion and role-play will be worth its weight in gold. Your entire staff must be prepared to answer these questions. I strongly suggest that each team member undergo a periodontal evaluation. Each staff member should personally know the value of appropriate periodontal screening and care. When it affects us personally, it gets our undivided attention. Medical health-care providers don't labor over telling their patients the truth regarding their health status. I think it's time we in dentistry step up to the plate and speak from our hearts — with compassion and kindness — while we honestly inform our patients of their periodontal health status and options for care.

Beverly Maguire, RDH, is a practicing periodontal therapist. She is president and founder of Perio Advocates, a hygiene consulting company based in Littleton, Colo. She can be reached at (303) 730-8529 or by e-mail at [email protected].

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