Most of the dentistry I’m doing today is repairing older dentistry, whether from leakage, decay, or breakage. One of the more challenging and grayer areas of dentistry is when to treat. Unfortunately, we live in a time when patients are guarded against over-diagnosis and overzealous treatment planning. The difficulty comes when their skepticism meets your honest and sincere concerns for treatment needs. In an ideal world, I would alert every patient to anything and everything going on in their mouths that I would want explained to me, not just the “need to treat now” findings. I would say that, the majority of the time, I do a really good job with this. I spend extra time going above and beyond to inform and educate, with verbal explanations, photographs, and radiographs. However, I’m human, too. It’s difficult situation to walk into a room and have the patient start the exam by saying they don’t want you to find anything or the hygienist telling you that the patient doesn’t want to do anything unless it is broken or painful.
The internal struggle I face in these situations is an ever-present one. The people-pleaser in me wants to make this patient happy. But I’ve just been informed that their happiness is dependent upon my withholding information until things break or hurt, which isn’t in the patient’s best interest. In my experience, when I suppress that little voice telling me to make the patient like me, and I inform them of my concerns for future dental needs, even if nothing is decayed, broken, or hurting, I sleep better at night. That patient may, in fact, choose to wait to fix things until they have physical evidence of a “need” to treat, even if it means more procedures in the end. But at least it was their decision to wait, and I provided them with all of the risks and benefits necessary to arrive at that decision.
I’m working hard to squash that little voice each and every day that I practice dentistry. But let me tell you - she’s a persistent little bugger. Do you struggle with this? Does she ever go away? What are your best methods for dealing with this struggle?
Courtney Lavigne, DMD
I struggle with this a lot as well. Recently I went to a lecture about treatment planning and the speaker really emphasized that you should not be afraid to tell the patient about all their issues in fear of scaring them off. As much as I already knew that, for some reason it clicked that time and I have been trying to get over it. I find that when I am alone with a patient, especially a new one and I am going over my findings after their cleaning many things I may tell them simply go over their head or they conveniently choose to forget about it and before you know it 6 months passed and we are back at square one, me sounding like a broken record at their next check up appointment and them acting like they are hearing me for the first time. Something new I have been trying (so I cannot tell you how well the response is, but give me a few months) is if I see that they need some type of treatment, even if it is just to replace a couple of leaky amalgams, either before or after my exam I will ask my assistant to take occlusal photos of their teeth. Then I will outline on the photos in red the teeth that need treatment as well as teeth that may need treatment in the future and I will forward these to the patient along with their treatment plan. This way, they will have a reminder of what we discussed during their visit and once you get used to doing it (I use Keynote but Powerpoint works well too) it only takes about 5 minutes of your time. Another nice thing you can do if you mentioned veneers or some other type of cosmetic treatment is to outline a quick smile design on a photo of their teeth and pass that along as well. It's definitely not a comprehensive workup, but I find patients respond very well to visuals along with a treatment plan and again it does not take a large amount of time once you get comfortable with it. Hope that helps!
ReplyDeleteLilya
Courtney,
ReplyDeleteMay that voice in your mind always be with you. Yes even after 35 years I still have that voice. I always feel a need to have that advocate for the patient in my head.
However much energy it takes I always try to not prejudge anyone. This is the treatment I did for myself and would do for a friend or relative.
Over decades I have found that I remember the joy of all those I was honored to treat and forget many of those who where not ready at the time our paths crossed at the chair.
Hope it helps!
Enjoy the Journey,
Bob
Courtney,
ReplyDeleteI now have changed the way I introduce myself to my patients. I now start with a statement of my commitment to my mission for my patients to keep their teeth for life. All my treatment and service recommendations are based on that statement. I agree that the patient may not choose to do the optimum and least damaging thing for their teeth or may elect to avoid protective suggestions, but I have to tell you. I sleep better at night and I may not have as large an income as my fellow dentists, but I maintain my integrity. Nice post!