BY EILEEN MORRISSEY, RDH, MS
Don is sitting in my office reception area, waiting for his six-month exam and recare visit. When I return from lunch, I can smell his cigarette smoke the moment I walk through the front door. I greet him, make small talk about the weather, and tell him I will be with him shortly. The levity of spirit I enjoyed through my lunch hour is beginning its downward spiral.
I bring Don in and seat him. The cigarette aura now fully permeates my treatment room, and with a sinking heart I mentally prepare for what I know the next 45 minutes will bring.
I go through the protocol of preliminary questioning - nothing has changed. I steel myself and examine Don intraorally, hoping for a miracle. There is no miracle. Don presents with his typical lack of oral hygiene. His teeth are coated with thick, furry plaque biofilm. Under that layer are plentiful amounts of calculus with heavy cigarette stain. However, Don is blessed with amazing tissue resistance. While fibrotic from the smoke, he has minimal attachment loss as exhibited by his sulcus depths and radiographs. He's a lucky guy.
Other articles by Morrissey
- I only want to be with you! Guiding the patient who wants to return home from the periodontist
- Don't lend me this ear! Hearing can contribute to dental patient sensitivity
- It's about the relationship, silly: Dental appointments are supposed to be pleasant
I, on the other hand, am an unlucky gal. I've been treating Don for more than a few years. Early on I attempted to inspire him into behavioral changes, to no avail. My dentist informed me long ago that it would be like beating a dead horse with a stick. He'd been there and done that, and Don made it clear that he would show up for hygiene visits, but wanted no efforts encouraging him to change his ways.
My greatest frustration is how physically hard I must work to get his teeth clean. I'm stressed through the appointment. I work feverishly with my ultrasonic, using a heavier tip as well as my slims, all while knowing full well there will be little or no time to finish with hand scaling. I'm aggravated each and every one of his visits because I've asked Don to consider coming in more frequently and he refuses. His response? "My insurance covers twice-a-year cleaning..." Does he not see what I go through to get his teeth clean? Why can't he try simply brushing his teeth before his appointment so that I don't have to tunnel through the sludge before getting anywhere near the calculus?
He typically asks how my employer is treating me. He says, "If he's not treating you right, let me know and I'll have a little talk with him, hon." It's almost comical, except that it's not. My response is simply, "No worries, my employer is a prince." I want to gag at his comment, but I'm a professional.
My doctor then comes in for the exam. He is a master at small talk and a five-star dentist. Each and every patient leaves feeling that they have received an award-winning dental exam. They are recognized, cared for, listened to, and appreciated. Dr. Antonio Cifelli escorts Don out, and I'm left to try to disguise the smell that now reeks from my treatment room and has likely become part of my aura.
I suspect some of you might be more confrontational with patients like Don. Maybe you would hand him a toothbrush and ask him to brush his teeth before you treat him. (That will not happen with an adult patient in my office.) Some of you might offer educational counseling or a motivational pep talk in the hopes of getting the patient to change. But remember, in my case, Don has requested no motivational talks. He does not care about what the future may hold for his mouth. Having suffered a heart attack three years ago, he practices present-moment living. (I'm quoting him.)
From Wayne Dyer, my favorite writer and speaker, I'm reminded of this mantra: "Change your attitude; change your world." What is the take-home message? I am a professional, here to serve my patients. Don is in my chair, and shows up like clockwork for his six-month recare visits. He allows us to X-ray him at the intervals prescribed by my doctor. He does not try to talk while I clean his teeth, and he is extremely complimentary regarding the fabulous treatment I've provided for him. He states this consistently, and reiterates it to Dr. Cifelli. From a fiscal perspective, he pays what his insurance does not cover at the time of his visit. While patients like Don can be exasperating to work with because of their collective refusal to comply, client-centered care suggests that we take a step back and allow them their right to make choices about their own care as they see fit. Patients like Don help fill out my schedule and keep me gainfully employed.
Change my attitude; change my world. Wayne Dyer is right. Onward we go; it is in our hearts' core! RDH
EILEEN MORRISSEY, RDH, MS, is a practicing clinician, speaker, and writer. She is an adjunct dental hygiene faculty member at Burlington County College. Eileen offers CE forums to doctors, hygienists, and their teams. Reach her at [email protected] or 609-259-8008. Visit her website at www.eileenmorrissey.com.