Ideology to Reality

Dec. 1, 2012
Imagine with me the following practice scenario. A new patient enters the office and is greeted by the receptionist.

By Joann R. Gurenlian, RDH, PHD

Imagine with me the following practice scenario. A new patient enters the office and is greeted by the receptionist. She is informed that her entry data has been updated and asked if she brought her health history form (previously emailed to her) with her to the appointment. The patient is escorted to a private conference room and introduced to you.

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You take a moment to introduce yourself to the patient and talk with her about what brought her to your practice and what she hopes to accomplish. You explain your practice philosophy and ask her if she would like a tour of the office now or after you review her health information.

You take 30 minutes and discuss the patient’s general and oral health conditions and concerns, and complete a risk assessment. You introduce the patient to the team member who will be taking vital signs, using the intraoral camera, and preparing her to meet the dental hygienist. The hygienist performs comprehensive oral cancer, caries, periodontal, and deposit examinations and reviews the findings with the patient. Next is an oral health risk assessment profile, a process that takes approximately 45 minutes.

Once a summary of findings is conducted, you confer with the team members who have been caring for this patient and all of you escort the patient back to the conference room to discuss your findings, proposed treatment, and answer any questions the patient has. You present several realms of treatment options to the patient and obtain an informed consent. You make a recommendation that the patient seek a medical consultation for a potential finding of hypertension, but advise the patient that her readings are still within the safe range to provide dental care. You consult with a nurse practitioner or physician colleague who shares office space with you to have the patient scheduled for further evaluation of hypertension. In addition, based on the patient’s overweight condition, you recommend that she schedule an appointment with the registered dietician, who is part of the practice.

You proceed to a 15-minute wrap-up session to discuss some initial patient education and advise the patient that you will continue with oral health education and product recommendations at the next scheduled appointment, during which time dental hygiene treatment will commence. The patient is scheduled for the next dental hygiene appointment based on the hygienist’s plan of care.

How does this scenario sound to you? Plausible? Nirvana? Never happen in your lifetime?

One more question. Who owns this practice? Now, imagine that the owner of the practice is YOU! Plausible? Nirvana? Never happen in your lifetime?

If you could take a few minutes and write down your version of the ideal practice, what would it look like? Who would be on your staff? Who would your health-care colleagues be? What practice parameters would you establish, and what would you want your patients and staff to be saying about you?

I raise these questions because I recently attended a phenomenal meeting sponsored by Philips. We had an opportunity to talk about our ideology and changing the landscape of practice to focus on the oral care life cycle of patients. It made me think about the way things have been changing and how our profession has yet to create the practice that meets the needs of this very different world. It made me pause and reflect on our experiences and how we have often shortchanged patients by our current approaches to care.

Mind you, we do have many wonderful elements to our practice behaviors and settings. However, I am not convinced that we are responsive to the true health needs of this country, the impact of economy and cultural influences, and the changing health-care and political arenas. We have not accepted our role and responsibility in shaping changes that will improve both the oral and general health of the public.

This is the perfect time to think about what our ideal practice should look like and start making that a reality. We have to explore our practice ideology and ask ourselves what we can give up as people, procedures, and practice behaviors that are no longer relevant. What do we need to do to help our patients fully value oral health as health, and believe that pursuing regularly scheduled dental and dental hygiene appointments is as important as taking care of any other part of the body?

At the recent meeting I attended, one of the speakers suggested that we let go of things that hold us back from making good decisions for ourselves. Let’s take that one step further and let go of the decisions that are also not in the best interests of our patients. What are the things you can or would like to let go of in your practice? What would make you feel as though you were able to take off those cement shoes that hold you in place? If you can identify even two or three things, you are on your way to giving yourself and your patients something very special. Go for it! RDH

JOANN R. GURENLIAN, RDH, PhD, is president of Gurenlian & Associates, and provides consulting services and continuing-education programs to health-care providers. She is a professor and interim dental hygiene graduate program director at Idaho State University, and president-elect of the International Federation of Dental Hygienists.

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