by Anne Nugent Guignon
In June, I had the wackiest conversation with a meeting planner from Ottawa, Canada. During the call, she commented on how hot it was that day. The temperatures were in the 30s. Holy cow! If she thinks 30 is hot, then what is her definition of cold? I consoled her concerning the heat wave she was experiencing and added that the Houston forecast for the next couple of days predicted temperatures in the low 90s.
When I got off the phone, I wondered about Canadian temperatures. What would the weather be like in late October when I'm scheduled to speak in Ottawa, or when I present in Toronto in December? Thank goodness, my rarely used winter coat is heavy and long. Still, temperatures in the 30s are hardly a heat wave in my book.
Several days later, I recounted this story to my friend, Cate, who lives in Toronto. She started laughing and said that Canada reports temperatures in Celsius, not Fahrenheit. If the Ottawa meeting planner made the same assumption about temperatures, she must think Houston weather is hotter than an inferno!
Since we were both speaking English, neither of us perceived a language barrier during our conversation. This type of communication block is difficult to avoid. Just think of all the times that we assume the language we use with patients is simple, clear, and impossible to misinterpret. We know all of the words, phrases, and meanings of our unique language, "dentalese." Our dental hygiene degree makes us fluent in reading, writing, and speaking our own peculiar professional language.
Do our patients really hear what we are saying? Do they understand all of our terms and the nuances of our language? Does the term cleaning mean the same to them as it does to you and me? If I could get rid of that one term in dentistry, I would. Each of us knows that cleaning does not accurately describe the complex variety of professional services that we provide. We need to clear up the confusion and help our patients and co-workers understand that the term cleaning is inaccurate. On the simplest level, referring to an appointment as a dental hygiene visit comes a bit closer to the truth, but it still does not tell the whole story.
When a patient hears the term "periodontal debridement" or more old-fashioned terms such as "deep scaling" and "root planing," are they thinking that these refer to another type of cleaning? Sometimes, even after 34 years, I just don't know what to think. But when a patient's eyes glaze over, or when they say they just want a cleaning, most likely there is a communication gap similar to the Fahrenheit and Celsius misunderstanding.
In addition, are most patients willing to pipe up and admit that they really don't understand what we are saying? Human nature makes people shy away from appearing dumb. It is our obligation to translate dentalese into a language that patients understand.
This discussion brings me to a parallel subject, in terms of communication with our patients. Two terms come to mind: "nagging" and "Q-tip." Ask any parent of a teenager if constant reminders to keep their bedroom clean compel their teenager to relish a spotless, orderly space in their lives. If nagging doesn't work in that situation, then why would it work in the clinical setting? Guilt and fear are not great motivators either. Many patients have heard the lecture hundreds of times before. They can recite it backwards, forwards and upside-down. Most would get a top grade if tested on the contents of the dental hygiene lecture.
Here are the facts. We are not responsible for patients' behavior. Yes, we must provide them with accurate information, including all alternatives, as well as the risks and benefits of choosing or declining proposed treatment. While we must do this, we are not obligated to beat the information into the ground. In this society, adults have the right to choose either to accept or reject treatment. We need to honor that choice. While we may not agree with their choice, they still have the right to make it. Before you get concerned that I have totally gone off the deep end, this discussion does not include abused or neglected children or the dependent elderly. These thoughts are limited to dealing with a fully rational adult who has the right to say yes or no.
Often, I hear hygienists complaining about patients that do not agree to proposed treatment. I've even heard dentists say that if a hygienist had done his or her job properly, the patient would have agreed to the proposed treatment. If a dental professional fails to provide information, then they are at fault, but if the patient still declines after being properly informed, then ... Q-tip! Quit Taking It Personally!
On the other hand, if we fall into the trap of educate, educate, educate, we are bound to become frustrated. Worse yet, we may be disrespecting our patients' right to choose. It is not possible to educate someone who is only seeking a service, and not information. Does it mean that it is wrong for us to merely provide a service without adding an educational component? No, but it does mean that we will be able to provide educational information only when a patient is ready to accept it, and not a moment before.
Even though each one of us would love to have all patients commit to necessary treatment right now, this just isn't going to happen. In the real world, there are many reasons why patients do not accept treatment immediately.
Sometimes, it is because of money. But, many times, there are other reasons — ones that may never be apparent to us. Nagging patients or trying to educate them when they are not receptive doesn't work. It only builds a stronger wall of resistance, hardened by a growing distrust of our true motives.
I vote for respecting patients' right to choose their own course of treatment, and letting them know we are ready to proceed whenever they are. Through the years, I've seen miracles with this approach. When patients are ready, they will seek care.
The downside to this approach is that some patients will never accept treatment. Some will seek another practice and complain to the next dental professional that their last hygienist or dentist did nothing for them or never told them about their disease. I don't believe that most dental professionals are incompetent or uncaring ... quite the contrary. If a patient is not ready, however, then chalk up the encounter as a "Q-tip" situation.
If they do not understand our discussions or recommendations because we are using our dentalese dialect, then it is our responsibility to break down the language barrier. If we continue to explain things in the same way over and over, why should we expect different results? Choosing a different metaphor, or using a softer or more direct approach may make it easier for the patient to understand the concept and the need for the treatment.
Finally, our worth and self-esteem as dental professionals should not be based on whether or not our patients comply with our every recommendation; rather, our efforts to provide quality services to those who seek our care should be a reflection of who we are.
In the meantime, I'm brushing up on Celsius vs. Fahrenheit so I can stay in my comfort zone when I travel to Ottawa and Toronto this fall.
Anne Nugent Guignon, RDH, MPH, is an international speaker, has published numerous articles, and authored several textbook chapters. Her popular programs include ergonomics, patient comfort, burnout, and advanced diagnostics and therapeutics. Recipient of the 2004 Mentor of the Year Award, Anne is an ADHA member and has practiced clinical dental hygiene in Houston, Texas, since 1971. You can reach her at [email protected] or (713) 974-4540 and her Web site is www.ergosonics.com.