by Anne Nugent Guignon
The words in the headline above are words of caution and respect. Three simple, familiar words, burned into the common vocabulary, can change our course of action. Every child is instructed to heed a stop sign, look both ways, and listen for cars before entering a dangerous intersection. Can this simple dictum be applied in today's dental hygiene practice?
Hygienists who are on autopilot — too numb to see what is coming — either cruise right on, never knowing they narrowly missed a near fatal professional wreck or they are forced to pick themselves up off the floor, wondering who and what just blindsided them. Regardless, either event is painful for all involved. Respecting and implementing these three words can result in some remarkable experiences.
Some of our finest hours as dental hygienists never involve a probe, curette, or mouth mirror. The moments of brilliance involve listening and responding in a human way, rather than focusing on the impact to the bottom line of the dental practice. Hygienists who have had such experiences can recall these rare opportunities like vivid movie clips devoid of commercials ... pristine moments that transform our professional lives from ordinary to extraordinary.
The scenarios are never the same, but the outcomes are predictable. Patients never forget our kindness. They never forget that we were willing to bend the rules, take time to listen, and take a risk to engage another human being on a non-clinical level. These appointments are a turning point in a patient's realm of dental experiences. They become patients for life.
If I were writing a screenplay titled, "Stop, Look, and Listen," I'd include the following scenes:
Ann-Marie DePalma, RDH, noticed that her patient seemed very preoccupied during the medical history review. Suddenly, the woman broke down and revealed that her 26-year-old son was battling alcoholism. He had taken a turn for the worse. Ann-Marie took a bold step. She gave the woman information about groups in the community that dealt with these issues. Even though the patient had taken her premedication, she decided to reschedule.
When the woman finally returned, the first thing she said was: "Thank you. You made such a difference in my life." She had attended not only the group Ann-Marie had suggested but found several others on her own. This woman now realizes that while she can be there for her son, ultimately he is responsible for the lifestyle choices he makes. Ann-Marie recognized that listening can be more important than spending time doing a clinical procedure.
Becky Grill, RDH, had only been in practice for three years when she took an unexpected risk with a patient. A woman arrived with her emotional balance hanging by a thread. At the beginning of the appointment, Becky's patient started crying and apologizing for her behavior. Becky got up, closed the door, and sat down on the floor in the corner across from this woman. Becky operated on instinct and did what felt right. She just listened for an hour and remembers not even thinking or worrying about the possible repercussion from the doctor and staff.
This woman was one of Becky's very dearest patients from that day forward. She has never forgotten her "therapy" dental session, even after 10 years. Becky sums up her thoughts this way: "Sometimes we have to give patients just what they need, not what we think they need." She continues, "Do I think this lady's opinion of a dental hygienist is more than just a teeth cleaner? ... Absolutely!"
Patti DiGangi, RDH, has observed that many hygienists believe they must be the teeth cleaner in order to meet expectations of others, whether this is true or not. She further explains her philosophy, "The way one views one's role is most important. We are not just 'teeth cleaners.' We need to be so much more."
Another colleague, Suzy Fred-ricks, recently had a woman on her schedule that she had never seen before. The patient had a complicated medical history requiring premedication, and Suzy sensed that the woman was quite anxious. After talking with her, Suzy realized the emotional toll of having so many maladies was overwhelming her patient. Even though the woman was very concerned about her oral health (which turned out to be excellent), the last thing she wanted to hear was a negative finding at this visit. From Suzy's perspective, magical moments are created when you help someone feel better.
In most situations, the role of caretaker is not appropriate in our patient relationships, but there are times when our role has to change to accommodate the circumstances.
Shirley Gutkowski, RDH, recognized this critical shift a few years back. A middle-aged male with less than ideal oral hygiene habits arrived for his appointment. Obviously distraught, the man revealed that his physician suspected the growth on his right hand was bone cancer. Shirley immediately took control and said, "Let me worry about your mouth so you can concentrate on your other health problems." She carefully explained how the periodontal pathogens use an opportunistic situation like this to wreak havoc in the mouth. Based on science, she recommended a two-month recare interval to help keep her patient's oral health ahead of the curve.
It worked. He kept his appointments every eight weeks, and Shirley kept his periodontal health stable. Fortunately, this man did not have cancer and they returned to his regular recare interval after the crisis was over.
After many years of clinical practice, Becky made an interesting observation. She feels that how we handle these unique situations is reflective of our individual personalities and how much flak we are willing to take from our dentist-employers. From her point of view, hygienists who are not mired down by "approval addiction issues" usually won't think twice about taking an alternative appointment path with a patient.
Toni Adams, RDH, is currently doing some research on listening for a postgraduate course in communication, which is the study of interactions between and among individuals. She offers a few timely thoughts about the benefits of careful listening. "When you take time to listen to people, you help them, the practice, and yourself. Patients get what they need at the time, even if it isn't clinical treatment. The office gets a grateful patient who will share his or her experiences with others. The investment of a little time and the sacrifice of one recare appointment fee will pay incredible dividends."
After years of clinical practice, Toni was sidelined by multiple repetitive stress injuries, but she feels that when we listen, we can gain a greater understanding of people and their needs, which can increase production while it serves the individual. She sums up her thoughts this way: "I think that when we practice like automatons, we burn out. If we constantly stuff our humanity for the sake of production, we can lose both."
Each one of these hygienists knows how to recognize her patients' emotional stop signs. They approach these situations respectfully, creating an atmosphere that will take their relationships to a higher level. They use their hearts and minds so that everyone wins. The points each of these hygienists made with their patients far outweigh the perceived loss of a few dollars.
Every one of these stories celebrates all that we can do for and with our patients. Again, if we stop, look, and listen, we can be their comfort zone. Sometimes it is so much more than teeth and gums.
Anne Nugent Guignon, RDH, MPH, practices clinical dental hygiene in Houston, Texas. She writes, speaks, and presents continuing- education courses on ergonomics and advanced ultrasonic instrumentation through her company, ErgoSonics (www.ergosonics.com). She can be reached by phone at (713) 974-4540 or by e-mail at [email protected].
