by Patricia L. Flanagan, RDH, BS
We hear it in our profession all of the time. Patients just don't comply with our treatment recommendations. Hygienists and dentists alike are frustrated by the lack of commitment that patients have for overall self-care. Many patients come to our practices believing that a visit will meet their needs if it values their busy schedules. This means getting them in and out, as quickly as possible. Others feel well cared for when they are not nagged about preventive services and self-care routines.
As oral health care professionals, we feel a sense of responsibility to provide the finest service to each person who visits our operatories. This includes the dreaded question, "What do you do to care for the health of your mouth?" Our patients respond by stating, "I confess that I don't floss as much as I should." In the awkwardness of the moment, the hygienist is unsure about how to respond. Is Mrs. Smith asking for forgiveness that she has not bought into this flossing thing? Should we jump in to rescue her by stating that this is OK, or she is absolved of this sin? With this approach, Mrs. Smith continues to experience gingivitis, which negatively affects her oral health.
Maybe it is better to once again explain the importance of flossing? The intent is to help her understand that she could eventually lose her teeth if she does not comply. We give it our best shot, and she agrees to try harder. Doctor X joins the appointment to complete the exam, and Mrs. Smith begins by informing him that she has already been lectured about flossing. Lectured? Huh? We feel a sense of confusion because our intent was not to stand at the podium this time. Scratching our heads, we wonder how this could have been more successful!
If our methods are ineffective, it is important to go back to the drawing board and begin again. The real question here is how can we become more effective in helping our patients make health-based choices? Our biggest asset to learning is the valuable feedback that our clients share.
This is an intellectual concept with an emotional component. It takes considerable risk to ask for feedback from the people we serve. This feedback should be viewed as a gift that helps us to grow both professionally and personally.
When a patient feels compelled to ask for forgiveness — or believes that he has been lectured to — it is a symptom of an unhealthy relationship. Our patients are intelligent individuals who seek our professional expertise. Listening to understand fully, their concept of health is the single most important criteria for mutual success. Offering guidance relevant to the patient's own goals — in a gentle, coaching manner — helps to create a collaborative relationship. This step helps both the clinician and the patient to understand the goals of successful care. This newer model is a partnership, which develops healthy guidelines of communication.
Listening to the preacher
Reflecting on my personal experiences, I have learned many valuable lessons by listening to what my patients have to share. This became very clear to me when working with one gentleman who generally did not like to spend time in a dental chair. This patient, a lecturer in a local church, had a history of sporadic care, primarily caused by his fear of the pain invoked by hygiene services.
My curiosity was piqued, knowing full well that supportive care can be very comfortable in the healthy mouth. This patient had a generalized gingivitis with bleeding upon probing and pseudopocketing throughout his mouth. We began to talk about the relationship between the clinical findings and his discomfort. Now I had a captive audience! This was a significant shift from one of lecturing to one of co-discovery.
Together, we explored the significance of how he cared for his teeth outside the dental office. He began to recognize that his sporadic flossing created most of the inflammation and hence the pain. At the close of our appointment, we had come up with a plan to create a more comfortable experience during his next hygiene visit.
Upon his return three months later, we enjoyed a very pleasant and comfortable hygiene visit. He also shared a story with me. During a sermon for his church, he chose to discuss the importance of understanding your values before a true paradigm shift can take place. At that point, one can weigh the value of achieving a goal with the price of what it might take to get there. He related the story of our appointment to all of his parishioners. He detailed his own values conflict about wanting to keep his teeth but also not wanting to go through the pain of having dental care. He stated that, until he had the information that was relevant to him, his patterns were unchanged. He explained to his parish how he learned about bacterial succession and the importance of daily disruption of plaque.
The pastor used this story to help his parish understand that learning, by itself, is not enough to cause someone to change his or her actions. Only when the learning is meaningful to an individual and congruent with their values and goals would a change take place. For him, this meant weighing the importance of increased comfort in a dental setting against the dilemma of slowing down to create a more time-intensive habit of effective self-care. Only after identifying these two conflicting commitments could my patient decide which was more important. His enhanced effectiveness with flossing was a small price to pay when he understood that this would decrease his discomfort in the chair. This, in turn, would allow him to hold on to his natural teeth.
But how do we, as professionals, understand what is meaningful to our patients? The answer is to slow down and facilitate listening, helping our patients to articulate and clarify what they feel.
When I first began viewing patient care in this way, it was rather unsettling. It required letting go of my own agenda and learning to recognize that my patients know themselves better than I do. No longer was it acceptable to believe that I could convince them to do things my way.
Letting go of assumptions and prejudgment is an essential component of this. It has been my experience that people make positive choices when they feel heard. I have learned many wonderful lessons by listening with understanding.
My patients have given me feedback of what self-care aids work for them and what have failed. They have shared their perception of oral health and how they judge if they are successful. Many have given me valuable insight as to how they want to be cared for when spending time in a dental setting. Each time I am given the opportunity to learn from a patient, it prepares me to provide the very finest service our profession can offer — helping patients achieve oral health!
Patricia L. Flanagan, RDH, BS, is a practice facilitator and practicing clinical hygienist working with Dr. Stephen Langlois in Manchester, N.H. The practice is a health-centered, comprehensive care restorative practice. She may be contacted by e-mail at [email protected].