Creative anticipation

July 1, 2002
Building scenarios into treatment plans can be fun - especially since the new climate in health care is to address the whole patient. It can make a lackluster job a little more exciting ... for the right reasons.

Building scenarios into treatment plans can be fun - especially since the new climate in health care is to address the whole patient. It can make a lackluster job a little more exciting ... for the right reasons. All professional curricula should require a class on "creative anticipation." Below are several examples where professionals turned their brains on auto-pilot, rather than looking at the larger picture to prepare for possible mishaps.

A pharmacist accepts two prescriptions for a single patient. One prescription is for a suspension of liquid xylocaine and the other is an antibiotic. At the pick-up window she hands over a bottle of a nasty-tasting topical anesthetic with a sig. for "swish and swallow" and a bottle of pills that are nearly an inch long. It should be obvious to the professional that a topical anesthetic for oral use indicates that the patient has pain of the oral mucosa and throat. She should be attentive enough to realize that someone in enough pain to require the xylocaine would have enormous difficulty swallowing a large pill - and substitute the liquid form.

A travel agent is arranging for a frail octogenarian couple to fly to Las Vegas. Their usual mode of travel is by train. This is the first flight for both of them. The agent offers a direct flight, and one that requires two layovers. One of the layovers is only 30 minutes. Not surprising, the flight with the layovers is $50 cheaper than the direct flight. They choose the lower-priced fare and miss the first connecting flight. This event traumatizes them as well as their daughter, who is 800 miles away.

During a routine dental hygiene visit, the hygienist finds out her patient is in two basketball leagues and plays softball. The hygienist encourages the patient to wear a properly fitted athletic mouthguard for all competitive sports, as well as any activity that requires some kind of sporting equipment. She explains that a properly fitted mouthguard will protect against concussion, not just tooth breakage. The doctor finishes his exam, and directs the patient to the local sporting goods store to get a boil-and-bite-type of mouthguard.

A homebound man cries out in pain. He has been bedridden for the last couple of years with multiple sclerosis; death is imminent. Today, he is suffering from tooth pain. The family finds a dentist who makes house calls and he is summoned to the scene. The diagnosis: decay and abscess in one of the last 10 remaining teeth. A prescription is written for antibiotics. A treatment plan is developed: root canal therapy, a crown for the bad tooth, a new bridge to replace teeth on the mandibular left, and a new upper partial to replace the missing teeth. The family is heartbroken; they want their relative to be comfortable, but at what cost?

None of these professionals looked very professional. Had they taken the time to put the pieces together and realized that the picture did not add up, they would have been forced to ask questions of themselves or the other primary players. Maybe it isn't even mind reading or creative anticipation. Maybe it is just plain old professionalism.

In the first example, the pharmacist was not putting two and two together. The transaction ended with a sharp word from a mother already at wits' end with a child who was suffering from cancer. What a positive impact that professional could have made by anticipating the upcoming swallowing problem. The travel agent in the second example assumed too much of the frail elderly couple in front of her, even though they felt they were saving money by not taking a direct flight. The dentist in the third scenario had a pat answer that, in his mind, made him look as if he cared about his patient's financial well-being. The last was an example of a dentist that appeared money-hungry, while he thought himself compassionate.

I like the term "creative anticipation." If we practice it all the time, we'll appear smarter to our patients, and we'll learn to expect the same kind of thinking from other professionals. We will learn to respect it in them.

Shirley Gutkowski, RDH, BSDH, has been a full time practicing dental hygienist in Madison, Wis., since 1986. Ms. Gutkowski is published in print and on Internet sites, and speaks to groups through Cross Links Presentations. She can be contacted at [email protected].