Overcoming resistance

July 1, 2009
We all have a set of standards that lead us to ideal treatment protocol. Unfortunately, most of us also face daily barriers in executing the protocols we believe are most appropriate.

by Lory Laughter, RDH, BS
[email protected]

We all have a set of standards that lead us to ideal treatment protocol. Unfortunately, most of us also face daily barriers in executing the protocols we believe are most appropriate. Resistance comes in the form of time constraints, employers, patients, and even development and refinement of our own skills.

In a fantasy practice, we would have all the time we need with every patient who walks through our door. Reality is a schedule based on units of time. Even if each of us has a say in how much time is devoted to a certain procedure or patient based on diagnosis, it is still a finite setting. Some days we simply run out of time.

Lack of time is often an easy barrier to overcome. Having the patient back for another appointment is my remedy of choice. While I can see your collective eyes rolling, there are ways to encourage patients to return. Early in my career, I asked them to return for education or a hygiene check. As expected, my acceptance rate was low.

Now I make time for education and instructions at the beginning of each appointment, so if a patient needs to come back it is because more treatment needs to be provided. Telling Mr. Jones he needs to return because you only removed the left half of the lower anterior calculus bridge works much better than asking him to return to evaluate his home care efforts. (He can feel the remaining ledge of calculus.)

If your situation or employer does not facilitate additional visits to complete treatment, suggesting a shorter recall schedule is an option. If you explain why more frequent preventive care is necessary before the patient hears that insurance will not cover it, acceptance is higher. It is wise to answer “Will my insurance cover this?” before you are asked.

In fact, deal with many employer/coworker barriers by keeping one important Beth Thompson (RDH, dental consultant) tidbit in mind: “It is sometimes easier to ask for forgiveness than for permission.” Do what you know is right and deal with any fallout as it comes. This also gives you an opportunity to explain your philosophy and protocol again. I have never worked with a dentist employer who did not eventually develop an appreciation for my progressive attitude.

Dr. Gerald Fraser, a general dentist here in Napa, shared these thoughts on why dental professionals do not always provide optimal treatment. His theory centers on the belief that 95% of dental professionals are compassionate and ethical. A bond of trust develops between practitioner and patient, and this gives the dental professional a certain amount of power and persuasive abilities. Patients listen to a trusted professional.

Ethical dental professionals, in Dr. Fraser’s opinion, do not take advantage of this bond with a patient. We know in these relationships patients will agree to all treatment recommendations. He believes that fear sometimes holds us back from offering more aggressive options — fear of abusing another’s trust. Therefore, instead of recommending a crown on the tooth with multiple hairline fractures, the dentist may instruct the patient to call at the first sign of symptoms. Not a wrong approach, but also not a preventive approach.

In my opinion, the biggest barrier to providing ideal care is our legal and ethical responsibility to informed consent. The patient must be informed of all recommended treatments and alternatives. Unfortunately, in every case there is the alternative to refuse treatment. It is the patient’s right to know and our obligation to inform — no treatment is an alternative.

I understand the frustrations of those who wrote to me with stories and situations that prevented optimal care for every patient. I wish there were a simple solution. Ethical practitioners will always face the reality of limitations.

About the Author

Lory Laughter, RDH, BS, divides her full-time clinical practice between general and periodontics practice in Napa and Sonoma, Calif. She is co-owner of Dental IQ, a continuing education provider (www.dentaliq.net).