Patients Who Balk At Medical Histories

Dear Dianne, All hygienists and doctors know the importance of the medical history. However, some patients have problems with our simple request to fill out a new medical history.

Dear Dianne,

All hygienists and doctors know the importance of the medical history. However, some patients have problems with our simple request to fill out a new medical history.

What should we do when patients either refuse to fill out a medical history or express resistance to filling out an update? It seems like it happens too often in our office.
Louise in Louisville

Dear Louise,

Great question! Many of us have had the unpleasant experience of having a patient express anger or frustration at being asked to update their medical history. Once I witnessed a patient literally draw a diagonal line through the middle of the medical history and write “NO CHANGE” in large letters, then slam the clipboard down on the counter. It appears that some people become ticked off by our seemingly simple request.

However, I don’t think people vent their frustration on us because they like to. So why do some people react so negatively when asked to fill out a medical history update form?

One reason is that our forms are intimidating and hard to understand. There was a recent article in the Illinois Dental News entitled “Uncovering the Secret Nearly 50 Percent of Your Patients May Be Keeping.” The substance of the article was that, according to the U.S. Department of Education and the National Adult Literacy Survey, almost half of the U.S. population is either functionally illiterate or only marginally literate.

According to the American Medical Association’s “Health Literature, a Manual for Clinicians,” several studies have revealed that those with limited literacy skills do not understand or are not aware of concepts basic to common diseases. Of those surveyed, 26 percent did not understand when their next appointment was scheduled, and 42 percent did not understand instructions to take medication on an empty stomach.

Functionally illiterate patients are a definite barrier to communication in the dental office. If there is, in fact, a correlation between functional illiteracy and the ability to understand simple concepts, as suggested by the AMA Health Literacy manual, then our task of communication becomes far more difficult.

Another problem related to filling out a medical history is that our society as a whole is in a hurry. Many people feel answering questions that they’ve answered in the past is simply a waste of time.

I recently was a new patient in a medical office.When I arrived, the business assistant gave me a standard registration form to fill out, but no medical history. I thought that was strange. However, when the nurse retrieved me from the reception area and took me to an exam room, she sat down and went over every question with me and filled in my answers. As we went through the process, it occurred to me why that office does it that way. They want to be certain all the questions are addressed and accurate responses are recorded. This process took all the pressure off me and gave them what they needed - an accurate and complete medical history. The whole process took approximately two to three minutes.

The ADA recommends that we do a completely new medical history every two to three years, depending on the health status of our patient. When patients have to stop and think about each question, they often remember something pertinent to their health that they might otherwise overlook.

Patients take several different prescription medications and/or dietary supplements, which can change often. My father is a good example. He received a kidney transplant in 2002, and he took approximately 11 different medications daily. Each month when he went in for his blood work, they altered one or more of his medications. It was a continuous balancing act to keep his medications regulated. Patients taking multiple medications should be asked to bring a list to their office visit so the clinician can update that portion of their history.

I observed a business assistant handle a situation with a recalcitrant patient (about filling out a new medical history form). When she asked the patient to update his medical history and the patient angrily retorted that nothing had changed, she replied, “Oh, but some of our questions have changed. Could I offer you some assistance?” This was a great way to handle the patient’s objections.

We all know the importance of thorough medical histories, and it is our responsibility to see that patient medical histories are updated whenever appropriate. It is interesting that one of the liability issues facing dentists is about prescribing medications that are contraindicated by the patient’s medical history. So, not only do we have to obtain good data, but we also have to be astute to potential problems when prescribing drugs.

On the interim visits between obtaining a completely new history, it is appropriate to ask patients if there have been any medical changes since their last visit, something patients sometimes forget.

I distinctly remember one of my patients in his mid 70s who, when asked if there had been any changes in his medical status since his last visit, replied, “Nope, Dianne, I’m fit as a fiddle!” He was a periodontal patient in for his maintenance visit. Just as I was finishing a rather bloody visit (his home care was horrible), he stated, “Yep, that little ticker they put in me has made me feel so much better!”

I felt the color drain from my face as I asked, “Excuse me, but did you say something about a ‘ticker’?” He said, “Oh yeah, I forgot to tell you that I got a pacemaker last month.” While I know that we do not routinely premedicate for pacemakers, it had only been four weeks since his procedure. So I excused myself and immediately called his physician. The doctor recommended that we give him some penicillin right there. Everything turned out fine, but the point is, even when we follow the correct protocol, sometimes patients forget.

It would be good for us to take a lesson from some of our medical colleagues and go through the medical history with our patients, rather than shoving a clipboard containing an ominous looking form with a lot of big words and medical jargon at them. We can also take it as an opportunity (by our actions) to express how important this part of the visit is to the patient’s total health. After all, with the emphasis on oral health/systemic health relationships, this is one way we can “walk the walk and talk the talk.” By personalizing the medical history gathering experience, we take the pressure off our patients, and we become better assured that we have gathered accurate and thorough data. Further, we’ve removed a frustration and turned a negative experience into a positive one, which is a win-win for everyone.
Best wishes,
Dianne

About the Author

Dianne D. Glasscoe, RDH, BS, is a professional speaker, writer, and consultant to dental practices across the United States. She is CEO of Professional Dental Management, based in Frederick, Md. To contact Glasscoe for speaking or consulting, call (301) 874-5240 or e-mail dglasscoe@northstate.net. Visit her Web site at www.professionaldentalmgmt.com.

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