by Lory Laughter, RDH, BS
A professor once told our class, "You don't have to know all the answers if you can ask the right questions." Too bad that philosophy never applied to his tests, but working with patients over the years I have found his statement to be profoundly true.
Often, the first question asked at a seminar or presentation on anything new in dentistry is, "What code do you use?" My opinion on treating or diagnosing by codes is no secret – I find it restrictive and borderline unethical. At the same time, I'm a realist who knows that dentistry is a business and that patients care if their policy covers a procedure. The balance comes in knowing how to present a diagnosis and completely explain treatment options. Much of this process involves asking the right questions.
In the September issue of RDH I presented a case study on white spot reversal. The case was completed more than two years ago, but the information was unpublished until September and not even shared outside my courses. While the article was complete, there were still factors outside my control that could alter the outcome. I didn't include those variables, instead expecting the opportunity to explain my study controls in response to e-mails or letters to the editor.
I was a bit surprised to read the same question in almost every e-mail – "What is the code for that procedure?" Other than one concerned father who asked for more information on MI Paste and the safety of acid etch, the burning question in each e-mail was the billing code. There was not one question about other products the patient may be using, the protocol for follow-up care, or anything related to the science or delivery of the procedure.
While not pointing fingers at anyone, or even discounting the coding question, the experience was an eye-opener regarding how our role as health-care providers is viewed. I realize dentistry is a business and that keeping current on coding is part of the job. Like it or not, we practice in the real world of monetary concerns, yet it would be nice to create our own perfect environment.
In my ideal world of health care, each patient is diagnosed and treated based on screenings, observations, and information gathered from conversation. Dare I say it – our appointments should include talking! Imagine what we could learn from merely speaking freely with patients without worrying about time left for scraping teeth.
During conversations we can provide education about conditions the patient may not even be aware are present. Talking can lead to answers about whether or not halitosis is a concern or if bleeding gums are recognized as a problem. (How many times have you heard, "My teeth always bleed"?) These chat sessions may lead us to understand the low priority someone places on stark-white teeth, and allow us to skip that pitch in favor of discussing the person's coated tongue. Patients rarely concern themselves with codes, so the topic does not need to be discussed in the education process.
In this ideal universe, procedures are recommended based not on coverage or our perception of one's ability to pay, but rather on need. Benefits, along with risks, would be presented for every diagnosis regardless of our assumption of the patient's ability to pay. The entire health-care process would begin with asking the right questions.
Most of us assume we practice with patients' best interests in mind, and I believe we do. However, I also believe all of us who provide clinical care are guilty of making assumptions about those who entrust us with their health. We like to think we have all the answers before we really ask the questions.
If we truly value our role in health-care delivery, assumptions need to be put aside. Inform patients fully, even when it is not comfortable. Converse often and openly with all patients, regardless of the impulse to protect them from expense or discomfort. Ask questions, listen quietly, and act accordingly – that is a great recipe for health care. And there is no code for that!
Lory Laughter, RDH, BS, practices clinically in Napa, Calif. She is owner of Dental IQ, a business responsible for the Annual Napa Dental Experience. Lory combines her love for travel with speaking nationally on a variety of topics.
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