by Eileen Morrissey, RDH, MS
This column is dedicated to Rona, a beloved aunt who died last week from lung cancer. And also for all those who are unable to quit a lifelong habit that can lead to their demise. A timely message as we start the New Year…
I so admire the contemporary dental hygienists of today, as well as those we are currently training in dental hygiene programs. I am a faculty member at Burlington County College in New Jersey. The students learn early on the impact that smoking has on the patient's oral cavity as well as his or her entire state of health and well-being. It is the hygienists' responsibility to have patients complete risk assessment forms and to follow up accordingly with educational, supportive dialogue. This is a simple fact-finding mission -- an assessment of a patient's risk with regard to periodontal disease, caries, and oral cancer.
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The student hygienists learn this, they own it, and they consistently follow up on the responses and corresponding risk in the client histories. I emphasize this with sincere admiration, as I come from a generation of practitioners who as a whole don't score so well in this department. (I apologize to those I am offending if you are one of the more responsible.) Me? I have quite a few clients who smoke, and I have a really difficult time raising the importance of their kicking the habit.
For example: Mr. Patient, aged 53, has had bypass surgery in the past year and is sitting in my treatment room for his recare visit. Old habits die hard, and he has found his way back to smoking one pack of cigarettes a day. Is it the moment of truth -- my time to gently speak to Mr. Patient about how he resumed his habit, and to inquire if he is thinking about trying to remove it from his life once and for all? Readers, I have such a tough time with this task.
Mr. Patient has already heard this from his physician and his cardiologist. He knows that what he is doing is just simply bad for every aspect of his health. So what would my reiterating all of this accomplish? It makes him feel worse, and it puts a barrier between us, despite my "I really care" sentiments. So unless he or any other patient brings it up, I often don't go there. If I do, I keep it very low-key. I have subscribed to the lifelong thought process that Mr. Patient doesn't want to hear it. My employer agrees with me. Hint: I am not saying you should choose us as your role models, because Mr. Patient probably needs to hear it!
My senior dental hygiene students would tell me that my doctor and myself are wrong for not speaking up. They are indoctrinated from the beginning that we are not doing our jobs as dental health-care providers if we do not raise the issue.
That message is reiterated at every recall visit. And sometimes, just sometimes, it makes a difference, and clients decide to walk away from their addiction. I remember one student hygienist who was so concerned about her patient's habit that she created a personalized PowerPoint for him to be shown at chairside. It inspired him and he quit!
Yet listen to this rebuttal from a 26-year-old smoker patient who sat in my chair yesterday that illustrates the flip side to the discussion: I interviewed him for this column, and he told me that if the smoking issue were raised at every recare appointment, he would stop coming, and he knows other smokers who feel the same way. In summary: "I know I shouldn't smoke, Eileen. I don't need to hear it over and over from any of you!"
I still applaud this generation of dental hygienists. While I sit idly by presuming an attitude of "It is his body, his decision, and when and if he is ready, he will reach out," the current RDH generation stands firm with regard to bringing the topic up consistently, and is armed with resources courtesy of the ADHA Smoking Cessation Campaign. Are you familiar with this campaign? We all should be. Visit the ADHA website. Today's students are knowledgeable and primed to talk about various strategies.
A word to the wise for those of you who tend to practice as I do: It has been hypothesized in behavior modification strategies that a hygienist's failure to address any health-care concerns may frequently be perceived as disinterest on the part of the practitioner. That's right! While we were busy staying out of their faces, they processed it as us not caring. Would it not be better to say: "I see you are smoking. If you are thinking about quitting, please know I am here with strategies when you are ready. No lectures, I promise." I think I can buy into this philosophy of care.
It's all worth analyzing our approaches to patients. Onward we go; it is in our hearts' core.
EILEEN MORRISSEY, RDH, MS, is a practicing clinician, speaker, and writer. She is an adjunct dental hygiene faculty member at Burlington County College. Eileen offers CE forums to doctors, hygienists, and their teams. Reach her at [email protected] or 609-259-8008. Visit her website at www.eileenmorrissey.com.
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