by Eileen Morrissey, RDH, MS
Jennifer Warner-Brook, RDH, is a teaching colleague and a friend. She shared a story with me a few weeks ago that contains a message important enough for this column.
Jen is employed full time in a private practice in southern New Jersey. Recently, a middle-age female patient arrived for a recare visit, and presented her with a dozen roses. She told Jen, "Thank you for saving my daughter's life!"
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Apparently, this patient's daughter (Mrs. X) had come in for her maintenance visit over the past year. She had recently had a baby. During the preliminary portion of the assessment, no red flags had presented. After Jen had finished scaling and was reviewing the radiographs, the patient had turned to look at the monitor. It was at that point that Jen noticed fullness on the left side of her patient's neck, adjacent to the thyroid. Not being sure, she had her turn once again and palpated the area. She asked Mrs. X if she had ever been told her thyroid was enlarged?
The patient stated that her gynecologist had indeed told her the thyroid was enlarged, but that it was nothing to be alarmed about and that it would "go away once she gave birth." Jen asked Mrs. X if she was planning on seeing the doctor again soon, and her response was that she had been in for her last checkup and was released. No mention had been made about her thyroid, nor did she remember her gynecologist rechecking the area. Jen asked her doctor to come back in to confirm that there was an abnormality. He said he was not positive but told her that she should have it checked. After her doctor left, Jen felt it was important to reiterate that message.
Jen called Mrs. X two days later and asked if she had followed through with the doctor; the response was that she had an appointment the next week. Jen followed up several times in the weeks to come but heard nothing back.
Fast forward to spring and the recall "Rose-Day" visit with Mrs. X's mother, who explained that when her daughter was evaluated two masses were found in her neck. One was on the thyroid; the other adjacent to it. She had both masses removed, as well as half of her thyroid gland. Apparently, the biopsy revealed that had these been left untreated, it would have been a type of cancer that metastasized quickly. Because it was caught early, no chemotherapy or radiation was necessary.
"Thank you for doing your job fully and thoroughly, and I am forever in your debt!" was the sentiment expressed to a now choked up and tearful Jen.
I asked Jen if she had provided a complete oral cancer screening, and she responded that it is always her protocol. Yet, she had detected nothing suspicious during that phase of the assessment, and it was not until her patient had turned at an extreme angle, that she noticed the fullness in her neck.
(It wouldn't be the first time I go through my oral cancer screening, detect nothing, and something leaps out at me as I'm working in the mouth). So, I see multiple messages here. Sometimes we simply do not see deviations as we go through our routines. Remaining observant, and taking notice after the fact warrants huge kudos to all of us who discern something later, then follow up (like Jen did) with a line of questioning, follow up with bringing our doctors back in to check, follow up further with reinforcement of a recommendation, and, finally, follow up with phone calls to the patient. This is caring, service-oriented, 5-star dental hygiene treatment!
I so applaud her! When a patient gets a clean bill of health from a medical doctor, there is a tendency to accept that as the final word. Jen knew that this young woman was busy with a new baby and might not make checking up on a high priority. That, coupled with the ongoing follow up is exemplary. Jen's patients are so fortunate to have her as their hygienist!
Hearing this story has me wondering about the following challenge: How many of you who are clinical dental hygienists have experienced a situation where you detected an abnormality on a patient, brought your doctor in, and he/she felt it was not worthy of follow up? What if you did not agree? How did you, or how would you handle such a dilemma? I remember posing this question to a group of hygienists and doctors at a seminar I presented. One senior doctor raised his hand and said, "The doctor's word is the final word. That is why we went to dental school. It is our responsibility and our liability." Write me at [email protected] as this is potentially another important column.
Onward we go; it is in our hearts' core. RDH
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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