Asking the right questions

Through the years, I've seen patients' complaints dismissed as not important or even as nonexistent, simply because a patient's explanation did not fit a clinician's understanding or definition of dental disease or discomfort.

by Anne Nugent Guignon, RDH, MPH
anne@anneguignon.com

Through the years, I've seen patients' complaints dismissed as not important or even as nonexistent, simply because a patient's explanation did not fit a clinician's understanding or definition of dental disease or discomfort. From the lofty perch of the professional pedestal, it impossible to see, hear, or understand everything every patient is saying or feeling. To further compound the confusion, it is possible that patients can describe or experience phenomena that we don't truly understand, have never seen, or don't know about.

Bottom line, we need to believe our patients. If they say they are in pain or something is uncomfortable, then we need to trust what they are telling us.

While there may be rare occasions when patients report a problem that is not biologically based, I believe the vast majority of patient concerns are legitimate, even if the cause is not readily apparent. There can't be that many hypochondriacs in the world. What person in their right mind would make up a story just to keep the attention of a dental professional?

Sometimes patients cannot articulate what they are feeling. Some find it hard, if not impossible, to describe discomfort during a dental procedure or how their teeth or gums really feel. Frustrated patients perceive us as bad guys who create pain, or as dumb bunnies who don't understand why their mouth is hurting. This inability to communicate effectively creates enormous challenges for every clinical practitioner. We try to ask the right questions and patients try to give us accurate information but often the gap in the communication process is wider than the Grand Canyon. Both parties get discouraged and nothing gets resolved.

Thirty years ago, I treated a young woman named Marie whose teeth appeared to be melting away. The exposed dentin got thinner and thinner and more and more sensitive. Erosion and dentinal hypersensitivity were not hot topics and many patients accepted the inevitability of pain and tooth loss.

Marie's case was baffling. I asked if she was drinking sodas, eating citrus, or vomiting. She denied everything.

Finally I asked one simple question, what she was doing? The answer was crystal clear. Marie had given birth to twins eighteen months earlier. She was obsessed with losing the weight she had gained during the pregnancy. In desperation, she ate a plate full of freshly sliced cucumbers doused with salt and vinegar for lunch every day and then drank the remaining vinegar. Her melting teeth were getting an acid bath every day.

This experience with changed the way I practiced. It taught me to ask more questions, specifically; just what was someone doing, rather than asking a stock list of questions related to behavior or symptoms.

When Jillian complained of sensitive teeth her during her three-month visit, I asked the usual questions about dietary intake and oral hygiene. Neither of us could come up with a reasonable explanation for the sudden onset of dentinal hypersensitivity. At the end of the appointment, I suggested that some behavior had changed over the last 90 days. I asked her to call me as soon as she discovered the culprit. Two and a half hours later, Jillian called the office.

Again, the answer came out of left field.

Jillian started out every day taking an hour-long aerobics class. To keep her mouth moist she chewed gum while exercising, but when she started having a sore TMJ she switched to sugar-free lemon drops, which were full of citric acid. So another patient's oral cavity getting a daily acid bath! She quit using the lozenges, started using daily fluoride, and the problem quickly resolved.

I've applied the same type of communication principles with patients over the years. It's critical that we believe our patient's stories. Asking them to become analytic co-partners adds a dimension of information gathering than can provide rich clues that can pinpoint the problem.

Step out of your comfort zone, learn to ask questions from a different point of view, and watch your patients become more accountable for their own health and willing partners in the success of their own treatment.

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