This topic was tackled in a recent online post and was of particular interest to the author. In a related situation, her elderly father, who suffered from x-ray-exposure-induced cancer for the great majority of his 91 years, regularly refused to have dental x-rays taken in the last few decades of his life. This resulted, not surprisingly, in his bouncing from dentist to dentist, each of whom either refused to treat him or provide only cursory services to varying degrees. So she was always on the lookout for information that deals with the clinical and philosophical issues relating to these types of "uncooperative" patients.
Dental practice management consultant Jan Keller stresses in the post that It?s important to understand why the patient might refuse to fill out these forms. While some of it may stem from privacy concerns, it may also come from difficulty seeing, reading, understanding, or other literacy concerns. Patients who are dyslexic, or who suffer from vision conditions like macular degeneration, may be afraid of making a mistake or being judged on their inability to complete the forms. And back to her father's case, perhaps a legitimate or perceived danger to the patient's health.
In certain situations, depending on the patient's reason for not wanting to fill out a history form, the dentist or hygienist can offer to work on the forms privately with the patient, and ask direct and leading questions to help get the needed information. This list of generally accepted questions included in the post could be a great place to get started understanding a patient?s medical history:
- When was the last time you visited your doctor, urgent care, or any other health-care provider? (This question often makes them think a little more about their last visit.)
- What medications, vitamins, or supplements are you currently taking? (If they are returning patients, review their medication list with them.)
- What is your family history of periodontal disease, diabetes, heart disease, cancer, etc. (This is helpful as a risk assessment.)
- Have you had any hospitalizations since your last visit? (Give them the exact date they last visited your practice.)
- Are you taking any new medications? Are you using any eye drops? Vitamins? Dermatology meds? Fish oil or herbal supplements?
- Are there any changes in the dosage of your medications?
- Do you have a need for antibiotics before your dental treatment?
- Is there any reason we cannot take dental x-rays today? Pregnancy? Recent medical x-rays?
Understanding why a patient would prefer not to complete forms?or submit to x-rays?and communicating the importance of that information, is crucial to providing the best possible dental care to each of your patients. Communicating the important tie between medical and dental health is something that every good dentist needs to be able to do. Add the compassion and flexibility components, and such recalcitrant patients may present an even wider opportunity for discussion and introspection.