Basic Rule 6: Consult, Consult, Consult
When we first started examining patients in dental school one of the first items to be filled out on the examination form was the section titled “chief complaint”. It seemed like a silly item at the time especially since we were going to do all the treatment anyway, were we not? Well, needless to say as time has passed I have, just as you have no doubt, come to learn that this is probably the most important item to explore and answer when we first meet our new client. Actually, we now refer to this not as the chief complaint but as the chief concern. This, along with knowing why the new patient left their previous oral care provider, must be identified before we proceed.
A patient’s chief concern will become the chief complaint if we do not address it first.
Another important point to be made before I discuss Basic Rule 6 is the 5 stages of convalescence. The 5 stages are as follows:
1. why me?
We all go through these different stages at different rates when we are faced with a difficult challenge.1 For example, if we are advised that we have a terminal illness some of us will go straight to stage 5 and apply professional advise accordingly, whereas some might go to stage 4 and seek alternative, non proven remedies.2 On the other hand, some of us might get stuck in stage 2 and find blame for our condition. Most of us go through these stages in our routine daily lives as well. A good example of this is a leaky roof. How many of us call the roofing company when that first drop of water on the kitchen floor is noted and order a new roof on the spot. Not many I would guess. Over the years I have had my share of roofing problems and I can assure you that I did a whole lot of bargaining (patching). This brings me to my point. We all have a practice full of patients that are usually mulling in one of the stages, usually bargaining. Such questions as “do I really need this?” or statements such as “I’ll wait until it breaks” concerning obvious necessary major restorative treatment are down right frustrating for the conscientious practitioner. Nevertheless, patience is a virtue and must be employed when dealing with patients especially when it comes to consideration of complete oral rehabilitation.3 We must help our patients go through the 5 stages at their own pace and offer appropriate support so that they can make the best choice for themselves. Patients that choose the treatment plan that is right for them are more likely to be satisfied with the final result. In a paper by Fitzpatrick it was concluded that completely edentulous patients were satisfied with their prosthetic outcome with or without implant support if they choose the prosthesis design.4 Getting to know our patients is thus of critical importance and working as a team with them to help them to decide what path they will take on their dental journey is prudent to say the least.5 This brings us to Basic Rule 6: Consult, Consult, Consult.
I don’t know about you but I find that the more time I spend consulting with a new or existing patient the less problems I have.6,7 This is because the patients are making the decisions, not us.8 Provided that the decided course of treatment does not compromise our core values then all we become in caring out the treatment is the operators. If there are any snags long the way the patient is working with us to move forward once again as quickly as possible. The pressure is off and dentistry remains fun. We just have to make sure that we do the job right by following all the Basic Rules.
I consult as often as the patient wants. I keep the consultation visits to under an hour. Usually all that is required is just one consult appointment. It’s probably because I have set in my mind that I am not in any hurry that it only takes one consultation. Having stated this, occasionally I might see the patient three or four times. It doesn’t matter since once the treatment has been decided upon and commenced we will more than make up our production costs. I also try to listen as actively and intently as possible. When Dr. Bill Dorfman was asked the following question in an interview (dentaltown.com, August 2005): “When a dentist … performs a bad makeover, where do you find they go wrong most often?” he responded: “I think that most often the dentists don’t listen to what their patients want …”. I agree. Please do not forget that with each consultation we also thoroughly document what transpired.
Finding out the patient’s major concern, facilitating the decision making process, and being patient as our client moves toward acceptance of their oral rehabilitation needs and plan harmonizes and optimizes the treatment journey. This is done by consulting. Consult, Consult, Consult. It will be the best time ever spent in our offices, guaranteed!
Further Suggested Reading and References:
1. Jensen BO, Petersson K. The illness experiences of patients after a first time myocardial infarction. Patient Educ Couns. 2003;51:123-31.
2. Stoller EP, Gilbert GH, Pyle MA, Duncan RP. Coping with tooth pain: a qualitative study of lay management strategies and professional consultation. Spec Care Dentist 2001;21:208-15.
3. White BA, Maupome G. Making clinical decisions for dental care: concepts to consider. Spec Care Dentist. 2003;23:168-72.
4. Fitzpatrick B. Standard of care for the edentulous mandible: a systematic review. J Prosthet Dent 2006;95:71-8.
5. Holman AR, Brumer S, Ware WH, Pasta DJ. The impact of interpersonal support on patient satisfaction with orthognathic surgery. Oral Maxillofac Surg 1995;53:1289-97.
6. Schouten BC, Eijkman MA, Hoogstraten J. Dentists' and patients' communicative behaviour and their satisfaction with the dental encounter. Community Dent Health 2003;20:11-5.
7. Schouten BC, Hoogstraten J, Eijkman MA. Patient participation during dental consultations: the influence of patients' characteristics and dentists' behavior. Community Dent Oral Epidemiol 2003;31:368-77.
8. Bailey LJ, Haltiwanger LH, Blakey GH, Proffit WR. Who seeks surgical-orthodontic treatment: a current review. Int J Adult Orthodon Orthognath Surg. 2001;16:280-92.