Approximately 40 million adults in the United States over the age of 18 years old experience some kind of anxiety disorder, according to the Anxiety and Depression Association of America.
I’ve done theater my whole life. From the shows my sisters and I put on in the living room every night to consistently performing in high school, college and (once!) in dental school, I’ve loved being on stage, in rehearsals and behind the scenes of a performance.
If you’ve experienced clinic, I suspect you have had at least one difficult conversation with a patient. Having these types of talks is one of the hardest parts of our jobs and can occur every day. As dental professionals, it is our duty to report the facts about our patient’s oral health to them. Once the patient is informed, they are tasked with making a decision about the course of treatment. How can we make these conversations easier for ourselves and our patients?
After I graduated in India with a Bachelor in Dental Surgery (BDS) degree, I got the opportunity to come to the United States. As I prepared my application for international dentist programs at U.S. dental schools, I shadowed and volunteered at dental offices and community dental clinics. Soon, I started working part-time as a dental assistant and eventually received my Certified Dental Assistant (CDA) certification and Registered Dental Assistant (RDA) license in California and started to work full-time.
In an American Dental Association survey, 69 percent of people said they were more likely to choose an ADA member the next time they were looking for a dentist because of the patient-first promise ADA members make as a part of the Association’s code of ethics.
The ADA has created short videos that present and answer ethical situations a dentist may face in his or her practice.
Does the thought of treating a patient with an intellectual disability make you nervous? Health care providers are often intimidated by the idea that they may not know how to properly coordinate the patient’s care, communicate with him or her, or even manage behavior during the visit. Take a deep breath and look at it from the other side–your patient is just as nervous about you! Dental anxiety is common among many of our patients, and this fear can be magnified in someone with a cognitive delay who is coming to your office for treatments that they may not fully understand. Treating these patients may be a challenge, but it also might become one of the most rewarding patient visits you will ever encounter. Try some of these practical tips to facilitate smooth and enjoyable visit for you and your patient.
- Practice active listening. Patients with developmental delays may have difficulty with speech and communicating clearly. But, you might be surprised to find that they can understand much more than they can convey. Stopping your work for a minute and listening intently shows that you care about what they have to say. Your patients may use verbal language, nonverbal language, or a combination of both along with gestures. Be perceptive and sensitive to their efforts to show you are doing your best to understand. This small act of kindness can make the biggest difference in how well the appointment goes. After all, everyone wants to feel heard and understood.
- Prioritize clear communication. It’s respectful to talk to your patients directly with eye contact, even when the parent or caregiver is in the room. Make sure to use simple instructions and repeat them often during the appointment. You may need to take extra time, speaking slowly and clearly, to demonstrate what your instruments are prior to using them. Be patient and give one direction at a time, using clear and simple language. Show your patients what you want them to do and remember to encourage them with generous, earnest compliments.
- Set appointments early in the day. Do this when possible to keep the patient fresh. It is also recommended to keep appointments short, even if it means scheduling multiple appointments. Doing so can efficiently engage a patient with a cognitive impairment and limited attention span, while avoiding fatiguing him or her.
- Keep your team well-acquainted with the patient. Allow patients to take the time to get to know you and your staff so that they feel fully comfortable with their surroundings, especially before you try a difficult procedure. Before each appointment, inform all members of the dental team about your patient. When he or she arrives, ensure that each member of the team helps greet the patient and makes him or her feel welcome and special. Consider even giving patients and their family members a small tour of the office before you begin.
- Get the family involved. A patient with developmental delays is often more comfortable if you can incorporate family members into his or her first visit. Showing the patient around the office also gives you an opportunity to explain what all the new sights and sounds are and more importantly, reassure the patient that there is nothing to fear. Consider allowing a parent to stay during the appointment to hold the patient’s hand and talk to him or her. Some patients may even respond well to a friendly staff member holding their hand. Asking a family member to bring in the patient’s favorite stuffed animal or blanket can add an extra sense of comfort and familiarity.
- Be mindful of your light. Patients with an intellectual disability are often also sensitive to light. Try to avoid inadvertently shining the light directly into their eyes, especially as you work with loupes on. You can also try using only your loupe lights and forgo the use of the additional overhead light. The patient may also benefit from the comfort of wearing sunglasses during the appointment.
By taking the time to get to know each patient and his or her individual needs, you will find your unease quickly replaced by eagerness each time you see the patient’s name listed on your schedule. Take each challenge as a new opportunity to learn and enjoy the process!
~ Jamie Udell, Utah ’18, chapter newsletter chair
The start of my third year of dental school also marked the start of our transition into clinic. My first rotation was in Emergency Care and despite the fact that I had no previous experience seeing patients up until that point, I felt confident. Assisting and observing my classmates in preparation for my rotation only confirmed this self-assurance. All I had to do was take the patient’s medical history and perhaps arrange for an oral surgery consult. It all seemed simple enough.
Seeing your first patient, especially as an emergency case, is an exciting milestone that can quickly turn into an emotional and stressful experience.