Written by Janice B. Cary, RDH Tuesday, 31 December 2002 19:00
One of the best parts of being a hygienist in a dental practice is the opportunity to meet and relate to individuals in all age groups and from all walks of life. Urban practices in high-rise buildings have a different style and patient population from solo practices in the suburbs or in rural areas, but they all have one goal in common: excellent patient care. The responsibility for that care transcends the obvious and routine dental hygiene scraping, polishing, and examining. In a profession where trust is earned and personal care is expected, hygienists are held to professional standards of care, but have an even greater responsibility to understand what impact they have on the total health of their patients.
THE NEED FOR MEDICAL HISTORY REVIEWS AND UPDATES
Evaluation of the information contained within the medical history is cursory in many practices. While the information has ramifications for the well-being and health of the patient, and in some cases may impact the safety of the staff, too often the review is regarded as “just one more thing to be completed during the appointment.” The pressure to follow procedures, set the room up, build communication links with the patients, probe for pockets, scale, polish, take x-rays, complete the examination, and break the room down as OSHA suggests leaves little time to actually probe into medical health issues that might be indicated by the information on the form.
MEDICAL HEALTH ISSUES: DRUG THERAPIES
Professional standards would indicate that a complete review of the patient’s medical history needs to be accomplished, changes noted in the chart, and attention paid to specific items that can impact treatment needs. As a simple example, patients taking aspirin, coumadin, ginko biloba, ginsing, garlic, or a newer drug called Plavix should be aware that bleeding issues abound, and the physician should have input prior to the appointment. Is it a standard of care for you to understand the implications, or is it a personal responsibility?
HERBAL AND ALTERNATIVE THERAPIES
Many patients and dental professionals are not aware that herbal therapy may have implications and contraindications with regard to dental and medical treatment. Probing for this information is important. For instance, patients taking echinacea at the first sign of a cold may be unaware that the herb works by stimulating the body’s immune system used to fight off viruses. According to the Nutrition Action Healthletter, March 2002, taking the herb as a preventive measure doesn’t seem to work. Patients should know that allergies to ragweed, daisies, and asters may indicate an allergy to echinacea, a plant from the same family, and patients who suffer from autoimmune diseases such as lupus or rheumatoid arthritis may suffer a flare-up if the immune system is stimulated.
THE IMPACT OF GOVERNMENTAL REGULATIONS
As professionals, we are well aware that the impact of OSHA and blood-borne pathogen/infection control standards has been massive. Changes were instituted immediately, and sterilization processes changed the way instruments and procedures were performed. Compliance dictated that disposable equipment was developed, that personal protective equipment was made available for personnel, and that anything that could be disinfected and/or sterilized was appropriately treated. This included bags, wraps, and autoclaves that would not damage instruments and/or handpieces, and disinfectant solutions that were sprayed, wiped, and shot through hoses. Many practitioners thought it was overdone, and in some cases perhaps it has had that effect.
STAFFING AND FACILITY DESIGN
With regard to staffing, professional practices have long understood that information about patients should not be shared outside the office. HIPAA is now making it clear that information should only be shared when necessary within the practice, and that patient conversations should be private and privately held for anything more than routine discussions.
YOUR DIRECT ACCESS TO PATIENTS IS IMPORTANT
Hygienists have more direct access to their patients on a routine basis than anyone else in the practice. Children gain confidence and learn trust through care given by the same provider at each visit. Subtle changes in a patient’s overall health can be noted and followed in twice-yearly intervals. It is a responsibility of staff members in your office to be aware of changes taking place and the possibility that heathcare is suffering. It is precisely through the trust built over time that children, adolescents, and adults share joyful and sometimes painful information with you. As an “outsider,” patients sense your objective caring and may lean on you for support when others turn inward. As a professional clinician, you have been trained for the former—as a person you may need to learn the latter.
Please sit back for a minute and wonder at the level of responsibility you share for your patients’ total well-being. Beware of just “going through the motions.” Do not take this responsibility lightly. It is a reflection of the confidence your patients have in you as a professional and as a person they trust. All those years of training, school, practice labs, and clinic never prepared you for the one time you may be the person who truly makes a difference in a patient’s life.
- Spolarich AE. The ten most prescribed medications for 2001. Access. 2002; July.
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