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The challenge of communicating at your patient’s level of health literacy is serious business. Your missteps risk post-treatment complications, poor at-home care, and in extreme instances medical emergencies and lawsuits. In this second installment of a two-part series, the health literacy of the dental patient is examined.
Health literacy is greater than just the ability to read and understand English. It includes the patient’s understanding of healthcare terms that you and your staff toss about like popcorn at the multiplex, as well as their application to the patient’s own healthcare in office and at home.
The U.S. Public Health Service includes health literacy as one objective for its national program: Healthy People 2020. The program also recommends four steps to help dentists communicate effectively with all patients:
G: Give easy-to-understand instructions, verbally and in writing.O: Offer to help fill out forms always, especially when people mention they “forgot their reading glasses.”A: Ask the patient to tell you their plans for following your advice, to assess how well they understand it.L:Listen to patients’ answers carefully when asked to explain what they know about causes and progression of their dental condition, which treatment works, what treatment they think they need, and which dental problems will mean they need to call back to make a dental appointment.
G: Give easy-to-understand instructions, verbally and in writing.
O: Offer to help fill out forms always, especially when people mention they “forgot their reading glasses.”
A: Ask the patient to tell you their plans for following your advice, to assess how well they understand it.
L:Listen to patients’ answers carefully when asked to explain what they know about causes and progression of their dental condition, which treatment works, what treatment they think they need, and which dental problems will mean they need to call back to make a dental appointment.
Naperville dentist Joseph Haselhorst, a Northwestern University Dental School instructor for 17 years, has countless examples of how a patient’s lack of understanding got in the way of proper treatment. “Often we are left providing less than optimal treatment because the patient has misconceptions about physiologic/biologic/microbiologic/engineering components of their dental problem or misinformation about available solutions,” he said.
Dr. Haselhorst described an older male patient who needs teeth removed, but refuses: “He says he just wants them ‘patched.’ It is hard to get him to tell me exactly what his objections are, but he seems to be under the impression that having parts of your own teeth in your mouth are better than a replacement — no matter how often I tell him that these teeth are really a source of infection at this point. He also convinces himself that he will tackle the problems before they get too big, but does not follow through. I think he has been a patient for maybe 10 years, with lapses of several years at a time.
“I just make sure he tells me he understands what I am saying, and keep telling myself that some dental care is better than no dental care and he will eventually see that his approach is not working. He says he understands and is very appreciative, but it is mind-boggling.”
Are some dental patients distracted from what the dentist is saying due to nerves or embarrassment?
Said Dr. Haselhorst: “Some undefined fear probably influences my patient’s decisions. I had given him a written treatment plan at this visit and also several years ago. I don't think [his resistance] was financial, because he elected to spend money restoring the teeth even though I told him it may only last six months. It was very frustrating. But I thought it might give him some time to accept what needs to be done. We will see, but I am not very optimistic.”
By testing tools, including the Rapid Estimate of Adult Literacy in Medicine and Dentistry (REALM-D) and Geriatric Oral Health Index (GOHI), Kathryn Atchison is amassing data in support of assessment. She’s a professor of dentistry in the Department of Public Health and Community Dentistry at the UCLA School of Dentistry.
She noted that both language and culture can be barriers to communicating treatment needs to certain patients.
In Boston’s Chinatown at a health center, she remembers suggesting to a young Asian woman with pregnancy gingivitis “eat dairy” for getting foods with calcium and vitamins. The translator refused to tell the patient to eat dairy products.
“In their culture it is wrong to take dairy when pregnant because they think it might hurt the baby! I said ‘dairy’ because I came from Wisconsin. Luckily, the translator told me I would lose credibility if this advice was translated. Instead, I said ‘eat kale and broccoli for calcium.’”
A tradition of working for the dental profession. The Chicago Dental Society was organized in 1864 and incorporated in 1878. The objective of the Chicago Dental Society is to encourage the improvement of the health of the public, to promote the art and science of dentistry and to represent the intrest of the members of the profession and the public that it serves.
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