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BY JANYCE HAMILTON
Visiting three orthodontists recently, I was given three completely different treatment approaches. With only minor esthetic correction needed, each of the three may have been a valid approach. Unfortunately, none of the doctors discussed other options.
Confused and not knowing what questions to ask, I was left no choice but to continue pursuing additional opinions.
“Twenty years ago when I was a full-time private practice orthodontist, people wanted to be told what to do by their doctor. Today, it’s different. People like to get options,” said Charles Thornton, DMD, MS. Dr. Thornton, a clinical associate professor of orthodontics at the Southern Illinois University School of Dentistry and an adjunct clinical associate professor of orthodontics at St. Louis University, remembers when patients didn’t expect detailed treatment conversations.
Dr. Thornton says that while the best approach is to give patients treatment options versus the singular treatment plan, do not feel the need to act as if all treatments are equal. “Most people want the answer to the question ‘What would you do if you were me, doc?’” he said.
Of course, in a busy practic, how much time can you give a patient to thoroughly discuss options?
Sheela Raja, a health psychologist and assistant professor in the Department of Pediatric Dentistry at the University of Illinois at Chicago, teaches communication and behavioral medicine. For UIC dental students, this means they learn how to talk to patients.
“They appreciate learning how to work with anxious patients and those who may be in pain,” she said.
Here are Dr. Raja’s steps to communicating treatment plans with patients:
Simple word choices, short paragraphs. Do not use dental terminology unless it is a patient well-versed in the lingo. Do not provide a detailed analysis; instead, give a broad overview of a treatment.
Always provide at least two treatment plans. Several different ways to treat the issue — including doing nothing — is advised, along with the prognosis for each, according to Dr. Raja. Talk about the pros and cons, the cost and the longevity of each.
Tell them what you would do if this were your situation. Patients appreciate knowing your preference as a doctor if you were “in their shoes.” But remember that you are not in their shoes, and there are factors influencing their decisions (such as fear and cost) that patients will not share.
Pause after each option and ask “What questions do you have about this option?” Next say, “How does this option fit for you?” Finally, add “Do you have any concerns about this option?” If this gets the patient admitting a concern, such as the expense, it gives you the opportunity to discuss a way to work this out.
Dr. Thornton said that he once asked a parent: “Why did you drive to me and past the other orthodontists’ offices?” The mom said that of the orthodontists who evaluated her child, he had been the most thorough.
“I recommended diagnostic models and X-rays before I could give her specific answers. I told her what we would learn from each, and how they might affect my decision to treat shorter or longer, and how that would affect the cost,” he said.
In this climate of concerns about radiation exposure and added cost concerns for second and third opinions, however, practitioners may need to rely on radiographs taken by another dentist — at least for an overview presentation to treatment approaches. Concluded Dr. Thornton: “Ask your patients to ask more questions, and to come back as often as they’d like.”
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