The title of this article means different things to different people. Regularly in your practice, you will find unresolved medical issues or problems that will impact outcomes of the dental care you provide. Some of that has to do with your personal life and professional experiences. Either way, many of us incorporate what we have learned from those experiences and institute them into our practice philosophies.
My practice philosophy revolves around my personal philosophy of health and wellness. In defining our practice philosophies, we must define ourselves, the directions we wish to take our practices, and what health outcomes we desire for patients to achieve optimal quality of life. The diminished quality of patients’ lives as they age and the onset of chronic illnesses in patients have motivated me to change the care for my patients. I choose to be proactive instead of passive about these issues.
Oral and physical health are inseparable. Relationships between the two continue to expand horizontally and vertically. Health is a state of physical, mental, and social well-being, and not just the absence of illness. Oral health now includes well-being or wellness.
The wellness approach to our oral health care philosophy includes treating whole patients, not just oral disease. A person’s attitudes, habits, and lifestyle are equally important when dealing with the diagnosis and treatment of oral diseases. Maintaining this continuum of knowledge can be difficult. As a profession, dentistry cannot rely solely on dental literature. Dentists must seek medical resources to learn more about the medical diagnoses, care, and treatment of patients with medical ailments.
The Internet provides up-to-date information. The National Institutes of Health, www.nih.gov, and its associated institutes are loaded with health resources that may be reprinted. For women’s health issues, the For Women Web site, www.4women.gov, provides many links to current preventative health programs. This is increasingly important because our aging population and changing lifestyles have led to substantial increases in the numbers and percentages of patients with chronic diseases.
You will find that you cannot make a practice what it isn’t. Your practice demographics and philosophy define what your practice is or isn’t. As dental practitioners, we are judged on how we care for patients. They, in turn, judge our care on our responses to their needs during that specific time and day. As our patients’ needs change, we should change with them. This might require a continuum of self-study and training in health areas normally reserved for the medical and nursing profession.
Worldwide during the past decade, chronic disease incidence has sharply increased to record levels and near epidemic levels for some diseases. Caring for these people has burdened the health care system. Furthermore, many of these people lack insurance and do not receive timely, adequate medical care, resulting in a loss of quality of life indices and increased medical complications. Because chronic illnesses or diseases affect one in 10 people, we are often asked to go beyond care for them.
Quality-of-life measures have been used by the medical profession as measurable outcomes. The dental care we provide should attempt to optimize this in an often compromised health care delivery system. Studies show that many patients fail to take prescribed medications correctly and don’t heed doctors’ treatment recommendations. This occurs for a variety of reasons, but cost is most significant.
We cannot change the medical system of care, but our care is affected by these sometimes negative changes. Patients still hold us accountable for treatment outcomes. We must inform them that the quality of medical care and their compliance with that care affects their oral health, then provide them with timely, preventative medical information and resources to achieve those goals. This describes the health-focused dental practice.
The health-focused dental practice:
✔Demonstrates responsiveness by listening to patients’ needs and concerns and consistently exceeds their expectations.
✔ Nurtures creativity by viewing the world as unlimited possibilities, then works continuously to invent and provide new and more valuable techniques and procedures that will enhance the quality of daily life for our patients.
✔ Achieves balance by promoting stability and harmony in all aspects of life: physical, social, emotional, spiritual, and intellectual.
✔ Strives toward excellence in everything and works to transcend the average and ordinary in pursuit of unparalleled quality and service.
✔ Provides compassion for the sick, assists those in need, and offers hope to the discouraged as an affirmation of a common humanity.
Link with the medical profession
Most of this collaborative experience with the medical profession is on-the-job. Our routine examinations of patients offer us opportunities to screen for head and neck problems, whether they are localized or signal systemic problems. During questioning, you might find other maladies that seem innocuous at first but have serious medical ramifications. This offers you opportunities to urge patients to see their physicians for further evaluations and elevates your stature as part of the health care team. You should also identify medical resources in your practice locale and devise a plan to use them.
Linking with medical colleagues can be antiquated. Many times you must use less electronic means to communicate specific requests or patient issues. The best way to communicate is in writing. I have tried with limited success to meet one-on-one with our medical colleagues, but this depends on the particulars of your medical market (small town vs. big city). Many health care providers prefer e-mail but are mixed on the timeliness of their responsiveness.
A pre-printed fax form is ideal for standard antibiotic prophylaxis requests, medical consultations, and general communications about patient care. We use a simple antibiotic prophylaxis form on which medical staff may check a “yes” or “no” box on a summary sheet that explains the rationale for antibiotics. Always sign the request form with specific contact information. When they fax it back, both parties will have copies for patient records.
In addition to your regular dose of dental continuing education, consider attending a medical symposium that has relevance to the overall health to your patient demographics. Examples include diabetes or women’s health forums. Some of the information might be over our heads, but try to glean a good familiarization of medical-care issues that potentially face your patients with chronic diseases or other health conditions. I always have warm receptions when I attend these meetings, and they also provide opportunities to network.
Familiarizing ourselves with medical-care standards helps us screen patients for undiagnosed problems. Bringing this to our patients’ attention and providing timely and appropriate medical and health care referrals add enormous value to the care we extend to patients. Our practice uses a simple pre-printed consultation sheet with blanks for specific reasons for medical consultations.
Think creatively
We often do not speak of assessing patients for impairments that might affect their achievement of preventative dental care recommendations. Many patients with chronic diseases have cognitive and physical impairments that affect their level of self-care behavior to achieve the oral health recommendations.
Arthritis is the most widespread chronic illness. In our practice, several elderly patients ask for our Crescent cushions (www.crescentproducts.com) prior to seating to keep them comfortable during their appointments. Other impairments that affect brushing and flossing include carpal tunnel syndrome, stroke, and aging in general. Carpal tunnel syndrome affects three times more women than men, and the effects of stroke and age cause physical impairments to the hands. Asking these patients to do an oral-care regimen similar to that of a 20-year-old does not work. We make a large number of oral-hygiene aids available to our patients so they may achieve adequate oral-hygiene goals. One of the best-engineered devices is the Sonicare IntelliClean System. It combines a brushing system with an automatic toothpaste-dispensing system.
This has proven a blessing for my patients with limited motor skills or stroke. My office offers these at a reduced price over retail. We also provide printed, preventative health tips on issues that affect patients’ oral health. Patients in our waiting room enjoy our subscriptions to health magazines such as Prevention and Diabetes Forecast.
Approaching patients’ dental care with an overall health focus can be a rewarding and satisfying way to practice. The value patients place on the care you provide is how you affect their quality of life.
Dr. Varon does not receive compensation from any of the products or services mentioned within this article.
Frank Varon, DDS
Dr. Varon is a graduate of the University of Texas, Dental Branch-Houston. He practices general dentistry in Omaha, Neb., and lectures on diabetes in dentistry and the health-focused dental practice. Reach him at [email protected] or (402) 733-4441.
