Patient Autonomy in Dentistry
The principle of autonomy is described as the ability to respect and embrace each individual's right to be self-governed. An autonomous person forms their judgement based on their particular needs. In healthcare, autonomy is the concept of the healthcare provider educating patients, then permitting the patient to make their own unbiased judgement on their health and or preferred method of treatment.
Healthcare providers spend years studying a specific field of medicine, receiving countless additional CE credits, and can often feel like they always know best for all their patients. In reality, there is no way a provider can know what is best for each individual by simply glancing through a medical history and identifying a few symptoms. Every patient is unique, each individual case is different and should be approached as such.
In dentistry, it is the responsibility of the dentist and or hygienist to effectively communicate all levels of diagnosis, treatment options and prognosis to their patients. When healthcare providers communicate with patients it is important to meet patients at their level of understanding. A provider can demonstrate effective communication by primarily listening to their patients and assessing their needs and priorities.
Often times language and cultural differences may cause communication barriers between providers and their patients. When patients don't fully understand the message their healthcare provider is trying to convey, by default they usually agree with what the provider suggests. The patient may also be reluctant to ask any specific questions. If language or cultural barriers arise it is important for the healthcare provider to attempt to address and overcome them quickly. I have seen this achieved in practices with various bilingual assistants along side the dentist.
What I have found successful in past, is to break these barriers the moment the patient makes their initial appointment. If a prospective new patient calls to make an appointment, if their accent is distinguishable, perhaps place them with a doctor or an assistant that speaks their native language. It is always a good idea for healthcare providers to get familiar with the demographics that they are serving and to ensure that all staff are culturally competent, this will minimize language barriers between providers and patients.
As a provider, when going through treatment modalities with patients its important to understand the patient's current needs and financial priorities. Providers should be cautious not to push treatment driven by personal daily quotas. An additional barrier that I have witnessed in dentistry is finances. According to an article titled, "Top 7 reasons we avoid the Dentist" in the Everyday Health Journal, cost is one of the top 7 reasons why people avoid going to the dentist.
When allowing patients to choose their method of treatment it's important to take their fiances into account. For example, a patient presents with deep decay that has affected the nerve on a particular molar. A dentist with a conservative approach may recommend root canal treatment followed by a crown, although this approach preserves most of the patient's natural tooth, it may be a more costly. While another dentist may suggest extracting the molar and eventually replacing it with some sort of prosthesis, when the patient is financially capable.
Although this maybe frowned upon in PPO and fee for service practices, I have witnessed this quite often in Medicaid/Medicare offices, as a simple extraction and replacing a tooth is more likely to get approved for an adult by Medicare, rather than root canal treatment and crown.
To overcome this, I believe it is essential to have a competent treatment coordinator present in every dental practice. A treatment coordinator is considered to be the liaison between the patient and the dentist, as a treatment coordinator works closely with the provider and the patient to correlate the type of treatment along with helping patients utilize and maximize their insurance benefits.
While working in Medicare and Medicaid offices, as a treatment coordinator, I have found it to be successful to treatment plan with various approaches. For example, present a treatment plan with fees for the root canal treatment and crown, followed by the secondary treatment plan for an extraction. Given that all prognosis are effectively communicated, it is important for the patient to sign and consent that they have received and compared both treatment plan options.
Dental providers should restructure the way they regard their office visits, with less of an authoritarian manner, but with more of a casual and mutual approach. I like to think of a doctor's visit as a mutual transaction, the provider may have the knowledge and the ability to diagnose, but ultimately the patient has the right to their own autonomous decision regarding their health. If a provider is against the patient's wishes, due to potential malpractice and or negligence, the provider can rightfully choose to dismiss the patient from their practice, or simply refer the patient out to another provider. As a dental provider, the main objective is to effectively promote and educate patients on oral health and disease prevention, ultimately allowing patients to make the best decisions regarding their health.
Healthcare providers spend years studying a specific field of medicine, receiving countless additional CE credits, and can often feel like they always know best for all their patients. In reality, there is no way a provider can know what is best for each individual by simply glancing through a medical history and identifying a few symptoms. Every patient is unique, each individual case is different and should be approached as such.
In dentistry, it is the responsibility of the dentist and or hygienist to effectively communicate all levels of diagnosis, treatment options and prognosis to their patients. When healthcare providers communicate with patients it is important to meet patients at their level of understanding. A provider can demonstrate effective communication by primarily listening to their patients and assessing their needs and priorities.
Often times language and cultural differences may cause communication barriers between providers and their patients. When patients don't fully understand the message their healthcare provider is trying to convey, by default they usually agree with what the provider suggests. The patient may also be reluctant to ask any specific questions. If language or cultural barriers arise it is important for the healthcare provider to attempt to address and overcome them quickly. I have seen this achieved in practices with various bilingual assistants along side the dentist.
What I have found successful in past, is to break these barriers the moment the patient makes their initial appointment. If a prospective new patient calls to make an appointment, if their accent is distinguishable, perhaps place them with a doctor or an assistant that speaks their native language. It is always a good idea for healthcare providers to get familiar with the demographics that they are serving and to ensure that all staff are culturally competent, this will minimize language barriers between providers and patients.
As a provider, when going through treatment modalities with patients its important to understand the patient's current needs and financial priorities. Providers should be cautious not to push treatment driven by personal daily quotas. An additional barrier that I have witnessed in dentistry is finances. According to an article titled, "Top 7 reasons we avoid the Dentist" in the Everyday Health Journal, cost is one of the top 7 reasons why people avoid going to the dentist.
Although this maybe frowned upon in PPO and fee for service practices, I have witnessed this quite often in Medicaid/Medicare offices, as a simple extraction and replacing a tooth is more likely to get approved for an adult by Medicare, rather than root canal treatment and crown.
To overcome this, I believe it is essential to have a competent treatment coordinator present in every dental practice. A treatment coordinator is considered to be the liaison between the patient and the dentist, as a treatment coordinator works closely with the provider and the patient to correlate the type of treatment along with helping patients utilize and maximize their insurance benefits.
While working in Medicare and Medicaid offices, as a treatment coordinator, I have found it to be successful to treatment plan with various approaches. For example, present a treatment plan with fees for the root canal treatment and crown, followed by the secondary treatment plan for an extraction. Given that all prognosis are effectively communicated, it is important for the patient to sign and consent that they have received and compared both treatment plan options.
Dental providers should restructure the way they regard their office visits, with less of an authoritarian manner, but with more of a casual and mutual approach. I like to think of a doctor's visit as a mutual transaction, the provider may have the knowledge and the ability to diagnose, but ultimately the patient has the right to their own autonomous decision regarding their health. If a provider is against the patient's wishes, due to potential malpractice and or negligence, the provider can rightfully choose to dismiss the patient from their practice, or simply refer the patient out to another provider. As a dental provider, the main objective is to effectively promote and educate patients on oral health and disease prevention, ultimately allowing patients to make the best decisions regarding their health.
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