In this episode, we talk about something relevant to chairside dentistry, but even more relevant to house-call dentistry. So no matter what type of Doctor you are, tune in, I hope this helps you out.
House-call dentistry demands more than simply developing rapport with the patient. I want house-call dentists to remember to be compassionate to caregivers. if you’re doing dental house calls, in many cases, you’ll be communicating with family members or caregivers.
Many times, inquiries may involve interacting with family members or even hired caregivers. It's important to understand the entire family or group dynamic. It's nice if you can gather as much information as possible before the appointment.
You or whoever answers your phones should ask some simple intake questions before arranging the appointment.
“You're calling on behalf of your mother. Are you your mother's healthcare proxy?”
The consenting guardian or health care proxy
It's important to understand who the consenting guardian is and who will be present at your appointment. My dental home care service, AccommoDental, uses Curve, a cloud-based eHr, that allows patients to log in to a patient portal and complete medical questionnaires, consent forms, HIPAA forms, and all necessary forms before the initial visit.
But I'll admit, this isn't a fool-proof process because a lot of patients who are best served at home, may not routinely use the internet. So many of my patients are self-consenting elderly people who do not have an email address. In such cases, I found it helpful to schedule some extra time at the initial visit to review all of the necessary forms and to spend some time chatting to understand the patient's unique situation. I suggest using that time to introduce yourself and figure out who is who. You’ll be spending an hour or so in a family home, it’s important they understand your role too.
Keep Calm and Carry on
Let's say you begin your exam on an elderly woman with dementia cared for by her daughter. You take one look and you’re just overwhelmed with the perio. Bloody gums and calculus galore...you know. These teeth look like they haven't been brushed in ten years!
Before you freak out or get angry with anyone, pause.
Before you place any judgment or blame, stop, breathe, and think.
Think of everything that you don't know. Ask questions and listen.
Ask the daughter, "How is brushing and flossing going? If she answers with a response like, 'We brush everyday, usually twice, but sometimes my Mom falls asleep before we get to brush at night. She hates when we brush, though. She can't spit, so I try not to use too much toothpaste in case she just swallows it. Honestly, I can't get in there to floss because she'll start swatting at me."
During this explanation, the daughter brings out her toothbrush, shows you the toothpaste they've been using, and shows you the flossers they've tried using.
Huh what do you think of that answer?
This patient is probably very difficult to care for and her loved ones are doing their best. They even called you for help because they care so much!
Now if the answer from the family clearly outlines neglect or if a family refuses to treat real problems that you diagnose, that's a different story. In that case, alert who you need to alert. We are patient advocates, just exercise good judgment here.
Please don't misunderstand me. I do not condone neglect. I want patients to have healthy mouths. I also want you to develop compassion for caregivers and join in on your patient’s care from a helpful place of compassion and guidance, not judgment and condemnation.
Help caregivers help their loved ones.
If possible, jump in by suggesting more frequent recalls, and throw everything preventive their way. PreviDent, Chlorhexidine, etc. Do everything to help your patients. Also do everything you can to help their families, too. This will ultimately help patients even more. Click here for deals on specialized products from TePe.
I’ve spent one of my house-call visits meeting a patient and her family at my local hospital. My patient is a candidate for OR sedation and she has extreme anxiety about visiting medical facilities. They asked me to be at the hospital and help bring her to their dental department for a consult. My presence was HUGELY relaxing for my patient and relieving to her family members. Don’t underestimate the value of your moral support.
When you work with a family, not against them, and arm them with instruments, products, and most importantly, knowledge, your patient will experience positive outcomes.
Thank you for spending your time considering the plight of, not only the patients who are best served at home but also the circumstances of those who care for them daily.
Whether you’re considering offering dental home care or not, you can support the cause by contributing to the Home Smile Care Foundation. The Home Smile Care Foundation is a nonprofit organization founded by myself and my loved ones. It exists to provide financial assistance to patients or families who struggle to afford dental home care. Visit homesmilecarefoundation.org to contribute.