Goodbye, informed refusals: A method for getting the x-rays taken with resistant patients

Emma Gibson, RDH, states that informed consent forms is a waste of effort. Better patient education about x-rays is the key

Content Dam Diq Online Articles 2017 12 Emmagibsonthumb122217

By Emma Gibson, RDH

Have you ever felt completely out of control when communicating with patients? With our profession, sometimes it feels like we can preach the same things over and over, yet things just don’t quite “click.” From educating our patients on brushing and flossing techniques or caries prevention, to harmful effects of the use of tobacco products, we can teach and educate as much as we want.

At the end of the day, though, we already know that it is only up to the patient to make those decisions. However, not all areas of dentistry should be looked at that way based on the patients’ preferences, because as dental professionals we know better, when they are in our chair and under our care.

Ditch the forms today

This may sound scary at first, but in order to provide the top notch care that we strive to give daily, the first thing that needs to happen is to forever say goodbye to informed x-ray refusal forms. Just think for a minute and let this sink in—as to what we are actually contributing to as licensed, knowledgable professionals when a patient doesn’t want their yearly bitewings once again..

All that we are doing is handing them a form to sign, which basically states

  1. That they are well aware that something could possibly be brewing interproximally
  2. They still want a cleaning
  3. Will take full responsibility if decay or any other issue that could have been detected radiographically was not diagnosed

Sure, this is a great way to have liability if something did ever go wrong, but we need to aim to be professionals that do not supervise neglectful decisions. We need to consider the goals for our patients that we do have control over. The ability is in our hands to educate our patients enough so that they know how crucial routine x-rays are. They need to be educated on radiation exposure (if that is the barrier), the importance of detecting cavities that cannot be seen intraorally, bone levels, calculus, etc.

How this can be handled

The best way to go about handling a sticky situation like this is to always educate first. Explain to the patient that without x-rays, you will not be able to give a proper, thorough cleaning if you can’t see “the whole picture.” The doctor will also not be able to give a thorough exam without them. Most of the time that is all that a patient needs to know before accepting them. To ensure that you and the patient are on the same level, go over their x-rays with them afterwards (obviously not diagnosing anything out of your scope), showing them the details, such as where their fillings are, how bone levels look, etc. It is such a great way to help them understand and know the significance that radiographs have.

In most cases from my experience, a little education is all you need for patient consent. Unfortunately, this will not always be the case and you may come across a patient who is confident in their decision to not receive them. If and when this happens, it may be best to explain to the patient that you will continue with the cleaning today (provided that they do come regularly for recall visits), but that they need to have their x-rays taken at their next visit or they will not be able to be seen and treated because of your office policy.

By doing this, and continuing with the cleaning after the initial refusal, the patient will not feel that they have wasted their time and feel as though they have been “kicked out.” However, the ball will now be in their court at their next visit, and they will fully know what is expected. Not once have I had a patient refuse again after knowing the policy.

Always remember what types of patients that you want to draw into your office. At the dental office that I currently work for, our motto is “Healthy teeth and gums for life,” and we stand by that rule every single day. Our patients are seen in our office for us to provide them with the best optimal care possible, and that is what they get. So, yes, our patients do receive their yearly bitewings because we hold a standard for ourselves to not ever let unresolved issues go undiagnosed due to neglectful actions.

Emma Gibson, RDH, is a practicing dental hygienist at Salvatore Dental in Malta, N.Y. Having studied dental hygiene in Ottawa, Ontario, and completing the National Board Examinations in Canada (NDHCB) and the United States (NBDHE), Emma is registered to practice in both countries. She is currently a full-time student, studying biology at the University at Albany. Emma plans on furthering her passion for dentistry by pursuing dental school in the near future. She can be contacted via email at gibsemmal@gmail.com.

More in Patient Education