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Obtaining medical histories for specialized populations who visit your dental practice

March 22, 2017
Every dental patient is different, and never is that more true than when dealing with people from different cultures and backgrounds. How does your dental office communicate with these people, especially when it comes to gathering their all-important medical history information?

Every dental patient is different, and never is that more true than when dealing with people from different cultures and backgrounds. How does your dental office communicate with these people, especially when it comes to gathering their all-important medical history information?

As our environment becomes more diverse, so does the population we serve. Our standard approaches to patient interaction must become individualized to effectively deliver dental care. Dental assistants can formulate and develop new protocols for specialized populations that address the homeless, immigrant, refugee, or culturally diverse individuals who seek health services.

Dentistry is recognized as an integral component to the overall well being of all populations. According to the CDC, “…dental issues are the most (informed) pathologic conditions reported to the states on the medical screenings of newly arrived refugees and immigrants.” One of the first steps to accepting new patients in the dental office is obtaining a medical history. For specialized populations, this will be challenging and requires an individualized approach that allows the dental team to effectively deliver care.

The medical history includes both the physical and mental health of an individual, both of which have impact on the prioritization, mode of delivery, and response to the dental care provided. The physical components are easier to obtain, such as a listing of current medications or past surgeries. However, it might be more difficult to get patients to admit psychiatric disorders, discuss their dental fears, or explain injuries relative to sensitive situations.

There are several considerations for your dental team as you begin addressing specialized populations and creating resources to facilitate a more productive dental care process. Ultimately, the more understood patients feel, the more likely they will be to complete the treatment plan.

Obtaining the medical history

Most medical histories in a dental office are obtained by handing patients a set of forms that they fill out in about 10 minutes and return to the assistant, who enters the protected health information (PHI) into the medical record. For specialized populations, this process is insufficient for determining the overall needs of a patient. The dental assistant could spend a little time in conversation with a patient to gain the medical history, thus establishing a long-term relationship with the individual. Not only will the time spent reduce fears, build trust, and increase office productivity, it might lead to the patient referring family and friends.

When in discussion, consider the following:
Ask open-ended questions
If using an interpreter, make clear the type of answers you wish to illicit
Do not assume understanding, look for questions
Be patient and encourage explanation
Assure trust and alleviate fears
Ask questions to gauge fear and anxiety levels

Existing barriers

Within specialized populations, dental assistants will encounter barriers that include language differences, cultural expectations, and low health literacy, among several other factors. A routine dental procedure could trigger a psychotropic reaction that the dental team is unprepared to handle, especially if a patient did not report a post-traumatic stress disorder (PTSD) on the medical history checklist.

For specialized populations, personal experiences may include prolonged abuse, torture, or atrocities that require attention to reduce fear and minimize the risk of adverse reactions. Gently asking open-ended questions and allowing time for a patient to respond may reveal key behaviors.

Other barriers might include the lack of health literacy of the individual. For instance, immigrants and refugees may be in the process of acculturation, still adapting to a new environment, culture, diet, and societal processes. This population will have undergone a routine screening, but will often lack a primary care physician. Chronic illnesses are not addressed and the patients are not familiar with the “westernized” health care system, which tends to focus on preventative measures.

Furthermore, many countries are not well versed in the psychological aspects of treatment and do not have mental health care in their normal medical practices. Dental assistants should realize that patients may not understand their medical condition or what it means to “feel” anxiety and apprehension, as these words require a mental assessment. Additionally, there may be some victims of torture or abuse, which will make dental treatment a highly stressful encounter.

A preventive approach

A preventive approach to establishing an individualized consultation includes identifying the specialized populations your office may encounter, the resources your office needs in order to facilitate a communication plan, modifications to your office protocol, and the knowledge gaps of the dental team. With a little research, dental assistants can increase the effectiveness of the overall treatment plan, beginning with a thorough medical history.

When preparing office training and building resources for reference, consider the following:
What communication barriers does the office face?
What demographic profiles need to be considered?
How does the normal office protocol interfere or contribute to effective communication?
What resources are available to grow the team’s knowledge base?

Most information about specialized dental patients and their needs can be gathered through an extensive medical history discussion. Patients may have cultural differences that keep them from revealing personal or family illnesses; others have psychological implications that contribute to their level of trust and predictability of the dental experience. As a team, look for opportunities for continuing education, and develop protocol unique to your dental office needs.

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Darci Barr is an educator and program director in Indianapolis, Indiana, with growing experience in board governance and advisory capacities. As a leader in dental education, she combines philosophies of career and technical education with progressive and innovative curriculum, designing pathways of growth and succession for dental auxiliaries. A firm advocate for continuing education, Darci shares her expertise through authorship of several articles and dental-related works. As continuing service to her communities, she repeatedly demonstrates leadership in fundraising while promoting the good of dental professionals.