Dental News - A simple act of kindness

Patricia Walsh, Editor in Chief, Hygiene Tribune U.S. Edition

Wed. 10 July 2013

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Last year I went up to Nantucket island just off the Massachusetts coast to celebrate the arrival of spring. The daffodil festival is a weekend event benefiting local charities. It allows residents and tourists alike to get a little silly. There are costume contests and goofy hats for both men and women. There’s a dog parade, a kid’s parade and an antique car parade. All of which are adorned with, you got it: daffodils.

A colorful island with traditional cobblestone streets, no matter what the season, a slower kinder spirit prevails on Nantucket. I keep a sticker on my iPad as a reminder of this way of life to offset my sometimes sterile electronic world. The oval “travel” sticker reads “A Random ACK of Kindness” — “ACK” being the code for Nantucket Memorial Airport.

Eva Grayzel spoke at our local hygiene study club recently. A non-smoker who was diagnosed with late-stage oral cancer, she was given only a 15 percent chance of survival. One of the best speakers I’ve ever heard: She inspires us to do what we already know how to do but sometimes fail to do in between the computer entries, switching plastic on light handles, the wipe down, the missing chart, the perio readings, the referral slip, the cranky last patient. She inspires us to take a deep breath, forget about our “routine” for a few extra minutes, and gather up strength to remember our humanness. More importantly, to remember the humanness of our patient and the fragility of life.

After hearing Eva speak, you get the feeling you really might just be holding your patient’s life in your gauze square. After you tell the patient that you are going to wrap his or her tongue up like a little burrito, did you look underneath where the gauze sat? Did you take the time to document enough details, or better yet -— take a photograph? Measurements and positioning can be subjective. When you hear a frightening tale of misdiagnosis and the misery that unfolds afterward, it's enough motivation to not ever ever ever allow the patient to self-diagnose. In other words, never saying “let us know if it changes” or “we’ll check it at recall.”

Suspicious lesions need to be rechecked at a later date with scheduled appointments. When we specifically tell the patient that we are performing an oral cancer check, we are telling the patient that we care. We are also verbally emphasizing the importance of the exam, rather than just going through the motions. If they go elsewhere, and the exam isn’t done, they will remember your proper oral cancer examination as the gold standard.

Many of us have extra bells and whistles that can be very entertaining to the patient as an adjunct to our exams, but the down-and-dirty is this: There is no replacement for definitive palpitations — the human touch.

Taking the time to roll out the lip, feel the floor of the mouth, touch the palate and caress the neck is so very important. Some will thank you for the massage. Some may not like having their tongues depressed to see the tonsillar area. Try to remember Michael Douglas. Beyond the tongue is where his tumor was hidden from routine view.

The rise of HPV lesions is in all the news and statistically lumped into the “oral cancer” category. The fact remains that its occurrence is usually down beyond the soft palate in “WNL never-never land” (We Never Looked).

Not long ago, I had an appointment with a well-respected ENT. For the first 10 minutes of the appointment I don’t think the doctor ever looked up once from his iPad while tap-tap-tapping his initial exam and interview notes. It was obvious he was enjoying his new toy. Electronic data entry is a wonderful thing, but it needs to be injected with the right amount of eye contact.

Fortunately, my throat issue had a simple solution. When you hear a gut-wrenching tale of survival from an oral cancer survivor such as Eva, it makes you cherish the human touch over medical or electronic devices. Too, it’s important for us to remember that a computer is only as good as the person entering the information.

I hope that any patients of mine who may find themselves on the long and rocky road through oral-cancer treatment and recovery will think of me as a hygienist with compassionate eye contact who sometimes lovingly tapped on their arm — not an iPad.

I want patients of mine to remember me as someone who relied first on her knowledge of normal head and neck anatomy and secondly on the dazzle of adjunct oral cancer detection-assistance measures. The human touch should not be obsolete.

Twenty-five years ago, the dentist I worked for was absolutely giddy over his new intraoral camera. He printed out two pictures of a new patient’s broken tooth. He placed one in the chart and handed the other to the baffled patient. Her response was, “I didn’t want a picture of my tooth; I wanted my tooth fixed.” I felt sorry for the both of them. Whatever latest tests and devices show up in our offices to assist us in oral cancer detection, we should not be distracted away from the time needed for our actual physical “hands-on” examinations.

For further information about Eva Grayzel and her six-step screening program for oral cancer, please go to her website, www.sixstepscreening.org.

Note: This article was published in Hygiene Tribune U.S. Edition, Vol. 6 No, 5., June 2013 issue.

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