Diagnostic processing & Patient history-Pafford Flashcards
What must be found before treatment planning?
Accurate diagnostic information
What is the foundation of the diagnostic process?
Data collection (information gathering)
- different types
- must be complete and accurate
- form a specific patient database of info that helps with future decisions
What is included in data collection
- findings from asking questions
- observing and examining structures
- diagnostic tests
- consults w/physicians, dentists, specialists
What type of information is obtained during data collection?
- patient history
What information is obtained obtained in patient history?
- dentist learns everything about their patient before they begin treatment
- dentist has to be an investigator
- no set amount of historical information required
- volume and complexity of information collected is dependent on the patients problems, goals, wishes, and lifestyle factors
Components of patient history
- Demographic data
- chief complaint
- History of Present Illness
- Past medical history (general health history)
- Past dental history (Oral health history)
- Psychosocial history
What information is collected regarding demographic data
- name
- address
- phone #
- physicians name
- 3rd party information=insurance
- SSN
What information is recorded as a patient’s chief complaint
- primary reason for visit
- symptom or request in patients own word
- pay careful attention to this statement
What information is collected as history of present illness
- history of chief complaint
- sometimes requires prompting to get the details
- should include:
- time frame
- description
What information is collected in past medical history(General health History)?
- Comprehensive health history
- review of all the patients past and present illnesses
- Review of systems (ROS)
- meds (OTC and Rx)
- allows dentist to recognize health problems that may affect dental treatment
- info suggestive of new problems that were previously unrecognized, undiagnosed, or untreated
What information is collected in past dental history?
- Asks questions like:
- date of last dental visit/exam
- frequency of dental visits
- if infrequent why?
- types of treatment received?
- history of any problems while receiving dental care
- oral hygiene practices
- problems with previous dental visits
What information is collected in psychosocial history/social history/family history?
- investigate the patients attitude about the profession, including priorities, expectations, and motivations for seeking care
- financial status/occupation
- available time for tx
- mode of transportation for dental visits
What information is obtained during a clinical exam?
- Comprehensive clinical exam includes:
- physical examination (PE)
- Intraoral and extra oral soft tissue examination (IEOE)
- periodontal examination
- Examination of teeth (hard tissue exam()
- Radiographic exam
Dental findings can include
- Sings
- symptoms
What are signs
- findings discovered by the dentist during examination
What are symptoms
- Signs reported by the patient bc they are causing problems
What is the purpose of the First Data Collection Appointment?
- Health History
- health questionnaire provides information about a patients well begging and highlights any potential problems
- local and systemic conditions that may affect tx
- any positive responses or questionable answers should be explored during the patient interview
What is the purpose of the patient interview during the first data collection appointment?
- establish a rapport with patient
- address physical problems that may affect tx
- determine the patients expectations for restorative care
- patients psychological make up will influence the difficulty of the clinical tx and success or failure of tx outcomes
What are Dr. M. M. House 4 classification of patients?
- Philosophical
- Exacting
- Hysterical
- Indifferent
What is a philosophical patient
- Mentally well adjusted
- easy going
- accept responsibility for their lost teeth
- little trouble to the dentist
What is a Exacting Patient?
- Highly demanding
- Perfectionist
- high expectations
- dentist should set clear expectations
- additional appointment time may be needed to meet patients demand, time, effort, patience
What is a Hysterical patient?
- Apprehensive
- complain without justification
- do not accept responsibility for dental condition
- debilitating systemic or psychological diseases
- minimal probability of success unless attitude changes
What is an indifferent patient?
- lack of motivation or concern for their condition
- ignore instructions
- uncooperative during treatment
- poor prognosis unless patient becomes accountable and responsible
How can we ascertain the patients expectations
- Listen, don’t lecture
- observe the patients body language
- speak to the person in terms they can understand and appreciate
What are some things to do during patients interview?
- dentists attitude and behavior can have a direct impact on the success of treatment
- face the patient
- at eye level
- make eye contact
- demonstrate active listening
- appropriate head nodding
- verbal following
- short responses “I see” “I understand”
- verbal reflection
- paraphrasing to demonstrate understanding
What are ways to collect patient history?
- Questionnaire and Forms
- Patient intervies
What should you observe about patients during the patient interview?
- Speech difficulties
- Neuromuscular deficits
- Lip length, mobility, support
- facial changes that indicate a decreased VDO
What are the pros and cons of questionnaires and forms?
- Pros:
- quick
- no special skill required to administer
- standardized approach
- customizable
- Cons:
- answers may not be complete
- miss important findings
- severity of condition may not be reflected subject to misinterpretation
- easier for patients to falsify information
- answers may not be complete
What are the benefits of patient interviews?
- Customizable to the individual patient
- can ask a combination of closed and open questions to get information
Types of questions?
- Open
- Closed
- Simple
- Compound
Open Question
- invites listener to respond with maximum freedom
- give generalities
examples of open questions?
- What questions do you have?
- What parts of the lecture were the most useful?
Closed Questions
- Guide and limit responses
- hone in on specifics
examples of closed questions?
- Do you have any questions?
- Was the lecture useful?
- Do any of your teeth hurt?
Simple questions
- concise
- express only one element
Examples of simple questions?
- Do you brush your teeth regularly?
- Do you floss regularly?
Compound questions?
- more than one element or content area
Biased questions
- aka leading questions
- suggests a response or makes a certain response more likely
examples of biased questions?
- You enjoy this course, don’t you?
- You feel ok now, don’t you?
Unbiased questions
- Allow adequate and accurate listener response
Unbiased question examples
- What about this course is enjoyable?
- how would you describe how you feel now?
How do you use the different types of questions in a patient interview?
- Open ended questions
- patient has freedom of response
- Facilitation
- creating atmosphere for communication
- Closed ended questions
- looking for a specific response to a specific question
The first five minutes spent with a patient represent the most important period of dentist-patient interaction. Patients should feel that the dentist is genuinely interested in them and in helping to solve their dental problems”
“We should meet the mind of the patient before we meet the mouth of the patient.”
