My new patient has arrived and presents her medical history. Let’s see….there are checks by these history questions: diabetes, heart disease, heart surgery, angina, bleeding disorder, neurological problems, lung disease and prosthetic joint replacement. She takes nine medications and reports an allergy to penicillin.
A history with this complexity might seem destined to increase my stress level. In only a few minutes I have to dig into each of these issues and determine what the impact may be to the delivery of dental care.
Here are some example questions that must be asked:
How often? What do you take to relieve them? When was the last one? How does your heart disease affect your physical capabilities?
I have to find out if the angina is stable or unstable and the likelihood of the patient having angina at the office during a procedure as well as what to do to prevent and/or manage it. And there could be several more questions if the patient has conditions such as valve disease or congestive heart failure.
Do you have type 1 or type 2? Are you insulin dependent? How often do you check your blood sugar? Do you sometimes have low sugar that affects you? How do you reverse it typically? Have you had long periods of uncontrolled diabetes? What was your last A1c?
I have to determine if there is a potential for a hypoglycemic episode or if antibiotics may be required during the healing phase.
So you don’t know for certain if you are allergic? Do you recall your parents telling you that you had breathing difficulties after taking it? Or a rash?
Often, the goal is to ascertain if it’s a true allergy history or not.
Is this a complete list? What are the dosage amounts? I may need to make sure that the medications match the reported history. Also I have to find out about the action, reactions and interactions of the medications my patient is taking.
Working through the history to determine stable or unstable disease, bleeding and infection risk, pharmacology implications, and how to modify my standard procedures takes time and is unavoidable. Because the entire team benefits from understanding the risks of a complex medical history, my hygienists, assistants, treatment coordinator, and sometimes even the receptionist need to be informed of issues. It should be a team effort when making sure our patients are safely managed.
How can this be made simpler? One way is having a software that interviews the patient virtually so that all of the preliminary questions are asked and answered before arrival at the office is helpful. And then studying a well organized, analyzed medical history summary saves time and makes one confident and competent in taking safe care of patients.
These medical history summaries are created for all new patients who register to the practice or who update their information. They can be shared with the patient who may actually see for the first time a nicely organized representation of their medical issues. And they are assured that the dental team understands their medical condition and gain confidence in the recommendations that are made.
It is important remember that sometimes patients make mistakes when completing their medical histories. This can be another obstacle that impacts time and stress.
Here’s an example of a mistake: A patient might forget to place a check by a hypertension question but then include an anti-hypertensive medication in their list of medications. But with an automated analysis of the submitted history, I am alerted of the discrepancy. After a few medical histories came into my office, I recognized that patients do indeed submit incomplete or inaccurate histories, some of which can have serious effects. A highly functioning office that is keyed into medical history analysis will have the administrative staff monitor submitted medical histories for discrepancies so they can be addressed even before the patient arrives if desired.
And considering that some laws require the patient record to reflect that the medical history was actually evaluated by the doctor and that risks related to the history are pointed out, recognizing these mistakes becomes more important.
Rather than compounding time and stress issues, assessing a complex medical and pharmacology history can be made more manageable using an interactive dental software in your practice.