Knowledge of pharmacology has never been more essential to dental patient care. As an instructor of pharmacology, writer, and professional speaker, I have always emphasized the need for obtaining a complete, up-to-date patient medical history.
With a new year beginning, now is the perfect time for you to recommit to one of the easiest standards of care to uphold in your office: updating your patients’ medical history, at every appointment, to reflect the latest changes in the status of their systemic diseases and the medications they take to manage those diseases.
Also, it is important to note that your patients can and do self-medicate, with a wide variety of non-prescription remedies and dietary supplements. Armed with limited, and often biased, information and faced with rising prescription drug costs, many patients add or substitute these remedies and supplements in their medication regimen, unaware of potentially serious adverse outcomes and, often, without mention during a review of their medical history. After all, from your patients’ perspective, if these products don’t require a prescription, then they are not “medications.”
Thus, gathering medical history information may sometimes make you feel like you are walking a fine line between being a concerned clinician and ardent interrogator. But, walk that line you must. While we all would like to avoid alienating our patients, we can also all agree that having the most accurate and up-to-date medical information is crucial for providing them with the highest standard of dental care.
The best way to gather the most accurate medical history information is to not rely solely on a photocopied form on a clipboard, but, rather, to also ask your patients a series of open-ended questions. For example, rather than asking if they take any medication, which can be easily answered by a yes or no response, a better question to ask is, “What do you take?”
This question is just open-ended and non-specific enough not to be confusing yet enable a discussion of the current prescription medications, as well as a discussion of their use of dietary supplements, herbal products, energy drinks, and over-the-counter medications, all of which may raise the risk of adverse interactions and may further complicate your patient management and treatment planning efforts.
You may be wondering why I don’t recommend just asking, “What medical conditions do you have?” Well, years of obtaining medical histories have taught me that patients will more likely admit to the medications they take rather than admit to the conditions those medications treat.
Some patients are embarrassed that they don’t know enough about their medical conditions to give you accurate information. Other patients question your need to know about their medical conditions, since you’re merely working on their teeth. And still others don’t want to tell you too much of their medical information for fear that you will not treat them at their scheduled appointment. However, patients are well aware that drug interactions can be deadly, so they are likely to provide you with a complete list of their medications.
Whatever the reason patients have for not divulging their medical information, for you as the dental clinician, a strong knowledge of pharmacology is like an inner voice that guides you. I call it the Phantom of the Operatory. Armed with this list of medications, pharmacology unlocks the secrets of the patient’s medical history and allows you to make informed decisions about patient care considerations and necessary treatment modifications. In other words, know their medications, know your patients.
For example, patients who admit to taking digoxin have provided you with a treasure trove of information. Digoxin is commonly prescribed to treat congestive heart failure. However, congestive heart failure is not ordinarily a primary diagnosis. Rather, it is often secondary to other cardiovascular conditions, such as chronic hypertension, coronary artery disease, thromboembolic diseases, and even heart valve disorders.
Also, congestive heart failure is often accompanied by other comorbid diseases, such as diabetes and chronic obstructive pulmonary disease. In addition, congestive heart failure and these related conditions may be indicative of that patient’s lifestyle choices, such as tobacco use and chronic alcohol consumption. Each of these conditions and behaviors opens up a discussion of, and more and more questions about, these patients’ current disease states, as well as other medications they may have failed to mention.
As dental professionals, we have been tasked with providing safe and effective dental treatment to our increasingly medically complex patients, especially with the aging of baby boomers and as our health system evolves into an oral-systemic health model. Pharmacology is a critical bridge between dentistry and medicine. This is all the more reason to ring in the new year with a new, up-to-date patient medical history.
Mr. Viola, founder of Pharmacology Declassified, is a board-certified pharmacist, clinical educator, professional speaker, and published author. He is a member of the faculty of 10 dental professional degree programs and has presented hundreds of continuing education courses to dental professionals in oral pharmacology and local anesthesia. Also, he is well known for his regular contributions to several dental professional journals. Through his informative, humorous, and engaging live seminars and webinars, he has earned his reputation as the go-to specialist for making pharmacology practical and useful for all members of the dental team. He can be reached at tom@tomviola.com.
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