The patient is a 51‐year‐old male and has been diagnosed with hypertension and states he complies with medication regimen daily. He sees his physician twice a year and his blood pressure has been controlled through medication for the past six years.
His dental visits have been less frequent. His last preventive visit was one year ago. He has posterior amalgam restorations on his maxillary first molars and composite restorations on both first and second molars in the mandible. There are generalized pocket depths of 3 mm and slight bleeding on probing. His biofilm control is fair, as he reports brushing twice a day but uses no aids to remove interproximal biofilm. No new carious lesions appear present.
The patient is also a recovered alcoholic who states that he has not consumed alcohol in two years since his divorce. He claims he is a light smoker, which for him is a few cigarettes a day. He has an active social life and uses social media to make and meet new friends.
Dental Hygiene Diagnosis
|Problems||Related to Risks and Etiology|
|Generalized gingivitis||Inadequate home care no interproximal biofilm removal|
|Leukoplakia lesion on tongue||Prior alcoholism and smoking|
|Clinical||Education/Counseling||Oral Hygiene Instruction|
|Record blood pressure at every appointment||Continue physician recommended regimen||Consult with pharmacist when taking any over‐the‐counter remedies|
|Chairside home care demonstration||Biofilm role in gingival disease||Flossing for interproximal biofilm removal|
|Smoking cessation||Suggest aids and counseling||Explain deleterious effects of alcohol and smoking|
|Assess and document lesion. Record location, size, color||Importance of referral||Follow recommendation of oral surgeon|
|Consult with dentist for referral. Take intraoral photograph||Lesion related to social habits|
|Document referral||Regularly do self inspections of oral cavity|
It is difficult to establish the oral effects of alcohol alone but as a mucosal irritant it can have etiologic importance. Persons who consume alcohol as a habit many times do so in conjunction with smoking. This trauma to the tissues can be extremely important in the etiology of oral cancer and the presence of leukoplakia. These habits are also associated with increased risk for other oral diseases such as caries and periodontitis. It is imperative for the dental hygienist to inform patients of this relationship and recommend cessation options. Professional communication with the patient must exhibit the principle of veracity. Veracity is communicating the truth and is expected between the patient and the health‐care provider and anyone else the patient may deem privileged to their information.
The private information of any patient is protected by law. The dental hygienist must communicate to the patient that his social habits may be contributing and exacerbating factors for his oral health and now for the appearance of a suspicious lesion (Shafer et al. 1983).
Patients have privacy and confidentiality rights afforded to them by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Individually identifiable health information is information, including demographic data, that relates to: the individual’s past, present, or future physical or mental health or condition, the provision of health care to the individual, or the past, present, or future payment for the provision of health care to the individual, and that identifies the individual or for which there is a reasonable basis to believe it can be used to identify the individual. Individually identifiable health information includes many common identifiers (e.g., name, address, birth date, Social Security Number) (USDHH 2016).
Confidentiality must be maintained by the health‐care provider and no information can be released without the patient’s consent or otherwise noted in public health laws. Information must be respected by the professional in both health‐care and social settings (Figure 11.3.1). The American Dental Hygienists’ Association states in its Code of Ethics that “we respect the confidentiality of client information and relationships as a demonstration of the value we place on individual autonomy” (ADHA 2016). Communication today has a wealth of options. Face‐to‐face communication has been lessened by technology. The telephone, email, text, Twitter, Instagram, and the use of social networking sites are common modalities of communication. These have become acceptable means of messaging. Friends and family, professionals, employers, employees, health providers, insurance carriers, and patients use these means on a daily basis. It is the patient’s choice to post private and public information not the health‐care provider’s choice.
Health‐care providers must respect the confidentiality of client information and relationships. Information that is shared from patients becomes part of their health record and cannot be shared with other parties not directly involved with their care.
Patients expect their medical and other health information to be private and should be protected. A breach of patient privacy and confidentiality of records was committed in this case story. The dental hygienist communicated possible identifiable protected information with patients and others via a social network. A social network is not a forum for professional communication. It is conceivable that one can determine who the male, last patient of the day, was. It is conceivable that the patient could be made aware of the post and see this breach. There are situations wherein a case may be presented and discussed in the professional community. Cases may be shared in a professional publication and as examples in educational presentations. Even then identifiable information should be anonymized.
To maintain professionalism, all professionals should strive to maintain the public’s trust in the profession. All professionals act within certain boundaries. They are professional boundaries. There are rules and codes that help one to clarify what is acceptable professionally and what are social relationships. Yet the professional faces daily challenges to keep those boundaries. Social networking and other electronic media are means of communication that can present these challenges and threaten the ability to maintain those boundaries. As a result, there are more and more opportunities and instances of lapses in professional judgment. Professionals must become aware and concerned about the possible ramifications of sharing certain information. Communication is a means to transmit information. In dentistry, as in other professions, communication takes on different forms. Much information exists about verbal and nonverbal communication. Even listening can be a form of communication. The dental hygienist is also obligated to communicate in a manner that includes intercultural considerations. Nonverbal communication is complicated and inconsistent. It can be unintentional and easily misunderstood (Adams 2011).
Theories abound as to what a person is “saying” and feeling in body language. Even the ubiquitous smile, which can be universally understood to promote content, friendliness, and happiness, can be faked. Appearance is also a form of communication. The first impression one gets through personal and office appearance is usually a lasting one.
Dental hygienists treat diverse patients from nearly every cultural background in the world. This would make it impossible to know all verbal, nonverbal, and norms associated with each one. The dental hygienist is obliged to become aware that the cultural norms in one society may be completely different in another. They must learn to respect those differences, and treat and communicate in a nonjudgmental and respectful way. There is research to read, courses to take, and experience to gain in the realm of intercultural communication. Studying is a way to gain understanding. In the professional/patient scenario it is appropriate to ask a patient if there are cultural boundaries a dental hygienist may not be aware of. It is appropriate to ask about touching when one is used to handshaking. It is a mistake to assume everyone has the same rules and then judge others on the basis of that assumption (Adams 2011).
In verbal communication, the dental hygienist must keep in mind that patients will have different levels of literacy: literacy in language and/or health literacy. It is important to become familiar with plain language to accommodate a patient’s lack of literacy in both. This is crucial especially when explaining a diagnosis and when giving instructions for patients to follow. Miscommunication can bring about untoward consequences and result in injury. Information and instructions can be communicated in writing or depicted in print or video. This is especially important when a patient has limited language proficiency in the hygienist’s language choice.
In personal social media communication, dental hygienists should be aware that employers frequently visit social pages of potential and present employees. These ramifications can have dire consequences for their positions, working lives, and even their license to practice.
As an aide to help keep the boundaries, professionals should utilize options for privacy. The Facebook network offers its users options for privacy settings. Profiles that do not have privacy limits allow a “friend” to access personal photo albums that contain information about one’s children, spouse, family, lifestyle, and other groups they may belong to. The privacy settings limit access to the user’s profile. Open access to one’s profiles is not typical of a health professional–patient relationship. Others can easily search a name and unintended information can be accessed into the future. Friends can easily copy a post or picture and forward it on and on out of the control of the person who posted the information. Other aides to keep professionalism in social media can be presented as a list of dos and don’ts. Do pause before posting and think of the ramifications of the post. Do use correct and appropriate language, spelling, and grammar. Be mindful of offensive or harassing words. Don’t complain about current or past employers, current or past patients, or the trivia faced daily. Don’t relate overly opinionated ideas. Share opinions tactfully especially issues about religion and politics. Don’t post inappropriate images (Ruesink 2014).
In a positive way social networks can have a dental hygienist become familiar with the patient’s family, and interests and this is being social but these are the types of “friends” that should not have access to all of a dental hygienist’s information. So some information is taken not given. It is good practice to minimize risk of legal actions and putting a professional career in jeopardy. It is expected that the dental hygienist has concerns and be cognizant of who is “friended” or who they invite to be “friends.” The dental hygienist should keep personal and professional relationships separate. One has to think first and be mindful of crossing any of the boundaries. There is no list available of what is acceptable information to share, yet professionals must determine what is acceptable and balance what is revealed to maintain the public’s trust and to protect the public they serve. Even a single lapse in judgment by a dental hygienist to create unprofessional content online can reflect poorly on not only themselves but on the entire profession. Social media can be an opportunity to educate the public about oral health and the profession of dental hygiene. It can be a means to gain professional exposure and putting the professional in a good light. Many professionals use the network LinkedIn to expose themselves to others with the revelations of skills, experience, and expertise. All social media has a potential to raise the respect for oneself and one’s profession. Encourage colleagues to become aware of the pros and cons of using social media (Figure 11.3.2).
- When counseling patients about smoking cessation use the ADHA’s “ask, advise, refer” paradigm without personal judgment.
- Record any atypical lesions for possible referral and follow up.
- Confidentiality of patient information is to be respected as a demonstration of the value placed on individual autonomy.
- Accept the obligation to tell the truth and expect others will do the same. Seek truth and honesty in all relationships.
- Keep social and professional communications separate and abide by the legal requirements for confidentiality.
- Become cognizant of different forms of communication, their positives and negatives in the context of cultural sensitivity.