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    The medical history mistake every dental provider makes

    Rephrasing how you ask your patients questions is critical in understanding their medical histories.

    It was a typical weekday in my private office. I was about one year out of hygiene school and had proudly mastered my time management in the operatory. In this office, I was hired to not only see a column of hygiene patients on the hour but also to anesthetize the doctor’s restorative and surgical patients. I still moonlight at this office from time to time, and I still receive comments from my colleagues asking, “How do you do it?” or “I would never agree to that.” Despite the busy days, I grew in my anesthesia, anatomy and pain management skills immensely, and for what it’s worth, I saw this hectic schedule as an opportunity to grow.

    As per usual, I received a note from an assistant asking me to deliver anesthetic to a patient for fillings. I excused myself from my hygiene patient, hopped over to the next operatory and introduced myself to the doctor’s restorative patient. While slathering on hand sanitizer and gloving up, I performed a quick skim of the health history and muttered, “Any changes to the health history?” in between asking my patient about her weekend plans. After a verbal “nope!” from the patient, I delivered the most gorgeous Gow-Gates Mandibular Block injection (I know what you’re thinking: I have never and will never use an Inferior Alveolar nerve block for mandibular anesthesia). Upon recapping my needle and internally celebrating how awesome I am for nailing the anatomy of my injection, my patient began to experience some adverse effects.

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    First, she asked me to sit her up, as she was beginning to feel nauseous. She was a petite 19-year-old with a clean health history, and my one-year of clinical practice ego had been jolted.  “Have you eaten this morning?” “Do you think you might have caught a flu bug?” “Have you reacted to anesthesia before?” The questions were racing, not in my mind, but out loud in a series of frantic verbal slurs to my patient. Immediately I began to mentally check the boxes: Did I overdose her? No. Did I deliver the injection intravenously? No. Did I deliver the anesthetic too quickly? No. I was lost and concerned for my patient, particularly when she awkwardly maneuvered among the cords and large equipment in my operatory to find the sink while muttering, “I think I’m going to throw up.” I asked my patient if I could do anything to make her feel more comfortable. Her response, “No, it’s probably just my morning sickness," to which I promptly felt like I was going to throw up.

    My mistake

    Medical historyAfter a few deep breaths and a giant swallow of my pride, I calmed myself in order to better evaluate the situation. Luckily, I had delivered my block with 2% lidocaine 1:100,000 epinephrine, a pregnancy category class B drug that’s considered suitable for pregnant patients (although several OBGYN physicians aren’t permitting the use of vasoconstrictor for concerns of elevated fetal heart rates, but maybe that’s for another article…). The use of 20% benzocaine topical was a slight concern, as it’s considered a category class C drug; however, such a small dose is systemically absorbed from the mucosal tissue and typically doesn’t dramatically affect fetal wellness. The patient was clearly still in her first trimester, as she was experiencing morning sickness and didn’t even have the small “Chipotle baby bump” showing on her tiny frame.

    I immediately informed her of the concern I had with regards to delivering anesthetic for elective care during her first trimester, which was minor when compared to the concern I had that PREGNANCY didn’t ring a bell for her when I asked if there were any changes in her medical history.

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    It was then that I realized my mistake: I had assumed, which my Midwestern dad taught me years ago makes a you-know-what out of you and a you-know-what out of me. While I couldn’t fathom how she lacked understanding about how her pregnancy qualified as a medical history update, I also recognized that I was not being very comprehensive in my medical history review. In fact, what kind of training had I received, via dental hygiene school some blah-blah-blah years ago or continuing education, that qualified “any changes?” as an appropriate medical history review? 

    As professionals, I think most of us can agree that private practice not only allows but also requires us to abbreviate many of the habits we were taught to be right as young dental hygiene students. Over the years, I’ve certainly developed various efficiencies that have helped me stay on task and on schedule. However, at what point have we gone too far? At what point are we no longer serving our patients but rather serving the timeliness of the schedule?

    Continue to page two to read more...

    Katrina M. Sanders RDH, BSDH, M.Ed, RF
    Katrina M Sanders RDH, BSDH, M.Ed, RF, is a graduate and recipient of countless awards from the University of Minnesota’s School of ...

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