Asking about the medications dental patients take is part of gathering a detailed medical history, but do clinicians know how to gather this information without overstepping or passing judgment? When it comes to opioids, some say clinicians do more harm than good.
An article published recently in Pain News Network in which chronic pain advocate Neen Monty expresses frustration over clinicians, including pharmacists and dentists, offering unsolicited opinions about her pain being managed by opioids and how their questions make her feel like a criminal. In response, dentists agree that they can do better when handling questions about pain management.
First, Dr. Randy Kunik of Kunik Orthodontics in Austin, TX, told DrBicuspid that he was not surprised by the story and has heard similar experiences from patients over the years.
“It really highlights how easy it is for clinicians -- even well-meaning ones -- to get it wrong when it comes to talking about pain and medication,” Kunik said.
Overall, clinicians need to lead with empathy and not assumptions, Kunik said.
“Respect is not hard, but it does require intention,” Kunik said. “Patients do not come to us to be judged. They come to be helped, and part of helping is listening, respecting their choices, and supporting the care they are already receiving.”
Dr. Daniel Croley, the chief dental officer at Delta Dental Insurance, told DrBicuspid that it’s reasonable for dentists to ask questions about conditions that may be managed by opioids. When dentists have a more complete view of patients’ health, they’re empowered to provide a level of care and support that can really impact not only their patients’ oral health but their overall health.
“Those questions should be asked for understanding, without judgment, so the patient is open and honest,” Croley said. “If a patient’s pain is dismissed or they feel judged for their treatment choices, it could erode trust or discourage them from seeking care. If the dentist has concerns, they should consult with the prescribing health care professional.”
Dr. Kyle Gernhofer, the CEO of DenScore, an online dental tool, told DrBicuspid that one of the most important aspects of patient-centered care is clear and compassionate communication so patients are allowed to express themselves freely, feel heard, and trust that their concerns are taken seriously without fear of judgment.
“Regardless of healthcare providers’ intentions, if they make patients feel the way the writer did, they fail in this regard and ultimately fall short of delivering high-quality patient-centered care,” Gernhofer said.
Croley concurred, noting that patient-centered care is about treating the whole person, not just their symptoms.
“Ideally, pain management should be approached from a holistic perspective, which means understanding the patient’s mental and social history in addition to their medical history and any current conditions that require pharmacy intervention,” Croley said.
Too focused on opioids?
Sometimes, dentists can put too much focus on opioids, especially when they zero in on the medication without understanding the context, Kunik said.
“We must think about the whole person -- not just the prescription list. Moreover, honestly, for many patients living with chronic pain, opioids may be what helps them function. That is not something we should ignore or criticize,” Kunik said.
Though dentistry has made progress in evaluating its role in opioid prescribing, Kunik added that it doesn’t mean that every conversation about opioids should be cautious or cold.
“We still need to meet people with compassion,” Kunik said. That starts with asking better questions, like, ‘Is there anything I should know about how your pain is being managed?’ or ‘Do you feel comfortable with the plan we have/ for today?’”
Moreover, Gernhofer doesn’t believe that dentists and other clinicians take other medications any less seriously than opioids. In fact, clinicians have a duty to know about all medications to understand how they can affect patient care.
“However, the unfortunate reality is that opioid-related deaths continue to rise, devastating communities nationwide, and clinicians are trained to recognize the signs and symptoms of opioid abuse,” Gernhofer said. “Many clinicians, including dentists, must ask patients about known or suspected opioid use to be aware of potential medication interactions. It is also their moral and ethical responsibility to have this conversation, even if it puts them in an uncomfortable or awkward situation.”
