"Please Handle Me with Care" patient form

[letsconnect]

www.lasertoothdr.com/form4.html

I came across this the other day and thought "what a wonderful idea"! I'd love to include a slightly modified form of this patient form in the "for dental professionals" section of www.dentalfearcentral.com (basically, leaving out the agreement at the bottom and perhaps adding some potential concerns). This would take the shape of a pdf file download.

If anyone would like to take a look at the "Please Handle Me with Care" form www.lasertoothdr.com/form4.html and share their thoughts (e.g. any concerns not mentioned which you'd like to see on such a form), that would be great!

[letsconnect]

Please let us know of any other statements to add to the list! Any suggestions are very welcome

Yes, I also reckon it's a marvellous idea - a lot of people find it difficult to articulate their fears, either because they haven't given it detailed thought, or because they feel intimidated or frozen with fear, or else because they're doing their damndest not to appear frightened. This form is so simple, yet so effective, and takes almost no time to complete. Unlike those horrible "dental phobia questionnaires", which would make anyone feel like a freak, the form suggests that these fears are commonplace and "normal". Great ! I love anything that's simple yet effective...

[letsconnect]

I just found out that the form was created by Mac Lee (of www.ihatedentists.com fame). So I'd like to e-mail him - but it would be good to have additional statements you'd like to see on such a form first. Please post them here, or e-mail me in private! Thanks

[letsconnect]

If anyone would like to contribute, please do! Any ideas are welcome, no matter how trivial they might appear. I'm wondering - does anyone else have a thing about dental charting (where numbers are called out)? I had a huge thing about it (esp. the "depersonalizing" effect), but I'm wondering is it just me, or is this a common fear. Probably just me - but it would be good to hear your opinions on this one!

[Hopeful]

Let's see...

Don't wait to ask me an array of questions when you have your hands and/or instruments in my mouth. I can't give intelligent answers - rather merely shake my head slightly from side to side or up and down. And drool a lot. As it is, I feel compromised, at your mercy. Don't make me feel like a moronic fool, too.

[justme]

Great idea.
I think it would be good to have a box just saying "there are other issues i would like to discuss that are not covered on this form"
In my experience there can be a wealth of issues for a phobic. Sometimes there are little things that can be easily solved if one had the space in which to discuss them.
Just my thoughts xxxxxxxxxxx

[letsconnect]

Guest-justme said:

I think it would be good to have a box just saying "there are other issues i would like to discuss that are not covered on this form"

Great idea! If you don't mind, the box will be included (using your wording) at the end of the revised version (hope Mac won't mind - I'm sure he'll be OK with it!).
Thanks

[letsconnect]

Could anyone comment on the following points:

1) Is having cotton in your mouth a common phobia? I know some people don't like it (who does), but would it be a big thing with anyone?

2) We're thinking of adding the following statement to the list:
"It helps me if your nurse holds my hand and if you can touch my shoulder or arm reassuringly now and then."
Reason: as a patient it would be very embarrassing/impossible to ask for something like that. On the other hand, would some people find a statement like that off-putting (or is it just me )? And what do dentists think?

3) We're also thinking of adding a statement "I cannot handle having a rubber dam in my mouth." The worry with this one is that a lot of people who haven't seen a dentist in years would not know what a rubber dam is, and the statement might prove frightening to them. Can anyone think of a more generic way of expressing concern in relation to the use of a rubber dam.

Any help (also from dentists) would be appreciated!

[Guest]

Not having been to the dentist for something like 14 years, I an currently on dentist no 2 (since 1999).

At dentist no 1, I had a different nurse each time. But they all held my hand.

At dentist no 2 it's always the same nurse. She also holds my hand.

Luckily, I didn't have to ask for it. Maybe I looked like I needed it; anyway, they just held my hand.

I agree though, it would be mbarrassing to ask for it. So having it on the form is a good idea. People who don't want that don't have to tick it.

[letsconnect]

Many thanks for the input - your comments are extremely valuable. I can now see that such a statement would be a very useful addition.

How would people feel about a male dental nurse holding their hand, though? And how do people feel about physical contact with their dentist? More comments would be great!

[Guest]

Well, I've never had a male nurse, so all I can do is speculate how it would make me feel. And i think I'd hold his hand just the same as I'm doing now with the female nurse.

Having thought about this, I don't think it's a male/female thing. It's more to do with feeling very small/little and being/needing to be comforted.

I guess it's one of those things: you either need it, in which case it all feels o.k. and helpful at the time, or you don't need this at all, in which case it seems weird.

As for "physical contact with your dentist" as you put it: they touch you a lot anyway, lol.
Once, when I had impressions taken (with that blue gooey stuff) mine put his hand on my shoulder and told me to breathe deeply through my nose not my mouth when I started to gag. That actually helped. I think I was starting to panic, and the hand-on-shoulder reminded me that he was there, making sure I'd be o.k.

Don't know if any of this helps you.

[letsconnect]

That helps a lot - thanks !! Obviously, there is a need for this statement. So it's in!
Might phrase it as an and/or question, though: ""It helps me if your nurse holds my hand and/or if you can touch my shoulder or arm reassuringly now and then." Some people might like one but not the other.

The other one I was uncertain about was the rubber dam question, see above:
"3) We're also thinking of adding a statement "I cannot handle having a rubber dam in my mouth." The worry with this one is that a lot of people who haven't seen a dentist in years would not know what a rubber dam is, and the statement might prove frightening to them. Can anyone think of a more generic way of expressing concern in relation to the use of a rubber dam."

Maybe one could phrase it so that nobody feels inadequate at their lack of knowledge, e.g. "Previous dentists have used a rubber dam, and I couldn't handle it". No point in alarming people unnecessarily, considering that many people don't have a problem with it (or even prefer it). That statement might still put ideas into people's heads though... any thoughts appreciated!

[toothlessish]

dumb moment but what is a rubber damm? pretty damn sure I can't handle anything that sounds like that anyway!

[letsconnect]

That sort of proves my point ;D

From Mike's online dictionary: "Rubber dam: A square sheet of rubber which is held over the mouth with a frame. A hole in the rubber allows isolation of a tooth or teeth from the rest of the mouth. This protects the airway from small instruments, irrigants etc during root canal treatment. It also reduces saliva contamination which is important for root canal treatment and procedures involving acid etch such as for composite fillings."

Some people would actually find a rubber dam more comfortable, so I wonder if a statement mentioning the rubber dam might put ideas into people's heads ("well, if it mentions this in the questionnaire, then surely it must be uncomfortable") and cause undue worry.

I'm just wondering how to phrase a statement which would allow people to discuss their dislike of rubber dams without worrying others who wouldn't find the rubber dam threatening otherwise.

I'm off now! See ya in in a couple of weeks' time! And best of luck with your dentist quest!

[letsconnect]

Instead of mentioning the rubber dam directly, what about this:
"I cannot handle having certain things placed in my mouth."?

This would then allow the dentist to ask further questions, without scaring anyone, making people feel stupid for not knowing what a rubber dam might be, or putting ideas into people's heads.

Anyways, here's a preliminary, revised patient form - comments appreciated (while it's impossible to cover every possible concern on this form, please let me know if I've left out something really important):


"Please check any statements that concern you or describe your situation. We are happy to address any concerns you may have.


I have not been to the dentist for a long time, and I feel worried about what you will say about my teeth and my dental hygiene.

I’m too scared to sit in the chair. I’d like to talk to you first.

My teeth are very sensitive.

Pain relief is a top priority for me.

I don’t like shots (or I’ve had a bad reaction to shots).

Lying down in the dental chair is very frightening to me. I much prefer sitting up.

I gag easily.

I cannot handle having certain things placed in my mouth.

I hate the noise of the drill.

I need to know that you will stop when I give a pre-agreed “stop” signal during treatment.

I have difficulty giving a “stop” signal during treatment. I need to find out how you will know when I need a break. I also need your reassurance that you will stop.

It helps me if your nurse holds my hand and/or if you can touch my shoulder or arm reassuringly now and then.

I have difficulty listening and remembering what I hear while sitting in the dental chair.

It would help me if you could explain to me what you are doing/going to do, in a language that I can understand.

I’m worried that you might recommend treatment that’s unnecessary.

Please tell me all the treatment options and the various ways these can be carried out so that I can make an informed decision.

I want to know the cost upfront. No money surprises please.

I have health problems that we need to discuss.

I prefer short appointments.

I prefer long appointments.

There are other issues i would like to discuss that are not covered on this form."


Anything which needs to be covered that isn't covered? Any superfluous statements? Any wording you'd like to see changed? Your comments are appreciated!

[letsconnect]

Mac has given the go-ahead and we'll run with this form. So, if you'd like to see any modifications, now is your last chance! (well, at least for the first draft - it can always be modified again).

So - comments please!!

[letsconnect]

The problem as I see it is how to increase dentist acceptance? As Mac says himself, some dentist feel the Handle me with Care is PUTTING ideas into patients heads and should not be used.

So I'd like to keep it reasonable. As it stands, the typical comment is (I picked this one, because it's well-phrased) "The last thing an overworked dentist needs is somebody handing him or her a form letter that says "I'm going to be extra-demanding and be a total PITA". And that's coming from someone who's sympathetic towards phobic patients ;D ... And I can see the point (in case this comes across as scary - I should probably point out that the comment may have been designed to point out possible problems with the form - and sure enough, it did ;D).
But not all dentists are overworked , so I reckon there's a "market" for it. The form might be a little long, though. I'd prefer to be able to put it one A4 page (and not by reducing font size or spacing, either). So are there any items that are not particularly necessary? What could be got rid off?

I'm also thinking of putting together two versions (or maybe even three) - one without "PITA" (that's "pain in the arse" for the unitiated) statements, the long version above, and a standard version that's somewhere in the middle (a compromise which appeals to both "sides"). We've already got rid off some of the original statements (i.e. the cotton statement, the waiting statement and the "contract" at the end).

Which of the above statements (in the long version) could go? And question to dentists: which of the statements would be considered "PITA" statements?

[Ihatedentists]

Hello, everyone. I am the original author of the Handle Me With Care concept. My approach to dentistry is more on a practical, common sense level than most dentists. As to the time issue; time is certainly the enemy of most dentist. It creates stress which sometimes translates itself in patients having a bad dental experience. That being said, it is still extremely important that the high fear, high anxiety patient be able to openly communicate with the dentist and his or her team. In order to replace bad memories with possible good memories, the bad memories must be talked about and examined with solutions in mind. The Handle Me With Care sheet allows for this natural exchange.

The key to the time issue is delegation to qualified team members. The team can spend the necessary time to get to know the patient, their fears, their desires, etc. This dialog is meant to be solutions based for both parties involved. The doctor enters the picture after these problems have been talked over and a tentative solution has been agreed upon. The doctor is brought into the dialog and rapport is past over to him or her.

I have been using this scenario for years and it works very well. I am so pleased and excited your group is discussing these issues. One day, we will do a rewrite of the I Hate Dentists book so your input is very valuable.

[letsconnect]

Hi Mac - thanks for posting here! Your input is very appreciated. Time pressure can certainly be a big issue, though this isn't always the case, depending on practice/office location, how established the practice is, whether you practice under a national health scheme, how much money you need to make in order to achieve an acceptable standard of living (by your own standards) etc. etc. Not all dentists are run off their feet... but it's true that time is the enemy of many dentists. That's one of the reasons I don't necessarily agree with the following statement:

Guest-Ihatedentists said:

In order to replace bad memories with possible good memories, the bad memories must be talked about and examined with solutions in mind.

I don't reckon it's always necessary to go into the nitty-gritty of detailing past experiences. In fact, dragging up those memories could have a detrimental effect under certain circumstances. Maybe it's just me... Anyway, IMHO it's not really necessary. Unless the patient mentions something spontaneously, I wouldn't probe too deeply. Saves time, too ! But you need pretty good technique to pull that one off. It's actually easier to ask "why do you not like shots?" than to go "no problem, the way I do it is..." and do the Derren Brown thing (don't know if you have him in the US, it's sort of like a mind-control telly show).

The other thing is, I don't agree with the statement "The key to the time issue is delegation to qualified team members. The team can spend the necessary time to get to know the patient, their fears, their desires, etc.". This may apply to "ordinary" dental patients, but for many dental phobics, one of the key aspects is the dentist-patient relationship - not the patient-receptionist relationship or similar. So especially for the first one or two new patient appointments, I would advocate an approach whereby particular emphasis is placed on the dentist-patient relationship. This starts with coming into the waiting room to greet your patient personally, outside the treatment room environment, and includes not leaving your pt, except to fetch x-rays or similar (if in different room). It would appear to me that the phenomenon whereby dentists to wander from treatment room to treatment room is US specific? At least as far as I can gather. What do you reckon?

Anyway, below, I've marked the statements that I reckon could be deleted:

I have not been to the dentist for a long time, and I feel worried about what you will say about my teeth and my dental hygiene.

[I’m too scared to sit in the chair. I’d like to talk to you first. - might be too PITA? what do you reckon?]

[My teeth are very sensitive. - tautology - see next item]

Pain relief is a top priority for me.

I don’t like shots (or I’ve had a bad reaction to shots).

Lying down in the dental chair is very frightening to me. I much prefer sitting up. [PITA, but necessary - this one stays]

I gag easily.

I cannot handle having certain things placed in my mouth.

I hate the noise of the drill.

I need to know that you will stop when I give a pre-agreed “stop” signal during treatment.

I have difficulty giving a “stop” signal during treatment. I need to find out how you will know when I need a break. I also need your reassurance that you will stop.

It helps me if your nurse holds my hand and/or if you can touch my shoulder or arm reassuringly now and then.



It would help me if you could explain to me what you are doing/going to do and why, in a language that I can understand.

[I’m worried that you might recommend treatment that’s unnecessary. - too PITA]

[Please tell me all the treatment options and the various ways these can be carried out so that I can make an informed decision. - should be standard!!]



I have health problems that we need to discuss.

I prefer short appointments.

I prefer long appointments. (these two can stay cos they're easy to implement and don't take up time)

There are other issues i would like to discuss that are not covered on this form."

Anyone have any thoughts on the above?

[ihatedentists]

We agree more than you think.

You are right about the different kinds of dentist. The "enemy" issue was directed to the dentist example in the above post. Here in the states, there are all kinds of dentists and unfortunately the public thinks they are basically the same which is something far from true.

Dentists who specialize in seeing the phobic patient certainly should not be so busy that they can’t take the necessary time to develop a trusting relationship. I see high fear patients everyday but rarely do I see the truly phobic ones. When I do, Sherri, my Patient Care Coordinator does a great job of making them feel comfortable. It certainly could be an America situation but I can assure it works very well when a highly trained person acts as the consumer advocate. In fact, we teach communication systems to dentist in the US for that very thing.

And of course I agree on not getting too deep with talking out past bad memories. But if someone tells me the past dentist could not or would not get them numb enough or that they were not numb and the doctor kept on working, I am going to talk that out until they understand such a thing will not happen in my office. These patients are going to learn they may belong to a certain percentage of people who don’t/can’t get numb in the normal fashion. They are going to know what happen to them in the past is not their fault and that modern technology now has a way to get 99.9% percent of the population very numb. They will know they will not be dismissed and will be believed in my office. They will also know we are there to solve their problems, not create more.

[letsconnect]

Of course we agree more than I think, I just like to get a bit of a discussion going ! I do agree with the points you made regarding past experiences. If it's relatively straightforward (e. g. not having been numbed sufficiently in the past, or injection fear due to a past painful injection), it makes sense.

Here's something I've been wondering for a while, in relation to time is the enemy (" The "enemy" issue was directed to the dentist example in the above post. Here in the states, there are all kinds of dentists and unfortunately the public thinks they are basically the same which is something far from true.
Dentists who specialize in seeing the phobic patient certainly should not be so busy that they can’t take the necessary time to develop a trusting relationship.").

I wasn't actually referring to dentists specializing in phobic patients, but dentists more generally. On the one hand, you've got dentists all over you-know-where trying to market their office to get more customers in. If the majority of dentists are inundated, how come they need to attract new patients?? That's the one I've never been able to figure out

"I see high fear patients everyday but rarely do I see the truly phobic ones" - who knows, some of the patients you describe as "high fear" might have perceived themselves as "truly phobic" . I don't think there is a universally accepted definition of what constitutes dental phobia. That's because there's too many different types of dental phobia going around. Which types of dental phobia are "true" and which aren't? Nobody knows. It's really in the eye of the beholder.

The "patient coordinator" seems to be a US thing? My own experience is limited to the one-dentist-per-treatment-room set-up (which personally, I prefer), so it's hard to comment.

Anyway, for anyone reading: any comments regarding the "Handle me with Care" form are invited !

[letsconnect]

OK, if anyone wants to chip in, here's your last chance (err... sound familiar ? - this time it's for real ). There'll be two forms, a short version and a long version. I decided to push the short version because my private "market research" indicates that it will increase dentist acceptance. But the long version will also be made available (freebie downloads). So here it goes:

Standard version:
---------------------------------------------------------------------
Please Handle Me With Care

Please circle the number next to the statements that concern you or describe your situation.

(1) I have not been to the dentist for a long time, and I feel worried about what you will say about my teeth and my oral hygiene.

(2) My teeth are very sensitive.

(3) Pain relief is a top priority for me.

(4) I don’t like shots (or I’ve had a bad reaction to shots).

(5) I feel out of control in the dental chair (or I have an extreme problem with lying down).

(6) I gag easily.

(7) I hate the noise of dental instruments.

(8) Please tell me about the treatment options and the ways these can be carried out.

(9) I need to know that you will stop when I give a pre-agreed “stop” signal during treatment.

(10) It would help me if you could explain to me what you are doing and why.

(11) I’m very concerned about money matters.

(12) I have health problems that we need to discuss.

(13) There are other issues I’d like to discuss that are not covered on this form.
----------------------------------------------------------------------

Long version:

----------------------------------------------------------------------
Please Handle Me With Care



Please check any statements that concern you or describe your situation. We are happy to address any concerns you may have.


(1) I have not been to the dentist for a long time, and I feel worried about what you will say about my teeth and my oral hygiene.

(2) My teeth are very sensitive.

(3) Pain relief is a top priority for me.

(4) Past dentists have had trouble getting me numb.

(5) I don’t like shots.

(6) I’ve had a bad reaction to shots.

(7) Lying down in the dental chair is very frightening to me. I don’t like being tipped back too far.

(8) I gag easily.

(9) I feel very claustrophobic when certain things are placed in my mouth.

(10) I hate the noises dental instruments make.

(11) I need to know that you will stop when I give a pre-agreed “stop” signal during treatment.

(12) I have difficulty giving a “stop” signal during treatment. I need to find out how you will know when I need a break. I also need your reassurance that you will stop.

(13) It helps me if your nurse holds my hand and/or if you can touch my shoulder or arm reassuringly now and then.

(14) I have difficulty listening and remembering what I hear while sitting in the dental chair.

(15) It would help me if you could explain to me what you are doing, in a language that I can understand.

(16) I’m worried that you might recommend treatment that is not really necessary.

(17) I’m very worried about getting infections from dental instruments.

(18) Please tell me all the treatment options and the various ways these can be carried out so that I can make an informed decision.

(19) I’m very concerned about money matters.

(20) I have health problems that we need to discuss.

(21) I prefer short appointments.

(22) I prefer long appointments.

(23) I have an extreme fear of dentists and I cannot handle sitting in “the chair”.

(24) There are other issues I would like to discuss that are not covered on this form.
---------------------------------------------------------------------------

All comments welcome!

[letsconnect]

OK, I'll keep talking to myself, then (actually, fair play to everyone who's given feedback by e-mail ... the "standard" version for general dental practice, which will undergo a test run soon, reads as follows:
---------------------------------------------------------------
Please Handle Me With Care

Please circle the number next to the statements that concern you or describe your situation.

(1) I have not been to the dentist for a long time, and I feel worried about what you will say about my teeth and my oral hygiene.

(2) My teeth are very sensitive.

(3) Pain relief is a top priority for me.

(4) I don’t like shots (or I’ve had a bad reaction to shots).

(5) I feel out of control in the dental chair (or I have an extreme problem with lying down).

(6) I gag easily.

(7) I hate the noise of dental instruments.

(8) Please tell me about the treatment options and the ways these can be carried out.

(9) I need to know that you will stop when I give a pre-agreed “stop” signal during treatment.

(10) It would help me if you could explain to me what you are doing and why.

(11) I have health problems that we need to discuss.

(12) There are other issues I’d like to talk about that aren’t covered on this form.
-----------------------------------------------------------------

Short and sweet. I know that this may look a little disappointing, but it's the best compromise I was able to arrive at. Sorry . Suggestions for improvement are welcome! This form will also undergo a test run with dental phobic patients, so it'll be interesting to see what people make of it.

Long version is still under development.

[letsconnect]

It's not so much the length per se I'm worried about (although shorter forms are perceived as more user-friendly), but rather the items themselves. The feedback has been, err... not-so-good. It is almost universally perceived as producing demanding patients and putting ideas into people's heads. Even some ex-anxious patients have said as much. Dentist acceptance for the long version is VERY low. I don't see the point in providing a "one-size-fits-all" form which is not going to be used by anyone. Essentially, it's a question of idealism vs pragmatism, and I suppose I let pragmatism win...

But I'd also like to provide a long version for dentists who are interested in such a patient form, and feedback on this one is still welcome. As I said, the "standard" version will be tested on real-life phobics, and their feedback will be taken into account. If acceptance is low, it's time to rethink things. Dentist acceptance for this form is much higher than for the long version, which is good. In the words of Tesco's: "Every little helps..."

Sorry if it's not enough
If you like, I can ask for more opinions on a dentist-only forum, but I can guess what the response will be...

[letsconnect]

It's not true that the form doesn't have the things on it that patients are anxious about. It would be more accurate to say that it doesn't have ALL the things on it that patients may be anxious about (hence the last item: "there are other issues I'd like to talk about that aren't covered on this form").

I understand that people may be particular upset that items such as "I have difficulty giving a “stop” signal during treatment. I need to find out how you will know when I need a break. I also need your reassurance that you will stop." don't feature. The problem with this item is - every patient would tick it ("hey, that sounds great!"). But few dentists will be able to offer this routinely, to every patient (time constraints, and over the course of the working day this would require an enormous amount of divided attention which most human beings are simply not capable of). While I do strongly believe that there is an onus on the dentist when it comes to calming patient anxieties, there is also an onus on the patient also to convey their needs and to cooperate to the best of their ability (i.e. working out, together with their dentist, a way in which they can reasonably comfortably undergo treatment).

I fear that a form which is perceived as producing "demanding" patients will alienate dentists who are otherwise very happy treating anxious patients. My fear is not based on a reluctance to "stir things up" (I'm always happy to do that ), but on dentists' reports of stress factors at work. To give another example, back in December there was a thread on a dentists' message board where, among other things, patients' refusal to be tipped back in the chair was discussed. The original poster was at the end of his tether after (having taken over another dentist's practice) he discovered that most of his patients refused to be treated lying down (which is a huge problem in terms of ergonomics, leading to back pain etc.). Now, I for one find it hard to believe that the majority of patients would have a huge problem with lying down. But I'm also sure that some of these patients have GENUINE reasons. How do you tell the two groups apart? A few dentists have "solved" this problem by simply refusing to treat patients who don't want to lie down, usually as the result of too many people asking for this. Now, if you have a patient form which encourages patients to ask not be tipped back, the end result may be that the statement ends up backfiring. If suddenly, a lot of people ask not to be tipped back (which, let's face it, would be to the detriment of the dentist's health), I would expect any sane dentist to say "well, that patient form was a crap idea, let's scrap it asap". And - I couldn't blame them. The form is supposed to make life easier, not harder - and if it makes things harder for either party (patient OR dentist), it's worthless.

I still see a role for the longer version for dentists who are not under too much pressure at work and who have a special interest in treating anxious patients, but it would appear to me that the long version is simply not viable for many dentists.

Having said all this, it may well be the case that I've overlooked something. If there are any items which you feel are easily implemented and which should feature on the standard form, let me know and I'll rethink things and run it past a few dentists .