10.22.10 Issue #450 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Carol Tekavec, RDH
Hygiene Consultant
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I Don’t Want X-rays!
By Carol Tekavec RDH

All dental clinicians have been faced with a patient who questions or refuses radiographs. What, if anything, can we do to prevent this?  What can we tell them to “convince” them they are necessary and safe?  What if they are worried about insurance coverage? Should the office refuse to treat a patient who will not accept the radiographic exam?

Let’s start with a brief review of a few of the reasons radiographs are necessary:

  1. Radiographs are the only way to reliably view the bone, roots, attachments, interproximal areas, and under and around restorations. Without radiographs, clinicians are working blind.
  2. Radiographs provide a starting point for what conditions exist today, and what changes may occur by the patient’s next appointment.
  3. Detection of harmful conditions such as cancer lesions and abscesses are often impossible without radiographs.

We understand that x-rays are necessary to provide appropriate diagnosis and treatment for patients. We have to have radiographs to do our jobs!

Preventing Patients From Objecting
Oftentimes, getting patients to accept necessary x-rays can be as simple as having the dentist “order” them. A patient may get the feeling that x-rays are being taken as part of a “routine” - that the same protocol is used for everyone.  This perception is common when a new patient is taken into a treatment room for x-rays or a prophy before meeting the dentist. Avoid this by making sure that new patients are met by the dentist in a private office or conference room prior to any diagnostics or treatment being performed.

Following this, an oral assessment can be accomplished by the dentist. After talking with the patient and getting to know his/her concerns, the dentist can say to the assistant or hygienist, “Please take decay detecting x-rays and a view of the patient’s entire mouth for me to look at.” In this way, the patient hears the dentist ordering the x-rays, reducing or eliminating the chance that the patient will refuse them.  If the patient has concerns, he/she can express them to the dentist rather than leaving the assistant or hygienist to address them.

In my experience as a clinical hygienist, when the dentist orders the x-rays, very few patients object, the schedule keeps on track, and it sets a positive rather than a negative tone to the patient’s first appointment. Additionally, current guidelines for exposing radiographs indicate that dentists should order them after evaluating a patient’s health history and a clinical exam. See “Guidelines for Prescribing Dental Radiographs” at www.ada.org. This can be interpreted as a requirement of a dentist’s exam prior to taking any x-rays.

When patients come for their recall appointments, we might say, “As Dr. Smith requested after your previous exam, I am going to take your x-rays now.” Avoid saying something like, “I’m going to take your x-rays now.  Is that ok?”  We don’t want to ask permission or pose a question that the patient can refuse.

“Convincing” Patients That X-rays Are Necessary And Safe
A patient may tell you he/she is worried about radiation. If it is the dentist’s opinion that x-rays are necessary today, the assistant or hygienist might explain: “We cover you with a lead shield to be sure we only expose the areas around your teeth that we need to be able to see. If the dentist does not have these pictures, he/she will only be able to look at the tops of your teeth. He/she won’t be able to see anything else, such as a cavity that is beginning between the teeth. It would be like taking your car to a mechanic and asking what is wrong with the engine without opening the hood.”

Patients May Be Worried About Insurance Coverage
Be ready with an appropriate response when a patient asks, “Will my insurance cover these x-rays?” At the morning meeting, try to determine whether the patient’s insurance typically covers x-rays at today’s appointment interval. If yes, we might say, “While we can’t ever be positive; your insurance usually covers decay detecting x-rays once a year.” If the insurance probably will not cover them, then, we can say, “Your insurance will probably not cover these x-rays. However, it is our job to take care of you properly. It is the insurance carrier’s job to pay only according to your employer’s contract limits, regardless of what you actually need.”

Should You Treat A Patient Who Won’t Accept Radiographs?
Although this may seem drastic to some, from a legal standpoint this may be the best policy. Even if a patient has signed a form stating refusal of x-rays as a personal preference and understands that the dentist cannot treat him/her properly; no patient can legally give consent for a dentist to be negligent. The dentist is liable for improper diagnosis and treatment, even with a “refused x-ray consent form.” A patient can always refuse any treatment or procedure; however, the dentist may also decline to treat that patient. If this happens, elaborate documentation in the patient’s record is recommended. A dismissal letter should also be sent to the patient with wording emphasizing failure to treat some dental conditions may result in “permanent, irreversible damage to your dental health.” Offering appropriate care for patients is a basic function of a dental practice, and dental x-rays are a necessary requirement for accomplishing this.

Carol Tekavec CDA RDH is the Director of Hygiene for McKenzie Management. Carol can improve your hygiene department in just one day of training “in your office.” Interested in knowing more about how to improve your hygiene department? Email hygiene@mckenziemgmt.com

Carol is also a speaker on dental records, insurance coding and billing, patient communication and hygiene efficiency for McKenzie Management.  Interested in having Carol speak to your dental society or study club?  Click here

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