Takeaway
When I told my dentist I didn’t floss regularly, it reminded me of a patient who shared she was not taking her medication as directed. Careful questioning of how the patient is actually taking their medication should be done before modifying the treatment.
Lifelong Learning in Clinical Excellence | August 21, 2024 | 2 min read
By Kyra Reu, medical student, University of Pennsylvania
Have you ever inflated your numbers by a smidge when your dentist asked how many times a week you floss? I know I have. Somehow, in the dentist’s office, flossing stops feeling like something I should do for the sake of my own poor gums, and more like a homework assignment I’ve shamefully neglected. The dentist starts to feel like an embodiment of the strictest grade schoolteacher I ever had. When I’m feeling brave, I might confess: “To be honest . . . I only floss when I feel something stuck in my teeth.”
When I heard that same phrase in clinic recently, “To be honest with you . . .,” it turned out to be a humbling experience. I’m a third-year medical student and was feeling pretty good at the end of my conversation with a patient, Judy. She shared her concern about her cholesterol levels dropping from 260 to 140 after starting a cholesterol-lowering drug (atorvastatin). She was worried low cholesterol could put her at risk for dementia and asked if we could cut her medication dose in half. I was feeling proud that I’d asked open-ended questions, like “What are you worried about?” instead of voicing my initial thought—that reducing cholesterol is exactly what atorvastatin is supposed to do.
I stepped out to present my assessment to the family medicine attending physician, Dr. M. We agreed it was important to reassure Judy that her cholesterol wasn’t dangerously low but thought it would be best not to reduce her statin dose and thereby risk setting her back to ground zero.
We reentered the room together and Dr. M gently broached the topic of her medication. That’s when Judy courageously said, “To be honest . . . I’ve only been taking it every other day.” That short sentence changed our plan completely. Since she was achieving excellent cholesterol levels with half the prescribed dose, Dr. M saw no problem giving her a smaller pill to take every day. Judy was visibly relieved.
Reflecting on this interaction, I realized I’d assumed Judy was taking atorvastatin as prescribed. I’ve since resolved to remember to ask the simple but important question: “How are you taking your medicine?”
I was also surprised to discover I now seem to have the same effect my dentist has on me, of making an adult feel like a student who didn’t follow the directions.When I visited a new dentist recently and confessed my dismal flossing habits, I felt relieved to get it off my chest. She told me it was ok and suggested trying to start flossing two or three times a week and we would go from there at our next appointment.
I’ve started flossing a few times a week. I was glad I’d mustered the courage to be honest, and grateful that she in turn responded with grace and a compromise.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.