“I found squamous cell carcinoma under a patient’s tongue. She did not want to go to an oral surgeon to have it biopsied. It took a lot of convincing. We have to be vigilante.”
Cynthia Xander, RDH
What do you say to a patient to improve compliance? Here is a script to try:
“I see a suspicious lesion under your tongue. How long has it been there?”
“I didn’t know it was there.”
“It’s a red and white area that is abnormal. I recommend it be biopsied.”
“Why? I don’t want to go to an oral surgeon.”
“Because, we don’t know what it is by looking at it. It can be hyperkeratosis, leukoplakia, eurythroplakia or even the start of an oral cancer.”
“What? Oral Cancer? I doubt that. I haven’t smoked in 30 years, and I only drink socially.”
“Oral cancer is unlikely, however, this abnormal tissue may have the characteristics to develop into a cancer. A biopsy will identify how we treat the area.”
“I have enough going on in my life. I can’t deal with this.”
“A biopsy will give provide peace of mind. The mouth heals very quickly, too. You will experience a little discomfort for a couple of days. That’s it. It’s worth it to know what is developing. Here is the name of someone to whom I would send my mother. I recommend you call today because it’s important.”
“I will think about it.”
“OK. I understand it costs money and time. And, it hurts a little. However, weigh that against definitively knowing whether this is something serious. Why don’t you call the oral surgeon today. Your appointment will be in a week or so. During the week, look at the area every night. If it doesn’t resolve completely, keep the appointment. Sound like a plan?”
Please share details of your dialogue with a patient and how you motivated compliance.
Eva- these are excellent suggestions for encouraging a patient that has a suspicious area in their oral cavity or on their head or neck to see an oral surgeon, ENT or dermatologist. It is so worth it to get these areas checked out. Keep up the good work !!!
Cindy, thank you for sharing your story. Your vigilance is saving lives!