Wednesday, May 5, 2010

Truth or Consequences

One surprising clinical observation is that so many adult patients here in Jordan have no significant findings on their health histories. In the US, one finds complex medical and pharmacologic histories of patients to be the norm. For example, US patients will frequently report cardiovascular problems, diabetes, emotional challenges, and /or kidney disease coupled with a daily routine of several prescription medications which all carry the potential of side effects and which influence the professional care plan.

It is not that Jordanians are healthier than Americans, rather I believe that a number of unique cultural characteristics influence the patient assessment process and theoral healthcare encounter, ie, 1) people here are very private about their health or disease status and reluctant to share their health problems; 2) many do not see their physicians frequently enough to know or understand their health / disease status; and / or 3) they fear discrimination if their true health status is revealed. This makes dental hygiene care particularly challenging because medical emergencies can be prevented, risk factors for oral iseases can be identified and used as a basis for patient education, and quality care can be provided only if the practitioner knows the health status of the patient. Not knowing the status means that standard patient management protocols may not be appropriately implemented. Without an accurate health and pharmacologic history, students gain limited experience in clinical decision making and collaboration with other healthcare professionals around the needs of the patient. Unfortunately, it also gives students the false impression that they need not worry about the health status of the people they treat. Partients too loose because they continue to be unaware of the oral-systemic risk factors that eventually manifest disease. With time devoted to good patient-practitioner communication, establishment of trust, case analysis, and emphasis on patient education, some of these problems slowly can be overcome.


  1. Michelle, now back in USA and able to access your blog. In regards to the sparce data provided on the health history, would you consider using the Simple Table to Determine Need for Medical Evaluation of Blood Pressure developed by Dr. David Kaelber and myself to identify the pediatric patient who may have elevated blood pressure and have cardiovascular damage due to untreated hypertension? It can be found online in Dimensions of Dental Hygiene, Feb 2010 issue. They interviewed us about the research and the clinical need for such a document. This would make a nice study for the students. They could collect BP values, using proper cuff size for size of arm, use the Simple Table to identify children/adolescents who need further evaluation of BP by medical/pediatric specialists, and report how many received a final dx of prehypertension or hypertension (stage 1 or stage 2). What do you think?
    Frieda Atherton Pickett, RDH, MS

  2. ooooooooooh

    this is a good website to remember the last days

    thank u prof for these pictures

    and I hope to come back to Jordan to see u