Question: How do you explain to a patient not wanting x-rays that the doctor will no longer see them...

As a patient if they don’t get their BWs done every year?

ANSWER:  First and foremost, we need to help our patients understand that radiographs are a necessary part of providing the patient with the best care and most informed diagnosis and treatment plan possible. If we don’t have the necessary radiographs, we compromise care for the patient by not providing competent care.

The ADA publishes recommendations for patient selection and limiting radiation exposure and you can find those criteria on their website.

Too often we allow insurance to dictate treatment, including when we take radiographs. We need to use the guidelines suggested and good judgement with each patient individually to determine the best course of action. In turn, just because a patient’s insurance will cover it, that’s not reason to take the radiographs either. We should use common sense and let the patient’s history and needs determine what is best practice for that patient. [mepr-show if=”loggedout”]Members only resources[/mepr-show] [mepr-active memberships=”629,630,37388,37393,37672,37676,37670,37668,37674,44674,232156″ ifallowed=”show” unauth=”message” unauth_message=”Answer hidden, please login or purchase a membership to view.”]

The usual reasons patients have for not wanting radiographs are Fear, Pain and Cost. We all have those few patients who have an issue with anything we do but we need to be ready to address our patients concerns as they arise.

Fear (usually of exposure) –
“Patient X, dental radiographs today are the safest they have ever been. The amount of radiation exposure is extremely limited due to the digital technology we now use. Because we can only see a portion of the tooth visibly, these radiographs provide us with valuable information about the part of the tooth we can’t see under your gums, around your fillings, crowns or other dental work, and in between the teeth.”

Pain (or gag reflex) –
“Patient X, we completely understand your concerns and today we have options for x-rays that are easier, smaller and more flexible to help with pressure points and gag issues. We will take it slow and help you through the process.” If necessary, a panoramic radiograph is always better than nothing for a patient who just can’t do otherwise.

Cost –
Sometimes patients use this excuse when there are other factors such as fear but there are options and if you feel the patient truly needs the radiographs there are ways to work with the patient who truly can’t afford them. Offer to have the patient pay at the next appointment, offer to take the radiographs at the next appointment so they are prepared to pay or comp the cost as a one time courtesy but let the patient know this is so you can give them the best diagnosis and not usual and customary.

If a patient refuses to have the needed radiographs, the patient may be dismissed from the practice. From a legal perspective, even if the patient signs something saying they refuse the radiographs, they can’t give consent for the practice and/or dentist to be negligent. If a patient refuses radiographs for proper diagnosis and they later develop a “dental issue”, the doctor could become involved in a legal battle.

Patients can choose to not have radiographs but the practice/doctor also has the right to dismiss the patient if they feel they cannot provide the best care for their patients due to incomplete diagnosis with out the proper radiographs. Good communication with the patient and good documentation in the patients’ chart is key.

It is crucial that the entire team be involved in understanding the best practices for our patients and that the same message if being sent to the patient. “We understand your concerns about radiographs but we are not able to provide you the best care you are accustom to without diagnostic radiographs. We would ask that at your next visit you would be prepared to have these radiographs taken so we can properly diagnose and treat any necessary findings.” If the patient continues to refuse the radiographs, then decision to dismiss the patient from the practice may need to be considered.

If the doctor decides a patient should be dismissed for refusing radiographs, some experts recommend that a dismissal letter be sent to the patient and that the terms “failure to treat could result in permanent, irreversible damage to your dental health” be included in the letter.

When our patients have the knowledge provided by us to understand the importance of radiographs and the benefits to them for best care, typically there is less issue with refusal. We need to look at each patients needs and not just a usual standard that radiographs are taken every year or at their recare visits. We always need to keep the best care in the forefront for our patients and the key is communication and documentation.[/mepr-active]