SDM PH521 Behavioral Transcript (5) PDF

SPEAKER 0 Batteries. SPEAKER 1 Now it's pretty good. All right. Cool. Thank you. Of course I'm going to do. What did you say? Southern. I. Oh. Good morning. Happy last class. There's a couple of things I want to do. If you have a chance today, I'd love you to do one major thing for me. So if you go...

SPEAKER 0 Batteries. SPEAKER 1 Now it's pretty good. All right. Cool. Thank you. Of course I'm going to do. What did you say? Southern. I. Oh. Good morning. Happy last class. There's a couple of things I want to do. If you have a chance today, I'd love you to do one major thing for me. So if you go to blackboard, I appreciate the front actually doing that. That was really nice. If you go to blackboard there are three kudos boards I don't know if you've ever used it before but it's essentially an online sticky note. For them. I didn't pay for like the extended version again because I'm still paying student loans, but I did do three different ones for all of the guest videos that we were able to watch over the last week, and my hope is that I'll be able to share just some, like, little notes to them. Maybe something you found funny to me. I put like little things because you can attach stuff and write whatever you want. Um, to Paul Polyglot, who presented on HIV to methadone, my patient from down the street, and then to Don, who was our final presenter last week. I think it'd be a really meaningful if we could share that with them. So if you have a chance, each board only has 100. So if you aren't the first hundred people to write on it, you probably won't get to. But that would be wonderful if we could get some different notes there as well. But today is the final lecture. But this is not the final time you'll be. I'm in your time in dental school, right? The idea is that we're continuing to build important skills. So we have already been doing a lot of things that we will talk about today and some of our work with written assignment one with our peers, feedback to our videos and discussion board three, and what we've been practicing from the very beginning, which is taking information as it is from a medical history and then seeing what else do we need and how are we going to use it. So there will be some time today to apply some of the knowledge that we've been working on. Hopefully do a little bit here to help you in the final writing of your script for Written Assignment two, and we'll go over all of that at the end, or I'll probably do it a little bit before the end, just so that we all don't rush out of here to go prep tooth number 13 and whatever else we're doing. Okay, so I think that we've talked about this, but I'm getting quite a few questions about. How do I redo written assignment one? How do I include new information? My goal for you as you finalize your written assignment two script is to take what you had from written assignment one and add to it. You have to use the track Changes feature. So this is the reason why is I want to see what's new. Right. And I want you to make changes based on not only what I commented in your feedback online or on the assignment, but some of the feedback that you think is really important to consider based on your discussions within your discussion groups. The rubric outlines how many changes you need to make so you don't have to change. Spend all day changing your old script. I just want you to think about what you said and how you might be able to say it better. If I were you, I'd probably consider what my feedback is. But if I didn't give you a ton of feedback because I think you did really well, I would focus more on the feedback that I received in my discussion group. From there, you also add in counseling and an important element of the counseling that we're going to talk about today is ensuring, first, that we have all the information to then be able to provide the counseling in a meaningful way. So when we elicit information, we think about what they're doing, what they want to do, right. Because that relates to those theories of motivational interviewing, those theories of behavior change. The trans theoretical model that we talk about, that trans theoretical model must come up in your reflection. So you should really think about where your patient is in the process as you strip them out. Some of you, as you probably watched in the discussion group or as you think about it, have really done the full cycle, right. You're like, oh yeah, okay, cool. Now I'll make a change. I'm ready for some action. Right? And others are still thinking about it. There's no right or wrong. I just want you to think about how the topics we related, especially when we talked about theories and talked about important ideas, how that relates to the unique situation that you've created within your script. Make sense? Now, once you do that, you can infuse counseling. It doesn't mean you just need to put counseling at the end, right? We've talked about that, and many of you wrote in your reflections and I commented on it once we talked about it, that it's so hard to do this without telling them what to do or how to provide counseling, but I don't want you to think about the only place to put counseling is at the very end, but you should not be providing counseling until you have the information you needed to actually or need to be able to provide the counseling wherever it fits into your script. Does that make sense? Yeah. Um, so I think that when we think about counseling options, we think about things like social supports. We think about things like all of those psychosocial factors that influence someone's behavior change. One important area to consider is how can we collaborate with other health professions. And this has come up in a few lectures from some of you, from some of our presenters, in different ways, as we think about how we can then make sure that we have services available for the patient that helps fit their specific needs, right. So when we think about the types of collaboration that we can do as dentists, there are really two types. One type is intra professional relationships. Right. And as dentists we're really good at this. We're really good. If you see a tooth that needs a root canal and you live in a big city and you don't do root canals, guess what? You do send them to an antagonist, right? If you see someone with third molars that need to come out and you don't take out third molars, you send them to an oral surgeon. We're really good at collaborating with colleagues within our own profession, and that's what intra professional. Uh, providers are we're thinking about within our dental profession. We also think about it within our team now. It might mean that there's a patient that really needs a cleaning. You send it to your hygienist, there might be a patient that could be benefit from other members of the team to be able to provide things within our office. So I want you to think of intra is all of the people that in your clinical experience, all of your experience in Apex and thinking about kind of the different ways in which we interact, these are people that are part of the dental team that you would readily refer folks to. But it's interprofessional collaboration or interprofessional health care team that extends beyond the dentist, right beyond dental professionals, beyond the folks working within our team. And I want to think of, you know, what are some examples of them. So we'll pull up. We'll start with the little word cloud. SPEAKER 2 Whoops. Not that. SPEAKER 1 What are some examples? What's the first one that comes to your your mind when you think of other healthcare professionals that we might be collaborating with as dentists, interprofessional professional partners? Oh, it was at the first slide, but I'll bring it up, I thought I did. Oh, did it stop? I'll fix it in a second. Should be able to do it again. SPEAKER 2 Oh, jeez. Okay. There should be good. He. SPEAKER 1 So we got some different ideas on the board. And these are all folks that I want you to think about. As you start to provide counseling. And today we're going to practice a little bit in some of the different activities that we'll do. And hopefully it will be really productive for you as you think about how you can make some modifications and prepare your script. So a lot of you wrote PCP, right? Primary care physicians are essential collaborators for a lot of patients. I won't go over the reasons why. I know you know them through your other coursework, but it's important that we open up that collaboration, and we think about where on the medical history that every patient will complete. If they're a patient at Bu, at the dental school, where can we find different ways or ideas in which we would think that being a collaborator with a primary care physician is important? So as we go through all of the different interprofessional health care team members that we can partner with or think about providing referrals to, we want to think about where in the medical history could we flag that this might be someone that we want to partner with or talk to? And those questions are here on on the bottom of these slides. Now, many of you might not have a primary care physician, but might have a nurse practitioner. I know I do for my primary care. So these are other folks that could be providing essential services to patients that might be equally as important for us to collaborate with. Besides nurse practitioners, we might also have physician assistants who could also be a patient's primary care provider. Now, for many of you, you might already know this, right? But as we think about how we would engage with different folks, it's important for us to understand the relative scope of their practice. And for some of these roles, you know, different providers can serve in totally different capacities based on where they work and what their job functions are. But then we start thinking about other folks who might not be necessarily part of that primary care team that we think about. So not those physicians or nurse practitioners or Pas that serve as primary care providers. We start thinking about other providers that might be helpful based on an individual's specific needs and how they respond or interact. I know when I think about one of the most helpful interprofessional collaborators for my daughter's care, I think of occupational therapy, and she actually has occupational therapy every Friday at 730. So I've missed them for the last ten weeks. But it's a service that they come to the house as part of early intervention. And for those of you with kids, you might be more familiar with this topic, but they assist with activities of daily living. So the whole time she's in my house for that entire hour, she's working with my daughter to help her work on her standing, as you saw last week. She's there to help different functions. For some folks, it's simple feeding therapy. For others, it might be how they fold the laundry or getting upstairs. For us as we think about. Occupational therapists from the lens of potential interprofessional collaborators. Interprofessional collaborators we think about? Is there something they can help us with to increase their accessibility to care for their teeth or gums? Right? If they have an occupational therapist. If there's someone. These are the types of things I want you to think about as we're thinking about potential people that we could refer a patient to, or who we could collaborate with. If we know a patient, like, for example, who has an occupational therapist is really struggling with cleaning her teeth the way she wants to be able to clean them. It shouldn't just be me who's creating the plan for her. I should be partnering with her occupational therapist to ensure whatever she or he is recommending is going to align with what I want her to be able to do, or what I'm instructing her to do in my chair. There's also physical therapists, right? So there's different ways that we can think about how we could collaborate with PT. Does anyone have an idea how actually in my practice on Tremont Street where this comes up most. Uh, readily. And as we think about dentistry. TMD. Right. So we think about Jaw. Have anyone ever heard of dry needling? Yeah, acupuncture, dry needling. I was really brought on to it by a patient that I treat on Tremont Street. So I think there are definite ways in which we can partner or refer patients, whether or not it's a direct referral or a paper referral, but even through word of mouth to be able to provide services that patients could benefit from and thinking about other healthcare providers. And I think that's a big place where we can collaborate with physical therapists. We might also work in different environments when we graduate. We're collaboration with a social worker might be more essential, whether that social worker helps gain access to important things like healthy foods and safe housing, or whether that social worker is really a good partner to ensure that the patient has completed the appropriate paperwork for that insurance or for whatever they're applying to make sure that they have their state and Medicaid insurance. There's different questions on the medical history. And again, these are folks that could be really helpful. And for those of you who plan to practice in a community health center will be really essential to collaborate with social workers and their team to ensure that you're doing everything you can for holistically for your patient. There's also different areas or places. Can talking to clinical psychologists based on ways in which you could help engage with someone. I think this is when I think of some of the interprofessional collaborators that we're going to mention, kind of from here on out, they might be ones that you might not want to tell a patient. You should see a clinical psychologist write that directly. How would you like if someone told you that? Maybe some of us would like it, but maybe some of us wouldn't. Similar to how we think about the receptive nature of how we communicate that information, and how we think about motivating someone to ensure that this is a good choice for them. Talking to a clinical psychologist can be really helpful, but I think it's about promoting or to partnering and to suggesting, not necessarily making sure that we're mandating or ensuring that someone's doing that because we feel they need to. There's also dietitians. For those of you who have nutrition counseling as your topic, this could be really important. Why is that? SPEAKER 2 If you have. SPEAKER 1 Nutrition counseling, this is really important because. We know the sugar in our diet affects. Our teeth, right? We know sugar plus bacteria. Equal acid. Acid over time causes cavities. So it's not just what we eat, but it's how we eat it. And for a lot of folks, health insurance plans cover access to dietitians. We also have eye doctors in the variety of different eye doctors. If you're not familiar, eyeballs are really not my thing, but the idea is that there's different folks that we can partner with if we think that a patient might benefit from them. And while maybe none of the assignments in this course suggests a referral to an eye doctor as essential, we might be someone who's seeing or treating a patient every three, four, or six months, and as they age, might be really helpful to bring up to either their loved ones, their caregivers, that you might think that they're starting to have a little bit more trouble seeing or interacting the way that they have in the past. You know, athletic trainers might be focused on an interprofessional team that refer more patients to us as we think about sport guards and night guards. But as we saw a few years ago, kind of with the news and how essential they can be as collaborator on the team, especially with NFL and all the different needs there, I think athletic trainers are people we should be aware of. That could be really essential partners in the communities in which we serve. So as you get situated and settled in practice, you know, partnering and being accessible to them as a place for a referral of a tooth is available, or if a patient needs a mouthguard, could be really helpful for your practice and for the needs of your community. There's also speech and language pathologists. I think again, what I think too, the ability to provide different resources to our patients. I think a lot of times these folks are really helpful in thinking about how we swallow and eat. And for very young kids, I think we might have mentioned or I know Don mentioned last week in her video that some of the different devices that are coming to the market as far as having an electric toothbrush with built in suction availability for folks who might not be able to manage their secretions, like her daughter Emerson. I think about things and partnering and learning about different resources, and maybe not directly, how we can refer a patient to a speech and language pathologist, but how we can access them. And to see if there are any of these adaptive techniques and devices, that could be really helpful for the folks that we're working with and the folks that we're providing care to. Of course there's pharmacists. And I think this is a for those of you who have been in clinical practice, when you have a question about a specific drug or medicine that you're prescribing to a patient, they're really essential partners not only to think about contraindications to different medications that you might be giving or how things might interact, but also what is the best course of treatment or the best dosage for a particular patient when you're thinking about a specific clinical manifestation? Now I want to spend maybe the next three minutes thinking about my first patient and some of the things on his medical history, and I want you to talk to someone near you. Who are some folks that you might want to refer Phil to based on some of the bullet points on the screen. We'll start now. So I had a really good question. And that really good question was, well, doctor, who's going to get most hands on who's going to get nitty gritty with my patient, who's going to actually make the biggest help, make the biggest improvement for whatever I want them to do. And I personally think it's more about the individual that we're going to be referring to, then it necessarily is what exact specialist, as long as it's tailored to the person that you're talking to and grounded in your own experience. So a few weeks back when polyglot was presenting, he mentioned this. He said, one of your responsibilities or should be your responsibilities as a provider, is to know other providers in your community, not only dental providers and not only those intra professionals, so all of your dental specialists, but to know other health care providers in your network and learn from your patient's experience with those folks in those providers offices or however they service and treat those patients learning and keeping a running list. Like, where do you go for that? What's it like? What do you like that they do? Would you recommend that I refer someone that might have a similar concern to this provider is a really essential way for us to collaborate, because it really isn't your job as a dentist to ensure that you're sending them to someone who's really hands on. That's going to do everything that's perfect because you're not overseeing them, right? You're not a specialist in that particular area in which you're sending that patient. But what you are is someone who can see if there's a need and think about a resource. And while maybe our health care system isn't set up to allow this as smoothly or as directly as possible, it's about ensuring that you have resources for someone that can help provide their holistic care and to view dentistry not necessarily as a silo where we're only focused on teeth and gums up and to the end of the hard palate. But thinking more about how we can then partner with different folks. So for Phil, there's definitely some different people that we could think about referring to. I think this relates most clearly to folks thinking about smoking cessation and that and that product. And and Phil, when I was working with him, really had no desire to talk about his smoking habit. So as we think about motivational interviewing, as we think about tailoring what we're going to say to someone. In our assignments for this course. We're thinking about potentially, and for most of you, at least, your written assignment was based on a first clinical interaction, right? It's the first time you meet them. It's the first time you're going over that medical history. But for many of the patients that we're going to treat and talk to. Providing that counseling or that direct referral at that first visit might not be the place. It likely isn't the place because we might not know enough about them. I know you're collecting as much information as possible through these assignments, but sometimes you have to see how someone interacts. Sometimes you have to see, like we saw in some of your classmates videos as they're picking up a toothbrush and they're practicing how they use it. We have to know a little bit more about the supports they already have or that they receive, or what they've tried before, before we can make a recommendation. So keeping all of this in mind. When I think of Phil. Phil wasn't really open to talk about his smoking until the day we inserted the new dentures. Does anyone know why? He. He was concerned. About what? How he looks. Yeah. Staining. Yeah. Mandy's got it staining on his new dentures. He wanted to make sure his smile. Say, just as bright for his daughter's graduation. I think when we learn more about what motivates a patient. And that we take action. We show empathy and we build trust. The way in which we can provide recommendations can shift and change. Now, I'm not going to stand here and say, I was so successful. Phil doesn't smoke, right? Because honestly, I went on externship as a fourth year. I came back, he was getting his permanent dentures with one of my classmates. I went to all the appointments. But, you know, our tight knit relationship had faded. And that's part of what happens when we treat patients in a dental school environment. But that will be different than what will happen wherever you land and where you practice in the community in which you'll serve. So when we think about the relationships that we build, I of course talk to fill. My suggestion was for him to reach out to his primary care physician, to see if there are any resources available for him to assist in quitting smoking, or cutting down the number of cigaret study smoke for him to make a real, tangible plan. But I think that a big piece of all of the things in Phil's medical history are like many of the medical histories. And folks that you'll meet in the clinic is that we first get to know them and, and think about how these recommendations will work for them, and then to provide some real resources which link back to Polly's concept. Who have you learned? What have you? What have you been able to do? Who could you partner with to actually be able to send someone or make a recommendation to actual place where they can call instead of just saying you should get an occupational therapist, you know, you should Google it. A lot of times, barriers that can get in the way of providing care specifically for our patients who have high needs or who have a lot going on in their personal lives. Influenced by all of those other psychosocial factors we've talked about in the class, could influence their ability to partner with other folks and their willingness and their desire. SPEAKER 2 So. SPEAKER 1 We're going to spend the next. 25 ish minutes. Working on an activity. So if you go to the content folder of the blackboard site, there's a link to an Excel document similar to what we did in week three. And there's different tabs for each of your topics for written assignment two. The task that I want you to do. And I didn't ask you to sit with your partner. I don't think you need to, but I do want you to talk to someone sitting next to you so you can gain the perspective of someone who has a different topic for your written assignment and what we're doing in column one, there's a dropdown of all of the different providers that we've talked about today that are interprofessional providers. And then there's a block next to it for you to include information as a script to what you might say, as you're practicing referring someone to somewhere. I think with what we've been talking about in this class today, these little blurbs of questions or introductions are going to be really helpful for you to look at and hopefully not take directly unless it's yours, from which I won't be able to tell. But it's okay into your script for Written assignment two. So thinking about how when we're providing counseling, a big piece of counseling is seeing. Is there anyone else that can help you? Because these really can't always all be on you to solve this. And for many of you who think about a lot of different topics, maybe apart from oral hygiene, right. But I think oral hygiene still could partner with folks like occupational therapists or different folks, um, nutritionists, dietitians. These are great ways for us to practice what we would actually say to a patient. So we're able to find that on blackboard. I want you to work I'll put up a timer in a minute for about 15 minutes. And we're going to pull up some examples of what folks have said as we wrap up class today. Okay. So I'll let you get to work. But with that, I'll also put the attendance on the screen in just a second. UNKNOWN Or why? What is? And on my uppers. Only in my mind. Space. But in. Actress with. Touching his skin. Now. Guilty as sin. I keep these longings alive. SPEAKER 3 Court in lower case inside a vault, someone told me. There's no such thing as bad. UNKNOWN Only your actions are. SPEAKER 3 Your fantasy. UNKNOWN Good breath taking all of me. We've already done it in my head. If it's me. Why does it feel like a foul? We'll both uphold somehow. What if he's relying on my upper thigh? Only in my mind. My grave without. Touching his skin. How can I. SPEAKER 3 Be guilty as sin? What if I roll the stone away? They're gonna crucify me anyway. What if the way you hold me is actually what's holding. If longsuffering propriety is what they want for me. UNKNOWN They don't know how you've haunted me so stunningly. I choose you in me. SPEAKER 3 Religiously. What if he's written. UNKNOWN Mine on my upper thigh? Only in my. Amazing. Oh, what a way to die. Chris. How could I. SPEAKER 3 Be guilty as sin? He sent me downtown love. UNKNOWN I hadn't heard it. Why? Am I allowed to cry? The who's who of who's. SPEAKER 3 That is poised for the attack. But my bare hands paved their path. You don't get to tell me about sad. UNKNOWN If you wanted me. SPEAKER 3 Dead, you should have just said. That makes me feel more alive. So I leap from the gallows and I levitate. Down your street. Crash the party like a record. Scratch as I scream. You should be. UNKNOWN The scandal was contained. The bullet. SPEAKER 3 I just grazed. At all costs. Keep your good name. You don't get to tell me you feel bad. UNKNOWN Is it a wonder I broke? SPEAKER 3 Let's hear one more joke. UNKNOWN And we could. SPEAKER 3 All just laugh until I cry. So I leap from the gallows and I levitate down your street. Crash the party like a record. Scratch as I. UNKNOWN Scream. Who's afraid of? Want me. SPEAKER 3 Take my journal to the circus. Life made me mean. Don't you worry, folks. We took out all her teeth. UNKNOWN I was afraid of. Well, you should. SPEAKER 3 So tell me everything is not about me. But what if it is? I then say they didn't do it to hurt me, but what they did. I want to stall and show you just how disturbed. UNKNOWN This is made me. You wouldn't last an hour in the asylum. Where? They raised me. So all you care. You can sue my house with all the cobwebs. I'm always drunk on my own tears. Isn't that what they all say? SPEAKER 3 Do you? If you step on my love. Lon. That I'm fearsome. And I'm wretched. And I'm wrong. Put narcotics into all of my songs. And that's why you're still singing. So I leave from the gallows and I levitate down your street. Crash the party like a racket. Scratch as I scream. Who's afraid. UNKNOWN Of a little old me I was. SPEAKER 3 Tame, I was gentle till the circus life made me beat. Don't you worry, folks. We took out all her teeth. UNKNOWN Cause the prey. You heard me. And he taught me. They called. For me. Let alone me. SPEAKER 3 Who's afraid? A little old me. The smoke cloud billows out his mouth like a freight train through a small town. The jokes that he told. And far too loud. They shake their head. UNKNOWN Saying, God help her when I. Tell him he's my. SPEAKER 3 But your good. UNKNOWN Lord doesn't need to lift a finger. I can fix him. No, really I can. And only. SPEAKER 3 I can. SPEAKER 1 One thing I just want to mention with maybe five more minutes left, if you haven't done this already, Google is there. You're saying you want to send them to a dietitian? What dietitian are you going to send them to? You want to send them to an HIV testing center. Which one? Get specific. SPEAKER 3 Use Google and I could see it from a mile away. A perfect case for my certain skill set. He had a halo of. AI is great. He just hadn't. UNKNOWN Met me yet. They shake this. Saying God help her when I. Tell him he's my man. The good Lord doesn't need to lift a finger. I can fix him. No, we. You. And only I can. SPEAKER 3 Good boy. That's right. Come close. I'll show you heaven. If you'll be an angel all night. Trust me, I can handle me a dangerous man. No, really, I can't. They shook their head. UNKNOWN Saying, God help her when I told him he's my man. I'm his manager. Good lord. Didn't need to lift a finger, I. No, we. SPEAKER 3 Oh, maybe I can't. UNKNOWN Who's gonna stop us from waltzing back in to rekindle the flames? SPEAKER 3 If we know the steps anyway. We embroidered. UNKNOWN Them. The rest of the time I was. Way stitching. SPEAKER 3 We were just. UNKNOWN Kidding. Babe, I said I don't mind. It takes time. I thought I was better safe than sorry I. I felt a glow. Like this. Never before and ever since. SPEAKER 3 If you know it in one glimpse, it's legendary. You and I go from one kiss to getting married. UNKNOWN Still alive. Killin time at the summit. Never quite. And you shouldn't have. In the nick of time. You low down boy. You stand up guy. Holy ghost, you. I love your. Love of your. Her life. About a million times. Who's gonna tell me the truth? When you blew in with the winds of fate. Told me I reformed you when you're Impressionist paintings of hell and turned out to be fakes. But you took me to hell, too. And all at once the ink bleeds. A con man sells a fool to get love. Quick scheme. And I felt a hole like this never before. And ever since. If you know it in one glimpse, it's legendary. What we. SPEAKER 3 Thought was for all. UNKNOWN Time was momentary. Still alive. Killing time. The cemetery. You sent a file in black and white. All those plot twists and dynamite. Mr. Steele, your girl. SPEAKER 3 And make her cry. UNKNOWN The love of your. You should talk to me under the table. SPEAKER 3 Talking rings and talking cradles. I wish I. UNKNOWN Could recall how we almost had it all. Dancing phantoms on the terrace. Are they? Second hand, embarrassed that. SPEAKER 3 I can't get. UNKNOWN Out of bed cause something counterfeit. It was momentary. It was unnecessary. Should I let it stay buried? Oh, what a valiant. Coward claimed he was a. I'm combing through. The braids of lies. I'll never leave. SPEAKER 3 Dreams and. UNKNOWN Goals in. Somber eyes. I can read your mind. She's. SPEAKER 3 Having the time of her. UNKNOWN Right there in her glittering prime. SPEAKER 3 The lights refract sequins, stars of your silhouette every night. I can show. UNKNOWN You. Yeah, I. SPEAKER 3 Can handle my shit. They said, babe, you gotta fake it til you make it and I did. Lights, camera, bitch. Smile. Even when you wanna die. He said he loved me all his life. But that life was too short. Breaking down I hit the floor. All the pieces of me shattered. As the crowd was chanting more. I was grinning like I'm winning. I was hitting my marks cause I can do. UNKNOWN It with a broken heart. I'm so depressed I act like it's my birthday every day. I'm so obsessed with him. But he avoids me like a plague. I cry a lot, but I am so afraid I. It's like. You know you're good when you can't even. I can hold my. I press. SPEAKER 3 I've been doing it since he left. UNKNOWN I keep finding his. SPEAKER 3 Things in drawers. Crucial evidence. I didn't imagine the whole thing. Sure I can pass this test. Tough kid. I can handle my shit. They said baby, go. Fake it till you make it, and I did. Lights, camera bitch. Smile in stilettos for my eyes. He said he love me for all time. But that time was quite short. We. Looking down, I hit the floor. All the pieces of me shattered. UNKNOWN As the crowd was chanting more. I was grinning like I'm winning. I was hitting my marks cause I can. With a broken heart. I'm so depressed, I. It's my birthday every day. I'm so obsessed with him. But he avoids me. Like to play. But I also predict. It's an. You know you're good when you can even do it with a broken heart. You know you get. Miserable. Track over my job. SPEAKER 3 Was any of it true? UNKNOWN And gazing at me starry eyed. SPEAKER 3 Jehovah's Witnesses. SPEAKER 2 Fuck. Where did it come? SPEAKER 1 So. I had some really good discussions at different points as we think about how do we apply this to clinic, right. Because we can write the right answer. We can know what a patient needs, but ultimately we can't force anybody to do anything right. We can say you need all these fillings. We can say you need a crown. We can say you need to go to an oral surgeon. But if we're not figuring out what motivates the patient and tailoring it to them in their unique situation by helping to find resources, and I talked a little bit of that with one group who might actually look close by to where a patient lives, to community health centers or networks where they could see a primary care physician. I think that we. Can maximize our impact by associating what we're saying with the motivation that influences the patient through getting to know them. And as we think about some of the different. Folks or ways in which you'll consider including an inter professional referral in your written assignment. Number two, as you think about providing counseling, we need to be thoughtful how we're going to say it. So let's look on the screen. Based on our discussion today, I believe it would be beneficial for you to meet with a social worker. I'll make a referral for you, and they'll be able to work with you to meet your needs and goals. This sounds like rainbows and butterflies, right? Based on this script. Who wouldn't want a social worker? SPEAKER 2 Right. Now. SPEAKER 1 This might be the case. And as we were talking earlier, it really depends about those specific folks that you're interacting with. And maybe you're in a multidisciplinary practice or you're in a clinic that's integrated with primary care and whole health. And that might make more sense, because maybe all the referral is, is sending an email or flagging someone for them to follow up with. But if you're in the dental school clinic, do you think this is going to work well? The patients that you're writing about or thinking about in your written assignments are dental school patients, right? You have a dental school medical history. You're imagining yourself as treating them in the dental school clinic. I want you to be as specific as you can in that counseling that you're providing, not just to say, this is what I feel like I need to say to get an A and my assignment. But more so. This is what I'm going to say in 2 to 4 months, when I actually have a patient that could benefit from this service. Now we don't have a social worker at the dental school yet. I think there's some hope that maybe one day we will, and very few schools, dental schools across the country do have social workers on site at dental schools to be able to provide resources to them. But as we saw in the scope of practice, social workers can do so many different things that I think it's also important to really be specific and not just overall in what we're saying, because this is saying someone will help you address your goals, right. There might be a lot of goals this patient have that the social worker can't help with. So I want us to focus as we think about incorporating a referral, especially for folks who have oral hygiene, because I do understand that as oral hygiene script, a lot of the work that we will actually be recommending is things that we're kind of responsible for as their dental provider. Right. We've talked about those things. We might spend a little bit more time even thinking, can you demonstrate for me how you brush your teeth? And then can we think about how they're holding a toothbrush and maybe a referral to someone else could be helpful, but that maybe is more of a stretch, right? It might be asking if they have other members of their team to care for them that you could partner with. For many folks in the practices might be saying, can you bring in your loved one or someone who's overseeing kind of what you're doing, whether you're treating a kid or a senior, thinking about how those facts and how what they're actually doing and interacting with folks who actually could help make a difference. And for me, it's really partnering with her, her care aide, and not just talking to her care aid, but talking to both of them about how they can work together to achieve the maximum goal. So I want you to think a little bit more about what you're saying. And I think that from a script perspective, what this person wrote is great, but I don't think this is actually applicable to what you'll be doing in a few week, months or weeks in the clinic itself. Let's look at another one. Maybe. Let's look at. SPEAKER 2 This one's nice and long. SPEAKER 1 What do we think about row number six in the nutrition column? What do you like about that response? What do you like? SPEAKER 2 Are you just talking about other stuff? SPEAKER 1 What do you like? Because there's going to be things you like out of every response. What does this one tell you? If you don't know what a nutritionist is, right, or a dietitian is, do you learn a little bit more about it here? Could that be helpful to a patient? Especially when we think about concepts of health literacy? Now are all the words in that script thinking about health literacy? Probably not. Right. We got some big words. Some big words are okay as long as we break them down. But we shouldn't be just using big words for fun, right? Maybe. SPEAKER 2 Yeah. SPEAKER 1 So? I think we should be thinking about the words we're using, but I think that's nice to always inform. Like this is why I think some referral would be helpful, and I think that's as good. What could this person do to make it more specific? Give me a real reason that how it relates to what you're doing. Maybe thinking more about explaining the cavity formation process in that counseling by explaining what we just mentioned, how bacteria plus sugar equals acid. Acid over time causes cavities. And it might be helpful to partner with someone to think about how this could apply to what you're eating throughout the day, eating and drinking throughout the day. Right. And we could even be more specific to look up actual examples. And, and I think as we're thinking about patients that we'll see in the treatment center, maybe those around the Boston neighborhood, potentially those who accept state insurance to be able to provide actual, real, tangible examples of those referrals. Let's look at smoking cessation. Lots of psychologists. SPEAKER 2 Let's choose a row. SPEAKER 1 Let's do 31. SPEAKER 2 What do. SPEAKER 1 You like about this. SPEAKER 2 One? What? SPEAKER 1 You got a name? You have a location. It tells you who's on their team, right? It gives you an idea of what they'd actually be able to do. And this is again, real application. And something that's tangible would be important. Now if you were to make this better, what would you add? Now as anyone, as a provider or as a student in an apex clinic heard a dentist say, this is what I would do if it was my family member, or this is what I would do if it was me. When we think about providing counseling, I don't think that line needs to happen to every patient interaction or in every script for you to be successful, but I think it's helpful when a patient knows that you've interacted with somebody who's who's experienced this before. Or that has benefited from this particular treatment. Right? You could even say there's live testimonials on the website of people who have used this resource. So you can research it a little bit more. And I think this might be a really good option for you to think about or explore, and I'd be happy to help partner in any way I can. And I think some of that soft skill, some of that interaction that again, relates back to motivation could be included in this particular script. But I like this example because it's showing me that you're thinking about your community, your resources, and the patient's specific needs and making sure that we're. Describing exactly what would a patient would need to do. Let's look at HIV testing. Let's look at number three. How would you feel if you were the patient and you heard that? SPEAKER 2 Can you see it? I can see some squinting eyes. I. SPEAKER 4 You are being quiet. SPEAKER 1 What are. What are some things that you could think about improving? What are some language that could come across not necessarily empathetic in that number three row? Patients with complicated medical history. Do you want to be labeled as a patient with a complicated medical history? When we think about motivation and we think about motivational interviewing, we need to make sure that we're thinking about what's motivating the patient and what goals you might have established collaboratively. So in some of the videos and some of the examples, some that you've generated, some that we've seen, and some of the conversations that we've had with actual patients or caregivers, I think we could use a little bit more of an approach that thinks about how what you're trying to recommend is bringing you closer to a shared goal and a goal that they feel that they've discovered, and that is important to them. Right. So I know you want to be a little bit more healthy or you want you want to stay a little more healthy. I know you want to be healthy and your health is important to you might be a way better factor to prioritize something that's positive than saying, you've got a complicated history, man. You've got to really do something. You need to see these people, because this is what I do when they're a little bit too complicated. SPEAKER 2 Right? SPEAKER 1 And it kind of comes across that way slightly in this script. And I have a feeling the person who wrote this had no intention of that happening. So I think the reason behind a lot of what we're doing and what we're practicing. And thank you to the folks who who did this thoughtfully today, is that my hope is that this is going to provide you an example. Of ways in which we can think, or to practice the way we're providing specific information and communicating to patients in ways that are the most approachable to them in their unique situations. What I mean by that is we have to remember that we're not just saying something to say it, but that we're saying it to ensure that we're following those same ideals, those same goals of getting them to a specific direction that's best for their overall health in a way that's meaningful for them and that's tailored to them. And for many of us, when we think about our own factors, our own upbringing, our own. Perspectives on what it's like to collaborate with other health professionals, whether we're from down the street or across the globe, it's important for us to think more broadly about how things sound to someone who might not be just like us. It's important for us to know the patient and to know as much as we can about them before we make those recommendations. So I know there was a lot of. Concern when we weren't affording you appropriate time to practice or to infuse counseling directly into your first assignment. But I'm hopeful that now that we see it from a broader lens and from some, one of the folks might actually say if they were in clinic today. That we need to collect that information and understand our unique patient before we're able to provide those recommendations. Test question practice from today. I'll move the bar in a second. SPEAKER 2 Oh, geez. I don't even know how I did that. SPEAKER 1 It shows up on your phone though, right? So you can. SPEAKER 2 Read it there. How did I even do that? Okay, cool. Oh, jeez. I don't know. Yes. Oh, wait till it gets to 100. SPEAKER 1 So when I read this question, they're probably two that we could eliminate right off the bat, and one that's a little bit less certain or two that we can that we can decide from. Right. The correct answer here. As we want to refer someone to someone who could provide guidance on their overall nutrition for their increased cavity risk. Right. And I know that that's kind of blocked out. So if you weren't reading it on your phone, that's probably why. Now if I was to say a secondary person, that could be helpful, maybe an occupational therapist, but you don't know enough about the person in this particular scenario to suggest they have any difficulty. Brushing or flossing, right? You know they're not doing it as effectively. But you don't know if they have any difficulties with their functions of daily living. So as we think about examples in what test questions will come, knowing a big picture, understanding of what the scope of practice are for each of those different individuals will help you get the few questions on this topic correct. SPEAKER 2 Now. SPEAKER 1 The discussion. The things that I would love to just briefly touch on is your. You have a few things that will be due between now and the final. You know that the discussion board that will be based on your written assignment number two, is due the night before the final exam. That was agreed upon when we change the due date. Your final exam is 50 questions in the test center. I hope to be able to email a seating chart in advance so you know exactly where to go. It's at 8 a.m.. New rules from academic affairs. If you're later than 20 minutes, you will not be allowed to enter the test, so please don't put me in that situation. The questions are based on. I've even provided you a breakdown of where the questions come from. So as you as you think about where there may be more depth of content information on the final, that is why I included those in the syllabus and I put them on the on the screen here. Please be mindful as you finish your routine assignment two that there have been quite a few questions on different elements of written assignment two and the use of track changes. All of that information is on the FAQ, and I expect you to really be able to use that feature when you're submitting. Follow the rubric. My goal is to really try to provide that feedback to you as timely as possible. But of course, there's a condensed timeline before the actual final exam. There's been comments about there's a final exam column on blackboard. Yes, because I hope to share that grade with you. So there's full transparency with how your your total grade for this course is tabulated. That's all I got. Have a good one. UNKNOWN Sorry. I have a quick question. Yeah. Okay. So. SPEAKER 5 Um, I, I upload, um, my script with the comments. Okay. But there was a thing I didn't realize that. What can I say? SPEAKER 1 Do you guys have a class after this? Yes. SPEAKER 2 No. Okay.