SDM PH521 Behavioral Transcript (4) PDF

SPEAKER 0 My hair. Good morning. I'm going to try not to take it personal that it continues to rain on Friday morning. So thank you for everyone for getting here on time. Today we're going to continue our discussion on motivational interviewing and starting to move to counseling. But before we do, I...

SPEAKER 0 My hair. Good morning. I'm going to try not to take it personal that it continues to rain on Friday morning. So thank you for everyone for getting here on time. Today we're going to continue our discussion on motivational interviewing and starting to move to counseling. But before we do, I want to bring us back to fill my first dental school patient. And what happened when I got to the treatment planning appointment. So for those of you who don't know, what we end up doing is we have a series of treatment planning, our data collection appointments, and we get to this treatment planning phase. And essentially that's when you go over with whoever, what type of case it is to get to a really nice plan for a complex case. And Phil was complex. You guys remember Remo? All of the terms that we had to use to describe phased extractions, immediate interims, definitive dentures, how long the plan would take. Clearly overwhelmed. Fill. So how does this relate to you, this course, the assignment that you've been working on. It really makes us think and start to break down how we present information. And we'll talk a little bit about that today. So the objectives are the same as last week. We're not learning any new information. I'm actually excited for some surprises that I have for you today. Yeah, there's always surprises. So I do want to follow up because I'm a little over halfway through grading your written assignment. Number one, I know some of you have asked me, what am I going to get your feedback? I am trying there's a lot of you. There's only one of me. And I want to make sure I give you some really clear points, just 1 or 2 sentences of things I want you to address in your revision for assignment two. But I've seen a lot of people saying this in their reflection, and they're not wrong. But I want to clarify. The assignment that you just submitted is where you elicit more information, and a lot of you did a really good job of that. And you all commented how it was really difficult not to provide counseling when you're eliciting information. Some of you did it more strategically. Others were much more direct and clear. So I understand your preference. But the fact is, before you can get to counseling, before you can provide your own recommendations for what the patient needs or what treatment you're going to provide them, you need to collect information. So as we move to an assignment two, this isn't that you have to show me all 100% of your eliciting information before you get to the counseling component, because for many of you, you have fragments, right? Those of you who looked at the medical history, you were supposed to thank you and you talked about more than just your assigned topic, right? You focused on your assigned topic. But there are a couple other things that you explored in that collection of information as well. I want you then to think about where counseling fits in when you incorporate it into your script. So it's adapting what you already have and not putting it at the end. So the guidelines for written assignment two don't tell you where you need to fit the counseling, because I get some of your points, I do that it's really hard not to say, well, oh well, you know, I think you should do this. But I really want you to start and pump the brakes. Sometimes when there's an opportunity to immediately provide counseling, because sometimes what you say immediately isn't as effective. Has anyone ever sent an email they wish they didn't? Oh, I see, I hand them back, orange raised in his hand. I'm gonna raise my hand double time. Okay? Especially like, ah, I can't I won't even get into some of the stories. But I think that that feeling where you reacted a little too quickly or you didn't slow down is the feeling I'm trying to prevent you from thinking about as you engage with patients and provide recommendations, because you already told me through the first four weeks of this class, if I say something that's offputting to you, is that going to motivate you? Are you going to change behavior? So I think that sometimes in the past and the reason why we design this assignment is not to be for me to say, you have to do a really challenging thing in assignment one because it was challenging, but I think you all did really well for the most part. You looked at all of the information, you looked at the guidelines. It's about collecting the information before you make some changes, and we'll see some examples of that today. So I will make this. We're going to do a test question at the beginning because there's no real new information. I'll put it up here. Is it working? Nobody's responded. So. SPEAKER 1 It makes me nervous. SPEAKER 2 Hold on. SPEAKER 1 All right. Somebody did. SPEAKER 0 Away till we get a little over 100. SPEAKER 3 Thank you. SPEAKER 0 All right. So the second thing I really want to mention today is that there are a lot of pieces of facts and approaches that we've learned, especially in the last lecture. Right. We learned all of the components of successful motivational interviewing, the four components. We learned the AWS acronym. We learned different tools that you can utilize in discussions when you're motivating patients. But these tools are not to be used all at once. They're not something that you must check off a list that you guarantee that you mention everything in real life. Part of what we're doing for these assignments is that you're thinking about the aspects of motivational interviewing infusing into your scripts because you are artificially creating a conversation, some of which are a little better than others, right? So when you artificially create a conversation, you can create opportunities to practice all four of these components of motivational interviewing that you can't do in real life when you don't know how the person you're talking to is going to respond, right? So I think when we think of the different types of communication styles, we know that a guiding communication style is going to be most effective, right? We talked about that. When you engage with the patient, you ask questions. You ask follow up questions. It's the same kind of idea of summarizing key components, putting the most important things together, right. These are all crucial elements. Of effective communication, but it's not something that we can do all the time. And this is an example, right? So we have 60% say directing. You're right. Sometimes you can't say, let's follow me. Especially when you're describing something really clear, like giving a medication. You have to be really direct in what you're saying, how you take it, what the side effects are, what they're going to do. For many patients, that could even include going to the pharmacy to get what they need to do. So while we know that other types of communication are more effective for motivating someone's behavior, we cannot use those types of communication solely. Right? We have to make sure we're using we have all of these different tools in our toolkit and pull them when we need them and when the situation is right. Let me take this down. So I think when we start thinking about moving from eliciting information to providing patient counseling, there's three things I want us to think about. And that's grounding our conversation in what motivates the patient. It's then using clear and concise language, which relates to all of the things we talked about at the beginning of the course. And we'll mention a little of that today. And then we're using the basic principles of ask, respond, probe, ask, follow up. So you're giving a cyclical nature of the conversation where it's not just you talking at someone or someone talking at you. Now, I mentioned last week that the assignment that we just submitted over the weekend is one where I expect that the provider is doing more listening, right. They're thoughtful for the questions that they're going to ask, and they do more listening to the patient. We know that not all patients can will be most forthcoming with information. And some of you weren't. But the idea here is that when we start moving to the counseling assignment, which is what we're talking about today, which we'll be giving you little tips, two of what we want to see you incorporate for the next three lectures. It's that we want to see that it becomes a circle conversation, right where we're moving now to where the provider needs to do most of the counseling, but it's really based on the information that's been collected. So this concept of health literacy you've learned about, we've mentioned before words matter. Several of you use some really big words in your script and in your dialog, probably words you're more familiar talking with with your dental school classmates than you are with patients. I want you to be really thoughtful about the words that you use as you create your revisions in assignment two. Not only in assignment two do you incorporate some of the counseling recommendations, but you also have opportunity to use track changes to change anything that you put above based on feedback. I'm going to provide you based on your classmates in the discussion board and based on what we're talking about here. So I want to see that you've made some changes based on what we're thinking about or how it came out when you practiced, or even how in what we saw when we presented, and watch some of our peers presentations within our discussion groups, which is part of our assignment due next week. So I have another question, because Wanda and Gabe asked me about moving the due date for assignment two. I believe in a democratic process where everyone gets a say. So I'd like to know if you'd like. The due date currently is Friday. And I'm open to extending it if we get a majority vote. It probably will do two things. One thing. I think the dates are right. Right. I kind of sleepy when I did this. It will do two things. One thing is, I cannot guarantee that I will have everyone's feedback by Friday at the exam, which was my personal goal. So that you would know your grade before you took it. Like what you had to get to get a certain thing. Because that seems like to what motivates 99% of you. So I will not be able to do that if they don't come in by Sunday. Or by Friday because I was planning on using some of the weekend. But I don't think that really matters. So it's up to you. I only see 123. I hope there's more than that in this room. See everybody's talking so they don't know. Once I get to 150, I'm going to hit it. SPEAKER 3 Okay. SPEAKER 0 So. Is a clear majority will move the assignment to Sunday at midnight. I'll change everything in blackboard once it's released, but that is with the knowledge that you'll have the same amount of time to do your discussion board. And I will not likely have all of the grades done by the final exam. I'm sorry, but I'm not a robot. Okay, so let's have some fun. SPEAKER 4 I. Good morning. Nice to meet you. My name is Erin, and I'll be your dentist today. SPEAKER 5 Hi. It's nice to meet you. My name is Aisha. SPEAKER 4 Uh, what brings you in to see us today? SPEAKER 5 At my last dentist, I was getting my teeth cleaned every four months. But I found that I'm still getting cavities all the time. And my gums bleed when I brush and I have soft teeth. So because of this, I haven't really been back to the dentist in six months, and I don't really mind the look of my teeth at all. But coming in for cleanings and always having cavities is really frustrating. SPEAKER 4 Thank you so much for your honesty. Working hard and going to the dentist regularly to get your cleanings is a great habit, and it's great to see that you are taking your oral health seriously. I also understand that it can be kind of frustrating to have these cavities all the time and have your gums bleed when you're when you brush. Um, let's take a closer look at your medical history, your social history, and sort of your oral hygiene habits to see if we can get to the bottom of this and work towards finding a solution together that works for you. Does that sound okay? SPEAKER 5 Yeah. Thank you. That sounds great. SPEAKER 4 So I see here in your chart that the medications you're taking, you're taking sex Enda and TLD. Are you currently taking this Zenda for your diabetes and TLD for an active HIV infection? SPEAKER 5 Uh, I'd rather not talk about my medications, if that's okay. Uh, why do you need to know your dentist? SPEAKER 4 I understand that it can be difficult to talk about your health or medications with a new person, but know that I'm here to not judge you or to shame you. But I want to get to know you better as a whole and understand your health so we can work together to sort of figure out what's going on, and all the things that are going on in your body can sort of affect your oral health, and we can work together to help make any changes and find a solution. So in order to move forward, I would need to know more about the medications that you're taking. SPEAKER 5 Oh okay. That makes a lot of sense. I'm happy to share if it means that I'll have a better outcome in the end. Yeah, I have been taking the TLD for a few years now. I am HIV positive and I'm taking this every day to remain undetectable and un transmittable. And I just recently got my type two diabetes diagnosis a few months ago and am now taking six and up for that. Oh, and while we're on this topic, I figured I might as well tell you that I used to have asthma, but I don't struggle with it too much anymore and I'm not currently on any medications for it. SPEAKER 4 Thanks so much. I really appreciate your transparency and your honesty. Um, with your new diabetes diagnosis, how are you working to manage that besides taking the sex? Enda. SPEAKER 5 I have honestly not implemented many lifestyle changes besides taking the medication the doctor prescribed me. I have been extremely thirsty and going to the bathroom a lot though. SPEAKER 4 Yeah, I do see that you wrote that on your chart here. Um, if you want to, if you could, if you could walk me through your day from beginning to end and sort of give me an idea of what you're usually drinking and eating throughout the day. SPEAKER 5 Sure. I don't really drink much water. I usually have a Coke with breakfast and a big bowl of my favorite cereal, and then a couple of cookies and a big glass of orange juice. I have a Coke with lunch, with a sandwich and a bag of chips and a chocolate bar. And then another Coke with dinner. Recently I've been making a lot of pasta. Sometimes I may even have more coke if I'm feeling extra thirsty. Oh, and sometimes some ice cream with gummy bears for dessert every night. SPEAKER 4 Coke is definitely a delicious drink. I really like it too. Um, but I want you to know that it is a very acidic beverage. It's full of sugar, and it also contains caffeine. Um, the fact that it's acidic and you're having it so often could be contributing to why you feel that your teeth are soft. Um, the acid can actually wear your enamel, which is like the really hard outer part of your tooth. And on top of that, all of the sugar in Coke is a really good food source for the bacteria that live in your mouth. And those can go ahead and cause those cavities. You're telling me that you're always having. And lastly, there's caffeine and Coke, which works as a diuretic, which means it makes you have to go to the bathroom a lot more. So even though you're drinking it because you're thirsty, it could actually be making you have to go to the bathroom more and make you even more thirsty in the end. SPEAKER 5 Oh, I see, okay, well, I don't really see myself giving up coke. SPEAKER 4 I would never ask you to give up your favorite beverage. Don't worry, I'm not asking you to completely eliminate it from your diet, but I think mixing in some water when you're thirsty, or maybe rinsing out your mouth with water after you drink the coke, could help reduce the amount of sugar that you're ingesting. And also, um, the cavities that you're seeing from all the sugar. SPEAKER 5 Okay, great. I can try that. SPEAKER 4 Craig. Nicola, next, let's go over some of your oral hygiene habits. I can see that you care about the health of your teeth. That's what brought you here today. Um, and your chart. You wrote that you're brushing every day, you philosophy times a week, and you do not use a mouthwash. Is that right? SPEAKER 5 That's correct. SPEAKER 4 So same like we do with your food intake. Can you walk me through what your brushing routine looks like on a normal day? SPEAKER 5 Well, when I say I brush daily, it's actually only once a day and it's at night so that I don't go to bed with stinky breath. Um. I've been using the same toothbrush for about two years now. My last dentist gave it to me and I love it. It's nice and hard, so it really scrapes away all the gunk and grossness on my teeth. After I brush the fronts and back my teeth, I brush my tongue really quickly, and if I feel like I still have something stuck in my teeth, I take a piece of floss and I really go to town up and down, making sure to hit the gums. I do find that my gums are often bleeding a lot after I brush, so I don't floss that much. And yeah, I rarely use mouthwash because it makes my last coke of the night taste kind of funny. SPEAKER 4 Well, it's really great to see that you're trying to get in there and clean your teeth and gums with brushing and with the floss sometimes, um, there are some ways that we can go over together that will definitely help reduce the bleeding you're seeing when you're brushing, and hopefully decrease some of those cavities as well. SPEAKER 5 That'd be great, because honestly, I sometimes find myself not being able to eat certain foods because of my teeth. SPEAKER 4 No, no, that's not great. What's. What kind of foods are you finding it difficult to eat? SPEAKER 5 Well, anytime I have something hot, like soup, my back teeth on my left side hurt a lot. Also, when I have really cold things like ice cream, I get the same painful feeling. SPEAKER 4 That's unfortunate. We don't want you to not be able to eat any foods that you would want to eat. I suspect that this could be related to the cavities that you currently have. Um, during our comprehensive oral examination, will evaluate your teeth as well as your gums. So we should really be able to identify what's causing this painful feeling for you. SPEAKER 5 Awesome. That'd be great. Thanks. SPEAKER 0 I think you should be applauding pretty strong. Again, my sample is a little biased because I've only looked at about 80 videos, but I think that we all probably could imagine that Aaron can take my job. There's a lot of really good things that he did in that video that I think is important for other groups, and I should did too. Credit to both of them as they crafted the script. But I think that these are little feedback and components that I want you to. When you're looking at your discussion board videos and you're watching your peers to think about. What you can do to your own script to infuse some elements that were really strong. What are some things that he did really carefully and thoughtfully that worked well for collecting the right information? Yeah. Tim. SPEAKER 6 She was like, well, you're just a dentist. Why would I tell? SPEAKER 0 So Tim, saying that sometimes people say like, you're just a dentist. Why do you need to know that? Right? And a lot of you had some element of that. And that's the resistance we talk about in motivational interviewing. Right. But he had a response that came off really naturally and thoughtfully. Right. You know, when you have, like, little things in your back pocket and you're like, when someone asks you a question, you know, what you're going to say. For those of you who think of your Apex experience or your own previous clinical experience, you already know how you would answer a question. A lot of times, if it's about a specific topic and there's probably little, as you gain more clinical experience, that would catch you off guard, right? I think, thinking thoughtfully about what you're putting in your pockets now as you get ready to go to clinic in just a few months, is going to be really important. And I think when you have an answer to that in a way that's meaningful and thoughtful. It comes off natural and it doesn't let it frazzle you, right? You know what I mean when I say that, right? Sometimes when someone says a comment, you're like, well, what do they mean by that? Right? And it can be a little bit off putting and start to create a little bit of space. But when that question was asked, and I think what Tim's picking up on is that question that could have created space between him and Aisha didn't. And that's what I want you to think about, how we can word things so that we do not create any of we roll with that resistance, and we have an answer that's going to support working together in collaboration. Other things that worked really well that maybe you didn't do in your own video. What topic did they have? Does anyone know? Nutrition. Very clear. Uh, what what did they do really well. I think some nutrition folks in the room didn't do this as clearly. Diet. He walked through what typical day looks like. Is that helpful? That's that's eliciting information. From there, we can start thinking about how we can make recommendations, right? He provided a little bit of information, but it wasn't direct counseling yet. Right? He provided information for context as to why learning about how someone consumes sugar and how they brush their teeth can influence their overall outcomes, right? But he didn't say what you should do yet, did he? And it came across pretty naturally because a lot of you, when we talked and we started this class today, said, well. I need to tell them what to do when I hear this information. He didn't tell them what to do, did he? He gave the information so that when he can look at everything comprehensively, after he looks inside the patient's mouth can actually provide better information in more tailored counseling to the patient. Because, you know, some of you have probably seen patients, too, that say they eat or drink Coke all the time, but there's not a cavity in sight, right? We've seen patients like that. It's not common, but there probably are some. I don't brush very well, but everything's beautiful. So I think there are a lot of factors that we need to piece together when we do this. And I really want to applaud this group because I think they did a great and excellent job. But before we move on, I just want to take a couple seconds where you turn to someone near you and think about some other fact or factoid that you can put into your script. Even if you didn't have nutrition counseling, that could be helpful. So we'll give about three minutes. I didn't mean to do that with the screen on. But, you know, sometimes we get. It just so happens they're sitting next to each other right over here to. Wait. Where'd it go? And. All right. I heard some good things. Um, we're going to see maybe 1 or 2 other examples, maybe one more example before I show a cringey video of myself just to make things equal. Um, but I want to move to another topic. So let's. I'm going to. I'm only speeding them up for the interest of time. Not because they talk slow. SPEAKER 7 Hello, Ryan. My name is Doctor Adam. It is very nice to meet you. How are you doing today? SPEAKER 8 Nice to meet you. I'm doing well. Thank you. SPEAKER 7 I'm glad to hear you're doing well. So what brought you in today? SPEAKER 8 I need a new dentist because my last dentist was too expensive. SPEAKER 7 Well, I'm very happy to help. First, let's get to know a little bit more about your previous medical and dental history. Sure. How would you rate your overall health? Do you have any issues that you think I should know? SPEAKER 8 No, I think I'm doing great. I actually just completed my first half marathon this weekend. SPEAKER 7 Oh wow. That's impressive. Tell me more about this. It's interesting. SPEAKER 8 Are you sure you have time for that? My previous dentist was very busy and didn't have time for stuff like this. SPEAKER 7 Oh, we are usually very busy, but you are very important to us and you have my full attention. SPEAKER 8 Well, thank you. I actually had a very tough year because I went through a breakup and that emotionally affected me. I started taking stuff that I shouldn't be taking, although I care much about my health, about being healthy, but I have challenged myself with a half marathon and have been working so hard to do it, and I feel happy that I did it. SPEAKER 7 I'm so happy for you. Your story is inspiring, and I'm sorry that you had to go through some tough times, but hearing that you are overcoming this makes me happy. SPEAKER 8 Thank you, I appreciate that. SPEAKER 7 Do you mind sharing with me? What have you been taking? SPEAKER 8 Don't worry about that. It's been a couple of months since I took any of these drugs. And I don't like, remember that. SPEAKER 7 It might be important for me to know, but I totally understand your feelings. Let's set this aside for later. And, um, I see that you had your license exam about six months ago. Where, um, were there any issues that needed to be addressed, or have you ever, um, have you had any previous dental treatment? SPEAKER 8 No, I just see the dentist every six months for cleanings. SPEAKER 7 Okay, perfect. I can see how much you care about your health. Just to confirm, have you had any medical issues in the past six months? SPEAKER 8 No. My teeth feel fine. And I've not felt the need to go to the doctor for anything. I don't have any concerns about my family history either. SPEAKER 7 I think it's good to know. I see you did not write any medications. Are there any medications or supplements that you are taking daily, like, uh, multivitamins or any pain medications like aspirin and gluten? SPEAKER 8 No, I don't take any medications. Sometimes I take Advil when I have a headache, but I haven't recently. SPEAKER 7 Thank you for letting me know. Um, and I see that you have checked off. No. For most of the other conditions on the list, I see you checked off your previous history of ulcers and sexually transmitted diseases. Uh, when was the last time you had ulcers or had a diagnosis of a sexually transmitted disease? SPEAKER 8 Why do you need to know? Don't you just have to look at my teeth and see if I have any cavities? My old dentist never ask me these questions. SPEAKER 7 I do understand your concern about these questions, and this might be a private matter to you, but as a dentist, I'm only concerned about your teeth. I'm concerned about your overall health. These are very important questions to ask. Is there anything I can I can, um, help you with to make you feel comfortable about answering these questions? SPEAKER 8 Thank you for explaining this. I would like to know more about how this relates to my overall health. SPEAKER 7 Sure. Now, some sexually transmitted diseases might present some oral manifestations and impacts your overall health. It is helpful to know this so I can provide treatment or prefer or refer you to someone who can help. SPEAKER 8 Oh, I didn't know this. I assumed it only manifested in other parts of areas of the body. I didn't know that the dentist would know this. SPEAKER 7 Or witness can be among the earliest and most common clinical signs of some STDs or other health problems, and dentists are trained and obligated to detect any early signs and relate them to any possible medical concern. From that point, I can either provide a treatment for oral problems or refer to the appropriate specialists. SPEAKER 8 So what would you expect to see? What are you concerned about. SPEAKER 7 Now in conjunction with this previous medical history, I see that you checked under social history that you use a IV drugs and shared needles. I am concerned that with sharing needles you may be exposed to certain diseases like HIV. Have you had any concern about this? SPEAKER 8 No, I don't need to worry about that because I only share stuff with people I know. SPEAKER 7 Well. New HIV infections are primarily acquired from sexual contact or intravenous drug use, and most infections are transmitted by individuals who do not know that they have HIV infection or are not receiving regular care. SPEAKER 8 Oh, I didn't know that. My friends have always said there's nothing to worry about, but I'm trying to stop. I want to be healthy again. And that's why I'm here. What should I do? I didn't really know this and now I'm starting to worry. SPEAKER 7 I think you are taking steps in the right direction by being able to listen and learn about this. These are. There are many resources I can provide where you can get tested and receive care. In case you have been exposed and provide more information on prevention. I understand that this might be a challenging, challenging issue, but I know you are capable of overcoming challenges considering you're a marathon champ. SPEAKER 8 That sounds good. I appreciate you being willing to help. So what is the next step? SPEAKER 7 Well, first let's take some X-rays and do an oral or an oral exam. After that, we can chat about ways I can help and ways for you to be healthy going forward. SPEAKER 8 Thank you for being so easy to talk to. My last dentist seemed judgmental and didn't care to listen. It feels nice to be heard. Thank you. SPEAKER 0 Your classmates are really impressive. What are some things you learned or liked from this video? Apart from if I was to give an Oscar, I think we have some people in the running here. Anything we liked. Yeah. Very empathetic lead with empathy, right? We started this class thinking about empathy, and it's been in every lecture. Right. I think it's pretty important. How is Adam? Empathetic. Uh, sorry. Too many. Yeah. No judgment. He talked about a difficult situation. Who felt who who else had HIV in the room as their topic? HIV testing. Who else felt? Oh, sorry. Happy Friday. I'm not allowed to know the answer to that. Okay. All right. Who else had the topic? HIV in the room for their HIV testing? Not even HIV because the patient doesn't have HIV. Or that we know of having HIV on the medical history for that. And we're all in groups where there is an HIV testing patient or medical history within them in our discussion board groups as we provide feedback. Right. So it's awkward, right? Some people went into a lot more detail than Adam did. How do you think he he he approached this topic? And how might it have been different than what you did or what you might initially think you have to do? Did he list the number of STIs you could potentially have? A lot of people did that. Do you have gonorrhea? Do you have syphilis? Does it really? So the reason why we ask this question is this is the Bu medical history that you're looking at, right? This is the form you're going to have to input into. Salud. This is not me. Like adding extra boxes to make you talk about things that are more challenging, right? This is actually what you're going to be doing in a few months. And there's a question. Question about STI is not. And so you know which STI you can talk to that patient about, especially if it's history of STIs. Right. Because it doesn't really matter. I don't think. Exactly what. Uh, sti it is. If it's something that's been treated and it was treatable, and the patient is cured right from that particular STI, what's more important, as we look at it, is about risk factors. And risk factors are an important concept that I want to touch on through the the remainder of kind of the course. And as we think about different types of people and how we communicate with them. And I think he did a really good job of approaching it from that lens. And he reflected a lot on why it was important, which was making sure that it's because he cares about the patient's overall whole health. Right? So as you think about revising your script, I want you to take knowledge from this example because there wasn't a ton of counseling here, was there? Anyone think there was huge counseling? No, but what he did is set the stage right. He said, hey, these things are important. I care about you. So when a patient understands that these things are important, are important, and they care about you, you're more likely to take into effect any of the changes that they're recommending or any of the counseling that they're going to offer towards the end of the appointment. Now, what was really impressive about the cyclical nature of his conversation? When we think about the illicit provide illicit and we think about collecting information, is he even looped back in something that he heard that wasn't really even dental related? Right. The piece about the marathon. These little things. Express that you have listened to what they're saying and know what's important to them. And I thought that that was a really clear point that demonstrates a lot of things, including the empathy that we try to underscore in all of our conversations as we move towards motivation. So I want to take all of this, and we're going to kind of move on just for the sake of time to what I'm calling my fireside chat series. So this lecture in next week, we're going to be inviting remote guests to come in to talk a little bit more about a specific population or a specific type of individual or situation that may. Help in thinking about how we collect information and how we provide counseling based on rather unique situations. So there is some of you in your examples and in your videos, talked a little bit about HIV risk and talked about why people should be tested. And I think last week when we think about the smoking cessation video, remember that that statistic of how many times it takes for someone to actually quit smoking. Little pieces of actual information can be really helpful in guiding someone through any specific counseling that they're going through. And one thing that I think of when I think about HIV testing is some of the recommendations from the CDC. And the CDC recommends that everybody, at least once in their lifetime, get tested for HIV as a way to contribute to what they call as the ending the HIV epidemic, when they're reducing the diagnosis of new cases. Um, as we march towards zero, is their ultimate goal, right? So I think when you have a general blanket statistic or piece of information, much like what we learned from smoking cessation last week, those types of pieces of information can be helpful in making recommendations, especially for folks that you might notice have a risk factor. But really, for anyone that comes into your chair, because this is suggesting that anyone who. Is between the ages of 13 and 64. Get tested for HIV at least once to know their status. Now, additionally, the CDC designates certain areas geographic areas as hotspots for new HIV infection, and these are hotspots where the rate of new infections is higher. It meets a threshold than other areas, so we can target certain interventions to these groups. In some places, like the states in blue, it's an entire state, mostly in rural areas and other places. It's by specific county within a state, which is represented by a blue dot. You'll notice that Boston and Suffolk County has a blue dot. That means that we are in a population where there are more likely to be folks that. Could be diagnosed with HIV. Or not know it, because there's statistics that a large percentage of Massachusetts inns, it's probably close to 70% of folks who have HIV are virally suppressed. But there are good number close to 1 or 2 in ten individuals who might be HIV positive and not know their status. So when we think about our role as health care providers and we approach it this way, not through the lens of you need to go to HIV testing, but through the lens of we're here to support you, making sure you know everything about your overall health, and we care about you to think broadly through the topic of what we're in an area where HIV infections are higher than other places in the country, as well as the CDC does make recommendations that folks get tested at least once in their lifetime. It might smooth out for those of you who have HIV, but have the patient with HIV, um, assignment to think of ways to provide that specific, tailored counseling. Now, the first person we're going to invite, um, is Paul Goulet. And I'll let him introduce himself. But he is the chair of what is called the Community Engaged Research Council for the Community of Engagement. And he's a consultant through the center for Aids research with Providence, uh, Boston, the Providence Boston Center for Aids research. So I'm going to play this video. I am going to speed it up a little bit, and we'll spend a lot of time listening to what he has to share. Thank you so much for joining us today. I'm really well, I'm really excited to welcome Mr. Paul Goulet to talk and share a little bit about his experience. So my first question for you is we'd love to get to know you a little bit more. Can you share a little bit about your work and maybe how we know each other? SPEAKER 7 Right. Sure. So my name is Paul Goulet, and everybody knows me as Paulie. SPEAKER 0 So I've been. SPEAKER 7 In I'm a person living with HIV. I've been living with HIV for the past close to almost 40 years. SPEAKER 9 Um, so. But I come from, um, I've always had an interest in health care, even before I was HIV positive. But my focus has always been on patient care, um, and communication between providers and patients and how, um, as I was telling Matt earlier, I had a sister who, um, who was a who was four years older than I was, but who lived with my mom her entire life because she was special needs. Um, and she had a brain injury when at birth. Um, but I always remember as a kid, um, just going to the doctors with my sister and my mom, even when I was really young and didn't really understand at that time, but how the doctor always treated my sister differently. Um, never really actually spoke with her or to her. Um, never asked her any questions. It was always, you know, you're going to do this, you're going to do that or spoke to my sister in a lot of instances where they thought she didn't understand because she had special needs. Um, they would either speak louder to her like she was deaf, which she wasn't, or that she really didn't understand. And, you know, I grew up in an age I'm 62, um, going to be 63. Um, and, you know, my parents were doctors were the end all, be all. And you just bow down to the almighty God and you do what they say. And there was no questions asked. And as I got older and, um, you know, more experiences with my sister, I became really frustrated, um, and just really angry about how, um, people in general who, you know, the hierarchy of the medical of the medical world, right? Like the doctors, the king or the queen, um, male or female. And you, you know, my parents were brought up, you listened to the doctor, and you shouldn't be asking any questions, but, um, I just remember early on, especially, like in high school, um, and, you know, just my life experience living as a gay man, um, and then finding out when I was, like, first, a second year in college, there was HIV positive and also noticing the way I was treated just because of the stigma associated with living with HIV. Um, you know, people would say to me back early on in the epidemic and even now, you know, you're HIV infected. You know, it's just so discriminating when you hear someone mention you as a disease, not as a human being, not as a person living with with a condition, uh, a condition that initially was not very easy to live with. But as we have, you know, medical advances and new medications, um, pretty much living a normal life. So my whole life has been dedicated to, um, community advocacy, making sure, um, that patients get the care that they deserve, um, and that they need, um, and that they have a voice in how they're treated, what kind of care they receive. Um, so I'm really into, um, patient advocacy community organizing. Um, also very interested in transitions of care as we age with HIV. Uh, the needs as we age, we, you know, lose our families, we lose our friends, we lose our support networks. And what does that mean? How do we continually engage and live life fully? Um, and to the extent that that we can live it. Um, and how do we make those decisions? And part of, um, you know, part of what I do is really just have conversations with people and talk about what their experiences were like, um, how they hoped it would be different, what they can do to help make it different. Um, and also my work with Matt, I met Matt, so I, I'm also the, uh, I was the, um, program director for the arts program at Boston Medical Center. And the arts program stands for Active Retention and Care for health. And it was for people who were what we call outliers, people who. Where? HIV positive. Um, who were not who may have been in care but who didn't sustain their care, were just lost out to wherever. Out to the streets. Out to, you know, people who were in the arts program with the highest acuity, meaning that they were really, you know, they actually had a lot of issues that they had to deal with. They may have been homeless. They may have been actively using, uh, they may have mental health issues. They may have experienced trauma. Um, they have they may have been, uh, from the immigrant and refugee community and, um, so suffered a lot of trauma, um, in their lives. Um, also, homelessness was a huge issue. So part of my job was to, um, there were probably about 800 people who were who were considered outliers. And my job was to get them back into care and to remain in care consistently. So using a team of, uh, social workers, community health workers, um, I was the person who would get them back into the clinic, um, do an evaluation, do an assessment. So there are some people who came back into care who had not known their diagnosis or had not been tested, and I would be the person to give them their test results, whether they were HIV positive or negative. Um, and really just have a conversation about, um, how important it was that they were valued, first of all, because a lot of reasons why, um, these folks were not in care was the way they were treated in the Ed. Um, they were high utilizes of the emergency department, were treated very poorly by staff because of their condition, whether it be medical, uh, whether it be drug use, whether it be mental health issues. Um, and many people really reflected their own biases and how they approached, uh, how they approach these particular patients. Um, they had their own agenda. Um, they really didn't take time to listen. And the patient always felt like they were being judged, uh, or they just didn't want to come back to the clinic just because the treatment was pretty horrible. And and that's been a lot of people's experiences. So, um, so that was where I really started a little bit more, getting more involved in the community and listening to patient stories and wanting to help in ways that other people. I didn't even think of or didn't want to talk about because, you know, HIV carries a lot of stigma. Patients didn't really want to tell their story because of the stigma and because they were treated the way they were treated after they told their story. And so, um, I also am part of the CFR, the Providence Boston CFR, which is the centers for Aids research, but I now work for I'm a consultant for all 19 CFR throughout the United States. And those are collaborations between universities, public health departments, clinics, clinicians, uh, uh, patients. Um, and I help researchers, um, from the implementation of their research plan to the dissemination. And so how did that for me is about research and making sure that the research that is being done is appropriate, that it has a consumer voice, that it has a community voice from its inception, from its idea, uh, right through the design, the implementation and the dissemination so that there's community engagement throughout the whole process. It's not what I call helicopter research, where you go in and get your participants. Um, and that's what people call, uh, people who, who, who, uh, who, uh, which I want to use, who volunteer to become, uh, uh, research participants. But I'd like to change that now, to have been called them partners because they really are partners to not just participants. Um, so it's important to part of my work is really engaging the community. Um, engaging, um. Our partners in research. And so like all this is kind of interlinked with the work that I do. And I was asked one asked at one point to work with Matt and to I've given a few, uh, presentations on HIV and dental care for the Bu dental school and other dental schools. But really they were address sort of our biases that we may have our fears that we may have, that providers may have and patients may have, and how to address those, how to talk openly without judgment, um, how to really think about our preconceived notions, um, about what we think about people living with HIV. You know, there's a whole cultural there are cultural issues. There are social issues, there are religious beliefs and how we sometimes carry all that into, um, when we think we're providing great care, but we're really actually not, um, because of the stigmatizing language that many folks are unaware of, terms that are used. The terminology that I use can be very stigmatizing to people. Um, so it encompasses all the work that I do, whether it's research, whether it's working in clinical settings. Um, but it's really about making sure that patients, um, no matter who they are, where they come from, their life experience, the road they're walking down, um, that they get the exceptional care that they all deserve no matter what the circumstance is. So it kind of brings me to, you know, helping Matt out with this project. Um, and, um, hopefully being able to address some of the questions or some of the issues um, dental providers or dental students may have, um, as they progress toward clinical and other ventures that they may journey on to. SPEAKER 0 Well, thank you. Polly, I think it's safe to say that we have so much we can learn from you and from your work and experience. S11 Um, so as we talked a little bit before, and as the students are working on their assignments as part of this behavioral science course, we're really practicing two things. And the first is thinking about eliciting new information from a medical history. So through your own personal experience, not only for yourself, maybe your sister, and also thinking of the work you've done with patients that you've served in your various roles. What recommendations would you make for a dental student as they ask and decipher different questions from a medical history? SPEAKER 9 So I you know, I'm my my view on this is it doesn't matter whether you're a dentist or MD or any other provider. I think the first thing to to really and I'm going to just speak from my own personal experience and sort of my journey with the 800 patients that were out of care who were really high acuity and sort of what I went by, what they needed and what they wanted. And also thinking about in a lot of reflection on a lot of reflection about what my needs were and how I wanted to be treated by my provider. So I would say one of the first things to do is, um, you know, I go, I have a great dentist here in, in Florida. I live in Fort Lauderdale, and it's a husband and wife team, and they are amazing. And the reason why I'm telling you this story, because I think it will help to, to, um, really, uh, hone down the, the points that are really important when you first meet your patient. So one of the first. So I remember walking into the doctor's office, I did a phone referral and they said, oh, can you come in at, um, you know, such and such a day. And the first thing they asked me, they said they didn't ask me anything about my medical questions. They said, how do you like to be addressed? Do you have like, a nickname? Do you like Paul? Do you like is do you want to be called by something else? So that already that just that one thing that they questioned me about, like how I want it to be addressed was just really comforting to me. And when I got into the dentist office, the front desk, um, people were amazing. They made me feel really comfortable. They asked me if I needed anything. I of course I had to fill out all the forms. Um, but when I sat in the dental chair, it's kind of a cool office. The, uh, my dentist wife is, uh, does children, works for children, and he works more with the adults. So it's kind of a fun office to kind of toys and stuff. But when I sat down, there's a big TB in front of me that said, welcome, Polly. And so that already set, like the tone for me, like there was this sort of welcome, you know, and we all know like, I hate going to be honest. I hate going to the dentist. I was always scared of the dentist when I was a kid. Uh, I never went to the dentist when I was a kid. My parents were like, didn't have the money, didn't have the insurance. So, you know, it's I got older, I like had a lot of issues. And so trying to get it all taken care of. Um, so this was like an experience that was just really kind of cool. Um, and I think the second thing that happened that I remember distinctly and they will always stay with me is that, um. Uh, my doctor just kind of, like, sat in front of me. Didn't didn't start tapping on a computer or didn't start, like, logging in all the information and just sat with me and said, you know, so just ask me how my day was. And, um, asked me if I had, you know, like, what were my major issues that I wanted to. Why was I there? You know, and I said, well, I need a cleaning, I think I need a crown. Um, and he just said, well, let's, you know, so he kind of asked me like, what my dental habits were and then just, you know, your floss and how things go with that, like, but just made it just very informal and just kind of a like, didn't get into like, you're not flossing or like blah, blah, blah, whatever. It was. Right? Like how people just kind of hop on something right away because they think that's what you should be doing, right? And and rightfully so in a lot of respects. Um, so the second thing, um, he asked me, he said, you know, just want you to know that this is a safe space and that, you know, if you have any medical conditions that you want to talk about or that, um, you know, will affect your dental care. And so, you know, I told him, um, about my life experience, what was going on. And, um, one of the things he, he was just great about was just, you know, un medications. What are you taking? How are you doing? Like, are you, uh, you know, missing any dose? It's like it was just this, like, really informal conversation with. No, uh, like, there's no judgment, like there was no judgment. And one of the things that I really appreciated about him is when I said I'm living with HIV. He, like, repeated that he didn't say, you know, you're living with HIV infection, you're HIV infected, like, but he would always be very much talking about making it very personal and had asked me what my experiences were, what my medical care was like. Was I happy? Was I, you know, asked me some personal questions about relationships. And just to kind of give a general sense of where I was. And one of the things that I think is just really amazing about that, it was that he was willing to a take the time, um, be not sitting in front of a computer and half listen to me or not listen to me and just kind of enter the data in just question after question after question. And I realized, you know, when you are going to a doctor's office, like, you know, they you whether you're a dentist or a medical doctor, whatever kind of provider you are, you know, you're you're you have this these statistics you have to meet, right. You have to see 20 patients a day, you have to blah, blah, blah. And it gets really crazy. But I can tell you, if you take the extra time, it is so worth it because you'll keep your patients, you'll build relationships, and for any kind of care, whether it's center or whether it's medical care, it's about your relationship with your doctor and your doctor's relationship with you. So, you know, it's a co-ownership. It's not a doctor telling you what to do all the time. It's, you know, you having the conversation with your doctor about what you're feeling. How are you feeling, what are the questions you have? Um, and a doctor who's willing to sit and listen. Um, and it doesn't have to be a half hour conversation. I always. If I have questions, what I do is I write them down before I go. And like there might be ten questions and I'm like, okay, I know he probably doesn't have to get get through ten questions, but my three most important questions right now are these three. And so a lot of times I'll send an email and I'll send the questions in beforehand. And my doctor is great at that. They oh, he says to me, you know, 50 questions. Get them to me before so we can, you know, I can be ready to answer. So. And, you know, fortunately, I'm one of those people who have the opportunity to have that kind of relationship with my doctor. A lot of people are not right. They don't have access. They don't have access to insurance. Um, and they don't know how to ask. They don't know how to say, you know, this is who I am without feeling like they're going to be judged or that their care is going to be less than because of their illness, whatever that might be, or because of the condition, whatever that might be. So I guess the first thing I would say is, you know, to have the conversation is to meet eye to eye, look at your patient. And, you know, this sounds like really trivial, but I'm going to tell you, it's like when you make that connection with someone, that's the key. And and on the other hand, that the flip side of that, I think some people you just can't read, right. Like no matter what you do, it's just not going to happen. Right. So but the thing to do with that is just to be patient and to treat your patient the way you would want to be treated while you're sitting in a chair or in a doctor's office or, you know, body language, you know, just be able to have this, you know, look at each other in the eye, not be looking off, not be like, as I said earlier, tapping on the computer. Um, but I guess what the important thing I'm trying to say is, it sets the tone, it puts you at ease, it puts the patient at ease. And if there are things that you don't like, if you say something to a patient may look at you funny and you kind of notice it, you might just say, did I say something wrong? I said, I use a wrong term. Or if you're not sure about something about a subject or a question, ask the patient to say, how would you? You know, I have some questions to ask you. Do you mind if I ask you these questions? You know, everything here is confidential. I think part of that is, again, it's that relationship and having that dialog. Um, and I think one of the second things I want to say that's really important too, is if you ever get to work in a dental practice or if you're working in a dental practice, the first thing I think that providers should remember is their front desk staff. Because if you have a front desk staff that does not treat your patients in a caring way and a compassionate way, um, is that it's already a turn off, your patient is not going to come back, and that's the last thing you want to do. So anything that happens at the front desk where there's patients in the waiting room where people, other patients can hear other patients, questions like medication, questions like HIV status, any personal questions should not be should be taken into the office where it's private, into the examining room. And then question there. So many people want to try and get all that stuff out of the way, but in doing so, you can put people at risk, um, because of stigma, because of, you know, people. They may know people in the dental office who are waiting for an opponent who don't know they're HIV positive, and they don't want them to know that it's happened in the past, that other practices have been that where the first question is, is a positive, but medication, do you take it? Why aren't you on medication? When was the last time you saw your doctor? But what the viral load, what your T-cell look like, it's like not appropriate. So making sure that that stuff is, um, done within the confines of a of the doctor's office itself. S11 So many great points. I think that share to your experience, but also relate to a lot of what we're learning in this course. So think about as we motivate and think about changing behaviors of any patient. You know, creating that safe space really is important. And I think to me, what I heard really loud and clear is that we're humans. So when we modify behavior the two way street. So to also figure out what was working and what is in and creating that line of communication between the patient provider and even other members of the dental team can really help ensure that we're creating that environment where change can happen. And I think that's a really important point. So I really thank you for sharing. SPEAKER 9 Yeah. And I want to just mention one more thing too. And also about your contact from, you know, patient to provide a provider to a patient. You know, you don't I and I want to really, uh, enforce this thought in your head because I've been to before I went to the dentist, I went to several other dentists who were like, Triple glove, like, have the glasses and then the helmet and then the, you know, the hazmat suit, basically. And, you know, you have to you have to think about what message is sending there. And, you know, you have to go and know that I always assumed that my doctor would think everyone is HIV positive, right. And that you use universal precautions with everybody. But then when you found out that I'm actually positive you double gloved, you had the goggles and then you had a helmet over the goggles, I'm like, really? I mean, that that's not a good message, right? So again, it's about even those little things like people catch catch up on that and it makes them feel less than. So again, universal precautions knowing your facts. Um, and, you know, knowing how to approach a patient I think is certainly the most important first step. S11 And so it's not just what you say, it's your actions too. And I think those really influence how we create a safe space. So as we elicit more information from medical history, you mentioned sitting down, looking at someone's eyes, focusing on them and not what you have to do next or always, and things that patients can pick up on and I think are really critical. Um, you know, my final question, and now that we've collected information from a medical history, it's part of our job to offer counseling to patients and to, in varying different ways, right. How we can help maximize health outcomes for them is offering different recommendations. So my second question for you is what recommendations do you have for dental students as they practice and and begin to implement, uh, different providing information and counseling to their patients on the clinic for. SPEAKER 9 Yeah. So I think that that can be a little bit difficult and again not impossible, but many I think one of the things that's important to remember is when you have the conversation, you know, asking how the patient is doing today, like what's going on. And if you notice that there's something they may be like, well, you know, I have had, um, I haven't been eating because I haven't been to the dentist in, you know, for months. And I'm having these gum issues and I'm having nutrition issues. I mean, if someone is telling you they're having issues, I think it's important that you have a mechanism for referral to say not to let the patient leave your office. Um. You know, without any, um, without any guidance or without any referrals. So I think it's really important to have, whether it's in your office or outside your office, is to have, um, you know, you'll see recurring issues with a lot of people. You know, some people don't really have great access to dental care, so, but they don't have money to get a toothbrush, toothpaste, mouthwash, floss. Um, you know, it might be something. And I think most dentists do, although I know some that don't. Um, give the patient a toothbrush and toothbrush every time they come in. Some dental floss, some toothpaste, some mouthwash, whatever. Um, or and then doing that, you could always say to them, is there anything else that I can help you with or that you think you might need? Like if someone you know, I've had several examples of this where people are not getting good nutrition, you know, you could refer them to a food bank or to I mean, it's information that you would have to have in your office. I think the worst thing that you can do is kind of not that you can fix everything, but if someone is saying something to you that you kind of rings a bell for you, like, oh, there's something not right here, then there's a way that you could give a referral, whether it's through your front desk staff, through trained staff, whether it's you have information, pamphlets in your, um, in your dental office, whether you can refer them to a website or any sort of help, you know, nutrition programs, for example, and nutrition, because that's usually a big, a big one, big need for a lot of people. Um, and also, you know, people who don't have dental insurance who don't know about Ryan White, you may be able to offer them assistance in filling out a weight application that can help with their dental care, but it's really all about, um, trying not to skip over. Like, it's really easy to be like, oh, I'm a dentist. I'm not interested in this. I'm not going to, you know, are like, this person is really depressed. Like, I'm just treating, you know, their teeth, like, you know, the dental care, um, that can have a really profound effect on the patient. Because if that's not dealt with, it may be being dealt with. If the patient is in care at their primary care or infectious disease position, you may have a social worker, but it might be just nice to ask, like, are you getting any other medical care? Do you have any, you know, social work needs or whatever? Um, and I always have said to, you know, one of the conversations I would have when I was at a clinic with doctors if there were other medical issues. So if the patient came in and, you know, we noticed that there was a dental issue, we obviously would refer to the dentist, but would also say to them, like, are there any other issues going on so we could refer them to somebody else, or at least have them leave an office, the office with information about a particular, whether it's nutrition, whether it's dental care, whether it's mental health care, whatever. So being able to navigate that and you know, you're obviously a dentist, you can't you can't address everything. But to actually have some referrals I think is just really, really helpful rather than setting the patient off. Because I think a lot of times if a patient, you know, whether they're suffering from depression, whatever it might be, that they're not getting referral, it just spirals and they may not come back into care. And we know good dental care is important in HIV as well as in any other medical condition. But but very importantly, HIV. So, um, I would just say try and, uh, you know, gather up. You know, once you learn from if somebody tells you like, oh, you know, I'm using so-and-so for this, uh, you know, mental health or so-and-so for nutrition, write the name down, like, use it as your own referral. The next time somebody else comes in, start building up your own referral process. And again, I get it. That's your not your main referral. But it's always good to have those, um, resources available to you and your staff. S11 And I think that's such an important message for any patient, right? To have to know that as a dental provider, our job is to be experts of the oral cavity, but to then be a facilitator and if we're asking questions to then be able to provide resources or referrals to places who can, you know, address an individual's concerns that they bring up in the appointment, is is really important. So really, I thank you for sharing that message because that helps establish the trust between the patient and the provider as well as they think holistically about their care. Yeah. SPEAKER 9 And another important point to that is if you cannot provide a referral or you don't know, say that. Just say, you know what I'm hearing what you're saying, um, you can say as long as you follow up, like, I don't know of any, but let me talk to a few of my colleagues or whatever, and then I can get back to you and notate that and chart that, or have somebody at the front desk get back to them. But if you don't have anything, just say, you know, I'm hearing what you're saying, you know, you know, you might say, unfortunately don't have the resources, but, you know, you can at least acknowledge acknowledge what you know that that's happening. Um, and then, you know, I think the bottom line is to try to find the resources or, you know, talk to your colleagues and staff and see if they've had that experience. And maybe you can refer them to to those people. But, um, I think what what's most important is that people need to be heard. Um, it doesn't necessarily mean that you're there to solve all the issues, but at least to be heard, to be acknowledged, um, and to maybe offer a referral if you can do that. But to be honest, if you can just say, I don't know who you should talk to her. I don't know how to refer you. Be honest. S11 And I think that comes back to what we were sharing before is, you know, honesty, acknowledgment and the feeling of being heard is really what's important either when you're listening, information kind of describing and hearing what the patient has to say or then providing counseling, kind of coming up with something together and giving resources as needed. It's okay to not know everything. And I think that's a really important part. As students get ready to move towards patients and move into clinic in just a few months. So really, thank you for sharing. Yeah. SPEAKER 9 And I want to just add one other thing because coming up a lot too. And what, you know, you want to provide the best care as. As a dentist, right? You want to make sure that people are getting great oral health care. But I think one of the things that a lot of times fall into is, um, not really looking at what a patient's priorities are or what they're going through at the moment. You know, they may be, um, not flossing three times a day, not flossing many times a day. They might be, you know, using some kind of mouthwash and brushing three times a day, but they're not flossing. Or there may be other things that are going on in their life that they're much more concerned about. So I think one of the things and it's and it's hard to do because you want to make sure that you give your patient the best. You want to make sure that they get the best care. But there comes a point where you have to say, I need to meet this patient where they're at right now, right? You can always build on that. We can as well. Next time, we'll just see if we can push a little bit more or do something a little different. So don't always assume that everything that you say that the patient needs to do. You can just say, you know. So I noticed, like you have a lot of packet, you know, I was flossing going. Have you been flossing? You're not flossing. If they say, you know, don't be like, you got to floss three times a day. This is like you're not taking it. Like, don't be judgmental. Just say, you know, maybe try flossing if you can. Some extra, you know, one time, extra day or something. But just give them options. Don't be like, you know, this is what you have to do. Um, granted. Yeah, they have to do it, but there are times where you just might have to spread that out a little bit more. That can be overwhelming for people, and they don't end up doing anything. So little pieces. Sometimes it can be frustrating, but at the same time, I think it also sets you up for success because the patient begins to have trust in you. And we know dental care is not like a top, you know, five favorite things for patients to be going through doing. Um, so, you know, for a lot of reasons and, you know, fear, stigma, you name it, they have it. Um, but but sort of building up those relationships and not being judgmental, just being. Okay. So this is let's try this, see how it goes for you. Let me know if you have any questions. Let me know if there's another way I can help whatever. But to have those conversations, I mean, most of the time what happens is no conversation. You need to do these four things and I'll see you in two months and no questions asked. So, you know, it's worth to take the extra time to kind of find out a little bit more about your patient. S11 And I think kind of little changes can lead to that big change. So start small, make it manageable and tailor it to your patient is really that big message. Because I think we all struggle with jumping to big changes and anything. Right. And I think as we approach our patients, keep a big goal in mind but make things practical. And I think that's a really valuable piece to consider. I think one of. SPEAKER 9 The easy ways that that providers is taking notes, like when you're reviewing a chart, you know, what are the three things that you left the patient with the visit or write those down in the chart and then your next visit. Those are three things. Okay. So how is this going? So is this constant loop. It doesn't get lost in the shuffle, right? Because you can find yourself spinning your wheels like asking the same questions but not really understanding that you ask that already and that you forgot about it. So really just kind of reminding yourself, like, okay, let me just check in with Paulie and see how he's doing on his flossing. You know, this next visit. So there's always that kind of like there's that trust, there's that care, there's that consistency. Um, and, you know, I'm not saying this is easy because it's not I mean, we all have different personalities and we all come from different places and on different journeys. But I think really understanding that taking those small steps and taking the time and I get that time is of the essence when you're providing services because of insurance and whatnot, but it's really well worth the while to have those patients well maintained and taken care of. And it's the responsibility of both patient and and physician as well. So, you know, making sure that there's that mutual conversation. S11 Well, thank you so much for your time today, Paulie. You know, as we wrap up, are there any final thoughts you want students to think about as they get ready to to review medical history and to motivate change for their patients? SPEAKER 9 I think I pretty much covered everything. There's probably stuff I'll think about after this is over, but I think if you have, I think one of the best things that you can do is if you have questions and if you have questions that you may not feel comfortable talking with your patients about, talk to your colleagues like, haven't have, you know, have the cooler discussion. Like, you know, this is what I'm feeling like I'm really uncomfortable with this or I don't know how to ask this. What do you do? Like how have you approached it, really, to have those conversations, um, and not be afraid to ask? There's no stupid question and there's no question that shouldn't be asked. Um, and I think that's the important thing. You know, we all have egos and we all come to the table thinking we might know everything, but we all don't. It's always a learning process. And so I think keeping the conversation open, keeping the conversation honest and never being afraid to ask the question. S11 I think that's a great way to wrap up today, and hopefully what the students are doing as they practice in their assignments. This this semester is really thinking about how these experience will translate and help their future interactions. So thank you so much, Paulie. And I know that his kind of popping in the corner that will also offer, um, different resources for the students too, so we'll definitely stay in touch. But thank you so much. SPEAKER 9 Thank you Matt. S11 All right. Perfect. Well, thank you so much for joining us today. I'm really. SPEAKER 0 So I know that this was a little bit longer of a video than what we'll be showing next week for sure, but I, I couldn't crop it. I tried. I thought about what I could take out. What wasn't as important, what I didn't want you to hear. There wasn't anything. So I think. SPEAKER 1 I don't know why it's doing that today. SPEAKER 0 So I think as we think about. All of the lessons that Polly learned. We're going to move to talking for the last ten minutes or so and answering some questions to someone sitting next to you. Hopefully some of you caught little pieces of information, or have a lesson learned that's slightly different than the person next to you. The various points that I saw some eyes closed. Uh, but I want you to think about how this can relate to what you're about to do in a few months. Not necessarily just for a patient who has HIV, but anyone who comes into their door. And maybe take a few notes to what you could do and add to your script for the written assignments, based on what Polly just expressed in his own personal experience. This is a slide that's available online. I'm going to pull up the QR code for attendance. So if you're walking out of the room, it's probably not the right time. Um, and we'll do that as we talk and we'll wrap up, um, in about seven minutes. SPEAKER 3 Mhm. Oh. Okay, I'm not mad about that. But I told my. SPEAKER 0 Two minutes. Um, so a couple announcements. I saw a couple of you scanned multiple times. What? I'm going to pretend that didn't happen. Academic affairs is looking into that, so please. I'm just. This is a blanket warning. It's not me telling you what you should or should not be doing, but if someone has an excuse absence and you sign them in today, you can expect to hear from someone. Um, a couple announcements, just really quick classes over at 920, right. I have 919. Um, your discussion board assignment is due at the end of the weekend. I hope to give all feedback by next Friday. If I don't, I'm going to beat myself up. But I'm going to try really hard to. I want you to start putting things into your script to revise it. I know that we gave you an extension to the assignment, but I don't think that the work you'll need to do to finalize it will be as significant. If you start putting things in. As you might have mentioned, we talked already about smoking cessation two weeks ago. We talked a little bit more about HIV. Today we're going to hit on some of the other topics for those folks that weave for those other medical histories in the coming weeks as well. Okay. Um, have a good week.