The Primary Health Care Team
Patients often have strong suspicions about the possibility of an abnormality in their mouth being malignant, cancer or 'nasty'. Primary care doctors and dentists are uniquely placed to deal with a patient's concerns, taking into account his or her psychosocial, medical and family background.
The skill in counselling lies in allowing the patient to express his or her fears and concerns in a controlled way, in a sympathetic and professional environment. Patients must be allowed to dictate the speed and depth of discussion. The clinician may wish to use such questions as:
'What do you feel is going on in your mouth just now?'
'Do you have any concerns about this ulcer (area, 'sore bit' etc.) in your mouth?'
Where the doctor or dentist has genuine concerns about a lesion being malignant or potentially malignant this information should be communicated to the patient in a controlled manner in response to direct questioning from the patient. Until a formal histological diagnosis is available, no absolute information should be given to the patient. However, the primary care team has a role to play in preparing a patient for 'bad news' (or indeed good news) and information from the specialist team. The doctor and dentist's verbal and non-verbal cues often help in ensuring that the patient is prepared for visiting the specialist team. Similarly, support mechanisms can be put in place via family and friends.
It is always helpful to leave the patient feeling informed and secure. Phrases may be used such as 'I have some concerns about what I can see in your mouth. However, I am not completely sure what is going on and I would like you to see a specialist'.
The patient may respond 'Is it serious, is it cancer?'
Again it is important not to give misinformation, but reiteration of the fact that further investigations are required is helpful.
'I don't think we can jump to any conclusions at this stage, because many different conditions occur within the mouth. That's why seeing a specialist is so important.'
Patients should be encouraged to return to the practice for further discussion and support as they feel the need. A formal appointment being made may allow the patient to sense they are not being sent away 'into the unknown' without any support mechanisms in place.
The referring practitioner should be aware of the likely scenario when their patient attends the specialist unit for investigation and treatment.