Siobhan Kelleher speaks to eagle-eyed dental hygienist Helena McGann, whose intervention helped spot a patient’s potentially life-threatening cancer.
Tell us about your dental hygiene approaches in practice
As a dental hygienist, it is possible, and I feel necessary, to care holistically for the patient. Through my excellent training in DDUH/Trinity College and NUIG in various complexities and years of honing these skills in my practice, I have accrued skills that allow me to examine a patient as a whole.
My appointment starts with an initial assessment of physical gait when I meet the patient. I will subconsciously and quickly note physical appearance and ‘read a person’ – for example:
- Does the patient look well?
- Are they showing signs of nervousness?
- Do they walk with a limp or need assistance with a stick?
- What are the facial expressions telling me?
While greeting the patient, I automatically keep mindfulness on the tone and sense of their response. Dr Catherine Waldron taught me about open-ended questions and how to communicate effectively and efficiently. Daily, with every patient, I see it is the cornerstone of my initial assessment of the patient’s treatment. I can take different approaches to treat a patient when I use these strategies.
If a person is physically well and able-bodied but is looking upset, I will always ask how they are feeling today. It may seem like a platitude, but honestly, in my experience genuinely asking means you will receive the message.
In these current times, I may have been the only person who this individual has had physical contact with or spoken to in many days, weeks or even months.
Tell us about the day Jane came in for her appointment
In walked Jane, happy and bright and seemingly healthy in every way one might subconsciously assess another person.
She seemed a little tired, but given that I know from her medical and social history (credit again to my training from Karin Nylund and Dr Waldron and particularly Dr PJ Byrne in history taking), she is a busy, working mom. It’s midweek, so I think it’s a noble condition to be a little bit tired.
In her charming way, she greets me in return. After a moment of joviality, I ask her to sit, and I can proceed with her appointment.
On donning her safety bib, I spot an ominous looking mole at her neck’s base just under her collar. I asked could I expose it slightly it was mostly under her garments. Again, I questioned her about it.
How did you approach telling Jane?
I knew she had moles generally and I followed up with the approach of determining the time frame and if Jane herself was aware of it.
If so, how long has it been there? Does she think or know if it had changed in shape, colour, size etc? (Credit again to DDUH head and neck cancer Professor Flint, my hero Professor Leo Stassen, Dr Mary Clarke, Dr Denise McCarthy, and Dr Omar.)
I take notes with a calm and gentle way. I clearly explain that while this is out of my scope as a dental hygienist, I feel it is my duty to alert her to it.
I’m aware the statistics that one out of every three cancers diagnosed in Ireland is of the skin. Then, I ask that she follows up with her GP and perhaps a specialist/dermatologist.
Also, I try not to alarm her. I explain that you should always get checked even it’s for peace of mind.
Why is it important to get checked early?
Cancer is so important to try to catch early in its stages. Oral cancer and skin cancer and other forms of cancer are consistently on the rise every year.
The awareness and competence of self-checking and examining are now more than ever of utmost importance. Anyone who suspects any changes should always seek medical advice.
As was the case for me, if it’s not something that the person is aware of, do not shy away from kindly bringing it to their attention. It is not rude or embarrassing to point out concern. If approached correctly, no one will take it in such a way.
When did you learn about Jane’s diagnosis?
Jane emailed the practice to informing me of her cancer diagnosis. She thanked me for saving her life and ‘giving her daughter a mom and her husband a wife’.
High praise is not something that I would shout loudly about without feeling a tad uncomfortable, as I feel that I am simply doing the job I love to the very best of my ability with the patient at the core every time.
Was Jane the first person where you suspected a lesion?
Jane was not my first cancer suspect (my father was – oral squamous cell carcinoma of the lip), nor do I fear will she be my last.
My reason for highlighting this case is that we as a profession often are the initial contact with someone whom needs help in a way we can safely provide aside from a periodontal treatment.
A reassuring smile or an ear can be as beneficial as the main treatment.
I have a lot to say now that I have started. I think all my knowledge is interlaced with my experience and training of which I can’t depart in this limited piece. My take home message is look, think and try.
Can you offer some guidance on further training for dental care professionals?
- Look at the patient as a whole
- Think about how you want patients to feel
- Try to help when and where you can.
Skin cancer: facts
According to Irish Cancer Society, skin cancer is the most common cancer in Ireland. In 2015, healthcare professionals diagnosed more than 11,000 new cases. The National Cancer Registry of Ireland (NCRI) expects this number to double by 2040.
Skin cancer is a disease of skin cells. UV rays from the sun or sunbeds cause nine out of every 10 cases.
Early detection is vital. If spotted early up to 90% of cases are curable. In the case of melanoma skin cancer, spotting it early can save your life.
For this reason, it is important to get to know your skin. Check it every month for change and if worried, speak to your doctor.
For further information, visit www.cancer.ie.
This article first appeared in Irish Dentistry magazine. You can read the latest issue here.