How Distributed Cognition Can Improve Patient Care

Enter your email to receive the CareQuest newsletter:

Get the latest oral health news, stories, resources, and education in our newsletter. Click here to subscribe.

October 3, 2022

By Kelly Schroeder, RDH, MS

Who is the true expert when it comes to a patient’s oral health?

The answer depends on the situation and the stage of oral disease a person might be experiencing. For example, when a patient presents to a dental clinic with oral pain, they are the expert, at least at first. Patients in pain find ways to communicate what the problem is, where the problem is, what makes the problem better or worse, and when the problem started. By sharing this invaluable knowledge, the patient is contributing to the identification and resolution of their problem. This is distributed cognition in action.

What is distributed cognition? It’s a learning concept that describes a person’s knowledge about a specific topic and how they make decisions based on that knowledge. Awareness of distributed cognition — and the ability to use it — can lead to better, more person-centered care.

Distributed Cognition in Different Health Settings

Cognitive scientists argue that we are continuously using past experiences and new information to frame our environment to make decisions. There are three types of distributed cognition that collectively contribute to oral and systemic health practice and patient care: past experiences, shared knowledge, and environmental factors.

All of life’s lessons play a role in distributed cognition and how thoseXRayCollaborationSized experiences shape us into oral health experts. As oral health professionals advance in their careers, various patient experiences, continuing education courses, state policies, and dental practice climate, to name just a few factors, affect their knowledge base and how they react to various circumstances.

The same is true for physicians. Both dentists and physicians use multiple sources to help make final decisions surrounding patient care. These sources include assessments, observations, and background information from support clinicians such as dental hygienists, dental assistants, and nurses.

But there also important differences between the two care settings. For example, nurses are generally not present when the physician examines the patient, whereas for dental visits, the dentist and support clinicians are in the same room. The dental hygienist or dental assistant can supply the dentist with additional or clarifying information as needed. The dental assistant and dental hygienists often act as an interpreter between the patient and dentist, emphasizing important points, and translating language from technical to layman’s terms, improving distributed cognition and communication between clinicians and patients.

Jeremy Horst, DDS, PhD, director of clinical innovation at CareQuest Innovation Partners, emphasized that dental hygienists and dental assistants contribute regularly to the patient’s oral health situation or background information. “There is a sense of urgency and a need to be efficient in the clinic. A dentist cannot take in all the patient’s information alone,” says Horst. “I’ll share an example: A young girl with a swollen cheek had been referred to our office from a medical provider. After doing an oral exam, we could not detect an oral health problem. Because the dental assistant had background information about the family, she was able to share this child was not vaccinated. Having this new information changed the appointment from a dental exam back to a medical exam, and we found the patient had mumps."

How the Environment Affects Cognition and Patient Care

Many different aspects of an oral or systemic health professional’s environment can affect distributed cognition and ultimately patient care. Factors such as state, local, or clinic policy; clinic software systems; community resources; and provider and patient knowledge, awareness, and beliefs all play a role in patient care and health-related outcomes.

Take the emerging changes in traditional oral health care delivery, for example. Using synchronous teledentistry to share patient information requires changes in distributed cognition to maintain good communication among clinicians.

Katie, an expanded practice dental hygienist in Oregon, illustrated the point: “When working with the same dentist in the dental clinic, you learn the specific information they want and how they want it presented. When working with different teledentists [dentists who work remotely and only review patient records], sometimes there is a breakdown in communication because I don’t know their specific process with diagnosis and treatment planning.”

Distributed cognition does not always equate to learned experiences if the new information is not received and processed accurately by another person. Miscommunication can result from failing to share the correct information; failing to actively listen to the information; systems failures; or making assumptions or decisions based on inaccurate information or outside influences. It’s important for providers to adapt to different situations, too.

Jane Frieders, RDH, RTT, had been a respiratory therapist for 24 years before going back to school to become a dental hygienist. Working for a dental office where the recently retired doctor never had a dental hygienist, Jane had to be assertive and compassionate with patients who were not familiar with the dental hygiene process of care. Jane explained that although she was new to dental hygiene, having the medical experience in respiratory therapy helped her with updating protocols with the dentists, other clinicians, and patients.

“I came from a medical field where we had to do things for patients they didn’t want to do,” she said. “If didn’t, they wouldn’t be able to breathe, so I learned to be compassionate but stern when impressing the importance of treatment for more functional breathing.”

Tips to Help You Avoid Miscommunication

Advances in technology can remove opportunities to communicate directly with co-workers and patients, tempting us to save time and reducing opportunities for distributed cognition among oral health providers. However, it is important to maintain clear communication among oral and systemic health providers and those who are receiving care. The good news is that traditional dentistry uses a communication method in which the dentist and support clinicians generally work together to share information about patient needs and expectations.

Here are some things you (and your organization) can do to utilize distributed cognition and avoid miscommunication:

Back to Latest News