Patient Management - The Dentist-Patient Relationship
Posted by John Doe at Dental Assistant on January 1, 1970.
Categories: Dental Secrets
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10. What useful physical attending skills comprise the nonverbal component of communication?
The adept use of face, voice, and body facilitates the classic bedside manner, including the following:
Eye contact. Looking at the patient without overt staring establishes rapport.
Facial expression. A smile or nod of the head to affirm shows warmth, concern, and interest.
Vocal characteristics. The voice is modulated to express meaning and to help the patient to understand important issues. Body orientation. Facing patients as you stand or sit signals attentiveness. Turning away may seem like rejection.
Forward lean and proximity. Leaning forward tells a patient that you are interested and want to hear more, thus facilitating the patient's comments. Proximity infers intimacy, whereas distance signals less attentiveness. In general, 4 - 6 feet is considered a social, consultative zone.
A verbal message of low empathic value may be altered favorably by maintaining eye contact, forward trunk lean, and appropriate distance and body orientation. However, even a verbal message of high empathic content may be reduced to a lower value when the speaker does not have eye contact, turns away with backward lean, or maintains too far a distance. For example, do not tell the patient that you are concerned while washing your hands with your back to the dental chair.
11. During the interview, what cues alert the dentist to search for more information about a statement made by the patient?
Most people express information that they do not fully understand by using generalizations, deletions, and distortions in their phrasing. For example, the comment, "I am a horrible patient," does not give much insight into the patient's intent. By probing further the dentist may discover specific fears or behaviors that the patient has deleted in the opening generalization. As a matter of routine, the dentist should be alert to such cues and use the interview to clarify and work through the patient's comments. As the interview proceeds, trust and rapport are built as a mutual understanding develops and levels of fear decrease.
12. Why is open-ended questioning useful as an interviewing format?
Questions that do not have specific yes or no answers give patients more latitude to express themselves. More information allows a better understanding of patients and their problems. The dentist is basically saying , " Tell me more about it . " Throughout the interview the clinician listens to any cues that indicate the need to pursue further questioning for more information about expressed fears or concerns. Typical questions of the open-ended format include the following: "What brings you here today?," "Are you having any problems?," or "Please tell me more about it."
13. How can the dentist help the patient to relate more information or to talk about a certain issue in greater depth?
A communication technique called facilitation by reflection is helpful. One simply repeats the last word or phrase that was spoken in a questioning tone of voice. Thus when a patient says, "I am petrified of dentists," the dentist responds, "Petrified of dentists?" The patient usually elaborates. The goal is to go from generalization to the specific fear to the origin of the fear. The process is therapeutic and allows fears to be reduced or diminished as patients gain insight into their feelings.
14. How should one construct suggestions that help patients to alter their behavior or that influence the outcome of a command?
Negatives should be avoided in commands. Positive commands are more easily experienced, and compliance is usually greater. To experience a negation, the patient first creates the positive image and then somehow negates it. In experience only positive situations can be realized; language forms negation. For example, to experience the command "Do not run!," one may visualize oneself sitting, standing, or walking slowly. A more direct command is "Stop!" or "Walk!" Moreover, a negative command may create more resistance to compliance, whether voluntary or not. If you ask someone not to see elephants, he or she tends to see elephants first. Therefore, it may be best to ask patients to keep their mouth open widely rather than to say, "Don't close," or perhaps to suggest, "Rest open widely, please."
A permissive approach and indirect commands also create less resistance and enhance compliance. One may say, "If you stay open widely, I can do my procedure faster and better," or "By flossing daily, you will experience a fresher breath and a healthier smile." This style of suggestion is usually better received than a direct command.
Linking phrases - for example, "as," "while," or "when" to join a suggestion with something that is happening in the patient's immediate experience provides an easier pathway for a patient to follow and further enhances compliance. Examples include the following: As you lie in the chair, allow your mouth to rest open. While you take another deep breath, allow your body to relax further." In each example the patient easily identifies with the first experience and thus experiences the additional suggestion more readily.
Providing pathways to achieve a desired end may help patients to accomplish something that they do not know how to do on their own. Patients may not know how to relax on command; it may be more helpful to suggest that while they take in each breath slowly and see a drop of rain rolling off a leaf, they can let their whole body become loose and at ease. Indirect suggestions, positive images, linking pathways, and guided visualizations play a powerful role in helping patients to achieve desired goals.
15. How do the senses influence communication style?
Most people record experience in the auditory, visual, or kinesthetic modes. They hear, they see, or they feel. Some people use a dominant mode to process information. Language can be chosen to match the modality that best fits the patient. If patients relate their problem in terms of feelings, responses related to how they feel may enhance communication. Similarly, a patient may say, "Doctor, that sounds like a good treatment plan' or "I see that this disorder is relatively common. Things look less frightening now." These comments suggest an auditory mode and a visual mode, respectively Responding in similar terms enhances communication.
16. When is reassurance most valuable in the clinical session?
Positive supportive statements to the patient that he or she is going to do well or be all right are an important part of treatment. Everyone at some point may have doubts or fears about the outcome. Reassurance given too early, such as before a thorough examination of the presenting symptoms, may be interpreted by some patients as insincerity or as trivializing their problem. The best time for reassurance is after the examination, when a tentative diagnosis is reached. The support is best received by the patient at this point.
17. What type of language or phrasing is best avoided in patient communications?
Certain words or descriptions that are routine in the technical terminology of dentistry may be offensive or frightening to patients. Cutting, drilling, bleeding, injecting, or clamping may be anxiety-provoking terms to some patients. Furthermore, being too technical in conversations with patients may result in poor communication and provoke rather than reduce anxiety. It is beneficial to choose terms that are neutral yet informative. One may prepare a tooth rather than cut it or dry the area rather than suction all of the blood. This approach may be especially important during a teaching session when procedural and technical instructions are given as the patient lies helpless, listening to conversation that seems to exclude his or her presence as a person.
18. What common dental-related fears do patients experience?
- Pain
- Drills (e.g., slipping, noise, smell)
- Needles (deep penetration, tissue injury, numbness)
- Loss of teeth
- Surgery
19. List four elements common to all fears.
- Fear of the unknown • Fear of loss of control
- Fear of physical harm or bodily injury • Fear of helplessness and dependency
Understanding the above elements of fear allows effective planning for treatment of fearful and anxious patients.
20. During the clinical interview, how may one address such fears?
According to the maxim that fear dissolves in a trusting relationship, establishing good rapport with patients is especially important. Secondly, preparatory explanations may deal effectively with fear f the unknown and thus give a sense of control. Allowing patients to signal when they wish to pause or speak further alleviates fears of loss of control. Finally, well-executed dental technique and clinical practices minimize unpleasantness.
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