One of the most critical issues confronting health care practitioners is the ability to effectively communicate with patients. Patient satisfaction with a dental practice is largely dependent on whether a positive relationship with the dental team is experienced, which is directly proportional to the quality of interpersonal interactions. One of the most common complaints raised by dental patients, however, is the practitioners inability to listen carefully, to give clear and understandable responses to questions, and to communicate effectively about the very issues that brought the patient to the practitioner in the first place. Ineffective communication skills are a barrier to empowering patients to achieve and maintain optimal health.
Patients value professional competence, interpersonal caring, and good care in the dental office. However, many people cannot easily differentiate mediocre from impeccable quality of care. Given the vulnerability of dental patients, a significant part of their care is how they experience the dental visit. Elements that build relationships, motivate behavior, and develop trust in the dental setting include:
- The dental provider caring for patients by attending and responding to their concerns and feelings.
- Patients knowing they can make a difference in their own health.
- Patients knowing that what they have accomplished, either great or small, contributes positively in some measure to the process of being healthy.
- Patients feeling they belong to the office, i.e., they are welcome and part of the practice.
THE PURPOSE OF PROVIDER - PATIENT COMMUNICATION
A fundamental purpose of communication between provider and patient is to provide information to patients about the causes of their problems and how to prevent them. Another purpose is for the patient to recognize his or her role in being healthy and to adopt health-promoting self-care behaviors. It is important for patients to follow through on the treatment plan and comply with home care instructions. From the provider's perspective, a patient experiencing a positive dental visit may promote the practice and refer others. Effective communication with patients has the potential to positively influence attitudes and behaviors to enhance patient satisfaction with care to facilitate the achievement of both patient and provider goals.
An important component of the initial visit is the health history review or intake interview. When conducted effectively, the health history helps build a trusting patient-provider relationship. Patient needs are heard and documented. Expectations of both the provider and patient are articulated, as well as health outcomes the patient can reasonably expect. An effective health history review serves to keep communication patient-centered, open, and free-flowing.
Interview
- After the greeting and introductions, ask a question which is broad and open-ended, giving the patient room to talk without restriction for example, "How are you?" After the patient responds, you may need to guide the discussion to the specifics of the dental visit. Throughout the interview, prompt the patient with nonverbal cues to send a message of genuine interest while facilitating the patient’s open communication. Nonverbal cues include:
- eye contact;
- attentive posture; and
- head nodding.
- Silence can even serve as a bridge to the next comment by the patient.
- Verbal cues also help the flow of the interview. Verbal cues include:
- Facilitation - bridging phrases which are short, e.g., "yes," "I see," "mmmhm," "go on", etc.
- Reflection - repeating or paraphrasing what the patient has said.
- Clarification - open-ended questions seeking more information.
- Observation - usually about nonverbal behavior, e.g., "You seem tense."
- Closed-ended questions - questions that require a human response, e.g., "yes," "no," "agree," "disagree," "former," or "latter."
- Open-ended questions - questions that require a more free-flowing response than "yes" or "no," etc.
- Hybrid questions - questions that present a closed-ended question or reflection followed by an open-ended inquiry.
- After the patient responds, it is useful to pause to see if the patient continues. Then summarize the patient's remarks, if necessary, to bring that subject to closure and, if appropriate, introduce a new opener for the next subject.
- Since the goal of an effective interview is to build a sensitive and trusting relationship, it is important to avoid some commonly recognized communication pitfalls. Nonverbal cues can disrupt effective interpersonal communication:
- Lack of eye contact.
- An authoritarian or condescending tone of voice: frowning or judgmental facial expressions.
- Insensitivity to body language, i.e., failing to recognize the patient's body language as an important though nonverbal communication.
- Verbal cues can also interrupt the communication process:
- Judgment - implication that you think the patient should do something differently.
- Hostility - judgment with emotion attached, e.g., anger, disapproval.
- Insincere reassurance - premature or false attempt to make the patient comfortable before full elicitation of patient response; the message denies that the patient has a problem.
- Probing - premature attempt to obtain specific detail outside the context of the patient's feelings.
- Inappropriate use of closed questions, i.e., questions that yield a "yes" or "no" response.
- Jumping to conclusions.
- Some of these "communication stoppers" may be appropriate to use to get specific information or to get the interview back on track. Practitioners are often concerned about overstepping the boundaries of ethical or appropriate information gathering, particularly if the health history reveals some sensitive issues pertaining to sexual behavior; communicable disease; or drug, alcohol, or tobacco use. Ethically sound practice requires gathering information relevant to dental treatment which contributes to the comprehensive health care of the patient. It is critical to orchestrate the interview process in a confidential setting which protects the privacy of the relationship. A sensitive and non judgmental manner contributes to establishing a trusting and empowering relationship.
2 comments:
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Hi,
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