A Reflection on Communication

Throughout dental school we have the importance of communication reiterated to us. Be it through lectures, modules, clinical teachers, interview preparation and of course our indemnity organisations. A high proportion of litigious cases could be prevented by a change in interaction. We are reminded that good communication skills not only help build a rapport with patients but also improve patient satisfaction with treatment and aid adherence to advice given. We know that a significant proportion of the public have dental anxiety towards some aspect of treatment which may be alleviated, even if slightly, by effective communication.

It can be risky to gloss over the value of communication when you hear about it so many times. With this in mind I wanted to share my reflection on how communication has helped me thus far.

The first time

I'll never forget my first patient. It was second year Periodontology Clinic in the afternoon. You could taste the sweat in the air on the clinic paired with the uncontrollable feeling of doom at the thought of disclosing, some oral hygiene issues and a supragingival scale in an hour....Do they think we are magicians? My patient was in his late 40's and of Middle Eastern origin, with a history of failed attendances and poor English. He had an unremarkable medical history and fortunately did not smoke, however he did not appear to clean his teeth either. He turned up on this day with a mouth that was, for the want of better words, not ideal.

In hindsight, healing forceps may well have been considered by a number of people. I pushed the one hour limit and my communication skills to the limit with him. My tutor wasn't happy with how long this appointment took but it was all a learning curve. I was not optimistic for an improvement in his oral health when he returned. I was gladly mistaken; with clinical scores all heading in the right direction. This experience opened my eyes to the importance and benefits of effective communication to improve the outcome in the more challenging patients.

I tried to keep the value of good communication skills high up on my agenda when seeing patients, for the reasons previously stated, and I was really starting to see how much easier dentistry could be once the patient is on your side and feels fully involved in what is going on, in comparison to when they are not. It goes without saying that the technical side of dentistry needs to also be proficient.

Some of our more interesting talks on communication had come from Professor Newton (probably because of his masses of research and skill in communication) which was also invaluable. I had built some strong relationships with particular patients to the point where each appointment was an update about both of our lives followed by a bit of dentistry instead of the other way round which makes the work much more variable and enjoyable. Seeing patients as 'Mrs Smith, who is a teacher and found out her students did well in exams, went skydiving last week, but is a bit anxious about root canal treatment today' is far more interesting than 'Mrs Smith LR6 endo' and I think the patients appreciate it.. Even though the NHS will put pressure on the time to do things and meeting units of dental activity, it only takes a few extra seconds to find out and talk about these kinds of things.

Patient no.123456

Then I received some of the dreaded emails from administration as we drew closer to finals and case presentations. Titled 'Patient no. 123456'. Emails titled this way are unpopular because they usually mean; you have done something admin is not happy with, the patient has cancelled their appointment, something is painful/broken in their mouth or they are complaining about you.

Fortunately mine were none of the above. Some of my patients had written in to the hospital to express their gratitude for treatment. These were amazing morale boosters in final year when you are drowning in deadlines and the masses of things that may come up for examinations. I was fortunate enough to be jointly awarded the 'Jack Wheatley Carlton Hunter' prize by my school, which is awarded to the students who set the highest standards of conduct with regards to courtesy, humanity and kindness in treatment of patients. I think this came down to the lessons I had learnt from my first patient, our teachers and subsequent patients along the way. This meant so much to me as these are aspects of dentistry that have significant value to me and patients.

Lessons learnt

I hope it is not prescriptive or exhaustive; there are for sure a multitude of other techniques and skills that can be applied to the clinical setting. However these are things that I have learned to be helpful. I learned from great communicators and received positive responses from interacting with patients. It is likely the majority of this is done naturally anyway!

-Introduce yourself along with your position early on (i.e. in the waiting room)

-Find out how the patient would like you to address them

-Let the patient know the plan for your session early on and confirm they are okay with this

-Invite the patient to tell you their problems 'Tell me about why you are here?' 'How can I help you today?'

-Chronologically and accurately summarise what the patient has said if they've spoken for a long time, do not simply repeat it.

-Encourage the patient to give you more information and ask questions 'Anything else you would like to tell me/you think I should know/you would like to ask?'

-Check the patient is happy to proceed before you do anything 'Are you happy for us to continue?'

-Clarifying that the patient understands can sometimes be tricky to do without sounding condescending so be careful using 'Do you understand?' or 'Is that clear?'

-Summarise what has happened at this appointment together with key information you would like the patient to retain at the end of the appointment (Check, politely, that they have retained information-for the importance of their treatment)

-Ensure the patient is happy with what has happened and any questions are answered before they leave (anything they forget to ask they can phone in, email or write down and bring to the next appointment)

The communication skills picked up are not only vital now but will be in our practising careers which is why I think it is extremely important not to gloss over it irrespective of the number of times we may hear about it. We know this skill is a big practice builder on top of all the other benefits so we should continue to pay attention to it regularly.