Your future success as a dental professional will depend not only on your clinical capabilities, but also on your ability to communicate effectively with your patients. With a growing body of evidence showing the importance of the clinician-patient relationship in patient satisfaction and health outcomes, we explore the key communication competencies every dental student needs to succeed.
Patient-centered communication is an approach in which the clinician acknowledges the patient’s autonomy, their unique circumstances, and their social, economic and cultural environments. The clinician works with the patient to develop a shared understanding of the problem at hand, the goals and priorities of treatment, and any barriers that may stand in the way. Ultimately, the patient is empowered to be an active partner in their treatment and to take ownership of their oral health.
A narrative review published in the Journal of Graduate Medical Education found significant evidence in support of this communication approach. The authors noted strong positive associations between a clinician’s use of patient-centered communication and:
- Patient satisfaction
- Understanding of recommendations
- Recall of key information
- Adherence to treatment plans
- Treatment outcomes
It was also noted that patient-centered communication reduces the likelihood of complaints and malpractice claims. This supports findings that miscommunication and misunderstanding, rather than malpractice, are responsible for a considerable proportion of dental litigation.
After reviewing the available evidence, the authors of the narrative review identified six key elements of effective patient-centered communication.
1. Fostering the relationship
Visiting a dentist can leave people feeling anxious and vulnerable, especially if they’re in pain. In the first few moments, they’ll be subconsciously assessing if you’re “safe” and capable and trustworthy. They won’t base this on your education or your qualifications though; they’ll base this on the way you make them feel.
Welcome your patient with a warm, friendly smile, invest a few moments to connect with them as a person, and show genuine interest in their wellbeing. This initial effort can put them at ease and set a positive tone for the rest of your discussion.
There’s often a presumed imbalance of power between the dental professional and the patient, so emphasize from the beginning that the patient is a partner. Encourage them to share their understanding of the problem and their goals and expectations for the consultation before you offer your own input.
Talk face-to-face with your patient while they’re sitting up in the chair. Maintain eye contact and communicate that you’re listening with non-verbal cues like nodding and appropriate facial expressions. And most importantly of all, give them ample time to be heard without interruption.
2. Gathering information
As you dig deeper into the reason for your patient’s visit, encourage them to share their perspective on the problem and the cause, how it affects them, and any concerns they may have. Use more open-ended questions than yes-or-no questions to elicit more detail.
To ensure that your patient feels listened to and understood, it’s good practice to summarize and relay their words back to them as you understand them. For example:
“So even though your jaw pain isn’t constant, it’s causing you a lot of discomfort when it does happen?”
It’s also important to look beyond the biological and ask your patient how the problem affects them in terms of work/study, family and social life, general health, self-care and leisure time. Research into primary care patients found better outcomes when the clinician followed up on cues about psychosocial factors. Examples might include:
- Personal stressors, e.g. the illness of a family member or a demanding job.
- The loss of a social support network, e.g. a recent job change or divorce.
- A change in financial circumstances, e.g. taking maternity leave or being made redundant.
These may not seem relevant to a dental exam on first glance. However, they can provide you with clues about oral health risk factors, or hint at circumstances that could affect the patient’s overall motivation or ability to maintain good oral health.
3. Providing information
When it’s time to share your own perspective on the patient’s problem, keep it simple and avoid jargon. Consider how each individual patient might best receive information, and any barriers that might affect their understanding. For example, children respond well to age-appropriate models, animations or stories, while patients with low English proficiency may benefit from resources in their native language.
As you explain, encourage your patient to ask questions and answer them openly and honestly. Continually check that your patient understands, but also ask yourself “how do I know they understand?” Some patients will nod along or agree out of politeness, even if they’re not following you.
To be sure your patient fully understands you, use the teach-back method. This involves asking the patient to relay your answers or instructions back to you in their own words, giving you the chance to fill in any knowledge gaps or to correct misunderstandings.
4. Making decisions
When it’s time to talk treatment, be sure to involve the patient in the decision-making process at every step. Outline several choices, identify the advantages and drawbacks, and explain your rationale for each in simple terms. Ask your patient how each option suits their preferences and circumstances. For example:
- Is the treatment affordable or covered by their insurance?
- Do they have the capacity or the motivation to perform the required oral care?
- Are they able to accommodate the recovery time?
- Would they like to hear about less invasive alternatives?
- Do they have any questions or concerns?
Taking into account any other health or psychosocial factors you’ve identified, keep in mind that the best clinical option may not always be the best option for this particular patient. You can offer your professional recommendation, but make it clear that the choice is ultimately the patient’s.
5. Responding to emotions
There are many emotions your patient may be feeling around dental care. Their oral health may have caused them considerable anxiety, pain, or shame. They might feel let down, angry or frustrated by previous dental encounters. They may be anxious or fearful at the prospect of treatment.
Whatever your patient is feeling, it’s critical to the clinician-patient relationship that you allow them to express it. A survey of cancer patients found that, of those who experienced problems with their care, 47% cited communication breakdowns like a lack of emotional support from their provider. To the patient, these failures were considered just as harmful as clinical errors.
Proactively respond to cues about your patient’s emotional state, give them space to vent, and provide empathy and reassurance. Even a simple “I’m sorry, that must have been so frustrating” can go a long way towards making somebody feel heard and supported.
6. Enabling disease- and treatment-related behavior (self-management)
Ultimately, treatment success will most often hinge on what happens afterwards. As you develop the treatment and follow-up plan, be sure to address questions like:
- Are your recommendations congruent with the patient’s goals, beliefs and circumstances?
- Is the patient willing and able to change/maintain oral health or lifestyle behaviors?
- Do they have the required skills and coping strategies in place?
- What support can you offer, and what support is required from elsewhere?
- Do they need advocacy within the dental or healthcare system?