Communicating with patients during appointments

Communicating with patients during appointments

THE dental consultation has been described as a conversation with a purpose; this includes the exchange of ideas and opinions by any means.

Picture the scenario: a nervous young, male, patient attends the surgery for a routine check-up. For the last few months, he has been experiencing sharp, intermittent, tooth pain which often occurs when drinking tea and coffee, and he is anxious about this. The diagnosis and treatment of dentine hypersensitivity depends on the patient communicating their symptoms to the dental team, so that other causes of transient tooth pain, such as a chipped or fractured tooth, or a carious lesion, can be excluded. The majority of patients do not seek treatment for dentine hypersensitivity because they do not perceive it to be a severe oral health problem.

Question time

How best should we, as DCPs, encourage him – and patients like him – to open up about their symptoms?

There are different types of questions that can be used:

  • Closed questions invite a short response, usually “yes” or “no”. They fail to open up the conversation and allow the patient to give a reply without necessarily having given it much thought. Closed questions need not always be avoided as they can be used to clarify what the patient has said. However, if you begin a meeting with simple closed questions, you will miss important clues and cues about appropriate action.
  • Open questions provide no guidance to the patient as to what the correct answer might be, and cannot be answered “yes” or “no”. They require the patient to give some thought to the response. The open question allows almost maximum scope in the answer.
  • Leading questions give the patient an indication of the answer that is expected. These should be avoided as patients are often passive and will agree with the question’s statement, even if it doesn’t refl ect the patient’s concerns or problems.

Whilst meeting with a patient, it is advisable to begin the conversation with more broad, open questions – ensuring that during the patient’s answer, all possible information from both the verbal response and non-verbal signs are noticed. Then, gradually, narrow down towards more closed type questions.

Verbal communication

Consultations are not of course exclusively question and answer sessions; other forms of verbal communication can be used to put the patient at ease, and to ensure that they know that you understand what has been said:

  • Social exchanges – polite, non-judgemental, greeting-type statements that are used at the beginning and end of a meeting to help establish and maintain patient rapport, such as “Good morning”.
  • Facilitation – general words and noises to encourage the patient to continue – “uh huh” “go on”, “you were saying…”.
  • Repetition – repeating or paraphrasing a sentence or part of a sentence that has been said to you tells the patient that you are listening closely and are interested in what they are saying to you.
  • Clarifi cation/interpretation – check that your interpretation of what has been said matches what the patient feels.
  • Reassurance, instruction, and advice – these usually occur at the end of the dental visit.

Non-verbal communication

Non-verbal communication is also extremely important, and there are a number of ways to use body language effectively:

  • Face the patient and maintain eye-to-eye contact (the layout and design of dental surgeries can often make this diffi cult). Maintaining good eye contact encourages speakers to continue and the ideal amount of eye contact is as important in a relaxed conversation.
  • Consider the optimal seating position to engage someone in a conversation – People are usually only found absolutely opposite each other in romantic restaurants or when engaged in combative discussion. Sitting opposite someone means that eye contact is inevitable and unavoidable. Therefore the more comfortable seating position for two people who are not particularly familiar with each other is at a diagonal angle. This suggests equality between the individuals. The position in a dental surgery where one person sits behind another whilst chatting is the most unnatural and prevents eye contact. Conversation will be easier if you sit where the patient can see you. Repeatedly straining one’s neck, trying to look at someone behind while you are talking, is uncomfortable – and yet it is a position in which dental patients often fi nd themselves.
  • Adopt a pose that is open and relaxed, maintaining a level position with the patient (do not stand while the patient is seated). 
  • Crossing arms and legs can be interpreted as defensive or shutting out actions. Lean discreetly forward to show attentiveness and an eagerness to hear more (do not exaggerate this, however, as it can be seen as threatening).

Most patients tend to stop speaking, or at least slow their rate of speech, when the clinician looks down to write notes. Notes therefore should be left to one side, particularly at a fi rst meeting with a patient, or when trying to glean important information.

Reasons for visit

A dental consultation involves discovering not only the patient’s needs, but also their desires and deeper worries. The DCP should always ask him/ herself, “why is this patient consulting me at this particular time?” Well developed interviewing skills are required to elicit accurate and relevant information, even more so if the patient presents with a ‘hidden agenda’, covert concerns or a second diagnosis. In fact, this may be the real, and only, reason for the visit in the fi rst place.