Communicating with patients as a new dental VT

Listening to patients is key to open and clear communication

This time of year brings all sorts of reminders of growth and change. From the season’s new green shoots and emerging bursts of colour to the approach of term-end with students starting out on their new careers and lives as professionals. Exciting times but nerve-wracking too perhaps? The transformation of final year dentist to vocational trainee can be quite an adjustment after the stress and strain of exams and that last, treasured summer break.

Meeting the patients who will (and those who won’t) become your regulars forms a large part of this journey and transition. Forging appropriate relationships and building trust and rapport can ease the stress of those first few months. Understanding your patients and adapting your communication style appropriately can help dramatically with this and allow you to identify and manage patient expectations – a key skill in patient satisfaction.

The interpersonal aspects of dental care

In practice, the clinical aspect of the dentist-patient relationship is a clear and obvious focus. However, the “softer” aspects of providing dental care can often be overlooked. As in most healthcare settings many patients visit their dentist with a certain degree of trepidation. Patients can be nervous, stressed and worried, and in this heightened emotional state can be more sensitive to the interpersonal aspects of the consultation.

At MDDUS, we often advise members in complaints where patients have had a consultation that has seemingly gone well, with all of their clinical needs addressed, but something in the dentist’s or perhaps receptionist’s approach has triggered a complaint.

One recent complaint received on behalf of an MDDUS member involved a mother and her son who had presented for routine check-ups over a period of two-years. Both mother and son were noted as having very good oral hygiene with gums and teeth being in excellent condition. Accordingly, the appointments were always straightforward and quick. The pair presented routinely for two years with no activity of note. The dentist was therefore very surprised to receive a letter via the local area complaints team with the main area of complaint cited as “rushed and impersonal service”.

The patient had felt that the dentist was not interested in them as patients, but only in getting them in and out the door as quickly as possible. Indeed, the mother stated that she had been keen to discuss braces for her son, but felt there was never an opportunity to open up a discussion with the dentist as they were dealt with so swiftly. The dentist always finished his consultation with: “All fine. Make an appointment at reception for six months”. He then turned away from the patient as they left the chair and room. The patient felt she had made it quite clear that she was poised to ask questions, but felt that the dentist had already psychologically moved on to the next patient and that this was her being “dismissed”.

This demonstrates where the functional aspects of a consultation have been fulfilled but the personal needs of the patient have somehow or other not been met. Such personal needs might include: feeling welcome, feeling understood, feeling comfortable, feeling secure and feeling listened to. The NHS Constitution and The Charter of Patient’s Rights and Responsibilities spell out the importance of communication, participation, respect and compassion and also emphasise the needfor feedback and patient participation.

Active listening

Building trust and rapport with patients can help fulfil these areas and a key aspect of this is simply listening. I say “simply”, but listening can be a difficult thing to do well. We are taught to read and write but are seldom taught how to listen. Listening is a key skill for any healthcare professional, but it can be difficult to spend time listening well to patients in the busy and time-pressured environment of a dental practice. Particularly at the start of your career when everything seems new and perhaps a little bit different.

There are a number of aspects to listening well. Think around the following:

• Listen through the patient’s words for the key themes, needs and messages.
• Stay in the interaction: pay full attention to the patient.
• Be aware of stereotyping and making assumptions.
• Observe the non-verbal communication: what’s their body language saying?
• Give signals to show you’re listening: eye contact, nods, encouraging noises.
• Use appropriate questioning: clarification, exploring, interpreting.
• Summarise what the patient is saying and reflect it back to them.
• Avoid jargon: use language which is easily understood; use diagrams.
• Agree a collaborative way forward: reasoning, methods, timescales, reviews.
• Encourage feedback: seek feedback and encourage questions (“Is there anything else…?”).

All of this can equally be applied to the dental team as well as patients. Information gleaned from team members can greatly inform your interaction with patients. An experienced nurse can be invaluable and give the newly qualified dentist a helpful steer with patient knowledge and associated behaviours – who needs a bit more time or information, who is particularly nervous or even simple things that just smooth an interaction like how a patient likes to be addressed.

GDC principles

Patients can find healthcare interactions confusing and are sometimes overwhelmed by the sheer amount of information available and can find it difficult to question and seek clarification on treatment. There can be particular issues with cost implications to the patient where financial pressures are an influence. Reluctance to question and feedback can introduce issues around many of the key risk areas including: communication, consent, treatment planning and diagnosis.

The first three GDC principles of registration are:

1. Put patients’ interests first

2. Communicate effectively with patients

3. Obtain valid consent

All of these principles are heavily dependent on effective communication. Listening well and employing clarity and transparency with your patients will aid your communication and allow you to create a fuller picture, which will in turn allow you to adopt an individualised approach. A holistic view can be developed of their overall health, reactions to treatment proposals and any concerns they may have – this will ultimately allow you to tune in to what is important to individual patients and enable them to feed vital information back to you.

Enabling this clear and open communication can lessen your risk and make interactions more positive and productive for the patient, and for you.

How do you ensure you listen well to patients? Do any of our experienced dentists have any tips for up and coming VTs? What helped you in the first few months of practice?