Communication gone wrong

Who hasn’t laughed politely at a joke that’s fallen flat or had to try to keep their eyelids open during a story that never seems to end? The question of whether it’s a good idea to indulge in a bit of humor or tell a long, drawn-out tale to distract a patient undergoing dental treatment is not just about relating to people, it’s about whether these conversations result in good customer service and appropriate patient care.

Kendra Knowles, who has been a dental hygienist in the Chicago area for five years, said she has listened in on some cringe-worthy conversations with patients initiated by one dentist in particular with whom she has worked.

Recalling the first time she assisted the dentist, Knowles said she was wondering if a TV crew was going to pop up in the office.

“I can honestly say that I thought I was on “Candid Camera,” she said. “Because he was dropping the “F” bomb and he always had some story that’s over the top.”

He also told patients a long story about how he had been called in the middle of the night to treat a dental problem for Hilary Clinton, a story that Knowles said grew more unlikely and outrageous every time he told it.

Knowles, whose name was changed for this article to protect her privacy, said she doesn’t frequently work with the dentist, but when she does she has found a way to cope with his chairside manner.

“Honestly, now I just tune him out,” she said. “It’s in one ear and out the other. I don’t listen anymore.”

Despite his style, which she said makes her cringe, she said some of the dentist’s long-time patients seem to love his free and easy manner.

“It’s just his personality,” she said. “That’s the guy he’s always been.”

Others, however, are not impressed.

“I had a patient tell me she was not happy with the crown he put in, and she wasn’t happy with the F-word (he used),” Knowles said.

Know how to relate

Leaning how to relate to patients is a long-accepted part of the curriculum at dental schools, said Sheela Raja, a clinical psychologist and director of clinical behavioral science at the College of Dentistry at the University of Illinois at Chicago.

“It’s such an important part of dental care,” she said. “Dentists have to be able to communicate with patients, talk about treatment plans and deal with anxious patients.”

To help dental students develop a chairside manner, Raja said the school audiotapes some visits (with a patient’s permission) between dental students and patients.

Afterward, students and teachers listen to those tapes in small group settings to brainstorm ways the students can better relate to and communicate with patients.

The idea is to help dentists develop the skills that can put patients at ease, answer their questions and concerns, and provide them with the best possible care.

“We talk about empathy and how to understand what a patient may be feeling, and reflective listening,” she said.

Reflective listening involves re-stating the feelings and information another person is conveying. Raja said it is easy to do and helps patients know that what they are saying is received and understood.

“It’s not all about you (the professional) talking,” she said. “It’s about giving the patient the opportunity to ask questions.”

It’s not as easy as it looks

The communication between a patient and the dentist or hygienist often is not as simple an interaction as it may seem. There are goals that a health professional is seeking, such as providing information that can help a patient choose a better path to ensure his or her dental health.

Learning how to encourage patients to adopt healthier habits is another aspect of the university’s curriculum.

“We talk about how to motivate patients for behavioral change,” she said.

As important as it is for dentists, dental hygienists and dental students to be able to communicate with their patients, Raja said it’s not always easy when a dentist or hygienist is focused on doing the technical job in front of them. Raja said it requires being able to multi-task.

“The dental students are practicing their hand skills while they’re also practicing their people skills,” she said. “It’s like they’re walking a tight rope.”

She said many dentists go into the field because they like to work with people.

“They tend to be outgoing and they tend to like to work in teams,” she said.

If there is doubt about how a joke or story or swear word will be received, Raja said it’s usually best to save it for another audience.

“If you’re not certain how a joke is going to go over it’s probably best not to say it,” she said.

Relationships matter

Studies have shown that building a good rapport among patients and health providers can have many good results, such as reducing malpractice claims for physicians, she said.

Knowles said she doesn’t feel comfortable telling this dentist to change his communication style. She does not think he would receive her feedback in a positive way. She said when patients are disturbed by a doctor’s style they usually speak with their feet, and then it’s too late.

“Most likely they just go shopping for another dentist and you never see them again,” she said.