At Enfoque dental, our purpose is not only to increase the amount of knowledge of our clients but to support them to implement ethical practices in the management of dental clinics successfully.
We have assisted numerous dental clinics on their way to excellence through the Mystery Patient service, coaching, marketing/sales training, teaching excellent patient care protocols, implementing business strategies and successful teamwork. We also manage the marketing plan if that is our client’s desire. During this journey, we have understood the main points in the relationship between a dentist and a patient and how this relationship is vital to enhance the confidence and trust in the patient to face the prognosis, diagnosis, and treatment.
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Paternalistic dentistry to emotional dentistry.
Historically, the prevailing dental model was the paternalistic one, where the dentist (the expert), decides with almost absolute authority what is best for the patient. This rigid model deprives the patient of their autonomy and restricts their freedom of choice to the prescriptions of the dentist. This asymmetric relationship tends to be balanced in the second half of the twentieth century when concepts such as autonomy, freedom, respect, trust, and confidentiality begin to take effect. It is then passed to a more humanistic model in which the role of the patient is critical during their illness.
In the initial establishment of the patient-dentist link, the dentist builds a bond with the patient to create harmony and trust. When the dentist neglects the time devoted to the anamnesis, they are not only losing the possibility of making simple diagnoses, but it is a core opportunity for establishing a healthy dentist-patient relationship.
This first contact is part of a ritual or routine (a custom or act that is invariably repeated), and something remarkable happens during it. The University of Anthropology of Standford agrees with our humanistic dentists like Dr. Marañon, Dr. Lain Entralgo, Dr. Bueno, Dr. Maglio; and with the classical Greeks Hippocrates, Socrates, Plato when they speak of the power of medical ritual.
When an individual arrives at a dental clinic, they sit in an armchair, under a spotlight, with an open mouth, allowing objects in and out of their mouth (needles, mirrors etc.) while being observed by strangers. It is therefore immensely important that what happens before this (the prior ritual), be a pleasant experience. The previous ritual/routine is that of the anamnesis. If this is shortened, interrupted, or the dentist seems inattentive (looking at the papers putting on gloves, etc.) you will be missing the opportunity to create a trusting dentist-patient relationship.
Anamnesis is key in the dentist-patient relationship.
What does anamnesis mean? The term anamnesis (from the Greek ἀνάμνησις, ‘memory’) means reminiscence and aims to bring to the present the memories of the past.
What is the anamnesis?
Anamnesis is the information the patient provides the dentist with during a clinical interview, to analyze their clinical situation and what shaped their clinical history. When the first ritual is well established (before sitting in the dentist chair), and the patient then enters the dentist room a definite decrease in dental anxiety will be noted.
How is it established an emotional relationship between the doctor and the patient?
By following these main points:
- Through empathy. If the dentist listens to the patient from the patient’s position, it will encourage the patient to listen to the dentist. It is therefore essential to create ‘personal’ ties in this time – trust, understanding, and loyalty. The patient must be loved. Avicenna, known as the prince of dentists said,” The best doctor is the friend.”
- Efficient treatment needs to attend to both the medical and the emotional (the patient’s personal and social experience). If we only act at the medical level, we are plumbers of the mouth. We have to merge the two: the body and the person.
- When the dentist diagnoses the patient, the dentist needs to listen to the how the patient feels carefully. The given example specifically refers to the specialization of orthodontics. When the patient is diagnosed with misaligned teeth, the dentist should allow the patient to honestly share their feelings (shame, embarrassment, etc.) and be accepting of that. People with poor dental aesthetics, without teeth or with halitosis may suffer rejection. The dentist should, therefore, be especially sensitive to this.
- A person who comes to improve dental aesthetics, trusts in his dentist and that confidence goes beyond changing the smile. In the orthodontic clinic – the same type of smile cannot be reproduced in different patients. Together with the patient – the doctor needs to develop a smile for the patient that is suited to their nature.
- Personalization of the relationship between the patient and the dentist. In the dentist room, shaking hands, smiling, using the patient’s name, trying to be close, but not
invasive (patients need human contact) and listening to the patient it is also key to achieve a personalized dentist-patient relationship. This personalization has been referred to by different humanistic dentists: Dr. Lain Entralgo (1983). All judgments about health should be referred to the belief system of the group to which the patient belongs. Dr. Tornico Linares (2002). We must understand the peculiarities of each type of population when it comes to practicing medicine. Dr. Bueno (2000). The dentist must show personal interest, know the patient’s characteristics and understand their needs.
- Ensure that the patient has understood the diagnosis and treatment well: Communication with the patient must be done appropriately, avoiding the use of terminology that is too technical and complicated. The study done by Bodenheimer in 2007 reveals that 50% of patients do not understand what their dentist told them [Bodenheimer T. A 63-year-old man with multiple cardiovascular risk factors and poor adherence to treatment plans. JAMA 2007; 298: 2048-55]. The word doctor comes from the Latin word docere, which means “to teach.” The fact that the terms “doctor” and “teacher” are used as synonyms puts us on the track of the direct relationship between medicine (in our case dentistry) and teaching. In effect, since before Hippocrates, the dentist instructed his patient and his family and friends about his illness, his treatment, and his prognosis. Nowadays, the pedagogical dimension, as we have already mentioned before, has to focus on highlighting the importance of becoming aware of the importance of oral health and of course the importance of a orthodontic treatment in improving confidence through improving smiles, preventing periodontal illness, avoiding head- and backaches as well as the impact on the body posture.
- Avoid painful words and absolute prohibitions. Elaborate all messages in a positive way. This concept is closely related to Neuro-Linguistic Programming (NLP). In a few words and as a way forward, NLP affirms the enormous power it has over our emotions, habits, and style of dealing with difficulties using positive language.
- External oral inspection to detect specific pathologies. The external oral investigation, allows the dentist to identify possible pathologies in the joints, jaws, ligaments, lips, and jaw. It also aids in the connection between the dentist and the patient.
- Be aware of the psychosocial meaning of the mouth. According to one of the fathers of psychology, Sigmund Freud, the mouth is the first area where we experience the self, and through it, we have the early signs of satisfaction and reward. It is therefore essential that the dentist ask the patient for permission to carry out oral examinations since the mouth is an intimate area. Some patients might feel (even subconsciously so) shame and a sense of invasion of their privacy through the inspection of the mouth (even done by a professional).
- Communicating by using fearful consequences. If for example, a patient lacks the necessary routine for maintaining good oral health, it is not beneficial to repeat or exaggerate the negative aspects of this bad by stating phrases such as “Bad oral hygiene will make you lose all your teeth in a short time.” This provokes even further fear in the patient and thus blocks him or her from establishing a relationship with you as their dentist.
- Nonverbal communication is particularly important in orthodontics treatments. It is essential to develop the sensitivity in understanding the non-verbal language of patients. A proper anamnesis involves capturing the subtle signals that complement the verbal interaction. Often, non-verbal language expresses feelings that the patient might not even be aware of. For example, the patient’s facial expressions, silences, looks, voice intonation (stretching certain consonants), sighing, smiling, expressions of fear and the facial expression of disgust; are all communicative acts that can be even more important than the verbal expression itself.
- Use humour when conditions are favourable. Many studies have shown how humour is fundamental in the healing of people and the development of resilience in patients during their illness.
- When a patient is looking for aesthetic treatment, they become a client. It is essential to understand the patient’s specific requirements. Ask the patient what they desire: What would you improve in your smile? The answer will help the dentist grasp what the patient’s wishes and requirements are.
More insight about the relationship between an orthodontic dentist and the patient.
In the new relationship between an orthodontic dentist and the patient, it is key to educate the patient in all dimensions (including the emotional) of orthodontic treatment. From our surveys, most of the patients still see an orthodontic treatment in a limited way. It is, therefore, important to transmit to the patient the following points thus educating and empowering them about their orthodontic decision:
- Orthodontic treatment develops new smiles, prevents periodontal illness, diagnose head- and backaches and improves body postures.
- Orthodontics does not only improve the physical appearance of a patient but affects the overall health, including that of the emotional.
- Orthodontists assist people in changing their lives by increasing their confidence and quality of life. Thus, it is not merely a mechanical job, but a profoundly emotional one.
Due to the emotional nature of orthodontics, it is essential that all orthodontists are well equipped to navigate through this sensitive world successfully.