The well-known Accreditation Council for Graduate Medical Education (ACGME) of the United States, has specified that the interpersonal relationship and communication skills between the doctor and patient are key components and are linked to the exercise of emotional intelligence – especially from the doctor’s side.
Is emotional management in the health field a pending issue?
Since Hippocrates, the doctor-patient / dentist-patient has changed a lot. Historically, the prevailing model was the paternalistic one, where the doctor (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 doctor. 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 his illness.
Guidelines in cultivating a close and active dentist-patient relationship:
Initial establishment of the patient-doctor link
The doctor establishes a bond with the patient to create harmony and trust with the patient. When we neglect the time devoted to the anamnesis, we are not only losing the possibility of making simple diagnoses, but it is a core opportunity of establishing a healthy doctor-patient relationship.
This first contact is part of a 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 doctors 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, he sits in an armchair, under a spotlight, with an open mouth, allowing objects in and out of their mouth (needles, mirrors ) while being observed by strangers. It is therefore immensely important that what happens BEFORE this (the prior ritual), be a pleasant experience. The previous routines 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 doctor-patient relationship.
What does anamnesis really 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?
This is the information provided by the patient to the dentist during a clinical interview, to analyze their clinical situation and what shaped their clinical history.
How is this ritual established?
Through empathy. If I listen to the patient from the patient’s position, I will encourage the patient to listen to me from my role as a 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 doctors said,” Equal to know the best doctor is the friend.”
- Parallel to the oral disease (the medical) is the patient’s personal and social experience (the symbolic).
- Efficient treatment needs to attend to both the medical and the symbolic. 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 we tell the patient what he has, and we have to listen to what he feels. For example, when we say to a patient that he has misaligned teeth, the dentist should expect his patient to honestly share his feelings (shame, embarrassment, etc.)
- A person who comes to improve dental aesthetics, trusts in his dentist and that confidence goes beyond changing the smile. There is a personal story, with its complexes and insecurities and often with its dramas.
When the first ‘routine’ is well established (before sitting in the dentist chair) a definite decrease in dental anxiety will be noted when the patient enters the dentist room.
In the dentist room.
- Shake hands. The American Dental Association emphasizes that up to 80% of patients prefer shaking the dentist hands before oral inspection.
- Smile. A sincere smile is a reliable instrument to establish a close relationship with the patient.
- Use the patient’s name often.
- Try to be close, but not invasive (patients need human contact).
- Listen to the patient: The first thing the dentist must do is listen to the patient. This act allows you to know the person the patient is and not just the patient who needs dental work. The dentist who listens to the patient with attention and affection generates a relationship of trust and cooperation. The exercise of real, active, committed listening is very unusual in the dental sector.
Personalization in the dentist-patient relationship
This is specified in the following aspects:
- Use a simple, adapted language according to the cultural and educational level of the patient to explain the diagnosis and treatment.
- Be versatile. The dentist, in his daily performance, should try to be versatile in his dealings with the patient since each person is different. Thus, there are patients have a greater need for positive reinforcement, while others need to be listened to, others need more empathic in the explanation of the diagnosis. Being able to understand these keys and thus individualize the interaction with the patient creates the possibility of obtaining greater success in the achievement of the objectives.
This personalization has been referred to by different humanistic doctors:
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 doctor must show personal interest, know the patient’s characteristics and understand their needs.
At Enfoque Dental we have made a differentiation of patients in dentistry based on their personality profile.
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 doctor 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 doctor 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. People tend to go to a doctor much faster than a dentist. Dentistry is a branch of medicine and the repercussions of improper oral health range from chronic headaches to cervical problems or even cancer. Also, people with poor dental aesthetics, without teeth or with halitosis may suffer rejection.
Avoid the words no, pain and absolute prohibitions
Elaborate all messages in a positive way. This concept is closely linked to Neuro-Linguistic Programming (NLP) on which we elaborate on later. 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. Prior to the internal oral inspection (which is usually the one that awakens more anxiety).
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 (also 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 dental surgery
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.
Why do we believe that our collaboration in your dental clinic would yield successful results?
- 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 offer personalized consulting processes for each dental clinic.
- We provide answers to those dentists and managers of dental clinics who are interested in developing their knowledge in the management of a dental clinic, being able to lead teams and add clinical and economic value to their dental clinics.
- Our work aims to embed the circle of excellence in your dental clinic, causing an increase in first visits and cultivating deep patient loyalty towards your dental clinic.
- We accompany dental clinics on their way to continuous improvement through the Mystery Patient, coaching, marketing/sales training, teaching excellent patient care protocols, implementing business strategies and successful teamwork. We can also manage the marketing plan if that is our client’s desire.