We’re ashamed to say it. We’ve had some bad conversations with our patients. We meant well; we were trying to get our patients to improve their oral health, but, instead, we ended up making our patients feel pretty bad about themselves. Instead of empowering them, we embarrassed them. Instead of trusting us, they disliked us.
We said things such as, “You’re not brushing – I guess you want to keep coming in for fillings,” or “It’s your fault your child has so many cavities,” and “If you don’t want x-rays, I am not going to see you.”
What’s wrong with saying those lines? They shame the patient. It makes them feel inferior and judged. They no longer feel comfortable asking questions and listening to our advice, and we don’t get the outcomes we want. How can we have healthy conversations and influence patients? We can do this by following effective ways of communicating.
Effective Ways of Communicating
The three pillars of effective communication are:
REASON: Be reasonable – this means that we must do our best to be logical and have fair and realistic expectations. We must be perceived as being able to adhere to rules and goals in a judgement-free way.
EMOTION: Express positive and welcoming emotions such joy and authenticity. Be kind and inspirational. Emotion is a relative term that should be customized to the unique patient experience. How we say things, our tone, and our body language are strong influences of emotion.
TRUST: Form trusting relationships that are based on logic, authenticity, and compassion. Trust is itself subjective, but can become objective over time if expectations and promises are clear and patient interactions are respected.
Let’s use the communication techniques we just learned to give better responses than the ones stated earlier.
Scenario 1: The Patient with Poor Oral Hygiene
We’ve all had this frustrating experience. We take the time to do comprehensive oral hygiene instruction, give the patients the oral hygiene aids they need, explain why they need good daily oral home care, yet the patients’ oral hygiene is still poor and they are constantly getting cavities. What should we say?
REASON: Be clear and accurate about your clinical assessment.
“You have five cavities and all of them are at the gum line where there is plaque. By brushing away the plaque, you can prevent future cavities.”
EMOTION: The tone and delivery of the message is where we can profoundly affect how a patient perceives the information. Treat this as an opportunity to “win” the patient over by being kind and using positive language.
“It’s a good start that you are brushing once a day in the morning. It’s best to brush twice a day and use the proper technique. Let’s see how you are brushing and talk about how you can add brushing at night.”
TRUST: Patients will trust you if you show that you care about them. Do not assume that the patient is being negligent or is not competent. If they are coming in for dental appointments, they do care about their oral health. Ask them about themselves so you will be able to give them advice that they can incorporate into their current routines.
“Why aren’t you brushing at night?”
“How about brushing after dinner since you are too tired at night to brush?”
Scenario 2: The Child with Lots of Cavities
It’s sad to see toddlers with decay who need general anaesthesia and extensive dental treatment. Yes, the parents are responsible for their children’s diet and oral hygiene, but instead of blaming them, help them in making positive changes.
REASON: It is essential to walk the parent along the path of diagnosis and prevention.
“Your child has several cavities. They can be treated and we can discuss treatment options. Let’s first talk about how the cavities formed and how they can be prevented.”
“Why do you think your child has cavities?”
EMOTION: All parents want their children to be healthy. Many feel ashamed that their child has cavities. Make parents feel like the situation is not hopeless and empower them to make positive changes.
“It’s good that you noticed the cavities and brought your child in to get treatment.”
“It’s good that you identified what is causing the cavities. That way we can stop future cavities.”
TRUST: Instead of dictating what the patient should do, ask the parents to show you how they clean their child’s teeth and ask them to list everything their child consumes. Empathize with them and help them with the areas they are struggling with.
“It’s tough to brush someone’s teeth when they are not cooperating. Here are some tips you can use.”
“It’s hard to stop the habit of the baby bottle. I also had a hard time with my kids. Here are some ways to stop.”
Scenario 3: The Patient Who Refuses X-Rays
“I don’t want x-rays,” is something we don’t like to hear. It makes us feel that our recommendations are not being respected and that we are not thinking of our patients’ best interest. Instead of lecturing them as to why they need it or giving them an ultimatum that they must do it or you won’t treat them, it’s best to have a conversation instead of a confrontation.
REASON: Explain to the patient why the procedure is necessary. Let them know that treatment/diagnostic tests are patient specific and discuss the benefits of treatment and consequences of not getting treatment.
“Without x-rays, I won’t be able to detect possible problems. By getting x-rays, you will receive the best treatment plan with an accurate diagnosis.”
EMOTION: Understand the patient’s perspective by asking them why they do not want x-rays.
“It’s good that you care about your health and are cautious about what happens to your body. What are your concerns with x-rays?”
TRUST: Relate with the patient and respect the patient’s opinion. Document the discussion and let the patient know that without x-rays, a proper diagnosis and treatment plan cannot be created.
“I understand your concerns with x-rays. I am also cautious about receiving x-rays.”
“I don’t want you to do anything you feel uncomfortable with.”
“If you don’t want x-rays, that’s fine. I won’t be able to give you an accurate diagnosis or be able to provide treatment without x-rays. Please consider x-rays at your future visit.”
We feel pretty proud of ourselves now. We’ve been following the communication techniques and they are working. We notice that health outcomes are improving and patients are happier. Remember the pillars of: Reason, Emotion and Trust; and keep the desired outcome in mind. By doing so, you will win conversations and influence patients.
- Stewart, M. (1995). Effective Physician-Patient Communication and Health Outcomes: A Review. Canadian Medical Association Journal, 152(9), 1423–1433.
- Frei, F. X., & Morriss, A. (2021, August 31). Everything starts with trust. Harvard Business Review. Retrieved July 27, 2022, from https://hbr.org/2020/05/begin-with-trust
- Shapiro, B., & Communication, O. (2017, November 14). 3 pillars for effective communication in the workplace. Shapiro Communications. Retrieved July 27, 2022, from http://shapirocommunications.com/effective-communication-in-the-workplace/
About the Author
Dr. Sanjukta Mohanta graduated from the University of Toronto, Faculty of Dentistry in 1999. She is a general dentist practicing in Brampton, Ontario. She can be reached at: email@example.com
Dr. Ramez Salti graduated from Western University’s Schulich School of Medicine and Dentistry in 2007. He is a general dentist with a focus on implants, oral surgery and IV sedation. He practices at several locations in the Greater Toronto Area. He can be reached at firstname.lastname@example.org
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