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Open question.

Following on from our greeting, introduction and small talk how do we transition to the dental side of things?

If we aspire to practice patient-centred care, then the tone of the interaction needs to be set early by starting the conversation with an open question – one which can’t be answered by a “yes” or “no” answer.

Although any question can receive a comprehensive answer, open questions intentionally seek longer answers, and are the opposite of closed questions. *

The aim of doing this is to encourage the patient to tell their own story and to enable as much information as possible to be obtained.

Examples that I use are “how can we help you today?” or “tell me what’s going on with your tooth?”.

Advantages;

1. Gives the patient a chance to describe the problem(s) in their own words.
2. Gain the patient’s perspective on the problem.
3. Facilitates patient-centred care.

Disadvantages;

1. TIME – likely to take longer.
2. Relevance – patients may give information that rambles off-track.
3. Recording information/ note-taking may be harder.

It is obviously patient dependent and the responses to an open question will vary widely across a spectrum from;

• The monosyllabic grunter who refuses to capitulate except to say, “you tell me, you’re the expert”.
• The older person living alone who when asked about their tooth proceeds to give you their life story or a rambling account of their daughter’s neighbour’s cat who had to see the vet etc. etc.

As a rule, an open question will lead to closed questions where more specific follow-up information is required based on the facts given or omitted in the opener.

Advantages;

1. Useful when specific information is required – “did it keep you awake last night?”
2. Fill in gaps in the narrative from the longer opening question response.
3. Emergency situations where very specific information is required quickly – “exactly how long ago was the tooth knocked out?”.

Disadvantages;

1. Continuous closed questions may make the consult feel like an interrogation.
2. Restricts how the patient can respond.
3. May go off in a wrong direction.

One more interesting concept to look out for is the interruption – there is no point in asking an open question, then tapping your feet impatiently and jumping in when the patient pauses for breath.

This will erode any good work you have done up to this point establishing yourself as a dentist focused on caring for the patient.

Beckman and Frankel in their famous 1984 study of physicians focused on the patient’s initial statement of concerns in response to the “what brings you here today?” type question.

They found that;

• Patients were provided the opportunity to complete their statement in only 23% of the visits,
• The average time to interruption was 18 seconds.

In follow-up discussion in 2017 they state serious concerns that once interrupted the patient did not raise additional concerns at the beginning of the visit – if raised at all, these issues came up at the end of the visit.

They say that “because patients frequently present with multiple concerns, and there is no evidence that the first concern is the most important … the most effective approach is to solicit all the patient’s concerns at the beginning of the visit and then negotiate what to focus on in the time allotted”.

QUESTION – how many times have you sat the patient up after a consult, the D.A. has cleared the instruments away and as the patient gets up, they ask you about another tooth or problem?

Very, very frustrating and often happens when you are already running late!!

Could this be as a result of not getting all the relevant patient information and perspective at the front end??

For me, on reflection, definitely guilty as charged …

 

* A closed question is one which can be answered by a “yes” or “no” or another single word.

I have been invited to speak to Dentists at the 2019 Australian Dental Congress on Saturday 4^th May, Communication in Dentistry – 3 key skills for more effective practice.

In my abstract submission I applied to speak at the lunchtime sessions – this less formal round table style is much more suited to interactivity and practical learning with the aim of taking away knowledge that can be applied immediately in your practice.

I will focus on 3 areas;

1. How to make a good first impression – “you never get a second chance to make a good first impression. You will gain an appreciation of what ‘presence’ you project to patients even before you meet them and what to think about when you greet a patient for the first time.
2. Learn to listen – discover that there are different types of listening and realise the most effective method so our patients can truly recognise that we care for them.
3. Understand empathy – the ultimate hack to building rapport and trust with your patients.

The old adage of customer service is more relevant than ever today in this increasingly corporatized environment – “people are likely to forget what you say or do, but they will never forget how you make them feel”.

A proportion of patients are searching out deals and they will be drift to whatever practice gives them a special of the month. You will attract these patients by winning a ‘race to the bottom’ – your margins will be so hollowed out that you will have to see more patients or ‘up-sell’ them on something else they might not necessarily need or want.

The patients you want to attract are the ones who value good service and seeing the same dentist who cares for them – they will never mind paying if you make them feel better about their choice to see you over somebody else undercutting your fees.

Using these skills creates strong, resilient relationships where your patients feel genuinely cared for, will value you and recommend you to their friends.

5 mini-habits later, 5 small practices that will help you to communicate more effectively in the crucial rapport building phase of the interaction with your patients.

So, what’s the point?

You may ask why should I invest time and energy learning communication skills when I could be reading up on exciting new materials, watching YouTube clips on how to prepare veneers or flying inter-state to learn high-end cosmetic procedures from overseas ‘gurus’?

It’s a legitimate question, especially in this time-poor world we live in, and indeed it’s a question I have been asked many times in the past by both students and graduates when I have delivered communication skills courses.

In these significantly more challenging times, especially to be graduating laden with debt and trying to establish a foothold in our very rewarding profession we need to consider;

• how to attract new patients by word-of-mouth recommendations,
• how to retain those patients in the long-term,
• how to build a trusting relationship where your patients will accept your advice (and treatment plans),
• how to ensure your patients will be inclined to give you the benefit of the doubt when things go wrong,
• how to minimise stress (by successfully doing the above) in an already high-pressure job in very competitive times.

I have been contemplating all of this recently while listening to some dental podcasts from the USA –http://www.thepassionatedentist.com/ and https://www.howardfarran.com/ . They interview leaders in various fields of dentistry and a recurring theme relates to young Dentists graduating with staggering debts and what they try to do in order to build a patient list and what they really should be doing.

Dr. Saib, ‘the passionate Dentist’, is quite even-keeled and rejects the aggressive sell tactics advocated by some marketers – “if you had $1,000,000 what would you do with your smile?”. He asserts that patients quickly see through the “don’t let them leave the building without saying yes” ethos – these tactics erode trust as patients equate it used car sales – at best they politely say yes and cancel later!

He remembers his early debt-saddled days and his feeling of desperation where, in his own words, he needed the dentistry to be done more than his patients did.

The light-bulb moment was when a mentor told him how this desperation was oozing from his pores – he reflected on this and realised if it was that obvious to his colleague his patients would sense it too.

He resolved to work on his communication skills, building rapport and trust before broaching bigger treatment-plans – he re-built his battered confidence and never looked back.

Dr. Farran is much more brash and up front about the money and the sell and I was about to give up on him when he came around to the same issue.

He said newly graduated Dentists were constantly contacting him and asking him about the wisdom of burying themselves further in debt buying Cerec and Cone Beam machines and/or investing further time and money learning about implants and complex restorative procedures.

His take on this was one of an exasperated but protective mentor figure – the expensive toys or complex training was absolutely the wrong thing they needed to focus on – there needs to be a much greater emphasis on learning fundamental communication skills.

These experienced Dentists and thought leaders were saying, in effect, “if I knew then what I know now” it would be to focus on communication skills first and from there you will be confident and calm, and your patients will see your passion to care for them.

The both double down on how important this is with the rapidly increasing corporatisation of our profession – 30 years ago you picked a location, fitted out a practice and the patients came. No longer!

We cannot compete against corporate entities on economies of scale, marketing budgets or flashy surgery fit-outs and equipment. We must compete on a different front – relationship building and personal service which in turn leads to trust and a deep loyalty that will see you through the ups and downs of trends and economic cycles.

The answer is clear. It is not buying a laser or Cerec machine. It is not traversing the country to learn complex techniques. It is not branding and social media presence.

What will amaze our patients is if we help them feel great about their choices and experience – patients don’t remember what we do or say, they remember how we made them feel.

We must realise that to get to that point of really understanding what a patient wants, which will then increase chances of satisfaction and referrals we must first work to identify and develop the fundamental skills of interpersonal communication.

There is no shortcut.

Rapport, trust and building resilient relationships first.

Practice growth, patient retention, treatment plan acceptance, reduced complaints and less stressful work-life follows.

Small talk.

Small talk (known in academia as non-task comments) is a key component of relationship building and in the healthcare setting it has long been recognised that “the opening exchange of either information or pleasantries is important and should not be omitted”. (1)

Small talk serves as a preliminary to the interaction at a more substantive level and should involve subjects that don’t invite strong opinions – my first job as a Dentist in Northern Ireland taught me to never stray into the territory of religion or politics and this rule holds true for me to this day!

A seemingly universal way of beginning is some variation the HAY (how are you?) question – it is generally acknowledged that this is not a literal question but a curtain raiser for the business to follow.

There are many variations of the HAY introduction from the simple “G’day” to the aristocratic “how do you do?” and it pays to know the local variations if you work with a specific group of people. My own Irish experiences varied from “Well?” in my hometown (a shortening of “are you well?”) to “Howaya?” in Dublin where I studied (a shortening of “How are you?”) to “What about ye?”, often shortened to “bout ye?” which completely flummoxed me when I went to work in Derry in Northern Ireland.

Small talk acts as a gentle transition for the patient from the tension and expectation of sitting in the waiting room to the task at hand in the dental chair. It is a social lubricant in a flexible and non-threatening way and I am always amazed at the relaxation in a patient’s nervous body language following a minute or so of small talk at the start of the visit.

Topics may be universal;

• Weather – the trusty default option,
• “Have you been away on holidays recently?”,
• Traffic,
• Sports,
• Light current affairs.

Sometimes it is specific to the person/ situation;

• “I like your shoes/ hair/ watch”,
• “How are your kids?”,
• “We are having some renovations at the practice”.

There may be some topics that are more pertinent to your patient demographic, for example it would be prudent to have a basic knowledge of rural issues if you work in the country.

The reverse of this is also important – the need for congruence – it can look very staged or false if you ask someone about the football and it soon becomes apparent that you don’t know one end of a ball from the other, or compliment someone on their shoes if this is not your thing (I leave that one up to my assistant, and it can work very effectively to bring a big smile to that patient’s face).

In summary, the use of small talk is a ritual we use as a warm up to the main event of the clinical issue at hand. It acts as a gentle transition for the patient from waiting to sitting in the dental chair and helps build rapport, showing the patient that you recognise them as a person and not just a disease entity to be managed.

Use of small talk is a skill – like any skill it can be developed, made into a mini habit and fortunately we can learn and practice relatively safely in any social situation.

Small talk makes for BIG CONVERSATIONS – the amazement on a patient’s face when you remember that their daughter was getting married, or you ask about a special holiday they were going on – this is the intangible gold that will build resilient relationships and, in turn, a thriving busy practice.

Reference.

1. Holli, B and Calabrese, R. (1998) Communication and education skills for dietetics professionals: Williams and Wilkins.

 

 

 

 

Eye contact.

The first question I always get asked on courses regarding eye contact is how much is appropriate?

A degree of eye contact, just as in a friendly demeanour and use of the patient’s name is a key part of initiating a person-to-person connection with the patient, and continuation is integral to maintaining rapport and trust throughout the interaction.

There are no one size fits all rules regarding how much eye contact to make – somewhere between a dismissive talk-to-the-hand and a boxing weigh-in staredown – however there are some factors to consider that may influence the degree of eye contact used:

• Cultural factors – for example some Indigenous people may be hesitant to make eye contact with non-Indigenous people,
• Religious reasons – some religions may discourage eye contact with people outside (or even sub-groups within) that religion,
• Gender – there may be gender based factors which may also be linked to culture and religion,
• Personality – some people are more reserved than others,
• The surgery environment – physical positioning of the supine patient with (often dark) protective glasses and the dentist sitting behind.

The bottom line is to read from the patient’s body language how comfortable you both are with eye contact.

It may be a matter of perceiving that the patient keeps looking away when you look at them – don’t keep pushing through if the patient is visibly uncomfortable with eye contact. Give them space and with building of rapport and trust it may increase over time.

Sometimes a patient may use a persistent eye contact to indicate anxiety (help!) or even to try to create dominance over you.

PS – most of these principles apply to handshakes/ physical contact too.

 

I have just completed Cert ADL.

What is Cert ADL?

It is a course that invites “global dental professionals” to participate in “an exciting Online Advanced Dental Leadership (ADL) programme developing young dentists into first class leaders and advocates for oral health.”

What are the criteria to participate?

In a literal sense I consider myself a ‘global’ professional as I have worked in Europe and Australia as a dentist, dispute resolution practitioner and teacher and did a student exchange at a Dental School in the USA – so I have encountered dentistry from numerous different aspects and in doing so worked with many great professionals and mentors.

Having completed the course I’m sure however that the meaning of ‘global’ is metaphorical – global in outlook, looking beyond the four walls of the room you work in.

I will, however, immediately disqualify myself from the ‘young’ part of the selection criteria, but I am passionate about advocating for the importance of communication skills as key skills that every dentist must be proficient in, not just leaving Dental School but also throughout their careers.

Any other commitments?

Yes, a very modest fee, your time and your energy. Like any online course it can be tick the box exercise that you could complete in 2-3 hours. If you go deeper to interact with and reflect on the material, then it is quite a bit more effort – like anything in life what you get out of it is proportional to the effort you put into it!

Who should do it?

Any dental professional – there will be something in it for all as there is a whole module on communication. If you have a leadership role such as a team leader in the government sector or the owner of a practice, then the leadership module will also have great value.

Was it useful?

Yes, I learned a lot from this even though I have already some prior experience in the field. Being online you could also meander through it slowly and if time poor just cherry pick items of interest to study further.

Downsides?

Some of the material was old and a there are a few broken links to external sites and material. The site needs a spring clean and updates in some areas.

Summary

For less than $100 AUD there is more than enough material here. If online learning works for you then definitely worth having a look.

Use the patient’s name.

“A person’s name is to him or her the sweetest and most important sound in any language” according to Dale Carnegie in his bestseller How to Win Friends and Influence People. (1) People love their names so much that they will often donate vast amounts of money just to have a building or foundation named after themselves.

Using a person’s name is the most obvious and efficient gateway to address their identity and individuality. It is one way we can easily gain their attention – note the reaction in a crowded waiting room when a patient’s name is called – immediate recognition and mutual understanding that the interaction is beginning, it’s their turn.

When an introduction proceeds well with a mutual exchange of names, it creates a good first impression demonstrating courtesy, a sense of equality and at the same time recognising each other’s individuality.

There is a belief for some people that they are ‘just not good with names’ – without debating whether this is a phenomenon or not there are still some tips we can use to help improve the situation.

1. A recent UK study (in a dental teaching hospital) states – “patients preferred to be greeted informally by their first name and didn’t mind how the clinician introduced themselves, or preferred them to use their first name also”(2).
2. My personal default is not to be over-familiar especially on initial interaction – if there is a significant age gap I tend to consider using titles Mr., Mrs. etc until the patient indicates otherwise. The Aussie habit of nicknaming and abbreviating should not be assumed – if in doubt, ask – “do you prefer Elizabeth or Liz?”.
3. Try – when you meet somebody and you can’t exactly remember their name it’s appropriate to use some humility and enquire, “I’m not very good with names” or “I know your name but seeing you out of context it’s just not coming to me” – if you try and are correct they will be flattered, if not most people are very understanding and will correct you.
4. Practice and rehearse – we have a huge advantage in our working environment in that we have a list with the names of clients that we are to see in a session. Take some time to check your list and mentally put faces to the name.
5. Repeat – use the patient’s name during the treatment session to maintain the connection and give reassurance that you are still attending to them (especially during tasks where you are really focused on the technical work you are doing).
6. For difficult names ask for a pronunciation – I hail from the land of Tadhgs, Saoirses, Eoghans and Caoimhes – if unsure just ask, and it helps to put a phonetic spelling in your record – they will be suitably impressed next time when you get it right!

Remember, people want to be treated as human beings, not objects. Using their name is a fail-safe way to connect, create a good first impression and build/ maintain a healthy rapport.

The arch enemy, Coca-Cola, used the power of naming and personalisation to huge success with the ‘Share a Coke’ campaign a few years back – introduced in Australia it was eventually rolled out over 50 countries with the most popular first-person names of each region printed on cans and bottles in place of the company’s moniker. The campaign helped “Coca-Cola achieve the largest year-over-year growth in 20-ounce packaging in its history – more than 19 percent”.

References.

1. Carnegie, D. How to Win Friends and Influence People. Random House. 2006.
2. Davies-House et al. Meeting and greeting in the clinical setting – are we doing what patients want? BDJ 222, 457-461. 2017.

Smile.

According to Krys et al “smiling individuals are usually perceived more favourably than non-smiling ones”. They cite numerous studies “demonstrating that smiling individuals are perceived as happier, more attractive, communal, competent, likable, approachable, and friendly, and that a smile from another promises a safe and satisfying interaction” (1).

This is enough incentive to make a mini-habit of smiling when I greet and interact with my patients. I don’t believe that any of us would doubt the value in making a good impression from the outset – the old saying that you rarely get a second chance to make a good first impression really resonates with me.

However it is not as simple as it may seem on the surface.

There are many different types of smile, some sources describe as many as 19 (with only 6 for happiness). I still have strong memories of the forced, nervous smile going into the waiting room to call my first patients at Dental School being mirrored by equally nervous responses from the patient!

Guillame Duchenne, a 19^th century French anatomist, identified the so-called genuine or Duchenne smile. This was verified by the modern authority on facial expression Paul Ekman who described it as “smiling in which the muscle that orbits the eye is active in addition to the muscle that pulls the lip corners up” (2). Note the incongruous expressions of botoxed celebrities who can’t express genuine smiles as their orbicularis oculi muscles don’t work!

As well as different types of smile there may also be different cultural interpretations of smiling. There is a Russian proverb which says, “smiling with no reason is a sign of stupidity” (1) and at the recent soccer World Cup, after spending billions of dollars on infrastructure there was a last-ditch realisation that volunteers and transport officials needed to be taught to smile and be helpful to foreigners.

Fortunately, this cross-cultural variation bodes well in the Australian context – in a 2016 study there was a strong correlation between smiling and perceived honesty in Australia (second only to Switzerland in a study of 44 cultures) – interestingly “this cultural variability was related to societal corruption levels”. Also in Australia “smiling individuals are rated as significantly more intelligent” than non-smiling individuals! (1).

To summarise, if you are going to make smiling a mini habit;

• Make it genuine – smile like you mean it;
• Be aware of any potential cultural context of smiling;
• As a leader in your practice once you have practiced making a smile your own default setting or ‘resting face’ consider “what’s the ‘resting face’ of your brand, your business, your website?”

 

References;

1. Krys et al. Be careful where you smile: Culture Shapes Judgements of Intelligence and Honesty of Smiling Individuals. Journal of Nonverbal Behaviour. 2016
2. Ekman et al. The Duchenne smile: Emotional expression and brain physiology. Journal of Personality and Social Psychology. 1990

As a profession we are aware that the days of ‘Doctor knows best’ in healthcare are over. More than 40 years ago George Engel, in a critique of the biomedical model of care, stated that “physicians are lacking in interest and understanding, are preoccupied with procedures, and are insensitive to the personal problems of patients” (1) – as an alternative he proposed the biopsychosocial model of care.

From this work the concept of patient-centred care (PCC) was formalised and later defined as “care that is respectful of and responsive to individual patient preferences, needs and values and ensuring that patient values guide all clinical decisions” (2). According to Rathert et al “there is a growing body of evidence that providing patient-centred care can lead to positive clinical outcomes for patients, as well as increasing their satisfaction” (3).

There are also other forces at work pushing modern healthcare in this direction – the advent of the internet (reducing the professional-patient knowledge deficit), consumerism (expectations of choice, convenience and options) and a patient base less understanding when there is a negative gap between their expectation and the outcome of care.

So, what does this mean for Dentistry and how to do we incorporate this healthcare worldview into our practice?

For a start the concept is written into our conditions of registration – Dental Board of Australia (DBA) Code of conduct states that “practitioners have a duty to make care of patients or clients their first concern” and that “good practice is centred on patients or clients” (4). This wording seems to be a very deliberate endorsement of the PCC concept.

We are explicitly directed by our regulator to practice Dentistry in a manner that is centred on our patients, and the expectations of our patient base coincides with this, yet we may have little or no teaching or guidance of what this entails in the real world.

This has been highlighted recently as a significant issue – “references to patient-centred care and its principles are becoming more prevalent both in dental literature and in policy documents. Despite increasing prominence of the concept, however, there is a lack of a universally agreed definition in dentistry as to what the term means or how it can be translated into practice” (5).

Taking a step back from the semantics, we see every day with our patients that disease presentation and management does not necessarily correlate directly with the patient’s experience of illness.

Contrast the patient who presents with obvious infection, broken teeth, pain and who just wants minimal work done, to the patient who demands to be seen as an emergency only to present with the tiniest enamel fracture on a lower incisor.

We often see patients with significant but asymptomatic periodontal disease who indicate, despite our earnest attempts to educate, that treatment is not a priority for them right now. Patients may decline treatment on the basis of cost only to nonchalantly mention, in the next sentence, their impending overseas holiday.

Examples like this can be very frustrating when we are trained and primed to diagnose and treat disease – if we are to practice PCC, the patient’s values should guide the clinical decision-making process in conjunction with our professional input. This will hopefully lead to the patient making an informed (and carefully documented!) decision on treatment/ intervention or non-treatment, based on the information to hand at the time.

In day-to-day Dentistry how can we ensure that we are translating the concept of PCC into our practice? Scambler et al say that PCC is about care that considers the following four basic factors (6):

1. “The illness in its widest context” – for example a PCC discussion about the need for an extraction would “explore not just the technical aspect of the extraction but the impact that the extraction is going to have on the person’s overall life” (6) – from potential implications of the patient’s medical history to options for replacement of the tooth (including costs and time-frames). Even something a simple as need for child-care while a parent is having the procedure and recovering may be relevant.
2. “The patient as a whole person: this is about the Dentist focusing not just on the mouth but the patient behind it” (6). In the example above of the reluctant patient with periodontitis we tend to focus on the disease, however there may be many factors outside of the mouth influencing the patient’s attitude such as anxiety/ phobia, financial constraints, other priorities (such as a family illness) or even embarrassment and shame. If we uncover and address these issues, along with the disease, then we are more likely to achieve realistic outcomes.
3. “The ethos behind the relationship with your patient” – the development of “a relationship based on trust, compassion, empathy and shared humanity” is “key to developing a long-term relationship that is going to be conducive to appropriate decision-making about possible treatments and their outcomes” (6). When we endeavour to empathise with and understand the reluctant periodontal patient rather than judge and preach to them we are more likely to achieve the next aspiration of PCC.
4. “Finding common ground with a view of sharing responsibility”. The “aim is to achieve a common understanding of the health issue in question and, where there is disagreement or divergence, to reach consensus” (6). This is crucial – with the rights of each party comes a responsibility to communicate and understand each other’s attitudes, decisions and potential outcomes/ implications.

In my view each of these points centres on effective communication – where patient and Dentist have a relationship in which understanding the perspective and attitudes of the other is key.

Before we pick up a scaler, drill, forceps or implement any of the Hard Skills we are itching to get to consideration should be given to allocating time, resources (and training if necessary) for these key, learnable communication skills;

• building rapport,
• listening effectively,
• demonstrating empathy,
• diagnosis (using your mental database of knowledge and experience),
• discussion of options,
• achieving informed consent,
• providing information,
• influencing and educating,
• identifying and managing behaviours,
• reassuring,
• addressing anxiety,
• seeing the patient’s perspective,
• showing that you care and understand.

We must maintain a broad view of what Dental practice is  – this will enable us to take our role beyond that of a ‘tooth mechanic’ managing Dental disease, to practitioners of PCC seeing the patient and their illness experience as a whole.

Our position as professionals is a privileged one, and with that comes responsibility to look after our patient’s best interest. This will ensure a win-win for patient and Dentist – our patients will feel a level of trust and assurance that we are attending to their concerns and we are much more likely to form resilient relationships, especially in these times of increased competition and over-supply of practitioners.

In conclusion, we perform PCC by keeping at the forefront of our minds the need to practice key communication skills alongside the diagnostic and technical skills we are taught and evaluated on in Dental school.

Scambler et al go so far as to say that we should be proactive in this – their “recommendation would be that the theory and skills of PCC are developed as part of Continuing Professional Development (CPD) for dentists who are already practicing but have not received training in this area” (7).

All of my courses are based on the underlying principles of PCC – this in turn aligns with the DBA Code of conduct which states that “relationships based on openness, trust and good communication will enable practitioners to work in partnership with their patients” and that “an important part of the practitioner-patient/client relationship is effective communication in all forms” (8).

 

References;

1. Engel G. The need for a new medical model: a challenge for biomedicine. Science. 1977.
2. Institute of Medicine. Crossing the quality chasm: a new health system for the 21^st century. Washington, DC: National Academy Press. 2001
3. Rathert et al. Patient-centred care and outcomes: a systematic review of the literature. Medical Care Research and Review. 2012
4. Dental Board of Australia. Code of conduct. 1.2.
5. Scambler et al. Defining patient-centred care in dentistry? A systematic review of the dental literature. British Dental Journal. 2016
6. Scambler S, Scott S, Asimakopoulou K. Sociology & Psychology for the Dental Team. Polity. 2016.
7. Scambler et al. Patient-centred care – what is it and how is it practiced in the dental surgery? Health Expectations. 2015
8. Dental Board of Australia. Code of conduct. Overview.

 

Get to work 15 minutes early.

Allow me to put this in context. I am not a natural, perky, early riser – there are many days when I feel I have to drag myself out of bed, especially in the darker winter months. In my first job in Dentistry I lived on the same street as the practice I worked in – I could still never get to work early.

This is something I have had to work really hard on but has paid handsome dividends for how I practice. There are 4 reasons I can give for getting to work early which enhance my ability to communicate effectively with my patients.

1. I am more relaxed starting the day. Best case scenario is that I am 15 minutes early and I have time to slowly set-up, have a chat with staff and colleagues and ease myself into a day that is always busy and will inevitably throw me a curveball or two.

Worst case is alarm doesn’t go off, I forget something important, get stuck in traffic and I get delayed. I still have a 15 minute extra window of time to play with, increasing the likelihood to still start in a calm state of mind.

2. I read through my patient list and records. I make a mental note of any significant points relating to social history, so that when a patient comes in the door I am ready to ask how their holiday was, how are the kids/ grandkids, did you see the match last night? Most patients value a degree of small talk which puts them at ease and builds rapport. We are not just treating dental disease but a whole person.

3. From a clinical perspective I mentally prepare for any tricky appointments (whether it be related to treatment or patient management) , check lab-work is in (before the patient is sitting in the chair!), read notes left by reception relating to any patient concerns. I get myself in a headspace to do my best clinical work and also have some mental capacity left to communicate effectively with the patients.

4. I get time to tweak the ever-changing appointment list. Some patients need longer/ shorter times or maybe a reminder on the day to confirm their punctual attendance. Also the assistant may need a heads-up on some imminent difficult procedure or even simply to prepare for the inevitable back-to-back molar root canal appointments booked in by reception.

According to Johns et al “time and scheduling pressures were referred to by every dentist as a significant source of stress, substantially more than any other stressor” (1).

Get to work early and allow yourself the luxury of starting on time, as prepared as you possibly can, for the busy day ahead.

PS – this is a statement of the obvious but it needs to be said – you must start on time – if you start late you are on the back foot early in the day playing catch-up and patients, while they expect some degree of wait at medical appointments don’t expect to be kept late if they are the first of the day and really value punctuality if you generally run on time.

References.

(1.) Johns et al. Source of occupational stress in NSW and ACT dentists. Australian Dental Journal. 2015