— PERSONAL + CAREER DEVELOPMENT —
Feng Shui And The Art of Communication
Dr. Raj DK Dhaliwal
Dentist, Dento-Legal Advisor and Contributing Author
Following a recent visit to Hong Kong it was interesting to learn about feng shui and how the position of a building, its height and spatial awareness within its surroundings is important to the success of the business residing in the block. This made me think of the importance of how we position ourselves when conversing with our patients.
In the opening article within this series, I discussed how first impressions are important and taking the time to collect your patient from the waiting lounge is helpful. Not only does it allow an opportunity for social conversation, it also eases the transition of the patient between the waiting room and the clinical environment.
In this second article, I would like to illustrate how we can inspire patient autonomy and encourage patient centred care using environmental cues during the consultation. The objective is to make the patient feel they are listened to and that they receive all the information they are seeking. Importantly allowing both parties to be equally informed before treatment begins.
Does your surgery allow for the initial consultation to be conducted away from the dental chair, around a desk perhaps?
Consider how this feels to the patient and ensure that the chairs are similar to communicate equality and so facilitate the exchange of information between you and the patient.
The dental chair and the consultation
Alternatively, do you seat the patient immediately in the dental chair? If so, the position and height of the dental chair is important. Ensure that the chair is upright and not in the supine position and not too low. If the chair is too low and you are higher than the patient this can give the impression that you are in authority and so the consultation may be perceived by the patient as paternalistic.
Once the patient is seated are you going to sit or stand whilst talking to the patient? Interestingly it has been shown that a clinician’s posture determines the perception of the time spent with a patient. Patient’s felt that the clinician had a better understanding of their condition and their questions were better answered when the clinician sat rather than stood for the consultation. 1
The optimal position is therefore for you both the clinician and the patient to be seated, ideally at 90 degrees to each other and at eye level. This allows the patient to see that you are attentively listening, encouraging more open communication.
Furthermore, it is vital to consider the distance between you and your patient whilst taking their history – how closely you position yourself. Dentistry is, by its very nature, quite invasive and it is important that the personal space of the patient is respected, during the clinical and non-clinical parts of the examination.
So how close is too close? This can vary according to culture, gender and age. Generally, it is customary to keep a minimum of an arm’s length between individuals for polite conversation in a formal setting.2 This will of course vary slightly as non-verbal communication comes into play, for example if you lean forward to show an interest in a particular point the patient may be making.
Computers and contemporaneous records
So perhaps it is important when designing the dental surgery to consider including a consultation area where both patient and dental practitioner can discuss the needs and expectations of the patient. Details of the consultation must be documented as part of the clinical record, which needs to be complete and contemporaneous.
The ideal position is where we can engage with our patients and intermittently input the information delivered to us. As the computer is a third party in the interaction between you and the patient, it is wise to explain that you will be making some notes during your consultation.
Use the computer as a prompt to read back the notes made to the patient to ensure that you understand the patient’s concerns. This process will allow you to decide whether you will be able to meet their expectations.
From another perspective it could be argued that accurate and detailed note-taking may lead to a lack of attention to the patient’s non-verbal communication. You may hear what they are saying but miss important signs from their body language.
An alternative approach would be to train another member of the team to take the notes during the consultation. The notes still remain the responsibility of the clinician so it is important that you review these to ensure that the notes are complete and correct.
Noise and confidentiality
Another environmental factor that should be considered is noise. Firstly, the patient should feel confident that their confidentiality and privacy is maintained during the consultation. This may be as simple as suggesting closing the door to the clinical area or other rooms such as the central sterilisation area.
Can conversations in adjoining rooms be heard? Does the surgery need extra sound proofing? Ensure that all staff are trained that – with the exception of an emergency there are no conversations between members of staff during a patient consultation.
Review the room and consider whether there could be other auditory distractions in the room, for example noisy air -conditioning units, ticking clocks, televisions or mobile phones.
Seeing your practice with a fresh pair of eyes is always difficult but consider asking a colleague or family member to walk through the practice as a patient. Ask them to come and sit in the consulting area and ask if they can see or hear any environmental cues that might be distracting.
This is a valuable exercise; patients that experience patient centred care are more satisfied with the care they receive, leading to a greater compliance and are less likely to raise a complaint.3,4
A ‘feng shui inspired mindset’ – thinking about and reflecting on space, furnishings and equipment – may well help you to create an environment that nurtures your patient centredness.
1 Swayden K et al: Communication study effect of sitting vs. standing on perception of provider time at bedside: A pilot study. Patient Education and Counseling 86 (2012) 166-171
2 Zarbock S: The art of physical assessment: Crossing personal space. Journal of the American Academy of Physician Assistants. February Vol 24 Issue 2 (2011) 15
3 Swayden K et al: Communication study effect of sitting vs. standing on perception of provider time at bedside: A pilot study. Patient Education and Counseling 86 (2012) 166-171
4 Silverman J et al: Skills for communicating with patients. CRC Press (2016) 32
DR. RAJ DK DHALIWAL
After graduating from the University of Birmingham Dental School, England, Dr. Raj DK Dhaliwal BDS LLM MDentSci MRACDS(DPH) MFGDPRCS MAICD undertook research into dental public health, published and presented this research in the UK and internationally and completed a Masters in Dental Science. Raj worked for many years in general dental practice in both inner city and suburban practices.
In 2013, she was awarded an LLM in Healthcare Ethics and Law with Merit from Manchester University. Raj developed her interest in care quality, clinical negligence, consent and confidentiality.
Raj has worked as a dental practice advisor to NHS England and works as a dento-legal advisor both in the UK and more recently in Australia. Since immigrating to Australia she also acts as an examiner for the Australian Dental Council and the Royal Australasian College of Dental Surgeons.