— PERSONAL + CAREER DEVELOPMENT —
Getting the Message Across
Dr. Raj DK Dhaliwal
Dentist, Dento-Legal Advisor and Contributing Author
In this final article in this series I would like to discuss how we as dental practitioners convey information to our patients. In previous articles we have looked at the importance of making our patients feel welcome and comfortable from the moment they enter the practice, ensuring that we listen intently whilst they relay their history. Once the patient feels that we have understood their concerns and that we are there to help, then they are more likely to hear what options we can offer them.
The next step is to gain more specific details through a series of questions leading to a discussion between both the dental practitioner and the patient. Keeping in mind the same principles of “feng shui” of the consultation that we discussed when the patient is speaking, ensure both parties are at the same eye level. Whereas the initial phase of the consultation was with the patient mainly speaking this phase will be more practitioner led.
The dental practitioner needs to ensure that they offer all the options available discussing the risks and complications of each treatment along with cost implications, timescales and maintenance. There is frequently an additional option of no treatment and the risks and benefits of doing nothing needs to be explained to the patient. It is important that whilst having these discussions that the practitioner reflects back on the information that the patient has already shared during the consultation.
It may be necessary to gain further information with open-ended questions for example “Tell me more about what you would like to achieve.” Clarification of information using phrases such as “can I check that I’ve understood you correctly?” or by paraphrasing the patient’s words when explaining options reassures the patient that you have understood them and are trying to address their concerns with your treatment options.
We discussed the importance of our body language when listening to our patients and this continues when we are conveying information to them. The tone of our voice, the speed with which we speak and the use of language all need to be considered. Limiting the use of dental terminology may be essential for some patients but others like to ensure they know the correct terms. Although this part of the consultation will usually be led by the practitioner rather than the patient, patients must feel they are able to ask questions. They may feel that they are interrupting the flow, and it is essential that the communication remains a two way process and our patients must be made to feel comfortable in asking questions.
Check for Understanding
It is important that dental practitioners do check that their patient understands the information that has been given to them so that may make an informed decision about the treatment options available. The rapport that has developed during the early part of the consultation should facilitate understanding or permit the patient to feel able to ask if something is not clear. Kemp has described that there are three ways this understanding can be checked. The first is a simple “yes – no” enquiry where the patient is asked a direct question whether they understand. Then there is the “tell back directive” where the patient has to explain what they have understood following the conversation. This can be quite intimidating for a patient and gives an impression that the patient is being tested. The favoured approach is the “tell back collaborative” which appreciates that the patient has been given a great deal of information and so there could be certain areas that they are unsure of.1
Keeping the focus on patient centred care will lead to a greater understanding of the patient’s needs and that any consent process is supported by sufficient information. Keeping a record of the questions that are asked by the patient and the answers which were provided is a good example of a practical approach to consent. Supporting the consultation with appropriate written information such as personalised patient information leaflets pertinent to the individual patient and treatment plan is important to allow patients to review the information discussed in the consultation.
1Kemp EC . Patients prefer the method of “Tell Back – Collaborative Inquiry” to assess understanding of medical information. Journal of American board of Family Medicine. January- February 2008 Vol 2 No.1 24-30
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.