Freeman / Humphris Communicating in Dental Practice

Stress-Free Dentistry and Improved Patient Care
1. Auflage 2006
ISBN: 978-1-85097-314-0
Verlag: Quintessence Publishing Co. Ltd.
Format: EPUB
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)

E-Book, Englisch, Band 30, 104 Seiten

Reihe: QuintEssentials of Dental Practice

This book focuses on major communication challenges in clinical practice—that is, communicating effectively with anxious, "difficult," or dissatisfied patients; communicating and integrating preventive and oral health messages and education in primary dental care; and finding ways to improve patient care without adding to the stress of frontline clinical practice. Implementing the strategies devised by these international experts can dramatically improve the success of any dental practice.

Autoren/Hrsg.

Freeman, Ruth

Humphris, Gerry

Inhaltsverzeichnis

Chapter 1: Introduction
Chapter 2: Basic Communication Skills
Chapter 3: Advanced Communication Skills
Chapter 4: Communicating in Special Dental Situations
Chapter 5: Understanding and Finding Solutions: The Dentally Anxious Patient
Chapter 6: Understanding and Finding Solutions: The "Difficult" and Dissatisfied Patient
Chapter 7: Preventive Health Principles for Dental Practice
Chapter 8: Integrating Oral Health Education into Primary Dental Care
Chapter 9: Communication, Stress and Improved Patient Care
Index

Leseproben

Chapter 1

Introduction

Dentistry can be a rewarding and satisfying profession. Dental health professionals must have a variety of skills to hand. These include not only clinical and technical skills but also those associated with patient management, managerial and financial acumen. This is reflected in their financial remuneration, which is often above average for staff employed within health-related disciplines. The principals of practices and, to a lesser extent, associates, have the ability to work at a pace they can ultimately decide upon. In reality this may seem something of a fantasy, as the demands on the modern practitioner appear less amenable to individual control. However, on closer inspection there are demands other than the financial and management constraints of running a busy practice that can cause difficulties. Some of these problems relate to patient and staff interaction and include the following:

• difficult and demanding patients

• encouraging patients to adhere to oral health recommendations

• managing pain

• the dentally anxious patient

• patients with unexplained symptoms

• informing patients about oral health, self-care and specialist treatments.

The aim of this book is to signpost principles and actions that will enhance the process of communication with patients and mitigate many of the difficulties listed above. The book will provide a framework within a dental context to assist with understanding the complex set of factors that make up dental practice in the 21st century. The authors have distilled the current literature into an authoritative account, with a small number of key references listed at the end of each chapter, including selected further reading.

What Makes this Book Different?

This volume translates recognised psychological and sociological principles into everyday clinical practice. The emphasis will be on application to the day-to-day working of the dental health professional. Hence, a major theme throughout the book will be communication between the dentist and the patient. Enhancement of an appropriate working relationship is a central focus. Less space will be devoted to systems of care outside the practice (for example, health organisations, mass media interventions and oral health surveys).

Self-care is a neglected subject in the health professions. The professional and philosophical underpinnings of primary dental care have tended to diminish the need to maintain good physical and psychological health of its practitioners while concentrating efforts on improving patient care. The authors would prefer to redress the balance and advocate the need of practitioners to ensure that they care for themselves enough to:

• maintain high standards of care for patients

• develop new techniques of prevention and treatment as they come on stream

• achieve longer-term personal goals and therefore become more resilient to the vagaries of occupational stress and burnout

• be able to recognise physical and emotional problems associated with work and outside the workplace.

Occupational stress is an easily recognised phenomenon in modern dental practice. However, the term has a tendency to be overused, or simply raised without further discussion of some of the underlying reasons for its experience for many working in dental practice. Alternatively, causative agents that can be championed conveniently (such as the remuneration system) exclude the individual practitioners and the means at their disposal to at least attempt to minimise some of these pressures. The reader is invited to accept the possibility that many of the day-to-day hassles that feature in practitioners’ work can be analysed and interpreted from the interaction that occurs between patient and practitioner.

Section 1: Communication

This section comprises three chapters (Chapters 2-4). Chapter 2 deals with different aspects of communication. Practitioners may be familiar with many of the fundamental building blocks of communication skills utilised in dentist-patient interactions. These basic skills are cornerstones that lend themselves to repeated attention and practice in the workplace. Even the simple application of a well-placed or considered greeting can pay dividends to the overall satisfaction and outcome from the patient’s perspective. Hence, these skills are described and illustrated from the dental practice perspective.

Chapter 3 expands the communication theme by identifying important areas of clinical practice that command excellent use of advanced communication skills. Negotiating with patients various options available for treatment entails a complex blend of skills to ensure cooperation and adherence to the eventual agreed plan.

Obtaining consent for treatment requires sensitive handling to ensure that patients are fully conversant with the implications of their decision to embark on a treatment, including possibilities of success or failure and any side-effects. Included in these discussions, in all probability, will be estimates of costs of care and requests for payment (under fee for item, insurance payment or private contract schemes). An additional area of communication often confronted by clinicians is the breaking of bad news to patients. This may take the form of simply announcing to a patient that a tooth requires extraction. The meaning associated with the tooth loss can be assessed with a well-chosen open-ended question. Alternatively, providing unwelcome news to patients may take the form of a potentially frightening opinion, such as a suspicious lesion under the tongue, indicative of an oral squamous cell carcinoma. Admittedly, this is a very infrequent circumstance, but one that dentists have stated as being one of the most stressful incidents in their working lives. It is assumed that practitioners who think about these scenarios and hopefully practise their skills in continuing professional development training events will improve their competency and also confidence.

Patient expectations are known to be increasing in the health care field. Without clear explanations of procedures and realistic estimates of outcome and costs the clinician will be prone to complaint. Even the most diligent and competent clinician will be exposed to the risk of treatment unexpectedly failing. Human error is, unfortunately, a feature of health service provision and requires sensitive handling and management. Over 90% of litigation in the health service has been attributed to poor communication skills. Some key points can be offered to the practitioner to prevent a complaint escalating into formal action (considered by the majority of dentists to be the most extreme stressor).

Chapter 4, the last of this first section of the book, extends the discussion of communication skills applied in certain situations to focusing on particular groups of patients. It is acknowledged that the identification of a patient group by attaching a label has negative connotations. For example, the ‘elderly’, a term sometimes applied to those over the age of 60, can introduce punitive stereotyping and discrimination. To make some generalisations for a particular group can, however, be illuminating if the practitioner is aware that the group profile will vary according to the individual presentation of the patient and that the requirements of the individual should remain paramount. The communication skills associated with the following groups will be described: older people, people with physical and learning difficulties.

Section 2: Patients

The second section, consisting of two chapters, focuses on the patient. A whole chapter (Chapter 5) is devoted to the anxious patient, who has been acknowledged as one of the most frequent and demanding types of patient the practitioner will meet. Much has been written about the assessment and management of the dentally anxious patient. The approach adopted in this chapter will summarise the recognised methods of identifying the anxious and phobic patient and suggested ways of encouraging successful treatment and continued access to the dental practice for long-term oral health care.

The second chapter (Chapter 6) of this patient section introduces the management of patients with difficulties that are not necessarily dental in origin but are expressed as oral symptoms or problems. Without a considered assessment and understanding of the complexities of the presenting symptoms and complaints, the practitioner may be drawn into unnecessary treatment or referral for further investigations. Attention to detailed history taking and formation of the treatment alliance (working relationship) are important features in providing appropriate care from the dental practice setting.

Section 3: Dental Health Education in Practice

The last section, consisting of two chapters, presents key material for practitioners to conduct, essentially, one-to-one dental health education with their patients. This work rests on the ability of the practitioner to communicate effectively (a central theme of this book) and to be aware of the substantial advances and benefits to patients available from adoption of these approaches. Chapter 7 presents a number of the extant models that have influenced dental health education over the years. They have been drawn from various areas and have had proven value in improving patient knowledge, beliefs and behaviour in relation to dental health behaviours such as toothbrushing, diet control and dental attendance.

Chapter 8 continues with a series of examples where these...