Barriers in communication between clinicians and patients are numerous. Some barriers are physical, such as hearing impairment. Some are due to a lack of understanding - for example having a limited command of the language used - while others are emotional, as most dental professionals will face a situation where a patient is unable to process the information provided due to a heightened state of anxiety.
Whatever the cause of the barrier, the problems that can arise are similar. For a patient, it might lead to an unexpected outcome, which can be stressful. It can also mean that the patient has not provided valid consent for the treatment. For the dental professional, it can be time consuming. Trying to explain things well, when the initial explanation has failed is difficult. For both, it can lead to frustration and all the difficulties that flow from that frustration.
Failure to communicate effectively is likely to lead to misunderstandings. This in turn can mean that a patient's expectations of their dental treatment are not met. If a dental professional does not fully appreciate what a patient is seeking, then they may fail to provide the appropriate advice, treatment, follow-up or referral.
Ultimately, if a patient is unhappy with the treatment or advice they receive, or they believe they have not being listened to or understood, they are more likely to make a complaint or a claim.
The following article provides some basic advice dental professionals need to consider to enable them to overcome many of the barriers in communication that exist in modern dentistry.
Dental professionals have a regulatory obligation to communicate effectively with patients, as set out in Principle two of the GDC's Standards for the dental team:
2.1 Communicate effectively with patients - listen to them, give them time to consider information and take their individual views and communication needs into account.
2.1.1 You must treat patients as individuals. You should take their specific communication needs and preferences into account where possible and respect any cultural values and differences.
2.3.3 You should recognise patients' communication difficulties and try to meet the patients' particular communication needs by, for example:
- not using professional jargon and acronyms;
- using an interpreter for patients whose first language is not English;
- suggesting that patients bring someone with them who can use sign language; and
- providing an induction loop to help patients who wear hearing aids.
Each practice needs to decide what adjustments they should make to reasonably meet the requirements of their patients. For example, if the practice has a number of patients where English is their second language, it would be reasonable to have information in the most commonly spoken languages available at the practice. This does not mean that every practice must have information leaflets available in every language that is spoken.
Failure to communicate effectively is likely to lead to misunderstandings.
The following groups may include patients for whom there are barriers to communication:
Patients with sight impairment
Ensure you greet the person as soon as they enter the room, and let them know who you are and what your role is. Speak directly to them and make sure they know you're listening by responding verbally, although avoid interrupting them. Explain what you are going to do before doing it: 'I am just going to guide you towards the chair.'
When providing patients with written information, consider providing it in a large print format if appropriate. Carefully read any written information provided to the patient so that they are kept fully informed.
Patients with a hearing impairment
Speak slowly and clearly, and listen carefully. When you are not examining or treating the patient, remove your mask so the person can see your lips. Consider using communication aids, such as an induction loop or providing information to patients in writing.
Be careful to reduce any background noise. This can be difficult in a dental practice, but remember that although many tasks (including clearing away instruments) become 'background' noise to anyone working in the surgery, they can be very intrusive for patients, especially those who have a hearing impairment.
You must give patients a written treatment plan before their treatment starts, but it may also be worth providing information leaflets about the treatment you have discussed as well as post-operative instructions after certain dental treatments.
Sometimes people can be embarrassed to discuss hearing impairments, and in some circumstances a clinician might assume that a patient has heard advice when they have not - so it is important to check that a patient has fully understood what's been discussed.
Patients with dementia
Patients with cognitive impairments such as dementia can present dental professionals with a number of specific challenges, but many of the basic considerations to take are similar to those discussed in this article - introducing yourself, explaining simply and clearly what you're doing, removing distractions and involving others as appropriate.
The DDU has published an extensive article on managing patients with dementia, and we would suggest reading this in full in order to address this complex area of treatment.
Patients who are unable to speak or understand English
The use of professional interpreters from a translation service may be required when treating patients for whom English isn't their first language. When using an interpreter, speak to the patient rather than to the interpreter.
Be aware of the potential problems that can arise from using a family member as an interpreter, as there is no guarantee that they are able to interpret correctly. Speak slowly and clearly, avoiding jargon. If a patient does not appear to understand, try rephrasing a question, and consider using pictures to help communication.
As with other groups, introduce yourself and explain your role. Try and arrange it so you are at a similar height to the child and follow the 'Tell, show, do' principle - describe in an age appropriate way what you are going to do, before showing the child and then performing. It can help to reassure the child during the appointment and to offer praise where appropriate.
Patients with a learning disability
Try and keep questions simple, and only ask one at a time. Give the patient enough time to respond and remove distractions from the surgery, such as background music.
Ask the patient to bring in a family member or carer who knows them well. They may often be able to provide advice on how to communicate with the patient. Provide the patient with a written treatment plan. If the patient consents, this can be shared with a carer or someone with legal responsibility.
Patients with severe anxiety
Severely anxious patients may often find it difficult to concentrate on what you are saying, so offer reassurance or a further explanation as needed. As well as some of the techniques described above, consider trying to see the patient for a discussion in a non-clinical environment which the patient may find more comfortable. Obviously any clinical examination would need to be carried out in an appropriate environment.
Patients don't always remember what their dental professional has said, especially when they are anxious, so it may be helpful to provide further written information.
Angela began her career in the '80s in general dental practice before joining the community dental service in 2000, treating patients with special needs and anxious children referred by GDPs. She was also on the investigating committee of the GDC for two years, giving her a special insight into the procedures and pressures of many dento-legal issues. She now combines her community work with her role as a dento-legal adviser with the DDU.
See more by Angela Love