July 30, 2018
by Julian Perez, Director, Regulatory Compliance, dentalcorp
Health care administration has evolved drastically in the last generation, and the expectations about how health care providers communicate with patients ranks among the biggest of these changes. Numerous studies have shown that patient satisfaction depends upon the attitude that dentists and doctors bring to their work, while others have tied treatment outcomes to the effectiveness of the health care team’s communication techniques. Despite the evidence, many health professionals continue to underappreciate the importance of soft skills, such as communication, and as a result, health care providers fail to invest sufficient time and energy into improving their communication skills. As a profession, dentists must commit to improving patient communication skills. If improving patient satisfaction and outcomes isn’t enough to persuade a clinician to commit to becoming an excellent communicator, it’s proven to benefit the balance sheet as well.
From paternalism to patient-centred care
For much of history, medical and dental paternalism was considered not only acceptable, but necessary. This attitude was premised on the belief that only a doctor could properly understand symptoms and draw useful conclusions. Taken to its extreme, the individual history of the patient didn’t matter, indeed, the input of the patient was quite often deemed irrelevant. Even with the most rich and powerful patients, the doctor formulated a diagnosis and determined the treatment; the patient was expected to accept the doctor’s orders unquestioningly. Doctor Willard Bliss’ treatment of U.S. President James A. Garfield after his wounding from a gunshot in July 1881 is a particularly vivid demonstration of the uneven power medical professionals held over the most famous of patients. Most historians now accept that President Garfield would likely have survived the wound had it not been for his profound faith in the doctor’s medical expertise.
While this may seem like ancient history to some, paternalism remained the norm for most of the 20th century and many practicing dentists started their careers in a very different world. In fact, the doctrine of informed consent was only recognized by the Supreme Court of Canada in 1980 in the case of Reibl v. Hughes. Gradually, over the last few decades, the dentist-patient relationship has evolved from “dentist-centric” to “patient-centric”. In patient-centred care, the patient’s needs and desired outcomes are the primary determinant of all health care decisions. The goal is for patients to become partners with their health care providers. Under the current paradigm, effective communication between dentists and patients is the sine qua non of a successful dental practice. Effective communication requires not only talking to your patients, it requires listening to your patients and understanding their needs, values and expectations.
From informed consent to informed choice
By now, every dentist knows that obtaining informed consent is an obligatory precondition to commencing a health care procedure. Through investigating hundreds of regulatory complaints against dentists, I discovered that too many clinicians view informed consent as a time-consuming process which distracts from the business of practicing dentistry. Other dentists treat informed consent as a defensive measure: a step in the treatment plan that must be taken to protect the dental team from future legal woes. Both these mindsets can and often do lead to the informed consent process being reduced to a form the patient must sign.
On the other hand, a dentist with sound communication skills understands that informed consent relies on the patient becoming a partner in his or her own care and actively participating in the decision-making process. Before a patient can effectively choose the right course of treatment, after all, he or she must, at a minimum, understand what the dentist is proposing, the other viable treatment options, as well as the risks and expected benefits of each. The truly great communicators in the dental office know that the primary goal of effective communication is to empower patients with the knowledge required to make an informed choice about their oral health. This process requires much more than a form—it requires dialogue, mutual openness, trust and respect. When decisions are made in this way, patients feel better about and more confident in the agreed upon treatment plan.
From soft skills to good business
Getting patients engaged takes time, effort and skill. However, the effort yields real benefits: several studies show that when patients are more engaged, outcomes improve, fewer errors occur and perhaps most crucially, patient satisfaction increases. This makes sense if you consider the first law of patient care: Patient Satisfaction = Perception of Results – Expectations. When a patient perceives care at a certain level but expected something more, they will be dissatisfied. A good dentist will usually achieve good “results” (i.e., esthetics and oral health); however, a good communicator will also mange expectations and (by establishing trust and respect) influence the patient’s perception.
Despite overwhelming evidence demonstrating the value of good dentist-patient communication, many clinicians continue to brush it off as a “soft-skill” and treat is as optional. Knowing how to build healthy, trusting and resilient relationships may indeed be a “soft skill”, but it is not optional. A 2016 article in Forbes Magazine put it this way: “Hard skills might be what get you the job—but soft skills are what drive friendship, success and happiness at work.”
Unsurprisingly, three of the four most important skills discussed in the Forbes article relate to communication: listening; nonverbal communication; and gratitude. The undeniable power of communication is also why you see so many health care and business articles that emphasize relationships and contain statements like “the single most important human element … is effective communication between [patients] and health care providers” and “for a business leader to be successful, solid communication skills are vital.”
Becoming a better communicator benefits everyone
One of the principal studies on dentist-patient communication concluded that “Routine use of … communication techniques is low among dentists, including some techniques thought to be most effective.” A similar study on the use of communication skills by dentists, found that “professional education is needed both in dental school curricula and continuing education courses to increase use of recommended communication techniques.” Many dentists will read these lines and think that this doesn’t apply to them. Unfortunately, studies have also shown that health care professionals tend to overestimate their communication prowess.
The bottom-line is that effective communication and including patients in the decision-making process have the potential to yield high dividends for health practitioners, including increased clinician satisfaction, greater profitability, and a reduced risk of regulatory scrutiny, burnout and malpractice litigation. Accordingly, dentists should assess and evaluate the effectiveness of their communication strategies. When shortcomings are identified, resources exist that help facilitate the creation and implementation of a quality care improvement plan.
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