It is interesting to note the editorial from Professor Bartold1 and the letter from Dr Lee2 regarding personalized dentistry. Indeed, communication is one of the most salient skills in regards to any clinician-patient relationship but, unfortunately, it is a subject which is readily overlooked and underemphasized, both at a dental school and continuing education level. In contrast, communication, empathy and rapport skills were recognized some years back as an important part of medical training. This was probably introduced as a result of a patient/public perception of a lack of communication in the medical profession and is now compulsory for all students at the University of Melbourne. As a medical student, we had to undergo workshops and participate in role playing exercises to highlight the importance of the skills being taught. Even though these may not be obvious to the student at the time, they can be highlighted or taught so that the student then becomes more aware of what to say and, sometimes, what not to say to a patient and when empathy may be required or appropriate.
Therefore, another important skill set is the technique of empathy and sympathy – but particularly empathy. We may not have experienced similar situations to our patients (sympathy) but we should be able to empathize with what the patient is going through, which for some with severe dental phobia is very important in establishing rapport and reducing patient anxiety. These techniques are not only verbal, i.e. ‘That must have been a terrible experience for you’ but also visual or interactive, i.e. giving tissues to a patient who is upset or crying. These represent acknowledgement of the patient’s concerns and may be considered intuitive by some. One can understand, however, with the pressures of clinical dentistry and the heat of the moment, that these things can be overlooked, which is disappointing because such subtle gestures can significantly aide dentist-patient interaction and build rapport.
An example of a lack of empathy is the occasional patient one sees in oral and maxillofacial surgical practice requiring a full or partial clearance under general anaesthesia who feels that the referring practitioner has criticized the patient as responsible for their dental condition. Fortunately, this is not a common occurrence. However, it is not our place to judge our patients but to help them through these difficult times. On further questioning of these patients, invariably, they have had a previous bad experience which has affected their whole dental history. Although it is terrible that, in these circumstances, the endpoint of exodontia has been reached, with the use of empathy and rapport we may be able to turn the patient’s experience around to a more positive one that may allow better optimization of their oral health in the future.
These communication, empathy/sympathy skills and development of rapport are important in communicating treatment plans and the options for treatment plans to patients. It needs to be explained why a particular treatment plan is suggested or recommended to a patient, and the more evidence based treatment plans are, the better. Central to this is the establishment of informed consent – what are the outcomes of having the treatment proposed but what are the outcomes of not having the treatment. A classic example of this quandary is the management of asymptomatic wisdom teeth. The patient should be informed of the risks of removal and the risks of leaving the teeth in place. Although we can suggest a treatment plan to the patient, sometimes in these situations the treatment plan is actually a decision made between the patient and oral and maxillofacial surgeon, and not a plan dictated by the surgeon alone. Having the patient involved with the decision-making in these situations also empowers the patient, giving them more responsibility over their own actions.
Therefore, the four assets made by Bartold1 are extremely pertinent, however so is the order of the points. Communication comes first and foremost. The better communicators we are, the better clinicians we will become.