A common complaint among providers is that patients do not listen or comply. On the other hand, patients complain that we lecture, scold, and try to sell them things they don’t think they need or understand. There’s a difference between information and communication. Information is one person speaking, while communication is a two-way dialogue that gets through to your patients.
According to the Institute for Healthcare Communication, “Research evidence indicates there are strong positive relationships between a health-care team member's communication skills and a patient's capacity to follow through with medical recommendations, self-manage a chronic medical condition, and adopt preventive health behaviors.”1
Three extensive topics are patient-centered care, motivational interviewing, and codiagnosing with patients. There are some techniques and strategies you can implement today to get you started toward better patient communication.
Ask for permission
I use this analogy when discussing patient interactions. A patient can either be a partner on the journey with can be tossed in the back like luggage, where we let them know when we arrive at the destination without their input. Who do you think will be more committed to care and positive outcomes?
A quick way to change is to partner with patients and ask their permission. “Do you mind if I recline your seat back? May I look inside your mouth? Can I share what I’m seeing with you?” These questions are the start of engagement and can help a patient feel involved and interested.
Also by Julie Whiteley
Don't bombard patients with information
We share information hoping patients will become more knowledgeable in making decisions about their health. The issue can be that in our effort to check every box and get all the information out, we ask patients to take in too much information and may overwhelm them. A study found that 40% to 80% of information given by health-care providers is immediately forgotten. The more information, the greater the percent that’s forgotten. Further, only about 50% of information retained is remembered correctly, and the more complex your presentation, the less a patient retains.2
Focus on one or two things at a time. People are better able to hear and retain information when it’s meaningful to them. Therefore, understanding someone’s preferences, goals, barriers, and objections can help you customize your messages.
Initiate patient-centered conversations
The traditional model of dentistry can be described as authoritative, paternalistic, and informing patients, typically during a procedure when it’s difficult for the patient to focus or respond. This can be a divided approach, particularly if the patient is not ready for what is indicated. It’s based on what the provider believes is in the patient’s best interest.3 We assume patients want the same level of optimal oral health that we do.
The patient-centered model is a conversational approach that involves two-way dialogue, being curious, avoiding assumptions, and reserving judgment. Asking open-ended questions is a good way to learn more about a patient. Skillfully asking questions can help patients arrive at their own conclusions versus being told what to do. This motivates change as patients are more likely to commit to something they hear themselves say. The more we can engage patients this way, the more we can help them on the path toward making decisions aligned with their goals.4
Here’s an example. I had an elderly patient who suffered from medication-induced xerostomia, presented with heavy plaque, and drank sweetened acidic beverages throughout the day. His goal was to avoid the carious lesions he presented with each visit. Here are some questions I had for him.
- May I tell you some of the things that are contributing to your condition?
- Which of these are you willing to change now?
- Which of the following products do you think you’d be most successful with?
- What’s your plan between now and your next visit?
I zeroed in on what he’s willing to do and why it matters based on what he shared with me. We focused on one or two small goals or changes at a time to set the stage for success. For example, instead of trying to tackle every risk at once or changing all habits immediately, he was willing to start by cutting acidic beverage consumption in half. With each success, we were able to add one or two more patient-driven changes to get him to his goal of decreasing caries.
Embracing that there is more than one way to help someone achieve healthy habits, even if it’s just one small step at a time, is very freeing. Also, patients are relieved they can avoid our redundant lecture and that they didn’t fail.
Practice active listening
Active listening means completely hearing, understanding, and retaining information. It requires you to be fully present when the other person is speaking and refraining from judgement and interjections, then summarizing and clarifying what you heard.
For example, “I’m curious what it is it you object to about x-rays.” After fully listening to the response you might say, “So what I’m hearing is you do not want the added cost and you only want this if you’re in pain. I’m struggling with you preferring to wait for pain to occur, yet I’m trying to help with your desire to keep finances in check. Pain is often a sign of less conservative and more costly treatment. How do you feel about this?”
As a patient thinks though the answer, it can guide them to the best decision. It’s more likely to resonate with them than removing their response altogether. Compare my example to a clinician responding to the refusal with, “It’s the standard of care,” or “You are due.”
It’s human nature to want to be heard. When people feel heard they’re more attuned to concerns and don't feel dismissed. This can bridge communication gaps. The easiest way to be heard is to listen to the other person.
Even though it is best to work with patients on one or two areas at a time, the same can be said for incorporating these strategies into your patient interactions. I suggest picking one patient, starting with one technique, and building from there. You’re likely to find something better than compliance—someone willing to do what you want them to do. You will be met with greater commitment, and more patients who align with better oral health decisions because they want to, and they understand the importance of those choices.
- Impact of Communication in Healthcare. Institute for Healthcare Communication , July 2011, https://healthcarecomm.org/about-us/impact-of-communication-in-healthcare/
- Kessels RPC. Patients' memory for medical information. J Royal Soc Med. 2003;96;(5):219-222. doi:10.1258/jrsm.96.5.219
- Rosengren DB. Building Motivational Interviewing Skills: A Practitioner Workbook. Guilford Press. 2017.
- Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. Guilford Press. 2012.