Arthur Dent is a practising NHS dentist in Scotland. Got a comment or question for Arthur? Email firstname.lastname@example.org
There are many stressful and rewarding things in dentistry. Should that be the other way round? Should we maximise the positive and minimise the negative? What’s the best thing in dentistry? What’s the hardest thing in dentistry? Are these rhetorical questions? Is this just a riddle?
So why am I getting all cryptic? Why don’t I answer a question? Well, I’m in a bit of conundrum. How do I address the single most infuriatingly complicated thing in dentistry: patients?
Where the hell do you start with patients? Well, I suppose we’ll pretend this is a new patient examination. This is going to be full of questions. That’s how you find out what people want. Isn’t it? Well, no. People don’t tell you what they want. They hide things, they tell half truths, they say what they want you to hear and what they think you want to hear. More riddles?
People are complicated. They also have complex needs and desires. They are often anxious about dealing with super-smart people in a position of power. Not only that; they probably don’t like being at the dentist and think they have something wrong which is going to require a horrible procedure to fix it. A psychological nightmare. Yet this is what we deal with day in day out. Additionally, many of our patients can have deep-seated psychological issues, some will affect our care and some won’t.
Are there some rules we can follow which might minimise our risks and maximise the rapport we develop? The one I was taught was treat everyone like they are your family. I hate treating my family. I find it very difficult to be objective. I don’t want to hurt them, but I don’t want my lack of ability to do the right thing to affect their care. That’s a horrible situation to be in. So I find it easier to avoid that. But that’s professionalism, isn’t it?
So let’s start again. New patient examination. Introduce yourself, be pleasant, likeable. Ask how they are? Ask what you can do for them? Listen and reflect the listening. I’m pretty sure that’s what we’re taught nowadays. In short, show you care. Show you want to care. That’s a very good start.
Obviously the next stage is to perform some treatment to the best of your ability and communicate a reasonable level of expectation. That is probably the simplest, most complex sentence in dentistry. This is the key to good patient management. Do something which the patient expects to happen. They expect it because you told them what to expect. The outcome is what they expect or better because you have managed their expectation commensurate with the patient’s desires, budget and reasonable clinical possibilities. This is simple enough to write but takes a lifetime of experience to deliver well. It is also a reasonable set of statements which can relate to all facets of healthcare.
Here’s the point where dentistry differs. Especially general practice. We have a much more frequent yet invasive relationship with our patients. GPs don’t see all their patients every six months. Neither do pharmacists or opticians. Certainly not hospital doctors, specialists or self-referral clinics. Admittedly, some people just self-refer to us when they’re in pain. They can be hard to manage. Some refer for aesthetic reasons. They can be even harder to manage. But the majority of our patients, return time and again. For treatment which can be difficult, expensive and sometimes painful. Yet they return.
How do we manage that? Charisma. Care. Understanding. Rapport. We need to create a long-term relationship built around sound clinical principles and reliability. Trust. It probably doesn’t matter the combination of these skills we develop or use because every single patient will differ subtly in their expectation. So we have to trust our own emotional intelligence. We have to learn to read people. Ask the right questions and assess their answers. Respond to the body language and decipher it. But also to deliver a consistent persona and professional demeanour.
A word of caution. Back to the treat-like-family thing. We need to strike a balance between rapport, trust and overfamiliarity. If we allow our patients to become too much like friends or family, can we really maintain a professional relationship? A level of professionalism which does not blind us to clinical need.
Equally, do not be so detached that you don’t get to know the patient. This is more of a clinical caution. Be wary of patients who attend desiring large amounts of treatment. If you don’t know them, clinically, then you may get caught out by unexpected clinical expectations, or a lack of possibility for the desired outcome.
So do we have some rules? Get to know your patient, clinically and personally. It will help to build the relationship and make better decisions. The better you know the patient and their family, the better chance you have of accurately assessing their expectations and desires. Remain professional throughout. Listen to the patient. Listen carefully. Don’t berate yourself when things go wrong. It happens very infrequently. Finally, enjoy the relationships we develop with our patients. It is a privilege to be involved and trusted to care for people. It’s the best thing in dentistry.