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Communication Skills for Dentists — page 1

Communication

Skills for

Dental Health

Care Providers

Lance Brendan Young,

MBA

Cynthia Rozek O’Toole,

RDH

Bianca Wolf,

MPH

Communication Skills for Dentists — page 2

Communication Skills for Dental Health Care Providers

Communication Skills for Dentists — page 3

Communication

Skills for

Dental Health Care

Providers

Quintessence Publishing Co, Inc

Chicago, Berlin, Tokyo, London, Paris, Milan, Barcelona, Istanbul,

Moscow, New Delhi, Prague, São Paulo, Seoul, and Warsaw

Lance Brendan Young,

PhD, MBA

Assistant Professor

Department of Communication

Western Illinois University-Quad Cities

Moline, Illinois

Cynthia Rozek O’Toole,

MS, RDH

Assistant Clinical Professor

Department of Preventive and Community Dentistry

The University of Iowa College of Dentistry

Iowa City, Iowa

Bianca Wolf,

PhD, MPH

Associate Professor

Department of Communication Studies

University of Puget Sound

Tacoma, Washington

Communication Skills for Dentists — page 5

Library of Congress Cataloging-in-Publication Data

Young, Lance Brendan, author.

Communication skills for dental health care providers / Lance Brendan

Young, Cynthia O’Toole, and Bianca Wolf.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-0-86715-690-4 (softcover)

I. O’Toole, Cynthia, author. II. Wolf, Bianca, author. III. Title.

[DNLM: 1. Communication. 2. Dentist-Patient Relations. 3. Attitude

of Health Personnel. 4. Clinical Competence. 5. Cultural Competency.

WU 61]

RK28.3

617.6001’4--dc23

2015018425

Quintessence Publishing Co, Inc

4350 Chandler Drive

Hanover Park, IL 60133

www.quintpub.com

5 4 3 2 1

al system, or transmitted in any form or by any means, electronic, mechanical, photocopy-

ing, or otherwise, without prior written permission of the publisher.

Editor: Leah Huffman

Design: Ted Pereda

Production: Angelina Sanchez

Printed in the USA

Communication Skills for Dentists — page 6

Part I

Communication Fundamentals

Understanding Communication

Preparing for Patient Communication

Developing Cultural Competence

Part II

Interaction Skills

Enhancing Listening Skills

Improving Verbal Skills

Refining Nonverbal Communication Skills

123

Part III

Communication During the

Appointment

155

Initiating and Interviewing

157

Interacting During and After Procedures

189

Presenting Treatment Plans

219

Part IV

Communication Challenges

245

Managing Life Span Challenges

247

Managing Hearing and Speaking Challenges

273

Managing Stigma Challenges

301

Preface

vii

About the Authors

Index

331

Contents

Communication Skills for Dentists — page 7

Communication Skills for Dentists — page 8

vii

Over the past 10 years, the three authors of this book have taught patient-provider

communication skills to the dental students at the University of Iowa College of Den-

tistry. In addition to our academic training, each of us has different real-world experi-

ence, ranging from clinical dentistry (O’Toole) to health insurance (Wolf) to business

marketing (Young). We therefore recognize the value of basing practical decisions on

sound research. Recent years have seen tremendous growth in research on commu-

nication between dental professionals and their patients. Individually and collectively,

however, we have been frustrated by the lack of a single resource presenting the most

reliable and recent evidence to suggest how dental providers should interact with

their patients.

In developing and refining our curricula at the university, we located four books

published within the previous 30 years that address communication in the dental set-

ting.

1–4

Although each text has its strengths, they all lack recent, evidence-based find-

ings to support the communication practices they recommend. The communication

patterns and expectations of patients have changed over time, so research conducted

in the 1970s and 1980s may be less reliable than research conducted more recently.

Further, demographic changes have resulted in patient diversity unknown to previous

generations of oral health professionals. Diversity challenges current dental providers

to develop flexible communication skills; scripted communication will not work.

The lack of a dental communication textbook left us scouring research journals for

information we believed our students should know before they began practicing on

patients. Having received positive feedback on the curricula we developed, we wrote

this manual so that other dental professionals may benefit from our work.

Because we exclusively teach future dentists, our focus in writing has been patient-

dentist communication. We can think of few instances, however, in which the evidence-

based communication skills described in this book do not also apply to dental aux-

iliaries, including dental hygienists, dental therapists, and dental assistants. We are

familiar with one text addressing communication for dental auxiliaries,

but it was

published 30 years ago and is long out of print. Until another such book is published,

we feel comfortable recommending our manual for dental auxiliaries who want to im-

prove their skills in communicating with patients. Throughout this manual, we typically

refer to dental or oral health providers and professionals, implying every member of

the dental team but particularly the dentist.

Preface

Communication Skills for Dentists — page 9

viii

Preface

The dental students we teach have completed an undergraduate degree, so most of

them have taken at least one course in communication studies. Similarly, dental auxil-

iaries may have taken a communication course during or after high school. Therefore,

this manual is written for readers with a basic understanding of communication theory

and skills. We assume, for instance, that a reader advised to “make eye contact” does

not need to be told how many seconds of eye contact are appropriate. We encourage

readers who need more basic instruction in culturally appropriate communication to

take an introductory course in communication.

Research into dental provider–patient communication is growing rapidly, yet it still

lags behind research into physician-patient communication. The two contexts share

many similarities, yet we are aware that they are not identical. In seeking research to

support the skills we advocate for dental professionals, we attempted to locate recent

articles using dentists or dental hygienists as participants. When such research has not

been conducted, we relied on communication research using other medical profes-

sionals (eg, physicians or nurses). All such research is cited. In areas where research

has not been conducted or is inconclusive, recommendations are based on clinical

experience, observation, and feedback from dentists, professors, and students. Such

recommendations are experience based and have no citation.

All three authors have completed extensive coursework in public health and highly

value the behavioral change theories in which so much patient-provider communi-

cation research is grounded. We have introduced our students to the more popular

theoretical models (eg, the transtheoretical model, the health belief model, and the

parallel processing model). Results were mixed. Although students appreciate that

these models provide a valid conceptual framework for encouraging patients toward

healthy dental behaviors, they prefer that limited class time be devoted to specific

recommendations for interacting with patients.

Given the considerable demands on the time of the dental students and profes-

sionals to whom this book is targeted, we have opted to write it as a practical manual

instead of a comprehensive textbook. We therefore focus on specific communication

skills and strategies rather than on the theory underlying them. The research cited

throughout the book includes material that will appeal to those interested in explor-

ing theories on health behavior.

Research suggests that much patient-provider communication training is not

grounded in evidence.

We wrote this book as a practical manual introducing dental

students and professionals to evidence-based suggestions for effective patient com-

munication. Readers vary in their communication skill level, and dental colleges vary

in their instructional emphasis, so we have written each chapter to be comprehensible

even if the other chapters are not read.

The manual consists of four parts. Part I presents fundamental communication skills

for dental professionals. Part II presents those skills as they are applied in specific

types of patient interactions. Part III presents chairside strategies to facilitate commu-

nication with patients during each stage of a regular appointment. Part IV presents

situations that sometimes challenge dental professionals and offers communication

strategies for managing such challenges.

Communication Skills for Dentists — page 10

This book reviews broad skills and presents specific strategies for optimal patient-

provider communication. To enhance comprehension and retention of the material,

each chapter includes activities such as exercises, discussion topics, and self-tests.

In addition, because patient communication involves professional ethics, common

ethical dilemmas are included throughout the text in a feature called “Question of

ethics.” This feature fosters ethical behavior by enabling readers to consider how to

respond to ethical dilemmas before they happen. Finally, checklists are now the state

of the art in health care, so in lieu of chapter summaries we have included a checklist

near the end of each chapter to provide a quick summary of the recommended com-

munication strategies.

6,7

References

1. Geboy MJ. Communication and Behavior Management in Dentistry. Philadelphia: Decker, 1984.

2. Jameson C. Great Communication Equals Great Production, ed 2. Tulsa: PennWell, 2002.

3. Wiles CB, Ryan WJ. Communication for Dental Auxiliaries. Reston, VA: Reston, 1982.

4. Chambers DW, Abrams RG. Dental Communication. Sonoma, CA: Ohana Group, 1992.

5. Veldhuijzen W, Ram PM, Van Der Weijden T, Wassink MR, Van Der Vleuten C. Much variety

and little evidence: A description of guidelines for doctor-patient communication. Med Educ

2007;41:138–145.

6. Gawande AA. The Checklist Manifesto: How to Get Things Right. New York: Holt, 2009.

7. Weiser TG, Haynes AB, Lashoher A, et al. Perspectives in quality: Designing the WHO Surgical

Safety Checklist. Int J Qual Health Care 2010;22:365–370.

Communication Skills for Dentists — page 11

About the Authors

Lance Brendan Young,

PhD, MBA

Dr Young is an assistant professor at Western Illinois University. He earned a master of

business administration from Tulane University and worked in marketing for 14 years

before enrolling at the University of Iowa, where he earned his doctorate in commu-

nication studies with an emphasis on health communication. He completed a 2-year

postdoctoral fellowship with the Veterans Health Administration. He has also been

a visiting assistant professor at the University of Iowa College of Dentistry, teaching

patient-provider communication to dental students. His research has appeared in the

Archives of Internal Medicine

Culture and Psychology

, the

Journal of Gerontological

Nursing

, and the

Journal of Telemedicine and Telecare

Cynthia Rozek O’Toole,

MS, RDH

Ms O’Toole has worked at the University of Iowa College of Dentistry for 29 years.

In addition to her clinical duties, for several years she has taught the communication

curriculum to first-, second-, and third-year dental students. She contributed to the

development of the communication curriculum for the first- and second-year students

and single-handedly redesigned the standardized patient curriculum for the third-year

students. She has secured several grants to implement innovative curricular enhance-

ments through technology (eg, videotaping of patient interactions) and through diver-

sity training (eg, Hispanic and deaf/hard-of-hearing patient awareness).

Bianca Wolf,

PhD, MPH

Dr Wolf earned a master of arts in communication from Arizona State University and

worked in the health insurance field for several years before entering the University of

Iowa, where she earned a doctorate in communication studies and a master of public

health degree, focusing on community and behavioral health. She taught patient-

provider communication at the University of Iowa College of Dentistry. She is currently

an associate professor of communication studies at the University of Puget Sound.

She has presented her research on patient communication about cancer and other

illnesses at regional, national, and international conferences. Her research has also

appeared in

Qualitative Health Research,

the

Journal of Social and Personal Relation-

ships,

and the

Journal of Family Communication

Communication Skills for Dentists — page 12

Part

Communication

Fundamentals

This first section introduces key concepts that are fundamental to effective

chairside communication with patients. Individuals who develop communi-

cation skills without first understanding communication or their audience

may express themselves in a way that sounds insincere or even aggres-

sive. Effective communicators understand how communication functions

and can anticipate how it might function with a specific patient in context.

This section provides an overview of health communication and its im-

portance to patient-centered care (chapter 1), describes patients’ percep-

tions of dentistry (chapter 2), and discusses cultural influences that shape

patients’ communication patterns (chapter 3).