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Dentist-patient communication—a major factor in treatment prognosis
Complete
dentures
Dentist-patient
communication-a
in treatment
maior
factor
prognosis
Russell W. Schabel, D.D.S.* University
of California,
School
of Dentistry,
San Francisco,
Calif.
R
ecent surveys of complaints from dental patients in large metropolitan areas of the United States have provided some very interesting and alarming statistics.lp * Seventy per cent of the complaints come from denture patients. This study revealed that half of the dentures were structurally and functionally correct and should not have been in the problem category. Half of the failures could have been eliminated through a high level of communication between dentist and patient. Unfortunately, the science of human behavior, as it applies to some 30 million denture patients in the United States, has been neglected. One aspect of human behavior which must be studied, taught, and practiced is communication between dentist and patient. PURPOSE It is not my intention to convert busy practicing dentists into pseudopsychiatrists, complete with black couch and soundproof room. However, I do feel that some measure of the country-doctor approach to patient management is indicated in modern prosthetic treatment. This approach requires that each dentist slow down and readjust his office procedures to allow a little more time to listen and talk to his patients. It is difficult to overemphasize the importance of communication, and yet most of us spend very little time or effort acquiring the ability to present our thoughts to others or to interpret their thoughts. A healthy relationship between the dentist and his patient is fundamental to the successful practice of dentistry. A breakdown in the communication process will lead to patient dissatisfaction, therapeutic failure, and a host of unpleasant consequences for the patient and his family, for the dentist, and for other members of our profession. The dentist-patient relationship is a social relationship which evolved from the Presented
before
*Assistant
Clinical
The
American
Professor,
Prosthodontic
Denture
Society
in Chicago,
111.
Prosthesis.
3
J. Pros. Dent. January, 1969
meeting of two people under conditions of stress. Stress increases as new demands are placed on dentists by government and by society to treat more people. Patients arc under the wear and tear of everyday lift: which is compounded by the fact that they must face still another hurdle in their adjustment to oral restorations. DENTIST-PATIENT
RELATIONSHIP
The dentist-patient relationship is very similar to traffic on a freeway. In one direction, we have a flow of information from the patient to the dentist which involves problems, hostilities, misconceptions, ignorance, fears, and hopes. In the opposite direction, we find a flow of information involving sympathy, patience, advice, education science, and skill. Assuming that the dentist has a basic knowledge of psychologyy, he should be able to place each patient in his proper psychologic category. On the bright side of prosthodontic practice, each dentist has his share of patients lvho arc mentallv well balanced and who can face, accept, and adapt to a iirw phasf: of lift: Unfortunately. each of IIS has had his share of psychotics who expect the impossible and blame e\‘eryone clsc for failure. his sham of paranoids who feel that c~~eryonc and rverythinq is against thtm. and his share of depressives who sing our praises one day and who curse us the nrst. ‘l‘hese tragic individuals are far beyond normal communicative procedures and should be tactfully referred for psychiatric consultation. All too frequently, general practitioners, as well as the specialists, are misled by this type of pat&t, and treatment. tcrminatcs after endless hours of frustration and great financial loss. II” your patient has not adapted to his first ten dentures: the cl~ances are that he will ncvcr adapt to your creation. One of the more pleasant sights you can ever hope to SEC will be this type of patient leaving your offlcc forever. METHODS
OF DENTIST-PATIENT
COMMUNICATION
‘1‘11~ methods of dentist-patient communication arc vrrbal, auditory, visual, and 5srittt22. L’crbal communication is a two-way street. In verbal communication, the patient is active and the dentist is passive. Since we have two cars and only one tongue, \vc must train oursel\-cs to bc good listeners as well as good talkers. We will learn the patient’s inajor problems from his verbal complaints. If the patient is about to enter the prosthetic phase of life, we lvill learn of his fears and misconceptions. If the patient has dentures which are not successful, WC may find the solution to the problrm very early in the consultation simply by being a good listenrr. After the consultatiorI and the examination, it is time to reverse the flow of information. Above all, communication from the dentist to the patient must be /~~citiz,e. Dentists must maintain a positive, optimistic state of mind in the face of and must prccondition the minds of their patients all of the negative conditions’ to success.J This is a basic approach to the practice of prosthodontics. I do not mean that the dentist should raise false hopes or promise the impossible. However, each dentist can improve on almost any situation with the careful application of the principles of proper dia
g*;g;
;1
Dentist-patient
communication
5
clinical and laboratory procedures. The patient, through verbal, oral, and written communication, must be educated concerning the oral problems which he presents to his dentist. An effective method of positive communication is the use of acrylic resin models made from casts which depict clinical situations of common oral problems.s Models of pendulous tuberositics, torus palatinus, and chronic irritation of soft tissue will quickly aid the patient in understanding his problems, and in becoming familiar with various methods of treatment. Quite often, a simple visual form of communication can clear up a patient’s misconceptions about his ability to use dentures as compared to a relative or a friend’s ability to retain and to use dentures. A small slide projector can be used to show a patient successful methods of treatment which have been used in conditions similar to his. Explaining denture problems before treatment with the use of every available educational means is positive communication and is the foundation for dentist-patient understanding. Explanations made after treatment are negative communications which the patient may interpret as excuses. Written communication should be presented to the patient as various phases of the treatment are reached. Booklets for this purpose must be written in simple terms which the layman can understand, and they can be written by the dentist himself so the information will reflect his philosophy regarding denture problems. Informative booklets can also be obtained from commercial sources. A chair-side manner should bc developed by each dentist. One half hour spent on a well-planned educational discussion with simple, easy-to-understand terms will definitely minimize prosthetic failures. CONCLUSIONS Words are the basis of the communicative process, and good communication is necessary in order to achieve a satisfactory dentist-patient relationship. We cannot measure the success of the communication process by the number of words spoken or by the sweetness of the tones. Success is measured best by the pleasure and feeling of well-being that the dentist will receive from the knowledge that he has another comfortable, happy, and satisfied patient. References 1. Kopfer, A.: Why Dentures Fail, D. Clin. North America, pp. 721-734, Nov., 1964. 2. Survey of Denture Wearers in the United States: Prepared by Crossley Surveys, Inc., for Clark-Cleveland, Inc., 1967. 3. House, M. M.: Full Denture Techniques, Lecture, Study Club No. 1, Whittier, Calif., Sept., 1935. 4. Sherman, N.: How to Turn Failure Into Success, Englewood Cliffs, N. J., 1958, PrenticeHall, Inc., p. 11. 5. Peale, N.: The Amazing Results of Positive Thinking, Englewood Cliffs, N. J., 1959, Prentice-Hall, Inc., p. 23. 6. Schabel, R. W.: Patient Education With Prosthetic Acrylic Resin Models, J. PROS. DENT. 17: 104-108, 1967. 1600 SIR FRANCIS DRAKE BLVD. SAN ASSELMO, CALIF. 94960
dentures
Dentist-patient
communication-a
in treatment
maior
factor
prognosis
Russell W. Schabel, D.D.S.* University
of California,
School
of Dentistry,
San Francisco,
Calif.
R
ecent surveys of complaints from dental patients in large metropolitan areas of the United States have provided some very interesting and alarming statistics.lp * Seventy per cent of the complaints come from denture patients. This study revealed that half of the dentures were structurally and functionally correct and should not have been in the problem category. Half of the failures could have been eliminated through a high level of communication between dentist and patient. Unfortunately, the science of human behavior, as it applies to some 30 million denture patients in the United States, has been neglected. One aspect of human behavior which must be studied, taught, and practiced is communication between dentist and patient. PURPOSE It is not my intention to convert busy practicing dentists into pseudopsychiatrists, complete with black couch and soundproof room. However, I do feel that some measure of the country-doctor approach to patient management is indicated in modern prosthetic treatment. This approach requires that each dentist slow down and readjust his office procedures to allow a little more time to listen and talk to his patients. It is difficult to overemphasize the importance of communication, and yet most of us spend very little time or effort acquiring the ability to present our thoughts to others or to interpret their thoughts. A healthy relationship between the dentist and his patient is fundamental to the successful practice of dentistry. A breakdown in the communication process will lead to patient dissatisfaction, therapeutic failure, and a host of unpleasant consequences for the patient and his family, for the dentist, and for other members of our profession. The dentist-patient relationship is a social relationship which evolved from the Presented
before
*Assistant
Clinical
The
American
Professor,
Prosthodontic
Denture
Society
in Chicago,
111.
Prosthesis.
3
J. Pros. Dent. January, 1969
meeting of two people under conditions of stress. Stress increases as new demands are placed on dentists by government and by society to treat more people. Patients arc under the wear and tear of everyday lift: which is compounded by the fact that they must face still another hurdle in their adjustment to oral restorations. DENTIST-PATIENT
RELATIONSHIP
The dentist-patient relationship is very similar to traffic on a freeway. In one direction, we have a flow of information from the patient to the dentist which involves problems, hostilities, misconceptions, ignorance, fears, and hopes. In the opposite direction, we find a flow of information involving sympathy, patience, advice, education science, and skill. Assuming that the dentist has a basic knowledge of psychologyy, he should be able to place each patient in his proper psychologic category. On the bright side of prosthodontic practice, each dentist has his share of patients lvho arc mentallv well balanced and who can face, accept, and adapt to a iirw phasf: of lift: Unfortunately. each of IIS has had his share of psychotics who expect the impossible and blame e\‘eryone clsc for failure. his sham of paranoids who feel that c~~eryonc and rverythinq is against thtm. and his share of depressives who sing our praises one day and who curse us the nrst. ‘l‘hese tragic individuals are far beyond normal communicative procedures and should be tactfully referred for psychiatric consultation. All too frequently, general practitioners, as well as the specialists, are misled by this type of pat&t, and treatment. tcrminatcs after endless hours of frustration and great financial loss. II” your patient has not adapted to his first ten dentures: the cl~ances are that he will ncvcr adapt to your creation. One of the more pleasant sights you can ever hope to SEC will be this type of patient leaving your offlcc forever. METHODS
OF DENTIST-PATIENT
COMMUNICATION
‘1‘11~ methods of dentist-patient communication arc vrrbal, auditory, visual, and 5srittt22. L’crbal communication is a two-way street. In verbal communication, the patient is active and the dentist is passive. Since we have two cars and only one tongue, \vc must train oursel\-cs to bc good listeners as well as good talkers. We will learn the patient’s inajor problems from his verbal complaints. If the patient is about to enter the prosthetic phase of life, we lvill learn of his fears and misconceptions. If the patient has dentures which are not successful, WC may find the solution to the problrm very early in the consultation simply by being a good listenrr. After the consultatiorI and the examination, it is time to reverse the flow of information. Above all, communication from the dentist to the patient must be /~~citiz,e. Dentists must maintain a positive, optimistic state of mind in the face of and must prccondition the minds of their patients all of the negative conditions’ to success.J This is a basic approach to the practice of prosthodontics. I do not mean that the dentist should raise false hopes or promise the impossible. However, each dentist can improve on almost any situation with the careful application of the principles of proper dia
g*;g;
;1
Dentist-patient
communication
5
clinical and laboratory procedures. The patient, through verbal, oral, and written communication, must be educated concerning the oral problems which he presents to his dentist. An effective method of positive communication is the use of acrylic resin models made from casts which depict clinical situations of common oral problems.s Models of pendulous tuberositics, torus palatinus, and chronic irritation of soft tissue will quickly aid the patient in understanding his problems, and in becoming familiar with various methods of treatment. Quite often, a simple visual form of communication can clear up a patient’s misconceptions about his ability to use dentures as compared to a relative or a friend’s ability to retain and to use dentures. A small slide projector can be used to show a patient successful methods of treatment which have been used in conditions similar to his. Explaining denture problems before treatment with the use of every available educational means is positive communication and is the foundation for dentist-patient understanding. Explanations made after treatment are negative communications which the patient may interpret as excuses. Written communication should be presented to the patient as various phases of the treatment are reached. Booklets for this purpose must be written in simple terms which the layman can understand, and they can be written by the dentist himself so the information will reflect his philosophy regarding denture problems. Informative booklets can also be obtained from commercial sources. A chair-side manner should bc developed by each dentist. One half hour spent on a well-planned educational discussion with simple, easy-to-understand terms will definitely minimize prosthetic failures. CONCLUSIONS Words are the basis of the communicative process, and good communication is necessary in order to achieve a satisfactory dentist-patient relationship. We cannot measure the success of the communication process by the number of words spoken or by the sweetness of the tones. Success is measured best by the pleasure and feeling of well-being that the dentist will receive from the knowledge that he has another comfortable, happy, and satisfied patient. References 1. Kopfer, A.: Why Dentures Fail, D. Clin. North America, pp. 721-734, Nov., 1964. 2. Survey of Denture Wearers in the United States: Prepared by Crossley Surveys, Inc., for Clark-Cleveland, Inc., 1967. 3. House, M. M.: Full Denture Techniques, Lecture, Study Club No. 1, Whittier, Calif., Sept., 1935. 4. Sherman, N.: How to Turn Failure Into Success, Englewood Cliffs, N. J., 1958, PrenticeHall, Inc., p. 11. 5. Peale, N.: The Amazing Results of Positive Thinking, Englewood Cliffs, N. J., 1959, Prentice-Hall, Inc., p. 23. 6. Schabel, R. W.: Patient Education With Prosthetic Acrylic Resin Models, J. PROS. DENT. 17: 104-108, 1967. 1600 SIR FRANCIS DRAKE BLVD. SAN ASSELMO, CALIF. 94960