Effective Communication: Patient Acceptance of Proposed Dental Treatment

Christina Hampton

Introduction

One of the most difficult areas to teach is effective communication. Students often utilize technology, social media, and inappropriate verbiage when engaged in face-to-face professional communication situations. Students find it difficult to draw on the required vocabulary to participate in professional conversations.

Young, high school students obtaining a vocational education are required to meet industry standards as they matriculate from the classroom to the workplace. Students do not question how or why decisions are made; consequently, they do not interpret communication as a dialogue between people. Parents, guardians, and teachers have taught young people to do what they are told and not to ask questions correctly. Students are inexperienced at differentiating among personality types, forms of verbal and nonverbal communication, and professional situations.

This unit begins with teaching vocabulary required to understand building a rapport with patients and presenting dental treatment plans. It gives students an opportunity to use and evaluate the vocabulary to determine if it is appropriate to use in a professional dental setting while applying the vocabulary to real world situations.

Next, students will research and read about how to build rapport with people. Students will draw conclusions about their rapport and why it is important how patients perceive their health care providers. Elements students will explore are conversation starters, effective listening, speaking with confidence, and explaining dental conditions to patients. Students will have opportunities to practice applying these skills.

At the end of the unit students will be able to write a dental treatment plan, develop a rapport with a patient, and present the treatment plan tackling most patient objections, while using confidence, proper vocabulary and excellent communication skills.

Michael Kesner DDS is President and CEO of Quantum Leap Success in Dentistry. Mike's practices, Made Ya Smile Dental, have been listed on the Inc. 5000 as one of the fastest growing companies in the nation for both 2012 and 2013. Dr. Kesner, wrote the book a Multi-Million Dollar Dental Practice. He states, “People will always find a way to do what they want but not necessarily what they need.”1 The truth is most people

decide to make a purchase based upon their emotions; consequently, education does not motivate most patients to want to do their dental treatment.2

Many people make decisions about their dental health based upon the rapport they build with the dental office. As dental professionals we often think that if patients understood the educational basis for needing the prescribed treatment they would commit to having the treatment completed. According to David H. Yu, DDS, MS, a Diplomate of the American Board of Periodontology: “Noncompliance among patients has been linked to many factors, including age, gender, fear, socioeconomic status, and even turnover in the dental practice” Additionally, patient compliance can be improved through visual aids. Dr. Yu states, “an estimated 65% of Americans are visual learners, while only 30% are auditory learners.”3

Students need to be able to identify a patient’s internal motivators and how the patient will learn most effectively. Students need to develop the skills necessary to begin having meaningful communication with patients. A survey by the Workforce Solutions Group at St. Louis Community College found that:

more than 60% of employers say applicants lack “communication and interpersonal skills” — a jump of about 10 percentage points in just two years. A wide margin of managers also say today’s applicants can’t think critically and creatively, solve problems or write well.4

As students begin to increase their level of communication, students will evaluate how to determine if the message they are trying to convey has been correctly interpreted. According to OTPIC:

All communication has two parts: a sender and a receiver. The sender has a message he or she intends to transmit, and she puts it in words, which, to her, best reflect what she is thinking. But many things can intervene to prevent the intended message from being received.5

As students begin to evaluate their verbal and nonverbal communication, they will look at the purpose, skills, application, and building rapport with patients to gain acceptance of dental treatment plans. The American Dental Association has simplified this with a seminar series on the Top10 Skills in Dental Communication.”6

The ADA guide will aid students to learn how to present treatment options to patients and to be able to anticipate the patient’s objections and then utilize effective communication to overcome any obstacle and improve patient compliance and practice performance.

Rationale

I am a dental assisting teacher at Hodgson Vocational Technical High School. Students are learning how to become dental assistants. There are currently 59 students in this 4-year track. During the senior year of high school, students participate in paid cooperative learning. Past and current employers have conveyed that students need to improve their communication with patients, vocabulary usage, and treatment plan presentations. These skills are imperative for a successful dental assistant.

The students typically struggle with oral communication, computing mathematical data, logically presenting information, and encouraging patient compliance. Students struggle with the cost of dentistry, because they view it from the consumer perspective not accounting for the health benefits. It is critical for students to understand the information they are presenting to a patient, and present it with empathy not sympathy.

To help students to reach a level of understanding necessary in the industry, one must teach the barriers patients face in convincing patients to consenting to dental treatment. These include: financial means, education, and motivation. According to onetonline.org the following skills are essential to be a dental assistant:

Dental assistants should have very good perception and communication skills. Many patients arrive at dental appointments with a good deal of anxiety. Since dental assistants are with patients during most of the office visit, they need to be able to be able to “read” and react to patients’ anxiety and comfort levels. Social perception, active listening, and service orientation skills are critically important for patient care. Oral communication skills are important as well to explain what procedures will be performed and why, after-care, and other clinical topics.7

The student population is made of seventeen 11th grade students. The students are taking course work in dental assisting. The students overall are focused, hard-working, and meet the standards for the coursework. The classroom consists of 15 girls and 2 boys. In this class there are numerous ethnic, socioeconomic, and geographic differences.

By integrating social issues and data about healthcare, patient compliance, and internal motivators, students will learn how to vary their treatment plan presentations to meet the individual needs of patients. Once students learn this process they will be able to formulate data for patients and put it into an appropriate presentation. Students will compare and contrast data, research social issues, and explore human behavior to gain insight into this process.

This unit will focus on 11th grade students preparing to matriculate from the classroom to the workplace. Students have learned to interpret communication in a variety of ways; however, they do not understand how to evaluate whether the intended

message they sent has been received. Additionally, students in the 11th grade have been communicating and presenting information for many years; however, they are not experienced in applying it to a professional environment. This unit is designed to improve their communication with patients to an appropriate level that will allow them to gain employment in the dental assisting industry.

Objectives

The American Dental Association has developed a list of the top 10 skills in dental communication. It includes an evaluation sheet with a 10-step checklist for effective communication and patient compliance to dental treatment. Students will gain a basic understanding of the information that will develop as they begin to utilize it during their cooperative work experience. Students will discuss oral communications and identify the differences between verbal and nonverbal communications. Discuss the “team” concept for bettering communication and reducing stress in the dental practice. Design a dental appointment schedule by looking at the treatment needs of the patients and when it is best to schedule certain procedures. Describe the type of relationship the patient and dental team should have by classifying appropriate topics of conversation. Describe good phone courtesy and compare the handling of different types of patient phone calls. Students will analyze a variety of scenarios and decide how the phone call should be handled. Students will listen to a various phone conversations, critique them and apply correct phone techniques while talking with a patient. Students will distinguish between internal and external marketing given marketing samples of local dental practices. Students will describe and compare external and internal marketing strategies and explain how both are necessary to promote the dental practice. Students will compile a patient chart, identify the types of dental practice records and summarize the information they provide to the practice.

This unit starts with teaching communication and treatment planning vocabulary. Giving students exposure to vocabulary they will use and hear in the industry will help them comprehend and apply the content of the unit. We will begin with effective verbal communication, and nonverbal communication: what it is and what does it look like. Students will learn what rapport, patient objections, treatment plan, and patient compliance mean in creating a successful treatment plan. They will understand how effective communication is initiated and continued through building a positive rapport.

Next, students will look at a variety of dental treatment plan cases. They will choose a case they would like to present. They will decide based on the patient’s biography how they will approach the presentation of the dental treatment. They will formulate possible patient objections to the dental treatment providing data to back-up their decisions. They will research information that can be used to support their specific presentation.

At the end of the unit, students will be able to look at a variety of treatment plan

cases and formulate plausible outcomes, presentation styles, and respond to difficult patient questions. The students will decide whether, based on the presentation, that patient should accept the treatment.

Student Lesson 1

2 sessions-135 minutes

Essential Question: What is the difference between listening effectively and communication?

Students will be introduced to the unit using an anticipation guide of the key points of the unit. Students will view incorrect verbal and nonverbal communication videos. Students will begin by viewing “The Importance for Nonverbal Cues as Told by Friends.” 8According to YouTube the constant miscommunication that occurs online is a direct result of the absence of nonverbal cues, which cannot translate across a computer screen. "Friends" is the perfect example of how important these nonverbal cues can be in the interpretation of messages. Also, "Friends" shows face-to-face examples.9 Students will complete the friends graphic organizer (see figure 1).

Figure 1

Figure 2

Students will develop a dialogue using nonverbal and verbal communication to share with a partner (see figure2). The students will decide whether the intended message being communicated is the message that was received by the other person. Students will document specific reasons how they decided what message was being sent (see figure 3).

Figure 3

Students will view the YouTube video “Communication Skills- The 6 Keys of Powerful

Communication” http://youtu.be/XCc6-qr0Gww.10. Students will complete an aha!/huh? graphic organizer for each of the six communication skills (see figure 4). Students will write on the aha! side something that was interesting or surprising. Student will write on huh? side anything that was confusing to them. Students will then use the information from the graphic organizer to complete a graphic organizer with the communication skill, what does it mean, how is it used, why it is necessary, and assess their own communication sticking points (see figure 5). Students will then look at the graphic organizer and determine what area or areas they need to improve. Students will create an action plan to improve their communication skills (see figure 6). Students will share with a shoulder partner and then the class will share out what their partner said.