1: Introduction to general communication principles

Effective patient-clinician communication

Effective patient-clinician communication is defined by the Australian Commission on Safety and Quality in Health Care (ACSQHC, 2016) as: 

“…the exchange of information between a patient and their healthcare provider, and includes communications with the family and carer. It involves two-way communication (spoken, written and non-verbal) that engages patients in decision making and care planning. It is tailored, open, honest and respectful and there is an opportunity for clarification and feedback” . 

Being able to communicate with your patient effectively is a core clinical skill and how you do this will profoundly affect and impact their care experiences and the motivation to manage their health when they leave your care.

What is included in communication?

Communication includes spoken, written and verbal elements. Some examples include:

Pre-appointment information collected through forms part of the communication process:

• Demographic data e.g. name, age, date of birth, home address
• Chief complaint and history of chief complaint
• Medical, dental, social, diet history.

Information collected and conveyed to and from the patients is also part of the communication spectrum:

• Questions and responses about the patient’s general and oral health
• Clinical records including findings, test results, advice provided
• Written and verbal consent
• Initial and modified care plans
• Summaries of telephone or email communication.

What are essential elements of effective patient clinician communication?

According to the Australian Commission on Safety and Quality in Health Care (ACSQHC, 2016), there are five essential elements to effective communication in any healthcare setting and this includes:

1. Fostering relationships
2. Two-way exchange of information
3. Conveying empathy
4. Engaging patients in decision making and care planning
5. Managing uncertainty and complexity.

As an early year clinical student embarking on your first clinical experience, it is important to focus on the first three elements prior to your first clinical care placements in year 3.

Fostering relationships, building trust

It is critical to start with a simple question such as “How can I help you?” to a new patient presenting at your clinic, as it can convey a care commitment from the student clinician that extends far beyond mere information retrieval. Fostering relationships and building trust is an important way to build rapport and a relationship with the patient.

• It signifies your values that prioritise patient care above all else within the dental team.
• Trust and confidence serve as cornerstone elements in nurturing the dentist-patient relationship.
• Central to this ethos is a genuine concern for patients, treating them with utmost respect, and fostering effective communication.
• When communication and trust falter, it often leads to conflicts between patients and dentists regarding treatments and costs. These are very much avoidable.
• The communication breakdown could escalate into formal complaints to dental practice boards and even legal proceedings.

This highlights the critical importance of maintaining open, respectful, and trustworthy communication channels in dental care.

Two way exchange of information with empathy

To start with, seeking dental care is usually an emotional experience for most people, especially if fraught with childhood experiences of unpleasant interactions, usually with older patients. A two way exchange is important and clinician should be empathetic especially allowing patients to explain the reason for attendance in their own words, as well as their own expectations of outcomes (Newsome et al., 2012).

The early year student clinician needs time to also develop their own patience and skill in learning to listen, rather than listening to respond.

A efficient exchange facilitates open, respectful communication encouraging the patient to share all information, especially sensitive aspects often disregarded as irrelevant to a dental or oral health situation.

For the clinician, listening to the patient will allow you to appreciate and respect the patient’s choice later on in the process. It is also relevant in being able to recognise that willingness to take ownership of home care is further influenced by specific factors unique to that patient and their family unit.

Tangible outcomes related to accurate diagnoses, interpretation of symptoms with less clinical errors are obvious outcomes for taking the time  to collect and collate a complete and accurate record.

Structured approach and definitions

A structured and systematic approach to gathering information is important. In your dental practice course in year 1 and 2, you will learn about the  specifics of information gathering and recording. There will also be a module on care planning in dentistry for medically fit vs compromised patient, requiring non-surgical and surgical procedures, as well as risks and relevant management strategies to mitigate risks.

However, it is key to always remember that the clinician is aiming to resolve the patient’s chief complaint as soon as possible as it represents a “golden rule” of treatment planning (Stefanac & Fontana, 2017). Full comprehensive examination and further care plans can be formulated once the chief complaint is resolved.

Type of questions in a patient interview

Open questions: not possible to answer as “yes” or “no.” Here the patient is more involved and reflective. You can ask for opinions, past experiences, feelings, or desires.

Closed questions: Here the patient may find these simple to answer using a few words. Such questions will permit the patient to clarify certain aspects of the history of presenting illness however are not open enough to go into great detail around their own extended beliefs attitudes, or emotions.

Watch Communication Essentials (YouTube, 5m32s).