Improving communication skills

by Dianne D. Glasscoe

Dear Dianne:

I work in a small practice in the north. I have been in my current practice for one year. However, I have been a dental hygienist for the past three years.

Recently, my boss called me into his office to inform me that "several" patients had complained about me. He said patients had complained about me being too direct and even offensive at times with my home-care teaching. He really laid a bombshell on me when he put me on notice that, if he received any more complaints over the next 30 days, I would be fired. Needless to say, I am hurt, angry, and scared.

In all fairness, I must mention that I was fired from my last hygiene job. The reason given was that I was "just not working out," whatever that means. I will always wonder what the true reason was for my termination.

I do not feel comfortable talking about this with anyone, but could you give me some communication tips that will help me?
On the Chopping Block

Dear Friend:

First, allow me to commend you for writing. I know this must have been hard. You show great courage in seeking help, rather than just becoming increasingly resentful. One of life's greatest lessons is that in order for us to grow and mature, we must be willing to identify and uproot those "life weeds" that tend to spring up and take root. Resentment allows those "weeds" to flourish and choke out the goodness and beauty that is waiting just below the surface. When difficult situations come in our lives (and everyone has those times), we can become bitter or better. I believe you want to become better.

Communication is a skill learned throughout life. From the moment we take our first breath, we begin a lifetime of learning to communicate. Some of us become quite effective communicators, while others never seem to develop the skill. Are these skills just given to some naturally and denied others? Granted, while some people are endowed with the "gift of gab," this by itself does not make one a great communicator. My grandmother used to say that a person who talked incessantly could "talk the horns off of a billy goat!" Another great speaker, Bill Brooks, CSP, confers the title, "oral hemophiliac" to those individuals that say very little with many words.

Good communication skills are as important as good clinical skills for all health-care clinicians. Dr. Gary Chapman, noted family counselor, estimates that 85 percent of all broken relationships are caused by communication problems. Further, Mark Swartz, a professor at Mt. Sinai Hospital in New York, estimates that 85 percent of all malpractice cases are the result of poor communication rather than actual malpractice.

The best communicators are those individuals who have developed a keen sensitivity to the people with whom they are seeking to communicate. Good communicators have learned to step out of their own preconceptions and consider the thoughts and feelings of others.

Albert Mehrabian, a communication researcher at UCLA, states these findings: words comprise 7 percent of our communication; tone of voice comprises 38 percent; and all other non-verbal forms of communication comprise 55 percent of our total communication. Stated differently, what you don't say can speak louder than what you do say.

Did you know that humans are capable of 20,000 different facial expressions? The most pleasant and most advantageous is a smile! The eight major emotions transmitted facially are happiness, pain, fear, anger, interest, determination, bewilderment, and sadness.

Learning to recognize non-verbal communication can be a powerful tool in the hands of a good communicator. Can you remember that "look" your mother gave you that said, "You better straighten up right now!" She didn't even have to open her mouth to say it, but you knew exactly what she meant.

Have you ever considered how your own non-verbal communication affects your patients? For example, the way in which you receive your patient from the reception room can set the tone for a great appointment. It takes effort to calmly enter the reception room, extend your hand, and warmly greet your patient with a smile. However, it is well worth the effort. Put yourself in your patient's place. I've witnessed office situations where the hygienist or assistant opens the door to the clinical area, shouts out the patient's name, and lets the door slam as she retreats to places unknown. That's not a very soothing introduction to a patient nervously awaiting treatment.

Please remember this fact: Nobody likes to go to the dentist. Anything we can do to make visits more pleasant, starting when the patient walks in the door, is advantageous. There are five essential skills needed in developing a superb chairside manner. Please pay careful attention to each one.

• Look. Eye contact is vitally important in establishing an effective communication bond. Never stand or sit behind your patient while talking with them. In addition, make sure the chair is upright and you are seated when explaining something to a patient. People feel vulnerable when they are reclined. Keep your eye level in line with your patient so as not to speak "down" to her or him. One more suggestion: As dental professionals, we often train our gaze to the other person's mouth while conversing. This tendency becomes second nature to us. However, we need to be sure to cast our eyes to the other persons' eyes, not downward to the mouth. A wise person once said, "The eyes are the window to the soul."

• Listen. Effective communicators have the ability to "read" other people. This ability is gained through listening and internalizing the feelings of those being listened to.

As dental professionals, we need to develop our listening skills to what the patient says verbally and non-verbally. This is called "listening between the lines." Always pay attention and acknowledge you patients' expressions (verbally or non-verbally) of pain, fear, frustration, etc.

Many times we engage in selective listening, whereby we hear only those things we want to hear. We tend to zero in on things our patients say that are good for us, while dismissing or ignoring other parts of the exchange.

Asking patients open-ended questions like, "Tell me about your past dental experiences," gives you an opportunity to listen, listen, listen. Pay attention with your eyes and ears. My very wise grandmother used to say, "Since we were created with two ears and one mouth, we should listen twice as much as we talk!" That sounds like reliable advice.

• Linger. In order for this concept to be workable, there must be good schedule control. The way you leave the operatory is important in helping the patient form a positive memory of the appointment.

Once I observed a doctor finish a procedure and leave the chair without a word to the patient. The patient then turned to the assistant and asked, "Is he finished?" This should never happen. Linger long enough to put closure on the appointment. Make sure the patient leaves with a positive word from you.

Sometimes patients have exciting news that they are anxious to share. You should feel honored when they share their joys with you. You must be willing to linger and listen.

Additionally, some patients come to us laden with personal problems. I've had patients to open up and share extremely personal problems with me, maybe because I seemed non-threatening. People often feel a desperate need to unburden. In these rare instances, I can be a sympathetic listener. You should consider it a compliment when a patient trusts you enough to share a problem with you. However, you must be willing to linger.

• Touch. Did you know that babies could die from lack of touch? An appropriate touch to a patient conveys warmth and caring. A playful pat on the head of a child, a sincere handshake with male patients, or a pat on the arm or shoulder of a female patient conveys that you genuinely care. A petite female doctor I know is quite good at using 'touch' with her patients. I have observed her patting the hand or arm of her patient while waiting on her assistant to load the anesthetic. Many of her elderly patients hug her at the end of the appointment. Old people suffer from touch deprivation. Although hugging may be totally inappropriate with most patients, many of our elderly patients welcome (and even initiate) a hug from someone whom they perceive cares for them.

You may have to step out of your comfort zone to use touch as a display of caring to your patients. However, an appropriate touch to a patient can be quite effective in conveying the message, "I care for you as a person — not just your teeth."

• Identify. The ability to identify with what our patients are feeling is very important. Identifying dental problems is easy for us. However, identifying what will make a particular patient happy is not always easy. If we see our patients as total beings and not just a set of teeth, we will be more successful at establishing the trust that is essential in any good clinician/patient relationship.

Can you feel what they feel? Do you care enough to try? Are you willing to be their dental caregiver and their friend? If your answer is 'yes,' you have the foundation that is necessary for building long-term, connected relationships with loyal patients.

Obviously, there are some problems with your communication skills. The good news is that if you can put the hurt, resentment, and fear behind you, you have an excellent opportunity to learn and grow. Two additional suggestions are:

• Set an appropriate time to talk with your doctor to get clear in your mind exactly what he feels are the problems you need to address.

• Read some good books on improving your communication skills. My personal favorites are by Nido Qubein, and the titles are How to be a Great Communicator and Stairway to Success. In the first, he talks about being a good listener and even has a self-test to help you determine what and where your weaknesses are.

Finally, in giving home-care instructions, take care not to use "you" statements, such as, "You are not brushing well in this area." Rather, say, "I see this area needs more attention." Take the focus off the patient and on to the behavior. Also, be sensitive to the volume and tone of voice you use. Be gentle and supportive.

I have given you several things to ponder about improving your own communication skills. Now, the challenge is up to you to get busy and improve your level of communication.
Dianne

How you present yourself sends a powerful signal to others about professionalism, or lack of it. Did you know it is impossible to wear clothes and not transmit a social signal?

Think about your appearance. What does your style say? Consider these aspects of appearance: attire, make-up, jewelry, hair, posture, gait, and facial expressions. The key to remember is this: present yourself each day in the manner that is in your best interest, both professionally and personally.

The June 2003 issue of The Archives of Internal Medicine contained an article by Lawrence J. Brandt, MD, that was titled, "On the Value of an Old Dress Code in the New Millennium."

He wrote, "Attire of the healthcare provider is important to patients across all lines of population and geography studied to date; young or old, child or parent, Eastern or Western, Northern or Southern. Among professional apparel, the name tag and the white coat are most preferred by patients."

In study after study cited in the article, a more formal look projects professional competence and inspires trust among patients, whereas a casual look, wearing sandals, clogs, scrub suits or blue jeans — is disapproved by most patients.