Chapter 6

Dentist-Patient Relationship

The dentist-patient relationship may be defined as the psychological relations between the dentist and patient.

A patient-centred approach to risk management will do much to strengthen the quality of the dentist-patient relationship and vice-versa. In this relationship, the patients’ needs must be fulfilled and they should:

• feel connected with the dentist and know that their best interests are the dentist’s main concern

• know the dentist can focus attention during their time in the practice

• feel relaxed and comfortable in the dental environment

• know that the dentist is technically competent

• feel that the dentist cares.

The relationship between dentist and patient is based on a dynamic interplay between two individuals between whom there may exist perceived status inequalities. According to Ruth Freeman, “The development of the status differential is associated with the professional and lay aspects of the dentist-patient interaction and is exacerbated by the tendency for the patient to perceive the practitioner as an adult figure and to feel like the child (s)he was”. The challenge for dentists is to foster an adult-to-adult relationship with their patients.

In one study carried out in 1988, patients identified a number of positive behavioural factors that helped to foster good dentist-patient relationships. These are summarised in Box 6-1.

Box 6-1

Positive Behavioural Elements (According to Patients) in the Dentist-Patient Relationship

Made me feel welcome.

Was polite to me during my visit.

Used words that were understandable in talking about my dental care.

Was friendly to me.

Encouraged me to ask questions about my treatment.

Told me what he was going to do before starting to work

Showed that he paid attention to what I said.

Showed that he took seriously what I had to say.

Told me to be calm or to relax.

Made sure I was numb before working on me.

Warned me when he felt the procedure might hurt.

Showed that he knew what I was feeling.

Worked quickly but didn’t rush.

Reassured me during the procedure.

Asked during the procedure if I was having any discomfort.

Had a calm manner.

Asked during the procedure if I was concerned or nervous.

Gave me a step-by-step explanation of what he was doing as he did it.

Was patient with me.

Carried on casual conversation and small talk.

Told me that if it started to hurt, he would relieve the pain.

Let me know that he’d do everything he could to prevent pain.

Gave me moral support during the procedure.

Smiled.

First Encounters

Cliff Rapp, the Vice President of First Professionals Insurance Co. (FPIC), writing in the company newsletter about effective dentist-patient relationships, notes:“The most important clinical encounter, in terms of establishing good rapport, is the initial patient contact. Experts point out that the initial clinical encounter, a one-and-a-half minute opportunity, profoundly affects all subsequent interactions. It may also represent your best opportunity to avoid a claim.”

Every patient who is seen by a dentist is a new patient to that practitioner at some stage. The importance of a satisfactory initial consultation cannot be overstated as an effective risk management strategy. It is a predictor of problems later in the relationship. Remember that both verbal and non-verbal cues help to create the all-important first impression – perception is reality. Rapp’s recommendations for the initial contact are summarised in Box 6-2.

Box 6-2

The First Encounter

Introduce yourself by name.

Use pleasing facial gestures.

Make eye contact.

Make physical contact – handshake, touch arm.

Use a positive opening phrase.

Ask the patient how they wish to be addressed.

Use the patient’s name.

Open discussion with a question.

Listen when the patient speaks – look at the patient.

Provide an explanation before performing examination.

The New Patient Consultation

Aim to establish the patient’s:

• reason for attending the clinic

• treatment expectations

• dental history

• medical history

• social history and factors that may influence the choice outcome of treatment

• ability to cooperate with treatment

• dental needs in the context of other relevant and associated healthcare issues.

Aim to:

• examine the patient

• determine the next, if any, course of action which may include tests, treatment, advice or referral

• provide information to the patient (or carer/guardian/parents as appropriate) and to discuss this information fully with the patient in a way that is understood

• allow the patient the opportunity to ask questions so that (s)he can be fully involved in any decisions

• agree a way forward that is acceptable to both the patient and dentist.

Risk Management Tip

History taking
Patient history can be taken in a number of ways: passive history taking, i.e., the use of questionnaires to allow the patient to provide information in his/her own time, has the advantage that the patient may provide a more complete history and may, therefore, give a fuller response – in particular, when asked open-ended questions. Pre-examination questionnaires can prove both helpful and deliver a caring message to the patient. The disadvantage is that the patient may not fully understand the questions being asked or may not have enough time to consider questions if, for example, the questionnaire is provided at the same time as the consultation.

Active history taking is on a one-to-one basis with any member of the dental team. This allows a much more detailed assessment to be made of the patient’s communication skills (both verbal and non-verbal) and may allow issues to be raised which the patient might not otherwise have committed to writing. The ideal history-taking technique is to use a combination of active and passive techniques. Even if the pre-examination questionnaire is not filled out correctly, it raises questions which may stimulate the patient to consider what (s)he wants from the visit.

Medical History and Documentation

It is difficult to remember what questions were asked in the course of a consultation, either by the dentist or the patient. If a problem arises at a later date, these questions may become very relevant. This is especially important when looking at issues such as patient expectations, patient concerns, consent issues and previous dental history. The only reliable way to recollect the questions is to have a record of the specific questions that were asked and the answers that were given.

The widespread use of word processing software makes it possible to design and produce questionnaires with relative ease. In the paper-free dental practice, the information elicited during history taking can be recorded and held on computer. The medical history should be confirmed and updated to ensure accuracy.

Case Scenario

A patient presents at the surgery on a Friday. A completed questionnaire reveals no relevant medical history. An appointment is made for one week later for scaling. In the meantime his medical practitioner advises the patient during a routine health screen that he has an identifiable heart murmur. The medical practitioner refers the patient to a cardiologist but does not re/>

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