The sole concern of your new patient, Jim, is his rotated maxillary right lateral incisor. He is otherwise content with his occlusal status. You suggest addressing this objective with a few aligners. He readily agrees, but advises you that his general dentist had delivered a maxillary full coverage night guard 2 months ago to address his bruxing habit, and he doesn’t want to pay for a replacement. “No problem,” you say. “Once we correct the tooth, we’ll modify the night guard to accommodate the new position of the tooth so you can wear that night guard.” You advise him to bring the night guard to the aligner delivery appointment so you can look at it.
A few weeks later, Jim comes for the aligner delivery. The appliance fits well, and in conjunction with minor interproximal reduction, you tell him that 2 months wear should be sufficient to rotate the incisor if he is compliant. Your evaluation of the night guard, however, indicates that it cannot be modified by the addition of either a small spring or a divot of acrylic to retain the corrected lateral incisor. You mention this casually but reassure him that you’ll “think of something that will work.”
A few days later, you receive a troubled call from his general dentist. Jim’s communication to her was that the night guard she made was inferior because it cannot be modified. Jim claims that you said that the dentist should make a new one after the lateral incisor is corrected. You explain the precise dialogue that occurred between you and Jim. Although you assure her that you would never insinuate that the night guard was inferior, she seems only partially assuaged. You have not worked with her in the past, so there has been little opportunity to instill her confidence in you as a person of integrity. You offer to call Jim to clarify your communication with him.
You wonder how your simple comment could be amplified to create so much angst.
Miscommunication is rarely a 1-way street. Often a tincture of humility is necessary to acknowledge such an inevitability. Miscommunication is ubiquitous: in the workplace, in the home, and in almost every personal interaction. It becomes more prevalent under times of stress, such as situations involving time constraints or in complex scenarios necessitating quick decisions. Miscommunication can be the basis of strained relationships or litigation in the health care arena. And it is uncanny that miscommunication usually involves not how much we say but, rather, how little.
There are several ways to diffuse miscommunication. The first is to recognize and acknowledge that a lapse in communication has occurred. And that should be done proactively, before an opportunity for reconfrontation arises. This is often a courageous act, but that’s where a dose of humility comes in. Accountability for your own role in the miscommunication requires that both parties, including you, need to take responsibility for the problem. Careful communication requires that the issue should be clarified to resolve the original misconception. This often takes time and patience but is well worth the effort if we are to help those who rely on our services and our expertise. That’s the essence of beneficence. Our responsibility to our patients is to communicate clearly as well as to resolve any miscommunication—intentional or inadvertent—as it arises.
Your communication to Jim should begin as soon as possible, immediately after your discussion with his dentist. You will need to acknowledge that the misunderstanding might have partially been your fault, but that you intended no criticism. And as the ultimate remediation, you should make it clear that you will take the necessary steps to minimize the possibility that the lateral incisor will relapse—including replacement of the night guard at no charge—if that’s what it will take to resolve the miscommunication.