Mrs Kraft’s appointment with you for a second opinion consultation is scheduled at the end of a hectic afternoon. Her dentist has requested that you discuss orthodontic possibilities to address her absent mandibular left first molar and mild anterior crowding. After Mrs Kraft has been waiting about 20 minutes, your receptionist tells you that Mrs Kraft wants to know when you’ll be seeing her. At that moment, your staff seats her. Several more minutes go by before you can get in to meet her. She greets you with a resentful, curt “hello.” She is obviously annoyed by the wait, and you immediately offer her a sincere apology for your tardiness.
Mrs Kraft tells you that she had seen another orthodontist who told her abruptly that “The space at the mandibular first molar cannot be closed by tooth movement for a variety of reasons. Period.” She refused to accept his recommendation.
After a thorough discussion of her history and a clinical examination, you patiently explain that space closure would be far more detrimental to her overall outcome than implant replacement of the molar. You notice a change in her attitude as you engage in a dialogue with her. As the visit concludes, she tells you respectfully that she understands your recommendation and asks you to provide her with proper correction. How had you gained her immediate trust when the previous orthodontist was unable to do so?
With the evolution from a paternalistic to an autonomous (self-rule) perspective of health care delivery, many patients no longer unconditionally accept a doctor’s expert authority to dictate therapy without considering options. The doctor’s communication style must therefore convey an appreciation of the patient’s concerns and complaints, as well as verbal skills that involve the patient in the decision-making process—all in an empathetic, personalized manner. Autonomous treatment decisions should involve a balance between the doctor’s address of the patient’s concerns and a respect for beneficence. These 2 principles can occasionally be conflicting. Patients who report effective communication with their providers have been shown to be more satisfied with their care and more compliant with treatment directives. Doctor satisfaction has also been shown to be enhanced in relationships when effective, fluent communication flourishes.
Not all doctors are good communicators, and self-assessments of communication skills are often inadequate. One study indicated that although 75% of a cohort of surgeons believed that they were adequate communicators, only 21% of their patients concurred.
Successful communication can be a powerful tool in conflict resolution. Emotions of anger, confusion, frustration, and helplessness are prevalent in conflict situations and can escalate if undetected. Verbal and nonverbal clues can provide useful opportunities for converting conflicts into successes from both clinical and interpersonal perspectives. And a positive patient relationship is important in cases of litigation.
Your interaction with Mrs Kraft was ample testimony of your effective communication skills. Your apologetic demeanor upon entering the operatory after your delay of her appointment demonstrated humility, and your nature was affable, even though the afternoon clinic period is the busiest and most complex time of your day. That shouldn’t be her concern. Your obvious patience and your ability to listen—and hear—her concerns, followed by your summary of them in your own words, let her know that you are her advocate. And your clear explanation of why molar space closure would not be in her best interest assimilated the ethical principles of autonomy and beneficence, which can be a difficult task indeed.
You’ve earned yourself a new patient, but more importantly, you have gained the invaluable trust of yet another person by effective communication.