While good clinical knowledge is important, so too is the ability to communicate – as Dental Protection Dentolegal Consultant Dr Colm Harney explains.
Dr Colm Harney’s interest in interpersonal communication began as a new graduate. “I went to work in Northern Ireland under the National Health Service system,” he recalls. “Certainly 30 years ago, there were high volumes of patients, lots of work, and I walked out of Dental School into a practice where I was seeing 30 to 40 patients a day.
“The clinical work was the non-negotiable, but because of the time constraints of seeing so many patients, what tended to get left to the side was the communication, the relationship building, the rapport building and putting people at ease. All that got chopped as much as possible to get through the volume of clinical work that needed to be done.”
After three years in the job, Colm burnt out. “We didn’t have the vocabulary at that time to describe it as burnout, but I was certainly very stressed and very disillusioned with practice. I quit with the intention of never going back to dentistry again.”
Colm left Northern Ireland and travelled to South Africa and Southeast Asia, before arriving in Australia eight months later – where he was quickly running out of money.
“I thought the most efficient way for me to earn money was to try dentistry again, so I got a dental job in a government clinic in Cairns,” he says. “It was a completely different experience of practicing dentistry. We had time to talk to our patients, ask how their day was going, and if they were feeling nervous. We could work through a diagnosis and spend time explaining an x-ray.
“I realised how important communication was in terms of the practice of dentistry and it piqued an interest in me.”
As well as helping to make a diagnosis and having the important conversation around consent, Colm says good communication has additional personal and professional benefits for patients.
“On the personal level, most patients would prefer a friendly, smiling face that is going to try to put them at ease. That demonstrates in a non-verbal way that you have the patient’s best interests at heart,” Colm explains.
“You take the time to make some small talk, try to put them at ease, understand what their problems are, and their goals for dental treatment. If you can do all that through good communication, patients usually respond favourably, and you can start to build a good rapport and trust, which is a key part of the dentist/patient relationship.”
Colm says everyone wants to work in an environment where colleagues are mutually supportive of each other. “In addition, on the professional level, being comfortable enough to discuss cases and ask for advice can only exist in a trusting environment where you feel your colleagues are looking out for each other.”
According to Colm, a common mistake with communication is not allocating the time to do it well. “We get trained in Dental School to be clinicians, so we are task-focused,” he says. “We want to pick up a handpiece or mirror and start problem solving. But before we do that, we have to allocate time to spend doing those things like basic greeting of the patient and understanding their problems and what they want. Giving enough time to do all of that before we pick up a mirror or a probe or a handpiece is, I think, the big key thing that a lot of dentists don’t fully appreciate how much time to set aside for that and how important that is.
“You’re not charging an item number or code for that time, but if you do that bit well at the start, it is really going to enhance both the therapeutic relationship you have with the patient, and your ability to make a proper diagnosis,” he adds.
Consciously allocate time at the beginning of every appointment. “Don’t be in a rush to push the patient back in the chair and pick up a probe and get into the mouth. That time to communicate at the start of the appointment is very important.”
Be aware of your non-verbal communication
Two-thirds of how we communicate is non-verbal. “Being aware of that is really crucial and some examples of that in the dental practice is the way we dress, our tone of voice, whether we appear rushed or not,” he says. “If are sitting with the patient and clicking a pen or tapping our feet and sending off non-verbal signals that we are impatient or feeling rushed, that can send rushed signals.
“Make sure our body position is demonstrating to the patient that we are listening, so try to sit facing the patient and make appropriate eye contact.”
“There are many podcasts and webinars covering communication that are very useful, and the Dental Protection website has many resources around communication, record keeping and consent, which all fall under the broad umbrella of effective communication,” he says, adding it is important to do CPD in those non-clinical areas. Colm’s podcast, Communicating Health, is available on any of the streaming platforms.
“A key component of many complaints is some form of breakdown of communication,” Colm explains. “Even if the complaint is overtly clinical, in many cases sitting behind that clinical mishap is some form of ineffective communication where the patient has realised a concern that hasn’t been addressed to their satisfaction, or they haven’t felt that the rapport has been sufficient.”
In many cases, Colm says there is a well-documented risk of increased complaints in first visits – before the “bank of good will” is established. “Your patient is much less likely to come to you first to try to address the complaint and give you a chance to address it if you don’t have that good rapport.”
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By Dr Colm Harney
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