- Create a welcoming environment – Every member of your staff should be trained to communicate clearly and without prejudice. Make it clear that making patients feel comfortable and welcome is a top priority. Patients should feel that their questions are welcomed at every stage of the visit. No patient should be made to feel like a nuisance for asking questions.
- Be an active listener – Encourage your patients to tell you their story in their own words. Use this opportunity to gather information about the reason for the visit.
- Slow down – Be sure to take frequent pauses to give your patients a chance to process what you just told them. Watch out for looks of confusion or loss ofinterest. Take extra care when explaining something you know is complicated or new.
Consider Patricia Olsen, the 42-year-old woman who was asked if she had taken her antibiotic premedication and responded:
Patient: “Yes…well actually, No, I didn’t. Tell me again why I’m supposed to take that medication.”
Dental Hygienist: “Pat, when I saw you last year you told me that you had had an artificial heart valve placed in your heart. Do you remember our discussion about that?”
Patient: “I remember my doctor telling me about my heart valve but I also remember her saying that I don’t have to worry about it.”
Dental Hygienist: “I know; and, most of the time that’s true. However, the mouth is a warm and moist environment and many germs live and grow in our mouths. When we clean your teeth it’s common for some of these germs to get into your bloodstream and travel through your body. Normally, your body’s defense mechanisms remove these germs within a short amount of time. However, when a person has an artificial heart valve, like you do, there is a risk that the bacteria might attach themselves to that valve and begin to grow. This can cause an infection around the blood vessel that could become serious. That is why we want you take an antibiotic before you have dental procedures done. That way, if any bacteria do get into your bloodstream, the medication will be waiting there to destroy them before they can attach to your blood vessel and cause a problem.” (http://circ.ahajournals.org/content/116/15/1736/T3.expansion.html)
Patient: “Now that you say that, I do remember my doctor telling me that I would have to take antibiotics if I ever have surgery. I guess I just didn’t think getting my teeth cleaned was such a big deal. Now that you’ve explained it to me it makes more sense.”
Dental Hygienist: “Pat, just so that I know I’ve explained it clearly to you, would you please tell me why we want you to take antibiotics before your dental appointments?”
- Use plain, non-medical language – Most medical and dental terminology is not familiar to people outside the profession. Whenever possible, replace dental jargon with a common, every day word. If a simple synonym isn’t available, be sure to clearly define a dental or medical term using a familiar example or analogy, for example, when discussing periodontal disease, you might say:“The gum tissue and jaw bone surrounds and supports the teeth, just like the foundation of a house surrounds and supports our homes. If we don’t take care of problems in the foundation of the home, it doesn’t matter how good the condition of the home might be, a weak foundation won’t be able to support it. The same is true of your gum tissue, no matter how healthy your teeth are, if the gum tissue and bone that support your teeth aren’t healthy, you might still lose your teeth.”
- Use pictures and images – Visual aids go a long way in helping people understand unfamiliar or complex concepts, and they are often more memorable. When you don’t have a visual aid on hand, try drawing a simple picture or diagram to help explain something.
- There are a number of very helpful resources located on the Proctor and Gamble website under “Patient Education;” providing patient handouts, parent’s guides, activity sheets, and visual images to assist in making dental information more understandable. The following link will take you to the patient education resources:http://www.dentalcare.com/en-US/dental-education/patient-education/patient-education-landing.aspx
- Limit the amount of information provided – Many patients feel overwhelmed by the large volumes of information they are often asked to process in a clinical encounter–and they often struggle to remember key instructions or recommendations. Focus on the main actions the patient needs to do follow through on and why, avoiding unnecessary background or supplemental information.
- Ask patients to bring their medications in with them to their appointment (the “brown bag” technique) to ensure that all medications are recorded properly.
Consider Mitzie de Quesada, the 56-year-old married woman who told you that she is taking several medications; however, she cannot seem to remember the names of her medications or to be able to tell you what she is taking the medications for.
Dentist: “Mitzie, would you please tell me the names of the medications that you’re taking?”
Patient: “I’m on so many medications that I can’t remember all their names! When my Dr. tells me to take something, I just take it.”
Dentist: “Well, can you tell me what you’re taking them for? For example, do you have high blood pressure?”
Patient: “I know that one of my pills is for high blood pressure but I can’t remember what the other ones are for.”
Dentist: “Mitzie, since we’re scheduling you to come back to the office next week, I’d like you to bring your medications with you. Just put them in a zip-lock bag or lunch bag and bring them all along. It’s important for me to know exactly what medications you’re taking and what you’re taking them for. I need to make certain that any medications we might use here in the office will not interfere with the medications that your doctor prescribes for you. It’s also important for me to know any medical conditions you have so that we can be best prepared to take good care of you while you’re here in our care.”
- Take extra care with numbers and numerical concepts – Numbers are often more confusing to patients than words, especially in context of proportions or statistics. Try to put numerical concepts in a context that patients can relate to, for instance, explain what it means when a lab result is higher or lower than the normal range.
- Use the “teach back” technique – One of the best ways to confirm that your patients understand is to ask them to repeat back what you just told them in their own words. It’s helpful to frame this as a check-in to make sure you’ve explained things well, rather than as a test of your patient’s comprehension. Start by saying something like, “I just want to make sure I explained this clearly.” If the patient doesn’t get everything right, rephrase your explanation and repeat the teach-back process until they can correctly explain the instructions in their own words. Using teach back and other methods for checking patient comprehension has been linked to improved health outcomes in patients with diabetes29 and fewer errors in patient pre-operative preparations.30 The following link will take you to the Always Use Teach-back! Training toolkit: http://www.teachbacktraining.org/ where you can view a video example of the use of the teach-back process.
Consider Wenjun Wei the 33-year-old man who has pronounced “notches” worn into the proximal surfaces of virtually all of his teeth.
When questioned, he says:
Patient: “Well, you told me to use a see-sawing motion with the dental floss for 10 seconds on each tooth.”
Dental Hygienist: “Let’s review the most effective way to floss your teeth. I’ll have you watch me floss your teeth first and then, just to make certain that I’ve explained this clearly, I’ll have you demonstrate the technique back for me.”
You might also consider giving patients written materials, such as a brochure with pictures that will serve as a visual aid in describing instructions. While printed materials can be very useful in educating patients, it is important to make certain that these materials are easy to understand and written using “plain language.”