Section 1: The Patient
“When asked where most practitioners fail in their extreme makeover cases.”
Dr. Bill Dorfman (Discus Dental; Extreme Makeover TV series) answered:
“They don’t listen to their patients …”
The Basic Rules of …..Basic Rule 1: Be Nice
Upon embarking on the journey for an oral rehabilitation the practitioner first and foremost must recognize that they will spending a considerable amount of time with their client, ie. the patient. It only makes practical sense therefore that everyone gets along with each other. It’s far easier to work with someone that we like and care for rather than in an adversarial relationship. In fact it’s imperative! One way we can build successful relationships is by being nice. Being nice means more than just smiling and telling jokes. Being nice involves developing a good relationship with our patients where mutual respect is fostered. Open communication and active listening are an integral part of this as well. The roadway of oral rehabilitation is fraught with many forks and pitfalls. A team approach which incorporates patient values as well as those of the dental personal will help smooth the ride when the road gets bumpy. Patients generally do not sue the practitioners they like.1-6
Over the years I have made my share of technical blunders. This I am not proud to state but it is a fact of my life. Nevertheless, the one smart thing that I always have done, though, is tell the truth. When it became apparent that a serious error had occurred, the patient was always informed immediately. Looking the patient in the eye and admitting that the treatment I have performed is less than ideal has always been, and still is, a humbling experience for me. Using simple words to express what has occurred and saying I’m sorry always goes miles in improving customer relations and satisfaction. Patients realize that I’m only human and their level of trust in our team skyrockets because of our honesty and the fact that we spent the time on developing a solid relationship before treatment commenced. In other words, we’re nice.
Being nice also takes advantage of the placebo effect or the “complex social interaction” that occurs between humans.7 It’s sort of like “love at first sight”. Research has shown that up to 50% of treatment efficacy for chronic pain patients is placebo related.8 Furthermore, it is known that the endogenous opioid system is activated in this process. Not only are placebo effects (the vehicle) of merit but also is an understanding of patient expectations. Through open communication and relationship building, what the patient realistically expects and the practitioner can reasonably deliver can be ascertained and leads to a nice way to practice dentistry. On the other hand, the harmful effects of an adverse patient-clinician interaction (nocebo effect), whereby negative words and attitudes of the clinician may induce negative expectations, can occur as well.9 A good example of the power of words is the fascinating study by Pollo A et al.10 In this study three separate groups of patients were created. Each group was told that they were being given a complementary medication to supplement an analgesic. All were given the same placebo (saline solution), however, each group were told they were being given something different. The first group was told they were being given a rehydrating solution, the second group that it could be a potent analgesic or a placebo, and the third group was told they were being given a potent painkiller. Group three ended up having a significant decrease in the amount of the original analgesic that was required compared to the other two groups. Therefore, placebo and expectations are another way to look at practice management and the delivery of optimal services through developing good, open, caring relationships with our patients.
As dental professionals we are caring, trustworthy individuals. Aren’t you? So being nice is easy enough for us to do. And it will definitely make our journey as smooth as possible on the road ahead.
For questions or comment: Contact me at firstname.lastname@example.org or (604)922-3465 or Skype at mikeracich1
Further Suggested Reading and References:
- Dunne M, Brown JL. Risk management in dentistry.
Curr Opin Dent. 1991;1:668-71.
- Irving AV. Twenty strategies to reduce the risk of a malpractice claim.
J Med Pract Manage. 1998;14:130-3.
- Colon VF. 10 ways to reduce medical malpractice exposure.
Physician Exec. 2002;28:16-8.
- Worthington K. Customer satisfaction in the emergency department.
Emerg Med Clin North Am. 2004;22:87-102.
- Lal S. Consent in dentistry.
Pac Health Dialog. 2003;10:102-5.
- Studdert DM, Mello MM, Gawande AA, Gandhi TK, Kachalia A, Yoon C, Puopolo AL, Brennan TA. Claims, errors, and compensation payments in medical malpractice litigation. N Engl J Med. 2006;354:2024-33.
- Stockstill JW. The placebo effect in the management of chronic myofascial pain: a review. J Am Coll Dent 1989;56:14-8.
- Benedetti F. How the doctor’s words affect the patient’s brain. Eval Health Prof 2002;25:369-86.
- Benedetti F, Lanotte M, Lopiano L, Colloca L. When words are painful: Unraveling the mechanisms of the nocebo effect. Neuroscience 2007;147:260-71.
- Pollo A, Amanzio M, Arslanian A, Casadio C, Maggi G, Benedetti F. Response expectancies in placebo analgesia and their clinical relevance. Pain 2001;93:77-84.