Listen

There are many courses set out to improve the way we communicate and speak to patients in an effort to improve rapport, heighten treatment acceptance and deal with anxiety. However these teach you the skills to use your mouth and body to get a message across to others. There doesn't seem to be enough emphasis on "listening skills". I've seen it in my reading, day to day life and practice that listening is the most important skill we can have as a health professional. This is because diagnosis is the first "medical thing" we do and we can't get a good diagnosis without good rapport and we can't get good rapport if we don't listen to the patient. Listening to the patient will almost always determine your treatment plan, affect patient motivations and improve rapport even without looking in their mouth.

Too often health professionals have the habit of cutting patients off early and asking closed ended questions that require short sharp answers. e.g Where does it hurt? is it to hot things? cold things? how long does it last? does it hurt to chew? Instead we NEED to use the power of silence. Listen to the patient and show them the respect of your attention. Tips I have found to be useful are:
-Look them in the eye. If you are behind them or putting on a mask and gloves or typing notes then you can't give them your full attention. and you can't listen to your full potential
-Resist the urge to cut them off. Ask them an open ended question at the start like: "What can I do for you today?" "What brings you in today?" Then shut up. Some patients will respond with a verbal essay, some will just list a problem. When they finish talking just stay silent. 15 seconds is an extremely long time to be in silence with eye contact and in most cases they will continue to speak before then and give you further information that you need to construct a treatment plan. One thing I remarked to my dental assistant the other day was that anxious patients chronic patients (who long to rant on and on..) seem to get along with me really well. To be honest they're not the clientele that I want to attract but honestly they are the most rewarding patients to establish a rapport. They are the ones that have been silenced by health professionals who only want to get on with their day. When they find someone who will let them speak and who is interested in what they say they will love you for it.
-Reflective listening: Repeat what they say and feign ignorance. "So let me just summarise, based on what you have said to me, and correct me if I am wrong. I am assuming your problems/goals/aims are.." People love to correct other people. They will either correct you and give you more information or agree with you and think you are a genius.
-Guide the conversation. A problem list is not a treatment plan. A goals list is. We should attempt to move our treatment plans towards figuring out where the patient wants to end up not what they need first. If we don't start with the end in mind we can't figure out what the first step is. A patient who "has a sore tooth" "wants fillings" or wants "braces" isn't giving you their goals. They're giving you a problems list or a treatment list. If they do that then feel free to correct them: "I understand that you have these issues or are seeking this treatment but why are you doing this? What do you want to achieve?" Goals will sound something like "I want to stop my teeth from getting worse" "I want to smile again" "I don't want to spend too much time/money on my teeth". These will guide your treatment plans towards their end goal. The hard part is figuring out how to achieve that goal.
-Acknowledge their fears, anxieties and move forward: A few years into practice, if you look into patients eyes and study their body language from the moment you meet them you will learn to pick the anxious ones from the rest. Averted gaze, rigid, closed body language, wide eyes, and hesitation/retraction are key signs. Acknowledge their anxiousness. I say "you don't look keen to be here" or "you look anxious". Roll with the punches and wait for the inevitable "I hate dentists". Use this as a springboard to assure them that anxiety is normal in their situation and you will do your best to diagnose and explain their condition and employ strategies to manage their anxiety. You need their trust to succeed.
-Give them time to process bad news. You can't make negative news better with more information. Bad things happen in life to everyone and if you have negative news to deliver, allow them the respect of silence and give them the time to process the news. If the outlook is poor but not hopeless feel free to try and bring up some positive points to balance out the negatives (if there are any)  but if their prognosis is hopeless then let them go through their own process of acceptance and only continue the conversation when they are ready to continue.

Communications skills are essential in our line of work but what separates the good communicators from the great ones is how they take in what other parties are saying and process the information. The simple act of listening can win over many difficult patients and allow us to discover their true needs.