Editorial

Dentistry being a part of health care profession bears the responsibility of creating and nurturing good dentist-patient relationships. The doctor-patient relationships are essential component of any health care profession especially so with dentistry. Dental patients visit oral health professionals with a variety of oral health problems which hinders their quality of life. Seeking oral health services from a dentist or an oral health care professional is in most instances a necessity created by emergency dental problems which need immediate care. In other instances, especially in the recent information era where patients are highly informed, patients seek oral health services for both preventive and restorative care other than emergency dental problems.

With the rise in consumerism in dentistry, patients look for a dentist who is more patient-centered, person-focused rather than a doctor who exhibits characteristics of high physician control type. A dentist who adopts the style of ‘person-focused' will be more patient centric and hence more approachable [1]. The person-focused style of a physician requires the dentist to embrace good communication and empathy skills. The necessary requirement of developing good communication skills is not yet realized in dental teaching curricula in many dental schools especially in developing countries such as India. The learning and teaching atmosphere of dental schools should incorporate training dental students in the area of communication with patients. Communication with patients does not limit its scope to information exchange rather extends to include creating, nurturing and sustaining the doctor-patient relationship through the entire process of establishing cognitive connection with patients, drawing diagnosis, planning and consensus on treatment options, and especially on patient compliance with the treatment plan. Communication process is the entire cycle of passing the message by a sender to a receiver and it is understood to be complete only when the sender receives the feedback from the receiver. The feedback process ensures the passage of message to the receiver. Patient compliance with the treatment plan agreed upon by both dentist and the patient is an indication of this ‘feedback' component of the communication process. Hence feedback, which is most commonly neglected in our exchange with patients, is a good indicator of our success of establishing a relationship.

This process of communication requires the underlying concept of empathy. Empathy can be described as an ability to imagine what life is like for another person. Without empathy, our communication with others will be one sided and we will be bound to face problems in relationships as we will be indifferent to emotions of others [2]. It is imperative that a dentist as an oral health physician has the skills of empathy for effective communication with patients. This aspect of understanding patients' feelings brings to picture the concept of dignity conserving care as proposed by Harvey Max Chochinov [3]. It is also known as whole person care or psychosocial care. The intimate connection between care provider's affirmation and patient's self-perception, underscores the basis of dignity conserving care [3]. A dentist with empathy skills knows how his or her patient feels and is willing to provide emotional support. When the patient says, “I feel lousy because my friends ridicule me for my bad breathe or crooked teeth” and the dentist is able to respond by saying, “Well, I understand how you feel. Let us work together about what's wrong with your teeth and we will come to a treatment which may best suit you”. This kind of reply from a dentist immediately will induce a sense of togetherness in patients. Empathy also helps in showing dignity and conserving the personhood of the patient.

Another important aspect of dentist-patient relationship is involving the patient in the process of diagnosing the problem. Throughout the process of interview with patient, the orientation of the dentist should be patient-focused. A patient-focused dentist will be open to a broader health care agenda with the patient and explores other possible issues. Such a dentist explores biological as well as social and psychological issues during clinical information gathering. The dentist who can connect with a patient on a personal level is more friendly and personable. This will help the patient to share control of the interaction and dentist will be able to negotiate options with the patient [1]. Scambler and Asimakopoulou proposed a model for Patient Centered Care, wherein Shared Decision Making is a fundamental aspect [4].

Dentists should encourage patients to participate in decisions and check their willingness and ability to follow the treatment plan. Wherever necessary dentist should provide resources and support for the patients. Involving the patient in decision making towards planning a treatment for his/her oral health problem places responsibility on the patient equally and helps increase compliance. This essentially nurtures the relationship and also helps build a culture of kindness in the dental hospital set up [5].

An effective communication provides benefits both for patients and dentists [6]. Benefits for patients are mainly patient satisfaction and compliance. Higher levels of patient satisfaction and compliance are seen to be associated with physician's nonverbal communication behaviors such as distance between the doctor and patient, forward lean and body orientation. Dental schools should incorporate teaching and training dental students in these areas of effective communication including verbal and nonverbal forms. Effective communication with positive talk and information giving will increase patient compliance. Patient centred communication is shown to increase positive patient perception that is required for better recovery from discomfort and better emotional health [7]. Such an approach also benefits dentists by creating higher work satisfaction and less frustration in daily work. Higher patient satisfaction also reduces the chances of malpractice claims. Communication gap is the most important factor in patient dissatisfaction which is a critical factor influencing patient complaints. Therefore it is always beneficial to use effective communication skills with empathy.

It is imperative for dentistry to embrace the skills of effective communication, empathy and interpersonal relationship by training dental students in these areas. It is also the responsibility of dental teachers in dental teaching institutions to inculcate these characteristic skills and be the role models for future dentists.