Contraindications
8.3.3 Non-verbal communication or body language Facial expression
One of the main functions of facial expression is to communicate emotions and attitudes, and it may be that a dentist will know a patient has no inten- tion of following advice given just by observing the patient’s facial expres- sion. The patient will also pick up the facial expression of the dentist, which may inadvertently register judgement, disapproval, disbelief, or even dislike.
This can affect communication and ultimately motivation. Conversely, facial expression can be used to enhance motivation. Something as simple as a smile helps to put patients at their ease and enhance trust. In a particularly unpleasant experiment the facial muscles of some infant monkeys and their mothers were cut and it was found that the pairs failed to develop any relationship with each other.
Eye contact
Eye contact is important because it enables both the dentist and the patient to
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collect information which can be used to guide the way the consultation is going. Students report feeling very frustrated when patients gaze out of the window while they are talking to them and will not give them eye contact.
They say ‘I’ve no idea if they are listening to me or not—I don’t know whether to go on or to stop’. When advice is being offered, ensure that the patient is seated at the same level as you are and not lying supine. If the patient continues to avoid eye contact, stop talking and wait to see what effect this has. If this fails, acknowledge that the patient does not appear to be listening and say ‘You seem uninterested in what I am saying. Is there a reason for this?’ This should bring eye contact back and provide the oppor- tunity for the patient to explain what they are finding difficult.
To know how it feels to be a patient, try lying in the dental chair, and attempt to floss or brush watching yourself in a mirror held by a colleague who is also giving you advice. All eye contact is lost and there is a sense of being ‘talked down to’ and a strong feeling of disempowerment.
Gestures and bodily movements
When emotions are aroused, pointless bodily movements are often made. For example, an anxious patient may scratch their neck or adjust their jacket or skirt. A patient unwilling to state that they have not used the fluoride mouth- wash recommended at the last visit may, for example, brush imaginary fluff from their sleeve when asked about mouthwash use.
Bodily posture
Posture can communicate as clearly as words. If the dentist is running late, and the patient in the waiting room is standing with their hands on their hips and chin thrust forward, this communicates a warning to ‘proceed with caution!’ When running late it is wise to inform the patient of the delay and apologize for it. Starting with an immediate apology will usually defuse a potentially explosive situation.
Bodily contact
Bodily contact in our culture is controlled by strict rules and is used mainly by families and courting couples. Professionals such as doctors and dentists use it, but not as a social act. In dentistry the adult patient usually accepts without question that their visit will involve touch, but it should be remem- bered that bodily contact can also help or hinder communication. A firm handshake in greeting may increase a patient’s confidence in their dentist, but not all students feel comfortable doing this or indeed think that it is always necessary or appropriate. A hand on the shoulder of an anxious patient as the dental chair is taken back may convey care for the patient and
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be reassuring to those who are anxious, but a confident patient may feel patronized or annoyed by it. Each case needs to be assessed individually.
Spatial behaviour
In most walks of life the importance of personal space is recognized and respected, apart from situations where overcrowding is accepted as normal, such as lifts and crowded public transport. Four spatial zones have been suggested:
• intimate zone 15–50 cm
• personal zone 50 cm–1.2 m
• social zone 1.2–3.6 m
• public zone 3.6 m
The personal space referred to as the ‘intimate zone’ is usually reserved for close friends, but it is automatically invaded when a dentist examines or operates. This is accepted by patients, but it is worth remembering that for some patients there maybe some embarrassment and anxiety that affects them receiving the dentist’s communication in this ‘intimate zone’. Just because it is culturally acceptable, it should not be taken to be without meaning for the patient.4When giving advice to a patient it is a good idea to return the dental chair to the upright position, ensure that eye contact is on the same level and move away from the patient to a position where communication is comfortable for both parties.
Clothes and appearance
Clothes and appearance communicate information. For example, a white coat may communicate one thing to a patient whereas a blue or green coat may communicate something different. One study showed that children’s heart rates increased by 10 beats per minute when a dentist put on a white coat.5 Badges too communicate information. The paediatric dentist who wears a teddy bear badge is communicating a message to a child patient and to the parent.
The style and décor of the surgery and waiting room also communicate a message to patients. Dental students who were asked to rate the skill and competence of several hypothetical dentists by looking at photographs of old fashioned, modern, and ultra-modern surgeries, inferred that a dentist with an ultra-modern surgery would be more trustworthy, more skilful, and more competent. Something as simple as plants, lighting, types and states of mag- azines all communicate, albeit at a subconscious level. One patient, when asked what she thought of the dentist’s waiting room, pointed to the posters on the walls displaying pictures of bad gums and teeth and said ‘Tell the dentist to take those home and put them on his sitting room wall and bring us in the pictures he’s got hanging there instead’.
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8 . 4 F A C T O R S T H A T E N H A N C E L E A R N I N G
Once patients have received information it is important that they remember it. Here are some specific suggestions to help patients remember advice.