COMMUNICATION SKILLS IN THE DENTAL PRACTICE: A REVIEW
individual, to enable the patient to understand what is the forthcoming treatment and whether / how it will change the quality of his life. This kind of approach strengthens the relationship between doctor and patient and makes the patient trust the doctor and strictly follow the recommended treatment. 4 A major role in understanding the information presented to the patient is the way in which communication is carried out. According to some authors, 65 % of information is transmitted nonverbally and only 35 % verbally. 5 It has been shown that when those two methods of communication complement each other, the information given can be accepted as a complete message. To be successful, the dentist should be familiar with the various methods and techniques of communication, because it is a part of good medical and dental practice. Ethics describes the different models of behavior between doctor- patient. The most popular and implemented ones are:- Paternalistic model;- Autonomous model;- Partnership model. In the paternalistic model the doctor chooses the treatment based on his medical experience and knowledge, provides information to the patient, so that he is able to conduct his therapy. This type of treatment is based on medical evidence. The responsibility for the decisions lies with the doctor. The autonomous model is based on obtaining an informed consent. The information is also transmitted by the physician to the patient, but it contains details that are important for the treatment from the patient ´ s point of view. So, after being fully informed, the patient understands the information and is involved in the decision to conduct the therapy. In a partnership model, the information flows in both directions. Making a decision is being influenced by: important medical details; the value system of the patient; his lifestyle and his needs; his everyday life. All aspects of the treatment are discussed with the patient and he participates in the medical decision-making process, bearing part of the responsibility. Initially the model of partnership was introduced in the treatment of chronic diseases and of diseases with different alternatives for treatment, all evidence-based. 6 The goal is that both individuals become actively involved in the decision-making process, based not only on medical information, but also tailored to the individual characteristics of the patient. The roles of the doctor and the patient in the partnership model are determined by their mutual work and the parity of both parties. In the English literature, this is called“ equipoise” 7 or“ balanced solution”. On the one hand, this balance relates to the different but equal treatments of a disease. On the other hand, equipoise means that the physician and the patient have the same influence on the medical decision-making process. 8 Knowing the different patterns of behavior, dentists can choose the most suitable method of communication with the patient, which affects the quality of service. The quality of the health service depends on how well it meets the individual needs of the patient. In the complex system of modern health insurance the best way to achieve high-quality care is to use a patient-centered approach. This includes respect for the dignity and uniqueness of the individual, based on the ethical and moral standards of health care. 9 Thus the patient is granted his right to receive quality health care. 3 There is evidence that if patients take an active role in their own health care, this leads to more accurate decisions, improved treatment outcomes, higher patient and physician satisfaction and more efficient use of resources in the health care system. 10 Harter suggests a sequence of steps for the patients’ involvement in the process of making decisions regarding subsequent health care. 6 With this approach of including the patient in the decision-making process, conversation has a strictly defined structure and elements: 1. Informing the patient about the necessity of decision-making; 2. Show equivalence in conversation; 3. Inform about the different choices; 4. Consider the patient’ s expectations and questions, understanding the problem; 5. Define the patient ´ s desires; 6. Discuss the variety of options; 7. Carry out a decision; 8. Define ways to implement the decision. In the dental practice the dentist should comprehend and use the art of communication in order to implement these steps successfully. The results of a study conducted by Gerbert show that, according to the patients, the most important skills of the ideal dentist are: professional competence- 86 %; 71 % are for the use of universal precautions; 63 % stress the continuous training of the physician; 54 % want painless treatment; 47 % expect the dentist to soothe the patient and 47 %- to be polite with the patient, 11 i. e. the majority of the responses are related to the ability of dentists to communicate properly. The above-mentioned issue is the topic of a survey by Sahm, Bartsch and Witt at University“ Julius Magnus” in Würzburg, Germany. The first study showed that 42 % of those treated are anxious to speak about personal subjects, while this desire decreases with the increasing age of the patients. 12 Witt and Bartsch expanded the study in 1993, using video equipment, followed by questioning the patients to examine the impact of the information and communication during the initial orthodontic conversation. The conclusion was that due to the use of multiple medical terms, patients understood only a third of the information. The authors assume that the amount of information that patients have understood is related to the satisfaction with the
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