The Dentists Insurance Company’s Risk Management Advice Line analysts speak with dentists daily who need help dealing with conflict. Whether they are concerned about having a difficult conversation with a problematic employee or discussing treatment options with a noncompliant patient, dentists frequently face situations that require thoughtful communication.
When dentists speak to Risk Management analysts, there is often just one thing needed to prevent or mitigate risks: effective communication. Positive communication is a vital skill for any member of the practice team and should be included in team training. Studies show that clear communication is associated with better treatment outcomes, increases patient satisfaction, builds trust and decreases the level of patients’ complaints. Within the workplace, 86% of employees and their employers cite the lack of effective communication as the main cause for workplace failures, while an environment that fosters positive communication increases employee retention by 4.5 times the average rate.
Advice Line analysts point out that a breakdown in communication is often the underlying factor in negative online reviews, lawsuits or complaints to the dental board and third-party payers.
One important factor leading to a breakdown in communication is emotion. Negative emotions channeled into negative outcomes directly relate to the communication climate between patient and provider. For example, analysts note that during Advice Line calls, dentists often express the feeling that patient complaints are simply an attempt to avoid payment for their services. Negative emotions based on this assumption may cause the dentist to fail to investigate if there are legitimate reasons why the patient is unhappy. The patient making the complaint in consequence feels unheard and increasingly dissatisfied, building upon the negative emotions and further breaking down the communication.
A case study on the importance of positive communication
A minor patient developed an abscess on tooth No. 7 while undergoing orthodontic treatment. The orthodontist’s office received an unpleasant phone call from the patient’s mother who requested to speak with the dentist. She reported that her child was complaining of discomfort on a front tooth and their general dentist had provided them with a referral to an endodontist to determine the source of his symptoms. The patient’s mother believed the abscess resulted from tooth movement during the orthodontic treatment and demanded a copy of the patient’s records, including radiographs and models.
In looking at the pretreatment radiographs taken two years prior, the insured noted evidence of a slight periapical radiolucency on No. 7. Given this finding, the orthodontist said they would have referred the patient to an endodontist then for further evaluation. The orthodontist was uncertain whether the extent of the treatment or the treatment outcome had been impacted by the delayed referral and diagnosis. Concerned about how to communicate this finding with the mother, the orthodontist reached out to TDIC’s Risk Management Advice Line for guidance.
The Risk Management analyst advised the dentist of the importance of reviewing pretreatment records prior to initiating any treatment and to establish protocols for conducting a comprehensive assessment of the pretreatment records gathered while developing a treatment plan. The analyst also advised the insured to return the mother’s phone call without any further delay and explain his findings in a transparent manner. The dentist was also advised to seek permission from the patient’s mother to speak with the endodontist to determine whether the prognosis would have been different had the issue been caught two years earlier when it first appeared on the radiographs.
The analyst offered the dentist de-escalation tips and reiterated the importance of listening and remaining empathetic. She also alerted the dentist that the mother could potentially interpret any minimization of the patient’s symptoms or necessary treatment as being dismissive of her concerns about the prognosis for her son’s tooth.
A few days later, the Advice Line received a follow-up phone call from the dentist, reporting that the guidance he had received from the analyst was helpful and the conversation with the patient’s mother went much better than he anticipated. The dentist explained to the patient’s mother that he had reached out to the endodontist and the endodontist confirmed that there were no changes in the prognosis or the extent of treatment needed despite the timing of diagnosing the radiolucency. The mother seemed to be receptive of the explanation the insured provided to her and was reassured that the overall prognosis for tooth No. 7 was favorable.
The benefits of understanding communication climates
Communication and behavior experts categorize interactions in terms of climate. A confirming communication climate is one in which the receiver gets a sense of their value and worth from the messenger. Conversely, a disconfirming communication climate suggests to the receiver that they are devalued and unimportant. Disconfirming climates lead to negative behavior patterns that impede communication, such as defensiveness, embarrassment and conflict, while confirming climates lead to positive behavior patterns that support effective communication, such as honesty, appreciation and collaboration.
Defensive communication behaviors are particularly important to avoid, because as one individual becomes more defensive in a conversation, they become less able to accurately perceive the other individual’s messages. Both sent and received messages then become distorted. The opposite is also true: defense-reducing or supportive behavior fostered by a confirming climate lead to fewer distorted messages in a conversation. The resulting communication is clearer and more effective, supporting more teamwork and less conflict.
An environment in which patients feel safe, understood and willing to cooperate is one where both provider and patient can benefit. The same standard is true for interactions with dental practice owners and staff members. Learning and adopting confirming communication strategies is one of the best tools you have for reducing risk.
Creating a confirming communication climate
In 1961, communications researcher Jack Gibbs identified six patterns of behavior that create confirming communication climates. These remain the gold standard for developing positive communication skills that de-escalate conflict and foster feelings of support and cooperation. Below are examples from TDIC experts that apply to interactions within a dental practice.
- Describe a behavior instead of evaluating it. A description provides detail about the person’s behaviors without passing judgement.
- Disconfirming statement: “It’s rude for you to arrive late to your appointments.”
- Confirming statement: “I’ve noticed that it’s been difficult for you to make it to your appointments.”
- Problem Orientation. Focus on the problem you are trying to solve, separating it from the person with whom you are communicating. Rather than exerting control over the other person, problem-oriented behaviors focus on finding solutions that satisfy both parties’ needs.
- Disconfirming statement: “You should floss every day.”
- Confirming statement: “Let’s talk about some ways that we could make it easier for you to remember to floss each day.”
- Spontaneity. In terms of confirming communication, Gibbs defines spontaneity as honesty or transparency. Instead of hiding an agenda, the communicator is simply honest rather than manipulative.
- Disconfirming statement: “What are you doing on your day off?”
- Confirming statement: “Next Friday, we need extra staff members on hand to finish purging paper charts. You could earn overtime pay if you are able to come in to help.”
- This is the action of responding to another person’s feelings by trying to understand the situation from their perspective. Being empathetic demonstrates that you value another’s opinions even if you don’t agree with them.
- Disconfirming statement: “This crown just needs to be replaced. It’s not a big deal.”
- Confirming statement: “I understand why you are angry and afraid. You didn’t expect to find out today that your crown would need to be replaced.”
- Messages of equality demonstrate that the person you are communicating with has value and worth, regardless of their amount of knowledge or expertise in a particular area. Try not to treat them differently because of age, gender, education or socioeconomic status.
- Disconfirming statement: “Since you haven’t been to dental school, you aren’t qualified to determine the best treatment.”
- Confirming statement: “I’d like to hear what you think about this. I want to make sure we find a solution that makes us both comfortable.”
- Provisionalism is being flexible and allowing for other points of view. Behaviors that demonstrate another’s opinions matter just as much as your own include letting others speak without interruption and encouraging others to contribute to the conversation.
- Disconfirming statement: “Postponing treatment is out of the question.”
- Confirming statement: “From my perspective, addressing this tooth sooner rather than later will result in a better outcome.”
A note on nonverbal communication
Verbal interactions are at the forefront of the conversation when communication is discussed. Do not forget that nonverbal behaviors are included in communication. Voice inflections, facial expressions and hand gestures can signal additional meaning to spoken phrases. Sarcasm, for instance, is often conveyed through a specific tone of voice. Nodding your head while listening is a nonverbal acknowledgement of the speaker. Ensure that your nonverbal cues sustain the confirming climate that you are working to create through your verbal statements.
It is also important to be mindful of patients who may require additional communication, such as patients with vision or hearing impairment, patients with a learning disability, patients who do not speak English or patients with psychological issues (anxiety or phobia). Be prepared to utilize technology, interpretation or a patient advocate to enhance communication and understanding between provider and patient.
Practicing these positive communication behaviors are the key to creating a confirming climate in your dental practice. While it can be especially difficult to remove your own emotions from a situation — particularly with a difficult patient — doing so is the first step toward confirming communication. This will help de-escalate and minimize conflict, ensuring that patients and employees are willing to communicate and work with you to create practical solutions to problems. While not all difficulties are easily or quickly resolved, your efforts to maintain positive, supportive communication behaviors can minimize the stress of a situation and improve outcomes.
Being entirely objective is not easy! TDIC’s Risk Management experts are available to assist you and draw upon their experience and communication strategies to optimize positive outcomes. If you find you need additional support or suggestions for creating a confirming communication climate in your practice, TDIC’s Risk Management Advice Line analysts can be a source of practical tips and suggestions for implementing new techniques and skills.
TDIC’s Risk Management Advice Line is a benefit of CDA membership. Schedule a consultation with an experienced risk management analyst or call1.877.269.8844. Reprinted with permission from the California Dental Association, copyright May 2023.