Communication Components of empathy - the ability to discriminate an emotional state in another person - the capacity to assume the perspective

of that person - the ability to regulate ones emotions - a level of self/other awareness Empathy multidimensional construct bottom up: automatic or unconscious affective process that allow us to recognise anothers emotional state top down: is the conscious cognitive process that enables us to not only explain and predict our own and others behaviour Benefits of empathy in patient-centred care Helps the patient to feel safe to discuss difficult matters Provides a meaningful experience where the patient is facilitated in expressing themselves Helps the patient matintain an active role in their treatment paln Enhances dentist-patient relationship Improves patient outcomes

4 models of patient dentist interaction 1. Consensus: patient being exempted from social roles, work, duties but the access to the sick role requires a gatekeeper, suited to acute rather than chronic forms of dentistry 2. Mutual dependence: a. Activity-passivity: related to patients who cannot participtate(unconscious or incapable) b. Guidance-co-operation: related to forms of acute illness c. Mutual participation: forms of chronic illness 3. Conflict: within DP interaction degree of conflict assumption: dentist always active and patient always passive, divergence in cultural background of the dentist and patient 4. Conflict and control a. Paternalistic (high dentist- low patient control) b. Mutualistic (diminishing conflict by apportioning equal control) c. Consumerist (patient as client or consumer) d. Default (dentist or patient take little control) neither meets each others expectation The setting Facilitate or inhibit the open transmission of information Privacy Comfort Sufficient time

Sharing information in dentistry Eliciting information from patients to diagnose the condition and understand them

Providing patients with information such as diagnoses, prognoses, prescriptions and treatment recommendations Helps establish a positibe relationship Broader aim is to understand patient more holistically: personality, life experiences, assets and liabilities, reactions to illness

Transactional analysis(BERNE) how people behave Analytical thinking process provides insight and control over actions and reactions 3 EGO: parent, adult, child o Own way of communicating and behaving o Shift from one to another at a subconscious level o Not roles but psychological realities o Activated by our emotions Parent mode o In youth we are conditioned by our parents o Hidden and overt recorded playback o Parent is our taught concept of life o Our parent is formed by external events and influences upon us as we through early childhood o Nurturing: (toothbrushing) Caring & regard: do you want help with the job? If you do let me know Help is given from a one-up position: here Ill help you, takes the work from the persons hand and finishes it himself o Controlling: Protecting: stop smoking it is bad for you Put down: youve made a mistake again Child mode o Our responses to the parental behavior develop our child o See, hearing, feeling, emotional body of data within each of us o When anger and despair dominate reason the child is in control o Child is the felt concept in life o Free child (fun loving and carefree) Free to express pent up emotions/pay no attention to parental rules or limits Belch at a dinner party or drive recklessly o Adapted child ( sulky and withdrawn) Productive ways of behaving eg look left/right before crossing a road Replay childhood patterns of behavior that are no longer appropriate for our grown up situations eg sulking Adult mode o Our adult is our ability to think and determine action for ourselves based on received date o Change parent or child must do it through adult o Adult grown up rational person who talks reasonably, neither trying to control or react o Ideal self thought concept of life Voice: steady, firm, clear, volume & pace Facial expression: congruent with words Eye contact: positive but not staring

Body language: open and relaxed

Interviewing techniques / Oral health instruction Open ended questions Silence Facilitation Confrontation Directed or closed questions

Strategies for giving information / Oral health instruction Instructions should be o Simplify the information o Brief/specific o Jargon free o Use repetition o Stress importance of compliance o Primary effect +7 / -2: number of objects/chunks an average human can hold in the working memory

Compliance: extent to which the patients behavior coincides with the medical or health advice Factors associated with non-compliance Social characteristics o Individuals social situation o Lack of social support o Family instability or disharmony o Patients expectations and attitude towards treatment o Residential instability o Environment that supports non adherent behavior o Conflicting demands Personal characteristics o Demographics o Sensory disability o Type and severity of psychiatric disorder o Forgetfulness o Lack of understanding Health beliefs o Inappropriate or conflicting health belief o Competing socio-cultural and ethnic folk concepts of disease and treatment o Implicit model of illness

Treatment factors associated with non-compliance Preparation for treatment Characteristics of treatment setting

Long waiting time Time between referral and appointment Timing of referral absence of individual appointment times lack of cohesiveness of treatment delivery system poor reputation of treatment facility inconvenience associated with the operation of clinics

Immediate character of treatment treatment recommendations complexity of treatment regimen duration of treatment degree of behavioural change inconvenience expense characteristic of medicine inadequeate labels awkward container design

Consequence of treatment medication side effects fear of side effects fear of dependency fear of reduced effectiveness do not fit in with life style sign of weakness do not fit with health belief social side effects

Understanding(definitions of illness, location of organs, casuality and seriousness) Memory (influenced by anxiety, knowledge, intellectual level, importance of statement, primacy effect, not related to age, recalling information after the consultation may be related to compliance) lead to satisfaction and eventually compliance

Compliance affective aspect: emotional support behavioural aspect: prescribing, adequate explanation competence: appropriate diagnosis and referral content of the consultation: information even bad news

Communication affiliative style o good eye contact

o o o o o o Chronic pain -

smiles leans towards patient(show interest and consideration) information technical competence dentist job satisfaction and adherence dentist view of the patient

Any pain resulting from non malignant causes that is not alleviated by appropriate medical, pharmacotherapy or surgical treatment Behavioural and psychological factors play an important role in the development and maintenance of chronic pain

Pain Unpleasant sensory and emotional experience associated with actual or potential tissue damage Subjective Personal experience that encompasses both sensory(pulling, burning, aching) and emotional(anxiety and depression) qualities Intensity or aversiveness of the pain experienced is not necessarily related to the severity of tissue damage

Verbal pain behaviours Moaning Complaints of pain Yelling Sighing

Non-verbal pain behaviours Taking analgesic medication Guarded movement Grimacing Absence from work

Assessment of chronic pain behavioural interview psychological assessment measures self-monitored behavioural observations diary direct observation of overt motor behaiours psycho-physiological measurements

Behavioural interview How the patient spends their time during the day What activities the patient has performed more or less since the onset of pain Whether any activities have been eliminated since the onset of pain

The degree to which the patient is experiencing depression or other psychological disturbances If any relative or friend or family suffer from chronic pain

McGill Pain Questinnaire Evaluate sensory, affective, intensity, dimension of pain 20 categories Ranked order of pain intensity First 11 scales sensory o 2: jumping, flashing, shooting o 7: hot, burning, scalding, searing o 9: dull, sore, hurting, aching, heavy o 11: tiring, exhausting 12-15 affect o 13: fearful, frightful, terrifying 16 intensity o Annoying, troublesome, miserable, intense, unbearable 17-20 miscellaneous pain dimensions o 18: tight, numb, drawing, squeezing, tearing o 19: cool, cold, freezing