Spring 2018

Using Ears to Mend a Mouth

Lesson one, as new dentists learn communication skills? Listen well.

By Monica Jimenez

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Illustration: Beppe Giacobbe

When Joseph Dudlek, D21, sat down to take his first medical history, he was nervous. “You think to yourself ‘OK, I know how to hold a conversation; I can do this,’ ” Dudlek recalled. “But when you’re sitting in front of the person and you’re going to learn information about their personal life and medical history, it becomes a little more complex.”

Facing a difficult interview—the man Dudlek was speaking with was self-conscious about a partial denture and flatly refused to talk about one part of his medical history—Dudlek put into action what he’d learned in the course Introduction to the Dental Patient (IDP) I. He maintained eye contact; nodded to show he was actively listening; and asked open-ended questions. By the end of the conversation, the man had opened up—and even brought up that topic he’d refused to discuss.

Although the man wasn’t an actual patient—the interview was assigned as part of the IDP course—the lesson Dudlek took away was real. “Patient interviewing is just as important as any training we receive,” he said.

That’s exactly the point of IDP I and IDP II, two full-year courses created three years ago as part of a larger initiative to bring communications and patient care to the heart of students’ practice, according to Ellen Patterson, director of interprofessional education, who leads the initiative with Y. Natalie Jeong, assistant professor of periodontology. “You can do the best restoration in the world, but if you’re not perceived as empathetic or you’re not listening and attending to people’s values and needs, you’re not going to get very far with the patient,” Patterson said. “How do we bring student dentists to the place where they actually see this as part of their professional role and something they feel confident doing?”

One obstacle is implicit bias, the unconscious stereotypes or attitudes that can affect all people’s actions and decisions and lead to disparities in care. To address this, IDP I and II expose students to a diverse patient population, help students recognize their own reactions and judgments, and give them tools for successful interaction. “By raising awareness of cultural competency,” Jeong said, “we equip students to deliver high-quality care to all patients.”

Jonathan Garlick, a professor and oral pathologist at the dental school helped develop a series of small group conversations that bring IDP students together for guided dialogues about sensitive topics in dentist-patient communications. “It gives students the opportunity to process what they think and feel in a safe environment,” said Garlick, who is also a Senior Fellow at the Tisch College for Civic Life and who has developed an award-winning Civic Science initiative.

Feedback after one such dialogue about implicit bias in patient care revealed new student understanding about how to be more open minded to different ways of life and more aware of biases that affect patient care to find ways to combat it, Garlick added.

IDP student Morgan Johnson, D21, said he has learned to look not just at patients’ mouths, but at their lives as a whole. He recalled shadowing a dentist who took the time to have a thorough conversation with a patient suffering from a sore jaw, instead of immediately prescribing medication. “They went through what the patient does before she goes to bed and realized she always reads the news on her computer, causing her anxiety. She would wake up after clenching her jaw all night,” Johnson said. “So the doctor had her meditate and relax before going to bed to resolve the issue.”

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