Cultural Competency Flashcards
(79 cards)
1
Q
You treat pts not
A
teeth
2
Q
Teeth do not walk into you office
A
Patients do
3
Q
___________ is the most important tool in dentistry
A
Communication
4
Q
Benefits of a good relationship with pt
A
More likely to follow our recommendations, pay bills on time, refer others to your practice, reduces anxiety, less likely to sue
5
Q
Don’t we know how to communicate?
A
Matter of how effective we are
Dentists consider communication 1 of 3 most important factors in delivery of care
About 1/2 of all dentists feel they received only fair or poor training in dental school
6
Q
Dental school
A
- Often human behavior and motivational techniques not taught in dental school
- Often taught that simply providing info is enough to change pts behavior (not true and need to motivate pt)
7
Q
Communication and Litigation
A
68-70% of medical litigation cases cited communication as the primary cause
8
Q
Outcomes of good communication
A
Build trust, reduce anxiety, increase pt satisfaction (increase your satisfaction), better pt assessment (better treatment plan and dental care)
9
Q
Non-verbal communication
A
Perception, Vocal, Nonverbal perception
10
Q
Perception
A
What’s perceived, not necessarily what transpired.
Delivery - how words are spoken (vocal quality, tone, pitch, emphasis, vol, pause, inflection)
Emotion - perception of compassion and empathy
Body language - Stance, posture, gesture, use of space
11
Q
Vocal/Hearing
A
Pitch, rate, pause, emphasis, inflection.
Americans least favorite mode
12
Q
Nonverbal perception
A
Facial/emotional - eye contact and smile
13
Q
Smile
A
Fake (“social”) smile vs genuine (“Duchenne”)
Genuine involves the eye muscles
Men not as good distinguishing the two
14
Q
Facial Feedback Hypothesis
A
Feedback, from the facial muscles to the brain plays a key role in determining the nature and intensity of emotions that we experience
15
Q
Unconscious personal habits
A
Vocal/healing
Facial/emotional
Kinetic/body language
16
Q
Vocal/healing
A
DON’T DO THESE
- uh
- you know
- right? ok?
- Clearing throat
- Monotone
17
Q
Facial/emotional
A
Eyebrows Fiddling with - glasses - hair - beard - earrings
18
Q
Kinetic/body language
A
Spinning the pen/pencil foot tapping thing fingernails - tapping rocking hand gestures
19
Q
What do I do with my hands?
A
Folded, behind back, akimbo, and fig leaf
20
Q
The greeting
A
Hello - short pause.
I’m ________ - offer hand for shake/elbow bump/really nice smile
Weight balanced on both feet
Eye contact
21
Q
Nonverbal
A
Appropriate space - arm’s length
Eye contact
Eye level
smile
22
Q
Roadblocks to good listening
A
Office distractions
Beware of bias
23
Q
Beware of bias
A
- Listen with an open mind
- Look for shakes of grey
- FOCUS - don’t not get distracted
24
Q
Office distractions
A
- Multi-tasking
- Reviewing chart
- Staff interruptions
25
Nonverbal that promote conversations: the dentist
Same eye level, lean slightly forward, don't cross arms
26
Verbal communication
Open-ended questions
Use Mr. Mrs. or Ms. unless they ask you to do others
Don't rush
Give the pt a chance to talk
Anything that you would do differently in photo?
27
Verbal that inhibit conversation
Rushing to diagnose - let the pt be a part in the decision making
Asking closed-ended questions
28
Negative dentist attitudes
Arrogance, sarcasm, high pressure marketing - most pt can tell when this is happening, don't push tx
29
As an educator
```
Dont just lecture - "I know you are going to yell at me - do I look like someone who would yell?"
Find out what they already
Then fill in missing info
Use memorable sound "bites"
NEVER use jargon
Keep it brief
Check pts/parents understanding
```
30
Know the person
What they like, what they do in life, just like getting to know a neighbor
31
Be respectful
Never assume you know what's best for the pt (composite vs amalgam)
Find out what their preferences are
32
Be accommodating
Make sure the pt is comfortable
| Be flexible to ensure pt acceptance
33
Know pts feelings toward dental care
Always ask about previous dental experiences
- what they liked, what they didn't
- how can you make this visit comfortable for them?
34
Being seen
Talk at eye level
Acknowledge facial and body expressions
Eliminate physical barriers
35
Being Heard
```
Use pts language
- don't use medical/dental jargon
Give feedback
Ask for feedback
Invite pt to tell their story
- listen for feelings, values, and thoughts
```
36
Being accepted
Avoid scolding or judging
| - if you must judge, judge the behavior, not the person
37
Careful what you say!
ADA surveyed malpractice claims
Critical comments made by dentists to pt about another dentists work are among the most common factors contributing to malpractice allegations
38
Establish a starting routine (helps with anxiety)
Small talk, tell them where they can put their personal belongings, seat them in the pt chair
39
The introduction ("need and greet")
```
Introduce yourself
Call you pt by name (Mr. Mrs)
Smile
Make eye contact
Sit at eye level
Don't turn away, swivel in chair, lean in doorway, etc.
Actively listen and don't interrupt
```
40
Pt visits
66% don't see DDS regularly
| - higher among - certain ethnic groups, low-income groups, less educated
41
Why do ppl avoid the dentist?
```
Fear
- #1 reason
- unknown
- known
High cost
- lack insurance
Lack of providers in some areas
```
42
Strongest predictors of dental anxiety (in order)
Attitude towards dentists
Check-up frequency (more frequent - less anxiety)
Satisfaction with mouth
Avg # filled surfaces (more fillings = less anxiety)
Gender (Females > males)
Annual income
43
Anxiety
A nervous disorder characterized by a state of excessive uneasiness and apprehension typically with compulsive behavior or panic attacks
44
Reasons for dental anxiety
"the injection"
- painful injection
- not getting numb
- the fact of being numb
- needle phobia
45
Reasons for dental anxiety
sights, sounds, smells (alcohol, cloves, fear)
46
Reasons for dental anxiety
Choking - afraid of swallowing instruments or other harmful substance
Gagging
suction
47
Reasons for dental anxiety
Painful - dentist is there to hurt them
Embarrassment - my teeth can't be saved, scared of "lecture", being judged
Parents - bad experience in younger yrs, influence kids, kids will follow by example
Money - high cost, what is he/she gives me the wrong treatment? Don't high pressure them
48
Initial contact questions
How long since your last dental visit.
What kind of past tx? How was it? How did it feel?
Do you have any concerns about receiving dental tx? - opens the door for pt to talk freely
49
Behavioral signs
```
Fidgeting with hands or objects
Sitting on edge of chair leaning forward
Rapidly thumbing through magazines
Pacing
Restless
Startled rxn to noises
Rapid head movement
Repetitious hand/leg and foot movements
```
50
Physiological Signs
```
Perspiration
- forehead
- heads
- palms
- upper-lip
- under-arms
Cardiovascular - BP and HR
Respirations - rate and depth
```
51
Good ideas to reduce anxiety
```
Explain procedures before starting
Give specific info during procedures
Give reassurance
Give the pt some control
Provide distraction
Build trust
Show personal warmth
```
52
Patients perceptions of a good dentist
```
Assured me that they would prevent pain
Was friendly
Didn't rush
Was calm
Gave moral support
Asked if I was nervous
Made sure I was numb
Don't let them see you sweat under ur mask
```
53
Ways to reduce anxiety in children
Tell
Show
Do
54
Vision impairment
Does not always mean total blinds. Most so-called "blind" persons ha e some usable vision
55
If a blind person seems to need help - offer it
Identify yourself, and make it clear ur talking to him or her. If your help is accepted, don't push or pull. Let the person take ur arm and follow your body motion
56
Go ahead and use words like "see" and "look"
there are NOT reasonable substitutes
57
It may be tempting to pet a guide dog, but that dog has an important duty and should not be distracted from it.
Distracting a guide dog can potentially put the person in harms way
58
Interacting with ppl who are blind/low vision
when your leaving say so
59
Avoid presumptions about a person physical abilities
You don't know what this persons physical abilities are. Just bc someone is in a wheelchair it does not mean that they are paralyzed or that they are incapable of taking a few steps
60
Greet a wheelchair user the same as you would anyone
Extend your hand, even if they have limited use of their hands or an artificial limb. Generally, its appropriate to offer to shake hands regardless of their condition
61
Speak directly to the person who uses the wheelchair
If someone is accompanying that persons DO NOT talk to the companion about the person in the wheelchair. If you are going to continue a conversation for a while, suggest you go somewhere where you can take a seat so that the person does not lift their head to look at you.
62
Power chair - learn locations of accessible ramps, doors and parking
Look for them throughout campus, in case you are asked or are giving directions
63
Offer to help when appropriate
Knowing when to offer a helping hand can be tricky. Remember that bc a person uses a wheelchair, this does not necessarily mean that he or she is in need of assistance. If you see a situation where they can use ur help, ask, do not move the wheelchair without permission
64
Get the person's attention before speaking
Call out the person's name; if that is not successful, a tap on the shoulder a wave, or another visual signal usually does the trick
65
Identify who you are
Introduce yourself or show your name badge or business card
66
Ask about communication strategy
Ask if it would be helpful to communicate by writing or by using a phone to type back and forth
67
Speak slowly and clearly
but do not yell, exaggerate, or over pronounce. Exaggeration and overemphasis of words distorts lip movements, making lip reading more difficult
68
Look directly at the person when speaking
avoid turning away to write on a board or pull something from a file
69
Maintain eye contact with deaf person
Eye contact conveys the feeling of direct communication. Even if an interpreter is present, continue to speak directly to the deaf person. He/she will turn to the interpreter as needed.
70
Invisible disabilities
Learning disabilities
ADD/ADHD
Psychological disabilities
Many chronic medical conditions
71
Self check: comfort with different populations
How do you communicate with an elder?
Child?
Someone from another culture?
72
What can we do?
Be aware of bias, learn to listen, learn to elicit pts perspective
73
A lifelong learning process of increasing awareness, knowledge and skills
Valuing diversity, learning about your own culture and other cultures, avoiding stereotypes, gaining cultural experiences, engaging with your local communities
74
Cultural factors that can affect oral health care
Eating habits and diet preferences
What healthy teeth and gums look like
Perception of time
Gender roles
75
Health Literacy
The ability of the pt to process and use medical information - read handouts, navigate websites, etc.
Associated with education and race/ethnicity
Not associated with age and gender
Need to make sure ur communication is appropriate for the pt - language reading level, etc.
76
Using qualified interpreters
Get on "same pg" before entering the room
Position yourself and interpreter
Address pt, not interpreter
Confirm understanding and agreement with pt
Document interpreter's presence
77
What not to do
Do not use unqualified interpreters - more likely to make mistakes, may breech confidentiality, may lead to misdiagnosis or tx.
Do not ask the interpreter to perform tasks out of his/her role
Do not say anything you do not want to pt to hear
78
What not to do
Do not use unqualified interpreters - more likely to make mistakes, may breech confidentiality, may lead to misdiagnosis or tx.
Do not ask the interpreter to perform tasks out of his/her role
Do not say anything you do not want to pt to hear
79
Kleinman's Questions
What do you think has caused your problem?
Why do you think it started & when it did?
What do you think your sickness does to you? How does it work?
How severe is ur sickness? Will it have short or long course?
Groups can have vastly different notions of health and disease.
What kind of tx do you think u should receive? What are the most important results you hope to revive from this tx?
What are the CC of ur sickness has caused for you?
What do you fear most about your sickness?
