Oral Health Reflection: Patient Relationship Factors

This reflective essay, written for the University of Melbourne's ORAL 10001 course, explores factors influencing the patient-practitioner relationship in a dental clinic, focusing on human factors that affect the therapeutic encounter. The essay identifies three key factors: language barriers, socioeconomic status, and dental anxiety, drawing on observations in a dental clinic. The essay further proposes three tools to enhance clinical practice and patient relationships: interpreter services to overcome language barriers, mindfulness techniques to address patient anxiety and promote understanding, and the 'tell-show-do' method to manage dental anxiety and improve patient compliance. The essay aims to demonstrate an understanding of these factors and propose strategies for more effective patient care. The author also included the references used in the essay.

Running head: REFLECTION
Reflection
Name of the student:
Name of the University:
Author’s note

1REFLECTION
This reflective essay is focused on understanding and reflecting upon factors influencing
relationship with patient in dental clinical practice. With the help of this discussion, I will be
developing a wide range of skills along with techniques for the future oral health professional
practice. To do so, I am going to identify strengths, challenges, and future opportunities by using
many personality activities and inventories. In this context, my major personality dimensions are
empathy, mindfulness, self-compassion, compassion, and effective communication (Guimin,
Weiping, Jiawei, & Hongmei, 2016). In this way, by utilising all above-mentioned personal
attributes I will demonstrate my ability to communicate effectively with the diverse range of
dental patients for dealing with the challenges and issues, which have risen during my dental
clinical practice. In this way, I will reflect upon how to understand patient for enhancing clinical
practice while discussing three major factors which thinking related to practitioner-patient
relationship.
Good professional practice depends on awareness of patient’s expectation and factors that
affect patient’s relationship. I have developed knowledge regarding the impact of different
factors on patient relationship by observing an oral therapist providing dental care to an
Ethiopian female patient in a dental clinic. The first factors that influence relationship with
patient included language barrier during care delivery. This barrier emerges when any
culturally diverse minority client or client with limited English language proficiency comes to
seek care. The main barrier that emerges is that poor English proficiency of the patient affects
practitioner-patient relationship by disrupting communication process and reducing practitioner’s
capability to engage in accurate patient assessment and diagnosis. Inability to interpret patient’s
message affects practitioner’s capability to build trustful relationship with patient. Unfamiliarity
with patient’s colloquial language negatively influences therapeutic communication process

2REFLECTION
(Maame Kissiwaa Amoah et al., 2018). I also witnessed similar issue while observing the oral
therapist interaction with the Ethiopian female. The patient was trying to tell something in her
language. However, the oral therapist struggled to understand her message and he was using
signs to interpret what the child is saying. I noticed that the patient was gradually getting
frustrated as she was getting the perception that she was not given adequate attention. This form
of poor experience has been widely reported for studies done with ethnic minority patients.
Degrie et al. (2017) supports that disparities in health care and barrier to access is seen when
providing care to ethnic minority clients.
While visiting the dental service, I learnt that language gap between patients and
practitioners leads to many negative care experiences and it negatively affect the capability to
develop therapeutic relationship patient. The challenges that the oral therapist faced during the
interaction with the minority client could have been resolved if the oral therapist had access to an
interpreter. Use of interpreter would have saved time of the therapist and helped him to
accurately understand the patient’s verbal message and concerns. The advantage of interpreter
service for patient is that they are effective in improving health equity for minority population
group and achieving high quality of care both for patients and providers. Language interpretation
service are particularly useful in reducing language accessibility gap while interaction with
patients with limited English language proficiency (Dowbor et al., 2015). Interpreters can play a
significant role in clinical encounters where linguistic differences negatively affect patients and
staff relationship. It can give practitioners the opportunity for better practice and efficient service
delivery (Hadziabdic & Hjelm, 2013). Therefore, effect of language discordance on patient-
practitioner relationship can be addressed by use of interpreter service.

3REFLECTION
While observing the patient, I also identified socioeconomic status of a patient as a
barrier to effective patient-practitioner relationship. I made this judgment because on oral check
of the Ethiopian female, the therapist found that she had dental caries and she could not afford
dental treatment in her country because of poverty and poor socioeconomic status. For the
treatment of dental caries, the therapist asked the patient to visit two times again to complete the
treatment. However, the patient was reluctant to complete the treatment then only she did not
wanted to spend extra money on transportation. Therefore, the key lesson from this scenario is
that poor socioeconomic status of patient affect practitioner’s ability to manage patient’s
compliance to treatment. Time barrier and cost related barrier can be difficult to overcome which
would ultimately affect relationship with patients too. Tran et al. (2016) supports that poor
socioeconomic status or socioeconomic inequality is strongly associated with poor compliance to
treatment. SES involves combination of variables like education, income, place of residence and
occupation. These factors affect patient’s ability to adhere to treatment and use health care
facilities. Hence, being sensitive to psychosocial and economic factors of patient life is critical to
promote positive relationship with patients and modify patient’s willingness to comply with the
treatment.
During my observation of the Ethiopian patients, I learnt that socioeconomic status of
patient has an impact of care continuity and developing appropriate treatment plan. The therapist
struggled to understand ways to manage treatment schedule based on patient’s timing and cost
factors. Oral hygiene specialist have reported challenged in working with patients with poverty
as it had resulted in missed appointment and poor compliance with treatment (Loignon et al.,
2015). Filc et al. (2014) reported that poor SES of patient results in gap in visits to specialist.
However, this situation can be managed by use of mindfulness technique and using

4REFLECTION
communication skills like active listening and empathy to convince patient to adhere with the
treatment schedule. Mindfulness is a process where non-judgmental attention is given to
experiences of patient’s experiences of the present moment. Hence, the oral therapist can use this
technique by using communication skills like openness, curiosity, empathy and openness to
understand patient’s contextual issues affecting health. It facilitates using sets of skills that
address healing aspects of patients-staffs encounter (Amutio-Kareaga et al., 2017). The
advantage of using mindfulness technique during communication with patient is that it will help
to provide psychosocial support to patient and enhance the healing process of patient by
alleviation of distress. Positive changes in level of stress, anxiety, burnout and resilience of
patients can be seen the use of this technique by practitioners (Gilmartin et al., 2017). Therefore,
the oral therapist can use the tool of mindfulness to understand patient’s concern and use other
strategies to address time and cost related barriers in care.
While carefully observing the oral hygiene therapist interaction with the minority group
patient, I found from patient’s expression that she was very anxious about her dental caries and
the pain associated with it. As she suffered for a long time and it affected her ability to enjoy
food, she expressed that she was suffering from anxiety. This is seen because the patient has the
perception that the problem is serious and she cannot manage dental anxiety. Unless proper
communication and empathy is displayed to such patients, this factor can negatively experience
patient’s interaction with practitioners. Anxiety is a serious factor that needs to be fixed by
practitioners because it is risk factor of psychological distress and depression for patient (Jones et
al., 2018). Anxiety also results because of poor perception about illness and lack of knowledge
about self-management of health conditions. For this reason, the patient in the dental clinic was
also worried as she was clueless about ways to overcome pain associated with her dental caries.

5REFLECTION
Therefore, anxiety can be a serious factor that can affect patient’s ability to follow the advice of
practitioners.
To overcome this issue in dental care practice, the key strategy that practitioners should
use to reduce anxiety included application of mindfulness technique while interacting with
patient. This includes responding to stress by developing understanding about patient’s present
difficulties at the moment. As the minority patient is unaware about appropriate dental care, the
therapist can use mindfulness to empower patient to self-manage her pain. During this process,
‘Tell-show-do’ method can be employed to teach patient about dental care. ‘Tell-show-do’ is a
behaviour shaping technique and the key advantage of using this technique with patient is that it
can reduce uncertainty in clinical setting. It involves giving verbal explanation of procedures
according to developmental level of patient and explanation of critical aspects of procedure and
then completing the procedure on patient. As this method uses positive reinforcement and
communication skills, it can work to alleviate dental anxiety (Appukuttan, 2016). Therefore, use
of this technique can be encouraged to develop positive patient relationship.
In conclusion, essay gave insight into different factors influencing practitioner-patient
relationship quality and hence put forward many useful suggestions accordingly. Through a
detailed content analysis as well as learning extracted from my own experiences, I have summed
up three major factors, which affect patient-doctor relationship quality. This included language
barrier, poor socioeconomic status and dental anxiety. Furthermore, future suggestions in the
form of three important tools have been included such as interpreter service, mindfulness
technique and tell-show-do method to enhance the clinical practice experiences for both patients
and practitioners.

6REFLECTION
References:
Amutio-Kareaga, A., García-Campayo, J., Delgado, L., Hermosilla, D., & Martínez-Taboada, C.
(2017). Improving communication between physicians and their patients through
mindfulness and compassion-based strategies: a narrative review. Journal of clinical
medicine, 6(3), 33.
Appukuttan, D. P. (2016). Strategies to manage patients with dental anxiety and dental phobia:
literature review. Clinical, cosmetic and investigational dentistry, 8, 35.
Degrie, L., Gastmans, C., Mahieu, L., de Casterlé, B. D., & Denier, Y. (2017). How do ethnic
minority patients experience the intercultural care encounter in hospitals? a systematic
review of qualitative research. BMC medical ethics, 18(1), 2.
Dowbor, T., Zerger, S., Pedersen, C., Devotta, K., Solomon, R., Dobbin, K., & O’Campo, P.
(2015). Shrinking the language accessibility gap: a mixed methods evaluation of
telephone interpretation services in a large, diverse urban health care
system. International journal for equity in health, 14(1), 83.
Filc, D., Davidovich, N., Novack, L., & Balicer, R. D. (2014). Is socioeconomic status associated
with utilization of health care services in a single-payer universal health care
system?. International journal for equity in health, 13(1), 115.
Gilmartin, H., Goyal, A., Hamati, M. C., Mann, J., Saint, S., & Chopra, V. (2017). Brief
mindfulness practices for healthcare providers–a systematic literature review. The
American journal of medicine, 130(10), 1219-e1.

7REFLECTION
Guimin, D., Weiping, Y., Jiawei, L., & Hongmei, Y. (2016). The research of factors influence
doctor-patient relationship quality: Investigation of public hospitals in Sichuan province.
International Conference on Service systems and service management, 1-6.
Hadziabdic, E., & Hjelm, K. (2013). Working with interpreters: practical advice for use of an
interpreter in healthcare. International Journal of Evidence
‐Based Healthcare, 11(1), 69-
76.
Jones, A. R., Al-Naseer, S., Bodger, O., James, E. T. R., & Davies, A. P. (2018). Does pre-
operative anxiety and/or depression affect patient outcome after primary knee
replacement arthroplasty?. The Knee, 25(6), 1238-1246.
Loignon, C., Hudon, C., Goulet, É., Boyer, S., De Laat, M., Fournier, N., ... & Bush, P. (2015).
Perceived barriers to healthcare for persons living in poverty in Quebec, Canada: the
EQUIhealThY project. International journal for equity in health, 14(1), 4.
Maame Kissiwaa Amoah, V., Anokye, R., Boakye, D. S., & Gyamfi, N. (2018). Perceived
barriers to effective therapeutic communication among nurses and patients at Kumasi
South Hospital. Cogent Medicine, 5(1), 1459341.
Tran, B. X., Hwang, J., Nguyen, L. H., Nguyen, A. T., Latkin, N. R. K., Tran, N. K., ... & Tran,
T. D. (2016). Impact of socioeconomic inequality on access, adherence, and outcomes of
antiretroviral treatment services for people living with HIV/AIDS in Vietnam. PLoS
One, 11(12), e0168687.

8REFLECTION
References: