Has this happened to you? You enter your physician’s office and the staff never even make eye contact with you. Do you feel like you are interrupting them? Not only are we used to this, we have come to begrudgingly accept it! Public perceptions are that if we are to receive treatment and possibly be freed from discomfort or pain we must put up with it. We become medical practice orphans, waiting for word from the caregivers who dole out attention as they see fit.

The dental profession is far more sensitive to patients than the typical medical practice. Since patients are more likely to put off dental treatment than medical treatment, it is vital that the dental practice be as accommodating and welcoming as possible. Team members must ensure that they stay connected with the patient. In many cases it is this sense of connectedness that increases likelihood of patient retention and referral. And here is where "attending skills" come in.

Good attending skills are behaviors that indicate we are truly "in the moment" with others. Many people relate this to body language and that is part of it. Eye contact while you are listening, getting at the patient’s eye level, orienting your body toward another while in discussion. These are all key attending skills, but much more is involved in truly staying in the moment with a patient. It’s what you say and how you respond to what a patient says. It’s awareness of the nonverbal clues sent out by the patient and an ability to anticipate patient needs or wants. It includes the ability to show empathy.

Here’s an example of poor attending skills. A focus group member described a hygienist that had been chatting with a co-worker while the patient was in the chair. "She carried on a conversation with the assistant like I wasn’t even there!" This situation was not isolated. "I might have passed it off except that this attitude was rampant in the office. I usually feel like I am interrupting them and that they have other things to do. The doctor seems like he is juggling patients every time I go in because he’s running from room to room. I feel like I’m not supposed to ask questions or I’ll get them off-track. I’m paying for this and it makes me angry."

The focus of the team in that office was on task, function and schedule. The patient was left out of the loop. Patients often equate clinical quality with the communication skills and service provided. If they feel you are not in the moment with them they may think they are not receiving quality clinical care either. Could this affect treatment acceptance? Of course!

I visited an office undercover. The young lady at the front desk had been busy with a phone call when I approached the counter. The schedule book was in front of her and she still had pen in hand as she hung up the phone. She seemed rushed and breathlessly turned her head in my direction. "Good morning", she offered verbally, but her body remained oriented toward the open book and she kept the pen in her hand. I was an interruption. Not a good first impression for a new patient.

I visited another office undercover. During the exam the doctor used the intraoral camera masterfully. He was a superb teacher with this instrument. His ability to explain complex clinical matters using patient terms combined seamlessly with his fluid use of the camera. I was impressed. But when he no longer had the instrument as a vehicle and he was forced to communicate with me directly there was a breakdown. Where the camera was the thread that connected us, once that was gone he literally and figuratively disconnected.

He became reflective as he thought about the condition and discussed the proposed treatment. I felt like a cardboard picture in the chair. He stood, leaned against the counter behind my line of vision, crossed his arms and looked out the window and at the ceiling as he talked. I could tell that he was clueless about the impact of his demeanor and I felt that he probably communicated with most of his patients this way.

The irony is that this doctor had hired me to be a mystery patient in his practice. All arrangements had been made through an intermediary. I used a pseudonym and he’d never seen me before so I was unrecognized in the appointment. During our meeting a couple of days later we discussed the matter of attending skills. He described the comfort level he felt when working with the intraoral camera and he contrasted that with the intense focus he placed on communicating clearly about condition and treatment possibilities. He placed such intellectual focus on processing information that he’d lost contact with the patient and he didn’t know it. If he could place even half of that focus on the patient via improved attending skills he would go a long way to increasing his rate of treatment acceptance. Until he was in the moment with the patient he’d miss all the nonverbal clues that the patient was sending him.

We discussed what that would take and what it included:

• Sitting and facing the patient instead of standing to the side of the patient
• Making eye contact with the patient to observe patient comprehension
• Observing the patient for clues about concerns or possible questions
• Engaging the patient via questions (like "tell me what your questions are about this …)
• Responding to the patient before changing the direction of the conversation

The doctor later called me and said that he’d gotten feedback from his staff indicating that they were appreciative of his increased presence with them also.

Attending skills must be shown in the first 15-30 seconds of interaction. Slow down in these moments and focus completely on the patient. Nonverbally show you are listening to the patient. Observe facial expression and patient breathing pattern for clues of anxiety; fearful patients are hypersensitive to attending behaviors. Here are some areas where good attending skills are particularly important to patients:

1. At the front desk: Direct eye contact and a smile as patient approaches the counter. Use the patient’s preferred name. With new patients rise and welcome them with a handshake. If occupied with other patients acknowledge the presence of the arriving patient by eye contact and a smile.
2. Transition to clinical areas: Assistant who greets the patient should make direct eye contact, smile, introduce herself and call the patient by name
3. Seating the patient: Help patients with anything they are carrying ("May I place that over here for you?") OR indicate where they may place these items. Once the patient is seated ensure comfort. Observe body language and anticipate needs ("It was so cold outside, would you like a blanket over your legs?" or "What may I do to help you be more comfortable?")
4. Team interaction in treatment room: If appropriate to the moment introduce teammates who enter the room. Or entering team member may make eye contact and smile. If your attention is called away from patient by another team member, a brief touch to the patient’s arm or shoulder reassures your connect and priority.
5. Doctor introduction: Shake hands, introduce yourself and sit as soon as possible. Place all focus and energy on the patient in the first moments. Team mates must not interrupt the connection that occurs in the first minutes of interaction between the doctor and the patient. This is particularly vital with new patients.
6. Close of exam or clinical treatment: Attending clinicians should not depart the patient without proper closure via eye contact, smile, handshake if appropriate. Even though this happens in seconds, it must be effected sincerely
7. Patient departure: Last impressions are often lasting impressions. Patient departure should always be accompanied by eye contact, smile and verbal "goodbye". If patients perceive diminished importance after monetary compensation has been made then they leave with a bad taste in their mouths … something they don’t want at the close of a dental appointment!