managing the patient, parent and practice iii

MANAGING THE PATIENT, PARENT AND

PRACTICE III

“THE DENTIST-CHILD RELATIONSHIP”

COMMUNICATING WITH CHILDREN

• Effective communication is a primary objective.

• Communicate in two basic ways:– verbally: school activities,pets,articles

of clothing, children’s television programs, books, muppets

– non-verbally: holding young child in lap; touching tenderly, smiling approvingly

MULTISENSORY PERSPECTIVE

•Transmitter: Dentist

•Medium: Office Environment

•Receiver: Child Patient

TELL-SHOW-DO

• Tell-Show-Do is the classical model for communicating with children in the dental environment.

• Developed (first documented in the literature) by Harold Addelston, of New York University’s School of Dentistry.

TELL• TELL

– before– during– after

• TELL… using euphemisms (substitute language)

• Understanding critical• Be honest in your TELLing!

SHOW • SHOW (demonstrate) the child what

will be happening,how it will happen, and with what equipment.

• But, it is not wise to SHOW fear- promoting instruments.

• Remember the multi-sensory perspective in SHOWing: children can HEAR, SEE, TOUCH, TASTE, and SMELL.

DO• DO what you said you were going

to do.• DO it in the manner you said you

were going to do it.• As you DO it, continue to TELL the

child what you are DOing. • DO NOT DO until the child has a

clear awareness and understanding of what you are going to DO.

• DO it expeditiously!

GINOTT PRINCIPLES• Acknowledge the child’s experience.• Grant in fantasy what you cannot

grant in reality.• Children are equal in dignity.• Praise• Give children choices-offer options• Acknowledge correctness• Children need to be liked.

GORDON MODEL FOR COMMUNICATING WITH

CHILDREN

Parent Effectiveness Trainingby Thomas Gordon

ROADBLOCKS TO COMMUNICATION

• Ordering, Directing, Commanding• Warning, Admonishing, Threatening• Exhorting, Moralizing, Preaching• Advising, Giving Suggestions/Solutions• Lecturing• Judging, Criticizing, Blaming• Praising• Name Calling, Ridiculing, Shaming• Interpreting, Analyzing, Diagnosing• Reassuring, Sympathizing, Consoling• Probing, Questioning, Interrogating• Withdrawing, Distracting, Humoring

“OWNING THE PROBLEM”

In the dental setting (and in every human relationship) there are times when:

• The dentist “owns the problem;” that is, some need the dentist has is not being met.

• The child “owns the problem;” that is, some need of the child is not being met.

• There is “no problem,” as the needs of both the child and the dentist are being met.

THREE “PROBLEM” CIRCUMSTANCES IN

THE DENTAL ENVIRONMENT

• Child is whining because doesn’t want to be in dental chair; wants to be finished and with parent. But child is being cooperative so dentist can complete the treatment. THE CHILD OWNS THE PROBLEM.

• Child is comfortable, seeming enjoying the experience, and cooperative. THERE IS NO PROBLEM.

• Child is satisfying needs, but is being uncooperative, tangibly interfering with dentist having his/her needs met of completing the treatment. THE DENTIST OWNS THE PROBLEM.

“OWNING THE PROBLEM”

Area of Acceptable Behavior for Dentist:

• Child Owns the Problem• There is No Problem

Area of UnacceptableBehavior for Dentist:

• Dentist Owns the Problem

WHEN THE CHILD “OWNS THE PROBLEM”

ENCODING PROCESS

CHILDTIRED

DECODING PROCESS

TIRED

“When are you going to be finished?“

Child Dentist

WHEN THE CHILD “OWNS THE PROBLEM”

ENCODING PROCESS

CHILDTIRED

DECODING PROCESS

TIRED

“When are you going to be finished?”

Child Dentist

“You want to get back to school.”

“No, I didn’t mean that. I meant I am really tired of holding my mouth open..”

WHEN THE CHILD “OWNS THE PROBLEM”

ENCODING PROCESS

CHILDTIRED

DECODING PROCESS

TIRED“When are yougoing to be finished?”Child Dentist“You’re getting tired.”

ACTIVE LISTENING...• In active listening, the receiver tries to

understand what the sender’s message means.

• S/he then puts his/her understanding of it into own words and feeds it back to the sender for verification.

• Does not send a message of own--such as an evaluation, opinion, advice, analysis or question--only understanding of the sender’s message.

ACTIVE LISTENING... . . . is used when:

the child “owns the problem.”

ACTIVE LISTENING...• Helps children discover exactly what they are

feeling.• Helps children become less afraid of negative

feelings. When dentist accepts the feelings the child learns that “feelings are friendly.”

• Promotes a relationship of warmth between the dentist and the child. Being heard and understood is very satisfying.

• Facilitates problem-solving by the child.• Influences the child to be more willing to

listen to the dentist’s thoughts and ideas.

WHEN THE DENTIST“OWNS THE PROBLEM”

• When the dentist is prevented from accomplishing what needs to be done, that is, the child’s behavior is effectively preventing such, the dentist, “owns the problem.”

• At such times, the dentist must confront the child’s behavior in such a manner as to change it.

• This is done most effectively by using “I messages.”

“YOU MESSAGES” ARE NOT HELPFUL

Our natural tendency in times when the child is not behaving in a manner acceptable to us is to send a “you message:”

• YOU stop that!• YOU must not do that!• Don’t YOU ever…!• YOU are being bad!• YOU are not acting like a big girl!• Why can’t YOU be good?!• YOU should know better.

“YOU MESSAGES”...• Are put-downs.• Impugn the child’s character.• Deprecate the child as a person.• Shatter the child’s sense of self; self-

esteem.• Underline the child’s inadequacies.• Cast a judgement on the child’s

personality• They point the finger of blame toward

the child, and are roadblocks to communication.

WHEN THE DENTIST “OWNS THE PROBLEM”

ENCODING PROCESS

Frustrated

“I cannot put the rubber raincoat onwith hands over the mouth.!”Dentist

WHEN THE DENTIST “OWNS THE PROBLEM”

ENCODING PROCESS

IAm Bad

DECODING PROCESS

Frustrated

“You sure are no help!”Dentist Child

WHEN THE DENTIST “OWNS THE PROBLEM”

ENCODING PROCESS

He isFrustrated

DECODING PROCESS

Frustrated

Dentist Child“I cannot put the rubber raincoat on with hands over the mouth.”

“I MESSAGES”• “I messages” are more effective in

influencing a child to modify behavior.• “I messages” must less apt to

provoke resistance and rebellion.• “I messages” are less threatening to

the child.• “I messages” are more effective

because they place responsibility for change within the child.

“I MESSAGES” “ I messages” can be sent non-

verbally as well:– A stern look says, “I am unhappy

with you behavior.”– A firm positioning of a squirming

child in the chair says, “I need to work on a non-moving target.”

SUMMARY• When you have a problem with the

child’s behavior…SEND AN “I MESSAGE!”

• When the child is having a problem…”ACTIVE LISTEN!”

• When neither of you have a problem, continually reinforce the child’s behavior, citing tangible aspects of that behavior.

SELECTING AND USING APPROPRIATE TERMINOLOGY

DENTALTERMI NOLOGY

Air SyringeHandpieceAnestheticExplorerEvaluator

Rubber DamX- Ray Equipement

WORDSUBSTI TUTE

Mr. WindElectric Pencil

Sleepy MedicineTooth Counter

StrawRaincoatCamera

VOICE INTONATION• The tone of the dentist’s voice

can also be a very effective way to alter the child’s behavior.

• Kind to firm, or soft to stern voice can communicate much!

• “I’m upset!” has shock value and can gain the child’s attention quickly.