Barriers to communication

May 1, 2004
I have been a hygienist in the same office for the past seven years. I have seen many of the patients numerous times for their preventive care.

by Dianne Glasscoe

Dear Dianne,

I have been a hygienist in the same office for the past seven years. I have seen many of the patients numerous times for their preventive care. I am privileged to have developed good relationships with some of them.

However, sometimes a patient will share some deeply personal information that I would prefer not to hear. Recently, a lady told me that her husband was having an affair with a co-worker of his. Another patient told me about his vasectomy. Both times, I felt awkward and did not know how to respond. Another patient, an older woman, asked me if there was any danger with oral sex!

Can you give me some tips on how to avoid such awkward situations in the future?
Speechless in Seattle

Dear Speechless,

To be sure, patients can say some shocking things! Your letter brought to my memory a particular female patient that I'd seen many times. As I washed my hands, I asked in casual conversation how she was doing. When she didn't answer immediately, I noticed a tear trickle down her cheek. I sat down and took her hands in mine and said, "What is it Pat? What's wrong?" She replied that her 21-year-old son just found out the day before that he was HIV positive. She was devastated, to put it mildly.

I told her how extremely sorry I was to hear that news, and that we did not have to go through with the appointment if she didn't feel up to it. She replied that she wanted to complete the appointment.

In one respect, I was sorry she told me about her son. Her sadness made me feel sad as well. On the other hand, I was very glad she told me about her sorrow. I would have otherwise felt, because her mood was so somber, that I had done something to make her feel badly.

In fact, her act of sharing this most personal and devastating news was really a compliment to me. She saw me as someone she could trust, who was non-threatening and/or non-judgmental, as well as someone who cared. Obviously, she did not have to tell me about her son's HIV status. (If it had been my son, I probably would not want anyone to know.) Knowing her problem allowed me to be sensitive and careful with my dialogue with her that day.

Patients come to us sometimes burdened down with some crisis or emotional upheaval. They may or may not share with us what their particular problem is. When they do, we have the rare opportunity to be a caregiver and a friend. It is those wonderful connected relationships we develop with our patients that make it worthwhile to get up in the mornings and go do our jobs! Further, I've known hygienists to stay in practices where they were unhappy, simply because they felt such dedication to the patients there.

Let's get back to the scenarios you described. Obviously, when someone finds out their spouse is unfaithful, the subsequent emotional stress could have physical consequences. As a hygienist, you may notice tissue that bleeds easily. While the news is not comforting for you to hear, not knowing about the crisis she is going through might cause you to blame her present gingivitis on poor oral hygiene. Can you imagine chastising her when oral hygiene probably has nothing to do with her bleeding?

One of our shortcomings as hygienists is that we want to blame almost every gingival problem we find on poor oral hygiene, even though oral hygiene is only one factor in a whole plethora of influences on oral health. So it was a good thing that she told you her problem. Any awkwardness you felt came because you were shocked by the patient's honesty.

The second scenario is a little different. I don't know of any oral complication that may come of a vasectomy, other than if the patient developed an infection, which would affect his overall health. However, would you rather have had the patient lie when you updated his medical history? Again, the honesty shocked you.

Forgive me, but the third situation made me grin. Quite possibly, this patient was looking for ammunition to use with her old codger husband who expected her to take care of his sexual needs orally! "My hygienist says I shouldn't do this anymore because..." It probably took quite a bit of courage for her to ask the question. Remember, you are supposed to be the oral health expert, and she is seeking information from a health-care professional that she trusts.

Actually, I can point you to a recent study that shows a link between oral cancers and oral sex. Researchers working for the International Agency for Research on Cancer (IARC) in Lyon, France, have recently published information showing a relationship between oral tumors and oral sex.

According to an article in a magazine titled New Scientist, scientists studied more than 1,600 patients with oral cancer and more than 1,700 healthy people from Europe, Canada, Australia, Cuba, and the Sudan. They found that patients with oral cancer containing a strain of the human papilloma virus (HPV) known as HPV16 were three times more likely to report having had oral sex than those without the virus strain. I realize this information may be too late for you in this situation. However, when patients ask honest questions like this, we should try to find answers if possible, even when it is shocking.

While patients often present with personal problems, hygienists are not immune from personal crises. I can remember times when I had some major personal problems in my life that I carried to work with me. During those times, I would not feel particularly communicative with my patients, but rather, preoccupied with my personal problems.

Here's some good advice for those times when you (or any hygienist) are going through personal adversity in your own life (but still have to go to work and see patients). On the drive to work, locate a particular tree, mailbox, or trash receptacle and mentally leave the problem there. Go to work and take a respite from the problem. Do not take the problem into the office. Focus on your patients, and give them the best care you are capable of providing.

Please do not ever share personal problems with your patients, because this is inappropriate and may cause them to question your ability to concentrate and provide high quality care. If you feel the need to unburden with a co-worker, please do not do it in the office. Rather, go to a restaurant for lunch or somewhere outside of the office. Finally, when you make your return trip home, you may mentally retrieve your problem where you left it and take it with you.

Think about it. If you are uncommunicative with your patient, the patient may mistakenly perceive you as unfriendly or uncaring. We also can jump to those same conclusions about a patient who may be going through a rough spot in his or her life and doesn't seem responsive to our communication attempts.

Personal problems are just one of the several attitudinal barriers to communication. Others include illness, perceived low treatment value, insufficient time, prior negative dental office experience, and negative relationships with other health-care professionals. These barriers can be erected by patients or clinicians — it is a two-way street.

The best communicators are those individuals who have learned to be keenly sensitive to the persons with whom they are seeking to communicate. Empathy and caring are borne out of a heart of love for people. Dental hygienists are in a unique position to be both caregivers and friends. I hope you will see this as a great privilege. As a result, the awkwardness you feel will dissipate. Chalk it up to a positive learning experience!

Dianne D. Glasscoe, RDH, BS, is a professional speaker, writer, and consultant to dental practices across the United States. She is CEO of Professional Dental Management, based in Frederick, Md. To contact Glasscoe for speaking or consulting, call (301) 874-5240 or email [email protected]. Visit her Web site at