Th 246898

A Study of Patient Behavior

May 1, 2007
Similar behaviors are exhibited by similar types of people during dental visits.
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by Rose M. Vrabel, RDH, MBA

Similar behaviors are exhibited by similar types of people during dental visits. Understanding the body language of our patients helps us understand how to communicate with them regarding treatment.

I have been practicing dental hygiene for many years, and have conducted an informal study that is a combination of dental office patient behavior both past and present. I gathered most of my information by observing patients in my chair.

As a result of these observations, I can state with some certainty that similar behaviors are exhibited by similar types of people regarding dental visits. These people can be classified into certain groups based on their reactions. To simplify these groups, I divided them into three categories: low-risk, median, and high-risk. I chose the word risk because, based on body language and behavior, I can usually profile a patient who will be compliant in the dental chair vs. a patient who will be difficult.

One constant in all of my observations is fear. The intensity of fear that a person experiences, whether imaginary or real, directly determines the behavior that person exhibits.

Another constant I observed is that of proxemics. The practice of dentistry throws the notion of proxemics out the window. The idea of one’s personal space and “intimate zone” are completely ignored and abused, as we all know when someone is poking and scraping in our mouths. I used to joke that this is one of the few jobs where I can get up close and personal with people and put them in compromising positions and not get arrested. There is an unstated agreement between patient and dental practitioner that the laws of proxemics will be violated. But as soon as treatment is completed and the patient is upright again, the rules resume immediately. But explaining the laws of proxemics to children is another story. They don’t care about the rules. They don’t want their space invaded!

Let’s look at the category I call the high-risk group. It usually consists of small children with fear, or adults who had a negative dental experience either as a child or an adult. A negative experience as a child usually has the most influence on the fear an adult exhibits.

Body language that screams fear

Paralanguage from the high-risk child usually consists of screaming (of course), crying, refusing to follow commands, or refusing to communicate at all. Out of the dental chair the child may seem shy and withdrawn. Because some of my dental patients are as young as three, they have not had the necessary time to be socialized to deal with fear of the unknown. But with familiarity and time, most can usually move out of the high-risk status.

Adults in the high-risk category can also show the same paralanguage of screaming and crying, but usually (thank goodness) not to the same degree. Their voice qualities are better indicators of their mood. High-pitched voices, quivering, or excessive talking are signs of high-risk group members. Their body language usually tells more about them. Crossed legs and arms, a firm grip on the chair handle, or sweating are signs that a patient is not comfortable. In severe cases, medication can be used to make the patient, as well as the practitioner, more comfortable.

In many instances, high-risk behavior can be assessed as soon as a patient enters the reception area. They can make it very easy on you by telling you point-blank that they’re scared to death, or they can be more subtle by using nervous body language or a quivering voice to project a sense of doom. As I said before, this is when I can usually start profiling a patient based on his or her behavior.

Fair to middling temperament

The middle group of patients I have observed, the median group, is between high and low risk. The median group is the average group; most people fit into this group with slight variances. They don’t like to go to the dentist, but they tolerate it. They will verbally express their displeasure, but will be compliant while exhibiting some negative body language.

Vocal qualities are very important with this group. Just like anyone else, they have good days and bad days. Their moods and behavior depend on what’s going on in their personal lives, so practitioners have to be prepared for anything. Unlike the high-risk group, where we know what we’re dealing with and can act accordingly, the average group can be less predictable. The intensity is not as high, but there are more variables to deal with. Patients you think will be compliant can become management problems because of this characteristic.

Body language can be obvious or subtle. The reception area can offer a preview. The amount of enthusiasm the receptionist is greeted with, the voice qualities, how a patient sits in the waiting room, or arms and legs close together can establish the mood. However, tapping feet or fingers, pacing, or repeated watch-checking can mean a person wants to be seen immediately, or it can mean anxiety. Since this is the largest and most diverse group, it is hard to give it a definitive description. But with most people belonging to this category, it shows how large the scope of “normal” behavior in our society has become.

Although the median group can be observed as the most diverse in terms of variables, it tends to be the most stable in terms of recall behavior. The majority of this group will likely comply with a six-month check-up schedule. Again, these patients don’t like to come to the dental office, but they do. In this respect, this group is the most predictable.

Weird: They want to be here

The last group is the opposite of the high-risk group. In my opinion, the low-risk group is the most fun group. Their body language is nothing but positive. They come into the office with smiles on their faces. They are very comfortable in the dental chair and usually get their best “rest” during their appointment. They make comments that people tell them they’re weird because they look forward to their dental visits. Their behavior and attitude can be infective and usually put me in a good mood, and their major vocalization is laughter. I wish I had these people for patients all day! Unfortunately, in dentistry, they are a fairly small group.

This group could perhaps be categorized into similar personality types, which would be interesting to document. However, this study is not about personality types. No personality tests were used, only firsthand observation.

It is difficult for me to quantify the size of this study, with so many people observed over so many years. However, I do feel that through my many comparisons, based on a fairly large population over time, certain characteristics and similarities were found that can be applied to other groups.

One way to test this theory is to have other hygienists record the behavior they observe over time in their dental offices and compare the results. I feel strongly that the data would be similar to mine.

A few other aspects of language should be mentioned. The profession of dentistry has its own language or professional jargon, as do many other disciplines. We can observe a break in the epithelial continuity of the mandibular mucosal lining adjacent to the buccal frenum. Or we can see a mouth ulcer inside the lower lip. A patient can have a carious lesion in the maxillary right distobuccal groove of No. 3, or simply, a cavity in the upper right six-year molar. It is important to simplify the language of dentistry so that patients can understand what we are telling them.

Because of new discoveries, outside influences, cultural and social changes, all languages are constantly evolving and expanding. However, one language has withstood the test of time and is still trying to be deciphered - the language of the patient in the dental chair.

Rose Vrabel, RDH, MBA, has been practicing dental hygiene for more than 25 years. She recently took a four-year educational sabbatical in which she completed a BS in anthropology and an MBA in management, in addition to her degree in hygiene. She is currently back in clinical practice in Richmond, Va., where she resides with her husband, basset hound, and cat.