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Communication

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Communication

Dr. Louise Hanrahan is a 2014 dental graduate from James Cook University and the winner of DPL’s inaugural The Young Dentist Award for Professional Excellence.

Entrants were encouraged to submit an article about risk management and Dr. Hanrahan chose the topic of effective communication. This is her winning entry:

We started our hand skills very early in dental school – only six months in and we were unleashed on plastic teeth. It was absolutely terrifying, and although my confidence improved with more practice, I knew there was more to dentistry than how well I prepared a tooth. Fast forward to third year, and the beginning of clinic, and I began to see very clearly how patients can quickly trust and distrust a clinician. It all breaks down to a few seconds, and even hours of rapport building can be dashed over a minute detail. Being at a university that focuses on rural and remote health care, I was very lucky to be mentored and taught that there is a difference between talking at people and talking to people. I also learnt the obstacles faced by clinicians and patients in areas who struggle to access health care professionals, for many reasons beyond logistics and location.

Five whole months of placement at one site was unheard of for most of my friends studying at other dental schools. I was excited to have so long in one place for many reasons: I could manage a large treatment plan to completion, which meant complex cases could be followed through giving the patient the chance to stay with a single clinician; I was able to spend two weeks total in remote Indigenous communities in Central Australia; I could go out of the clinic and treat patients in the corrections center and manage a patients care under general anaesthesia at Alice Springs hospital. It was an excellent place to be thrown in the deep end, with two supportive mentors and supervisors, Drs. Meg and Bruce Simmons, and the staff working out of Flynn Drive Dental Clinic.

I initially thought that my time in Alice would be where I learnt how to extract teeth and manage acute pain. I wasn’t wrong about that; but I also learnt a great deal about communicating with patients. I began to speak an entirely new language in Alice – from “rusty” (carious) teeth, to taking out “slack” (mobile) teeth, and taking care of a patient’s “paining”. I learnt the importance of waiting and listening, allowing patients time for contemplation when being asked questions. I found by encouraging family members to come in during appointments, I could have another aid in translation or a familiar face to help reduce anxiety.

Building rapport with the Indigenous individual in Alice Springs was so important. It required understanding the barriers our patients faced– limitations in opportunities to improve oral health literacy, and accessibility to services were common issues patients dealt with every day. Each appointment was an opportunity to impart knowledge and the way in which it was delivered – a key part of that was delivering a positive broad message, rather than speaking as we often find ourselves in Western culture. By explaining how everyone can keep their teeth and gums healthy, we were avoiding patients from feeling individually targeted and shamed by what they were or were not doing.

A relationship with the community, both within town and out in the remote communities, was more difficult to build. Central Australia is an area with countless allied health programs, some of which incorporate oral health screening as part of general health checks. Introducing ourselves to the community clinic nurses and the schools out bush, and walking around community during quiet times on bush trips were excellent ways to begin breaking barriers and encourage patients to visit us in the fixed or mobile dental clinics.

In Alice Springs, we had a good relationship with the Congress Aboriginal Medical Service, who would refer patients requiring dental care. It was saddening to hear from some patients referred from Congress that they had not previously had positive dental treatment. After spending time discussing the Find Out Survey, developed by Bruce for the Alice Springs clinic, patients would explain they had felt rushed during appointments and as though they were a problem. In some cases, their main concern wasn’t what the dentist considered the most pressing problem. This led to patients distrusting the dentist, and avoiding treatment, until they only attended for removal of pain.

It was rewarding to hear patients thank us for our care, not just for fixing their pain. After a few weeks, we would be doing our grocery shopping or walking home in the afternoon and have patients recognize us on the street and happily wave hello or come up for a chat. We began getting more siblings, aunts and cousins coming in for treatment, and parents bringing in young children for check-ups.

Going out bush was a unique experience – one I think I won’t have anywhere else. The success of a bush trip depended entirely on how we managed the patients, from day one. My two trips were completely different – Yuendumu, in March, saw us delivering care to patients in what is considered the largest community in Central Australia with roughly 1000 people. We travelled on mostly unsealed roads for 293km for a week’s stay to treat patients. Chronic health conditions included renal failure, obesity, type two diabetes, and rheumatic heart disease. Dentally, this meant a lot of periodontal disease management and antibiotic prophylaxis before treatment.

My second trip in May to Canteen Creek, was a short flight to the community, located almost 600km from Alice Springs. The mobile clinic was set up and waiting for us, and our patient care was focused on very different health conditions. In the sixty person community, we dealt with caries, assessments, and managing patients with rheumatic heart disease. We saw most of the community in four days, and took our time visiting the school to encourage the children to come in to see us.

Both trips started the same way and followed a common thread – local health care workers and children were our only attendees for day one. The children would check out the clinic, but mostly scrutinize us as we talked to them. They would then report back to their siblings, friends, parents, and elders. By the Canteen Creek trip, we had mastered encouraging children to come in and see us by promising to count their teeth with them, an application of “banana cream” (Duraphat), and a free toothbrush and toothpaste. They were thrilled when they could be the assistant and help count their friends and sibling’s teeth!

Then the women of the community would come in – sometimes with other siblings, other times on their own. This meant a shift in communication; namely a large focus on imparting oral health information, managing acute problems, and offering a clean to help their teeth feel nice. By the end of day two, we had women coming in and requesting a clean, and suddenly we were not left wanting for patients.

Finally, when the community was comfortable enough with us, the elders and men of the community came. When we got to this stage of each trip it felt like our efforts in opening communication between the community and three more new visiting health care workers were paying off. By our final day in both communities, we were needing to tell people to visit Alice Springs as we could not stay any later.

This article is not long enough to talk about my time in Alice Springs – I could spend hours talking about it with people who have worked in similar environments, and even longer talking to people who haven’t, and who should go out to remote areas. There is always a need for clinicians, and it’s a brilliant place to learn and improve your skills in practicing dentistry and communication with patients. It’s clear after working with Meg and Bruce that their dedication to patient care and communication has paid off. Many patients would ask after Bruce and Meg while we were out bush, and clinicians across the country who had also spent time in Alice would always recount their time in Central Australia fondly.

I was expecting my placement there to be an extremely difficult at times, with feelings of isolation and complete fear that my patients would sense my nervousness and request to be seen by someone else. I was surprised by how quickly I found my feet, and how much I enjoyed my time there in general. I credit this entirely to how I learnt to communicate effectively and put patients at ease. In a place like Alice Springs, it’s easy to have quiet days because of a lack of perceived need to spend time with the patient and discuss treatment with them, rather than quickly diagnosing and treating and moving on.

Every now and then, I reflect on my time in Alice and realize how lucky I was to be there, and how I miss it every now and then. My time with Meg and Bruce in Alice has helped me to define the kind of clinician I want to be – making patients feel as comfortable as I can and ensuring good communication pathways. I’ve encouraged dental assistants and dentists to become involved in RAHC placements out in Central Australia, even in the short time since I have been there. In time, I hope I can go back out to Alice on at least a locum basis, to continue delivering care in an amazing part of the country.

Dr. Louise Hanrahan


 

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