Helen: Welcome to Health Literacy Out Loud. I’m Helen Osborne, president of Health Literacy Consulting, founder of Health Literacy Month and your host of Health Literacy Out Loud.

In these podcasts, you get to listen in on my conversations with really remarkable people—hearing what health literacy is, why it matters, and ways we all can improve health understanding.

Today I’m talking with Dr. Leila Jahangiri, who is a dentist, clinical professor, and department chair in prosthodontics at New York University College of Dentistry. NYU is the largest dental school in the United States, and Dr. Jahangiri has vast experience in teaching and patient care. She is the co-author of the book A Guide to Better Teaching and focuses a considerable amount of time researching effective communications.

Welcome.

Dr. Jahangiri: Thank you very much, Helen. I’m glad to be with you this morning.

Helen: So am I. I’m especially glad to be talking to a dentist because I’ve had a lot of experiences lately on the patient end of things with my mouth wide open, not able to talk at all. How can patients and dentists best communicate?

Dr. Jahangiri: I think open communication is the way to go today. Maybe in the past, in our parents’ generation, things were just done. To reduce the anxiety of the patients and improve the communication, there has to be time dedicated to communication.

Helen: You mean time before I have all the goop in my mouth and two people’s hands are there. You’re saying communication needs to start before one side of the conversation can’t talk at all.

Dr. Jahangiri: Absolutely. Ideally, it’s away from the dental chair. In more extensive treatments that require a number of visits, it’s best to do this with no instruments around and at eye-level contact. If the office setup allows for this, ideally it’s around a round table where you can really have a conversation and ask all the questions.

An explanation of the procedure is not because we want to make patients become expert dentists, but they do need to know exactly what is being done and why it’s being done because their fear level and anxiety level gets reduced if they know what they’re in for, how long it’s going to take and what the expectations are.

Those things all have to be handled way before the treatment time. Ideally, it’s not even on the same day.

Helen: It’s so interesting listening to that. You start off talking about the physical environment. You’re not even talking about words right now. You’re talking about going to another space, sitting around a table, meeting each other at eye level, getting to know each other a little bit and doing your teaching. All of that is before the procedure.

Dr. Jahangiri: Absolutely.

Helen: I’m listening to how this applies to physical medicine as well. In health literacy, that setting and tone you’re establishing holds up too.

Dr. Jahangiri: The body position between a practitioner and even the assistant and hygienist, whoever may be in this environment, and the patient is really important.

When the patient is sitting up, they feel empowered that they can ask questions and be involved. If they are leaning back on a chair, it’s a little bit of an intimidating position for them to be questioning anybody.

At least in the first visit or so, this is our recommendation. We teach our students to sit at eye level if there isn’t a separate room. I actually like raising the patient’s chair a little bit in a sitting position if I am in the operatory.

I’d like to lower my chair a little bit because I don’t want to have an intimidating type of atmosphere created for the patient so they can ask questions, question what’s going on and really understand.

I think it’s important that X-ray films are shown to the patients so they have a general idea of how things look. Often in dentistry, the disease may not have any symptoms or pain associated with it.

Helen: That’s right. It’s my mouth. I don’t look at my teeth. A dentist knows my teeth much better than I do at this point. That’s really neat.

I wanted to ask you about a few issues you’ve been raising. You mentioned earlier about when patients are anxious. You talked about it perhaps being intimidating. That’s not my attitude about going to the dentist, but I know a lot of people are very uncomfortable or anxious about going to a dentist.

How do you make sense out of that? That issue of anxiety can show up in other kinds of medical situations as well. You must be the expert on anxiety. What do you do?

Dr. Jahangiri: This is my opinion. Most of the fear is fear of the unknown and fear of the pain. It’s either not knowing what’s going to happen or fearing some level of pain.

It really begins in childhood, and it’s usually programed by parents that tell a kid, “If you’re not good, I’ll take you to the dentist,” or, “You know we’re going to go to the dentist, and you know it’s going to hurt.” They precondition children into having expectations that are unpleasant.

For those listeners who might have kids going to the dentist for the first time, if you don’t know what to say, say nothing. We know how to handle their anxiety. Hollywood and movies don’t help. They never have the dentist in a good light.

Helen: I know. I’m thinking of some movie where the dentist is the bad guy. That doesn’t help.

Dr. Jahangiri: Honestly, some of the procedures can be a little bit unpleasant, but I think some of it is very old-fashioned. Some of the older procedures, techniques, instruments, and ways of getting people numb and making them comfortable were very different 40 or 50 years ago than they are today.

If somebody is in their 60s and they first went to the dentist when they were 8 or 10, their experience would have been set at that time. It’s very different to what they might experience now.

Helen: Thank you for that. Nonetheless, in other situations, people are worried, scared or afraid. What would you recommend to listeners? Health Literacy Out Loud listeners may or may not be dentists, but we all have some interest in communicating health information more clearly. What tips and advice would you give us?

Dr. Jahangiri: I think the best thing is to tell the patient exactly what’s going on and what they are to expect in the next visit. If there is a procedure where the patient needs to be numbed up, that needs to be discussed. You don’t want to surprise anybody on the day. That really helps.

That is not to go into the details, but say, “I think the procedure is going to take about an hour. You may be numb for two hours afterward.” Just give general descriptions of what might happen on the day. “I don’t expect that you’ll be in any discomfort during the procedure. This is routine.” I think explanation in very lay terms is critical. That’s one part.

Helen: I want to ask a question about terms. I have a very wonderful dentist. I like him a lot. He just did a whole bunch of stuff in my mouth, but as he’s going to do something, at some points he’d say, “This is going to pinch.” That’s not the word I would use to describe it. Sometimes it hurts a lot. How do you go about choosing words, like when you’re going to inject Novocain or something?

Dr. Jahangiri: First of all, we have different kinds of locations of injections that have a different sensation. In the lower jaw, a typical type of numbness we create is much more profound. The dentist should explain the duration of how long it’s going to take to get somebody numb.

I’m not sure I would critique someone for saying it will pinch because if you say, “It’s going to be a jab,” it’s going to create more of an anxiety.

Helen: That’s an issue everybody goes through. “This will just hurt a little bit.” My dentist does say, “It will hurt for a moment.”

Dr. Jahangiri: Yes. You can say it’s going to be quick or, “I will have to do it slowly because it’s a little bit less painful if you do it this way.”

We also have to gauge the terminology depending on the age of the patient. For the very young and very old, we keep to a simpler “pinch” type of terminology. For the in between, we can be a little more realistic.

Those are some of my recommendations as to how to handle more sensitive types of circumstances.

Helen: Thanks. That word choice helps. What else can we do?

Dr. Jahangiri: One of the other things that I really like doing is when patients are coming for surgical procedures, I give what we call post-operative instructions before the procedure.

After procedures, patients just want to run out and leave. They just want to go. If somebody is having any extractions or if there are children that are going to have teeth taken out, like wisdom teeth, it is better to give instructions to patients before the care starts. We usually have typed instructions as well as verbal instructions.

If anybody listening going to be a patient, you can always request it. Say, “Can I have some of those instructions now because I can focus on it a little bit more?” Afterward, you want to head home.

Helen: You do. I’m there at that desk thinking, “Get me home.”

Dr. Jahangiri: Written instructions go hand in hand with patient interactions being a little more enhanced. If that communication can be before anything has started, the patients usually feel better knowing what to expect tomorrow and the next day when they are fully alert. It may not be a lot of detail, and we can go over it again afterward.

Helen: What you’re talking about applies to all kinds of health situations. There’s another part of dentistry I’m thinking about that is universal in healthcare. That is the role of a team. At least when I go to the dentist, it’s not just the dentist I’m working with. There’s an assistant, hygienist and office staff. Everybody has a different piece of the puzzle for me. What about the role of the team?

Dr. Jahangiri: The optimal situation would be if all the team members are in one location, but that’s not often the case.

I’m a prosthodontist. Most of the time we work with surgeons, maxillofacial surgeons, periodontists or orthodontists. It is rare to find a prosthodontist who works with an orthodontist in the same facility.

I think it is important to set up web communications with the patient being in one of the operatories and the other person can chime in or through written communications. Often, and I think this is happening in medicine too, patients feel they’re being shuffled from office to office. They think, “Do people talk to each other?”

Helen: I think we all wonder about that sometimes.

Dr. Jahangiri: If it’s done in front of the patient or the patient is informed, “By the way, I spoke with your surgeon. This is our plan. This is how we’re going to go forward,” it helps.

We do it so often now that it has become part of our routine, but it’s important to tell the patient that we are having this background communication among ourselves. We have to include the patient in the communication.

Helen: I can relate to all these things you’re talking about. Set the right tone. Explain clearly. Use the words that have meaning to that person regardless of age or anxiety level. Work as a team. Give instructions ahead of time when the person can best learn. I wish everyone could be doing all that.

I’m so intrigued specifically about dental communication, which I know less about. For listeners who’d want to learn more, are there resources out there specifically about dental communication?

Dr. Jahangiri: There are specific and general resources. If a patient has a rare condition or something that is very involved, it is best to go to the American colleges that support those organizations.

There is the American Dental Association, American College of Prosthodontists and American Association of Orthodontists. Those organizations have a lot of information that is not commercialized. If there are more generalized questions that anybody can answer, those can just be googled and answered by reading things a little bit. A well-informed patient is terrific.

Helen: Thanks. I want to put a plug in for your book. It’s not exactly what we’re talking about, but your book, A Guide to Better Teaching, is excellent. Thanks so much. We’ll have that and a few other resources on the Health Literacy Out Loud web page.

The last question I want to ask you about is what can we as patients be doing? In an ideal world, what would you like patients to bring to the conversation?

Dr. Jahangiri: I would love the patients to listen to the condition of what’s going on in their mouth and not say, “I trust you. Do whatever you want.” It’s lovely to be trusted, but it is not lovely to not want to hear what’s going on in your health.

Helen: What do you want to know?

Dr. Jahangiri: Once in a while, I’ll say to a patient, “Let me tell you what’s going on,” and they say, “I’m not interested. Just do what you need to do.” Even though the trust exists and the relationship is a good one, it invariably leads to some misunderstanding down the line.

Sometimes I think, “We’re not sure if a condition is this or that.” Physicians say it all the time. “We have to test you to find out what’s going on.” As part of what we have to do, other than being skilled as clinicians, we have to be really skilled in our communication.

Helen: Thank you. It sounds like we as patients need to be skilled in that too. I need to tell you if it hurts, if my bite is off, and if I’m having trouble with this food or that food.

Dr. Jahangiri: Absolutely.

Helen: You’re the dentist of my dreams. Thank you so much.

Dr. Jahangiri: Any time you’re in New York, we’re at your service, but you’re in a good city.

Helen: I think you’re going to have a long line from Health Literacy Out Loudlisteners. Hopefully some of us will go to your students too, as I do.

Thank you so much for being a guest on Health Literacy Out Loud and making it clear about the issues dentists face, how similar that is to other health, wellness and illness situations, and how we can all improve health understanding.

Dr. Jahangiri: It’s been my pleasure.

Helen: I learned so much from Dr. Leila Jahangiri about health communication and dental communication. I’m really impressed and reflecting on all those similarities.

Health communication of all varieties isn’t always easy. For help clearly communicating your health message, please visit my health literacy consulting website at www.HealthLiteracy.com. While you are there, feel free to sign up for the free enewsletter, What’s New in Health Literacy Consulting.

NewHealth Literacy Out Loud podcasts come out every few weeks. Subscribe for free to hear them all. You can find more information along with many important links at the Health Literacy Out Loud website at www.HealthLiteracyOutLoud.org.

Did you like this podcast? Did you learn something new? If so, tell your colleagues and friends. Together, let’s let the whole world know why health literacy matters. Until next time, I’m Helen Osborne.