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Establishing expectations

16 October 2015

To establish expectations from the very beginning, it is a good idea to clarify what the patient or the parent/carer is looking for so that any gap between expectation and what can actually be provided is identified early.  

Rather than assuming or trying to guess, the best way to do this is simply to ask what the expectation of treatment actually is. Asking some basic questions can be very helpful in clarifying the wishes and views of the patient are – and importantly for those working with the patient groups seen in the HSE what the view of the parents or other interested parties are. Parents and carers can often have very inflated, sometimes unrealistic and unreasonable, ideas about what is possible so the potential for disappointment can be high unless these expectations are carefully managed. 

It is worth taking the trouble to make some basic enquiries just so that both sides have a shared understanding of the situation. A parent who brings a small child with widespread caries or a teenager concerned about overlapping teeth may not have any accurate understanding of what their treatment might involve or of how many visits it may take. Neither dentist nor patient are mindreaders so to ensure complete clarity and avoid any misunderstandings arising, it is essential to ask what they are thinking about the treatment. For example…What are you expecting to achieve with your treatment? What are you hoping for? How would you like me to help you? What would you like to see happen? etc.  

Although you may feel you understand the patient/parent/carer’s perspective without needing to make such enquiries, it does no harm to confirm your understanding is correct and it can be surprising to learn exactly what the other person’s view actually is. After all very few members of the public understand dental treatment as well as dentists!

Having clarified the patient (and parent/carer) viewpoint you will then be better placed to understand where they are coming from. Once you have done this, you should then summarise the situation to confirm with them that you have understood their view correctly and to check that you are both seeing the situation in the same way. 

If there is any issue or you have concerns that there is an unrealistic or otherwise inaccurate view of the position or of what can be done, then further discussion and explanation may be required. It is important that treatment is only embarked upon once there is complete clarity as to what treatment is available and what this can achieve.

Going to the trouble of checking this out when the clinician may feel the situation is all rather obvious may seem unwarranted, but in a surprising number of cases unrealistic expectations are not identified until they are not met. This is particularly the case when the expectations are those of parents and carers who have an understandable connection to the patient for whom they are not only responsible but who they have an emotional attachment to.

Individuals may forgive a perceived failing if it affects them but will rarely forgive a clinician who “fails” their child or other relative. 

Carrying out some simple checks at an early stage and then continuing to confirm that the relevant individuals are on the “same page” throughout treatment will go a long way to preventing misunderstandings building up. 

This is particularly important when a patient, or those responsible for him or her, may not fully understand what treatment might be available to him/her under HSE arrangements.

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