Transcript DownLoad - 口腔病理科教學網

牙科放射線學(1)
Communication skills in dentistry
with emphasis on oral radiography
接受X光影像攝影的溝通技巧
陳玉昆助理教授: 高雄醫學大學 口腔病理科
07-3121101~2755
[email protected]
學 習 目 標
- 認識牙科X光影像攝影
-了解牙醫師與病患
(含X光影像攝影)溝通技巧
牙科放射線影像攝影臨床指引
根尖片
咬翼片
咬合片
根尖片
 平行法
 分角線法
 難題解決
全口X光片
上顎
咬翼片
大臼齒
小臼齒
犬齒
門齒
咬翼片
犬齒
右邊
大臼齒
小臼齒
咬翼片
小臼齒
大臼齒
左邊
犬齒
門齒
下顎
犬齒
小臼齒
大臼齒
咬翼片
平行法
upper
前牙
左上、右下 象限
直放
橫放
右上、左下 象限
橫放
直放
後牙
前牙
lower
平行法
Anterior
Positioning
上顎門齒
Patient positioning
上顎門齒
平行法
Anterior
上顎犬齒
Positioning
Patient positioning
上顎犬齒
平行法
Anterior
上顎小臼齒
Positioning
Patient positioning
上顎小臼齒
平行法
Anterior
上顎大臼齒
Positioning
Patient positioning
上顎大臼齒
平行法
Anterior
Patient positioning
下顎門齒
Patient positioning
下顎門齒
平行法
Anterior
下顎犬齒
Positioning
Patient positioning
下顎犬齒
平行法
Anterior
Positioning
下顎小臼齒
Patient positioning
下顎小臼齒
平行法
Anterior
Positioning
下顎大臼齒
Patient positioning
下顎大臼齒
平行法
正確
錯誤
分角線法
原理
Alveolar bone level
is not accurate
Vertical angulation
too small
水平角
分角線法
正確入射路徑
前牙
Long
axis
of
the
film
packet
vertical
上顎
原理
2 - 3mm beyond
the incisal edge
下 顎
Long axis of the film
packet horizontal
2 - 3mm beyond
the occlusal edge
正確
後牙
分角線法
後牙
Bite fork
鱷魚夾
前牙
分角線法
上顎門齒
Patient positioning
Vertical angle
Patient positioning
Vertical angle
上顎犬齒
分角線法
上顎小臼齒
Patient positioning
Patient positioning
上顎大臼齒
分角線法
下顎門齒
Patient positioning
Patient positioning
下顎犬齒
分角線法
下顎小臼齒
Patient positioning
Patient positioning
下顎大臼齒
難題解決






下顎第三大臼齒
嘔吐感
根管治療
無牙區域
小孩子
殘障病患
Importance of patients communication for
dentists
1. The dentist–patient relationship is a crucial factor
that has an influence on the viability of the
average dental practice
2. Dental students should be educated about the
importance of developing and mastering sound
communication skills with patients.
Importance of patients communication for
dentists
3. Little emphasis was placed on the development of
sound communication skills because dental
students’ cognitive and clinical development have
always been emphasized
4. It has been noted that the ability to communicate
skillfully and with purpose rarely occurs as
a gift, but is learned, the reality is that the term
‘communication skills’ is perceived as an intrinsic
part of an individual’s personality, his/her
cognitive functioning and social experience
Steps for patients communication for dentists
A. Opening the interview (creates safe environment) :
1. Greets patient
2. Obtains patient’s name
3. Introduces self
4. Attends to patient’s physical comfort (here and
throughout interview)
5. Identifies and confirms patient’s chief complaint
Steps for patients communication for dentists
B. Gathering information: structuring the interview
(explains interview process):
1. Negotiates an agenda for consultation
2. Attends to timing
Steps for patients communication for dentists
C. Gathering information: exploration of problems
(determines chief complaint) :
1. Encourages patient to give history of chief
complaint
2. Uses open questioning technique(s)
3. Uses closed questioning technique(s)
4. Listens attentively (no interruptions; allow time
for patient to think before answering)
Steps for patients communication for dentists
5. Facilitates patient’s responses (use of
encouragement, silence, repetition, paraphrasing,
interpretation)
6. Clarifies patient’s statements which are vague and
need amplification
7. Summarizes at end of a specific line of inquiry to
verify own interpretation of what patient has said
to ensure no important data was omitted
Steps for patients communication for dentists
D. Understanding the patient’s perspective
(determines expectations, psychosocial issues &
emotions) :
1. Determines patient’s expectations regarding each
problem
2. Picks up verbal cues (patient’s need to contribute
information/ask questions; information overload;
distress)
3. Encourages expressions of feelings
4. Encourages patient to contribute ideas/
suggestions/preferences/beliefs
5. Accepts legitimacy of patient’s views/beliefs (nonjudgmental)
Steps for patients communication for dentists
E. Sharing information (presents treatment plan) :
1. Discusses treatment options
2. Discusses consequences of not proceeding with
treatment plan (in non-threatening manner)
3. Provides information about procedures,
processes, benefits & advantages, value &
purpose
4. Uses easily understood language (avoids or
adequately explains technical terminology)
5. Shares own thoughts & ideas
Steps for patients communication for dentists
F. Reaching an agreement on treatment plan(s)
(treatment plan acceptance) :
1. Obtains patient’s view of need for action
(perceived benefits)
2. Negotiates mutually acceptable treatment plan
(encourages patient to make choices; address
concerns)
Steps for patients communication for dentists
3. Elicits patient’s understanding about treatment
plan(s)
4. Takes patient’s lifestyle, beliefs, cultural
background and abilities into consideration
5. Encourages patient to be involved in implementing treatment plan (to take responsibility and be
self-reliant)
6. Asks about patient’s support network for
decision-making
Steps for patients communication for dentists
G. Closing the interview :
1. Summarizes session briefly
2. Contracts with patient regarding next step(s) for
patient and dentist
3. Explains possible unexpected outcomes and
safety-nets appropriately
Steps for patients communication for dentists
H. Nurturing the relationship (employs relationship
building blocks) :
1. Demonstrates interest
2. Demonstrates respect
3. Communicates warmth
4. Demonstrates appropriate non-verbal behavior
(for example eye contact, posture & position,
movement, facial expression, use of voice)
5. Reading, writing, use of computer do not interfere
with dialogue/rapport
6. Shows empathy with patient
7. Deals sensitively with embarrassing & disturbing
topics
Steps for patients communication for dentists
當病患現有懷孕時：
A.在放射線照射前，應告知她的法律權益
B.應警告她有流產的可能性
C.應告知她絕不可拍攝牙科X光片
D.視情況在適當的防護下可拍攝牙科X光片
(上列何者最正確)
http://www.scmh.org.tw/dental/dental_information/dental_x-ray.htm
Summaries
1. The culture of dentistry places a high premium on
technology. Dental schools should ensure a
balanced approach in their training of dentists to
ensure that the focus on technology is not at the
expense of the dentist–patient relationship
Summaries
2. Since dental care occurs in the context of
relationships amongst patients and dentists,
dental schools should complement students’
cognitive and clinical development by teaching
the human dimensions of dental care by means of
the development and implementation of courses
in communication skills
Summaries
3. Standardized patient (SP): a professional actress
was trained as SP to portray the case study
(clinical scenario) in a consistent, reproducible
and measurable manner )
4. To assist the SP in understanding the nature of
the dental scenario and its presenting signs and
symptoms, written case notes were prepared for
the SP to review