Focus On: Defining the Patient Experience

Bruce V. Freeman, DDS, DOrtho, MSc


Bruce V. Freeman, DDS, DOrtho, MSc, answers some common questions about developing empathy and putting patients at ease.

Q: How do we define the patient experience?

A: When I hear this question, I think of the poet Elizabeth Barrett Browning, who wrote “How do I love thee, let me count the ways” when thinking about her feelings (so history guesses) for Mr. Browning. The patient experience is one of those concepts for which everyone has different ideas on what it is all about.

Everyone on the clinic team may think they know what is best, but it is crucial that every member is on the same page and the protocols that are developed are clearly defined and can be delivered with ease. I will provide answers to some common questions on defining the patient experience and things to think about when designing a program for implementation in the hope that I can make the concept a little less complex!

Q: Is there science behind the patient experience?

A: In the poem “If” by Rudyard Kipling, the first line, for me, says it all: “If you can keep your head when all about you/Are losing theirs and blaming it on you.” As dentists, this really defines our daily lives. How do we do this? The concepts apply to everything, from dealing with our loved ones, patients, and teams to keeping the family dog happy. Neuroscience holds the answers.

The vagus nerve is responsible for our fight-or-flight and rest-and-digest states. Understanding that—particularly today, when there is a bubbling level of stress and anxiety in all of us—is the first step to grasping the importance of the Polyvagal Theory and keeping ourselves and those around us in the “Window of Tolerance.” The goal is to avoid a panicked state where the sympathetic branch of the vagus nerve has us in its grip. Instead, we want to be pleasantly guided by our parasympathetic nervous system, which allows for social engagement.

Simply guiding someone to place their hands and feet on a flat surface as you instruct them to focus and move certain fingers and toes is the first step, as your hands and feet are islands of safety outside the reach of the vagus nerve. With younger children, asking them, for example, to balance on one foot and count backward from 10 will help free them from the flight-or-flight state. The other key part is to guide the breath so that the exhales are longer than the inhales, which slows the heart rate. The hospital dental residents with whom I work have seen this in action with the very stressed patients in our facial pain unit, and the response is amazing.

Q: How do I show empathy?

A: Explaining the concept of empathy, let alone showing it, can be baffling. By definition, empathy is the ability to understand and share someone’s feelings. How exactly do we demonstrate this? Science to the rescue! Many studies have shown that simply taking the time to commiserate with a patient’s cold symptoms helped reduce their severity. Hearing and listening are 2 very different concepts. We must do both when a patient speaks.

For example, taking the time to allow patients to tell the story about how their diabetes or cholesterol problems are impacting their lives has been proven to improve their adherence to their diets and medication regimens. Think about the placebo effect, which is all about offering hope. The endorphin release from positively extolling the effects of a treatment is well documented.

Dentists are frustrated with patients no-showing for appointments. During consultations, in particular, simply letting them ask one extra question in addition to addressing the psychosocial aspect of how their concerns impact their lives has been shown to increase compliance with appointments. Remember to avoid acknowledging an emotion with a fact. Patient: “I am so nervous to have a tooth out.” Dentist: “Don’t worry, I’ve done this a thousand times.” For the patient, it is the first time you are doing it for them. They are not concerned about the other 999 times! We have to learn the origin of the fear.

Q: What am I saying wrong?

A: We know we cannot please everyone, but as dentists, it’s in our DNA to try. Our words and the tone with which we say them are so critical. I have learned from the marketing guru Simon Sinek the word “why” is extremely powerful. This is critical for everyone who encounters a patient; from the team member booking the appointment to those participating in clinical care, it is important to recognize that patients want you not to just listen but also hear what they have to say, particularly, as outlined above, when they are scared.

Those of you with children understand the difference between listening and hearing best when you ask them to do something and their response is a distracted “Yeah, yeah.” Hours later, you realize the poor dog is still waiting to be let outside. Starting conversations by asking, with interest, why the patient has come to see you today and inviting the patient to tell his or her story helps the patient feel he or she is in safe hands.

Inquiring as to what bothers the patient the most among his or her myriad concerns and developing a treatment plan that you draw out for him or her to see helps to further build a relationship founded upon empathy. Ask the patient next if your plan makes sense and if you have missed anything, and always end by thanking the patient for letting you look after him or her.

Remember, we are all of service to our patients, but we must first look after ourselves. Check in with your families and teams, but start with yourself. Naming your emotions and noticing why you feel a certain way helps get you in the right frame of mind so that you can help others. A little mindfulness goes a long way. Ultimately, self-care leads to the best patient care.

Dr. Freeman is an orthodontist and a yoga instructor. He is co-director of the facial pain unit at Mount Sinai Hospital in Toronto and the director of patient experience for dentalcorp. He can be reached at

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