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August 21, 2009

Ask the Expert featuring Dr. Barry Polansky

Question 1: How do you overcome recall patient resistance to an additional fee for oral inspection with the Velscope or Visilite if their insurance carrier does not provide any benefits? -- Dr. Barry Wohlgemuth, Denver, Colo.

Answer: Your question sounds less about what we do during an examination than a philosophical view on dental insurance. My book, "The Art of the Examination," discusses a practice model that de-emphasizes the role that insurance plays in practice. I am not being naive when I say that the dentists who hone their "soft skills" don't seem to have the problem of patients resisting oral inspection with the VELscope or Visilite. The same dentists also don't meet resistance with complete series of radiographs, study models, or any other diagnostic aids needed for comprehensive care. I have been preaching about these soft skills for years. Application of any technology depends more on a trusting relationship than on the technology itself. Thank you for the great question. I hope my answer starts a revolution in the profession.

Question 2: How do you motivate someone (a dentist client of mine) about patient relations and building trust when he believes he isn't people oriented and doesn't like to schmooze? I've explained how this impacts case acceptance and production, amongst other things. However, if someone has self-imposed blocks, it makes teaching much less motivating and more difficult. -- Denver-based dental consultant Rita Zamora

Answer: Let's face it. Some people just aren't good at schmoozing. You know what they say about teaching a pig to sing? The pig can't sing and you're just going to annoy the pig. As far as not being people oriented, well, that's just a prerequisite to a successful private practice. I've always believed it's difficult to delegate relationship building. I know of some practices where the doctor isn't comfortable with communication skills, so a treatment coordinator handles communication. Call me old fashioned, but I believe that building trust is the key to case acceptance, and the dentist who can build trust will generally get patients to say yes more often.

I believe that trust is the highest form of human motivation. I tell groups I speak to that with people, "slow is fast and fast is slow." This means that when you take the time to build trust the decision making process will be fast. Those who rush through the trust building steps will watch their patients take forever to make a decision. An inability to communicate is usually fear based. Just like public speaking, many people are very self-conscious about their inability to communicate, even when it's one-on-one.

There are many courses and seminars on this topic. I address it at length in my "Art of the Examination" seminars. Leadership and public speaking courses by the Dale Carnegie Institute are also excellent resources. All communities offer Toastmasters, which help people kill the communication demons. There are many books, such as Larry King's "How to Speak to Anyone, Anytime, Anywhere" and Neil Rackham's "SPIN Selling," which discuss the art of asking questions, another great conversational tool. As far as motivating your dentist client, I would work within his strengths and give him many "why's" to communicate, and the "how's" will come.

Question 3: I want to ask about the frustration I feel. I believe today's CE is contributing to the over-treatment phenomenon. There are guys out there with less than 10 years of practice who are still trying to feel their way and look to outsiders for guidance. Then we turn around and the majority of what we see is pretty porcelain cases on teeth that were actually almost acceptable by most criteria and standards to begin with, so we get a false sense of what is actually going on out there. Most of us practice within our own four walls and have very little interaction with other dentists. It makes me start thinking that I'm not being aggressive enough in my treatment planning. What is the answer? What advice do you have? -- Anonymous dentist from North Carolina

Answer: I feel this question needs to be addressed in our profession. There is so much confusion out there by dentists who are looking for a model of practice. Dentists go to seminars and see magnificent dentistry that is impractical for their style of practice. What's a dentist to do? Many years ago when I first began practice, it was about being a competent and ethical dentist. Since the late '80s when advertising and cosmetic dentistry became the standard, expectations changed.

What I find interesting is that so many of the cases we see at seminars were done under ideal conditions, on patients who were family members, staff, or friends of the dentist. When I see a beautiful veneer case in a magazine and I find out it was done on the doctor's hygienist, I'm not sure how practical it is to do in my practice on a daily basis. There are so many factors that go into producing a perfect case, factors that go way beyond the technical skills, such as finding the right patient, one who appreciates a certain level of work and is willing to pay for it. Years of hard work developing the dentist's hard and soft skills will lead to success, but to expect to go out and do this level of dentistry after taking a weekend course is unrealistic.

It seems that every magazine we see is filled with these high-end cosmetic cases. Lecturers seem to compete with one another on the beauty of their cases. As you noted, the dangers are a loss of judgment, and over-treatment. What's even more dangerous is that dentists, working alone, will develop a sense of inadequacy, and the last thing we need is dentists with low self-esteem.

My advice is to learn comprehensive and ethical dentistry, and to become an expert in both the hard technical skills and the soft people skills. Remember that dentistry is a journey, and the most important thing is to be fully engaged and happy in your work.

Question 4: As always, I enjoyed your article in the February issue of Dental Economics. I would suggest that instead of a gardener of the mouth, the term greenskeeper appeals to me. It's a much more awesome responsibility. You lose a plant, and you replace it if you're a gardener. You lose part of a green on a golf course and you find yourself wearing a sign that says, "Will work for food"!

Also, your article talked about the thrust change by educators in charging their proteges. Is your interpretation of the thrust change by educators based on what you're seeing from the dental schools, or what you're seeing from the post-grad (Pankey/Spear/Dawson) program educators? ? Steve Markus, The Centre for Dentistry at Haddon

Answer: As many readers know, I have been significantly influenced by the Pankey/Dawson philosophy of dentistry. I have always felt that dental schools were lacking in certain areas of dental education. Many dentists are not taught the skills necessary for relating with patients at a level needed to get the technical results. The mission at the Pankey Institute has always been to help dentists close the gap between what is known about dentistry and what is actually practiced. To answer your question, I would say that dental education has always had this problem. Sadly, I also see this with dentists who attend many of the popular continuing education courses. There has always been a dearth of learning in our profession regarding the skills that lead to success with people. I use the term physician of the oral cavity to represent an ideal of the dentist who has mastered not only clinical skills, but behavioral skills as well. Hopefully the profession will recognize the areas that will help dentists evolve into physicians of the oral cavity. That will truly save dentistry.

If you have a question you would like to submit to Dr. Barry Polansky, click here

Barry F. Polansky, DMD, practices in Cherry Hill, N.J. He is author of the book, "The Art of the Examination," and publisher of "Dental Life." He is on the visiting faculty of the Pankey Institute.

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