The learning ladder

So what is it? Trust? If you’re like me, there have been times when you really wanted to help someone return to health, but that person rejected your treatment recommendations. Even worse, they left your practice, complaining you were expensive and recommended treatment that wasn’t necessary. This patient had been going to good old Dr. Nice until his retirement, and he’d never recommended this treatment!

We could analyze everything you and your staff did or didn’t do, and come up with several plausible reasons for why this happened. Or, we could dismiss the patient as someone with a low dental IQ. But, in the end, that patient simply did not trust you! He or she didn’t feel you sincerely had his or her best interests at heart. Worse yet, the patient left thinking less of you. This is a true lose-lose-lose situation.

Trust is the cornerstone of our work with people. Without it, there is little treatment acceptance beyond emergency care. Trusting the dentist tops the list for satisfied patients in feedback surveys. In today’s world, trust is not readily given - it must be earned! Webster defines trust as “confidence in the honesty, integrity, reliability, justice, etc., of another person … faith and reliance.” How many of those words are primarily emotional?

With professional services, perceived competence is very important. However, we know it is difficult, if not impossible, for a layperson to accurately judge our technical competency, especially at the outset. People do judge our competency by how we act. How we act dictates how they feel in our presence, especially whether they feel safe and well-served. But trust is not only competency. If it were, then the most competent doctors would always be the most trusted. In truth, each time you attend a C.E. program and elevate your technical competency, you should become more trustworthy.

The more you learn, the more you see, diagnose, and recommend. You don’t see what you don’t know, and you diagnose and recommend what you do best. Ironically, you then overwhelm your patients. I vividly remember returning from the Pankey Institute in its early days, excited about what I’d learned. Shortly after I returned, one of my first patients was a middle-aged fellow with severe wear patterns and significant occlusal interferences. As I examined and discovered this - and began to explain the long-term consequences along with treatment options - a knot began to form in my stomach. This patient had gone to the dentist faithfully for many years, and no one had ever even examined his bite. Now, here was this young dentist, full of enthusiasm, finding all these problems and recommending a lot of treatment. He thought I was trying to pay for my new equipment and building by suggesting treatment he didn’t need. Actually, I was simply trying to be comprehensive and help him keep his teeth for a lifetime.

The late Dr. Bob Barkley, originator of co-diagnosis and a pioneer in health-centered dentistry, said that those dentists who grow technical competency, without also growing their behavioral and communication competency, become frustrated and even mildly depressed when patients reject their recommendations. After a series of such rejections, some dentists resign themselves to a remedial kind of “if it ain’t broke, don’t fix it” mentality of care.

So what do we do to build trust?

True learning results in belief change that leads to behavioral change, which in turn leads to positive results. I call this “The Learning Ladder.” It’s been argued that you have not truly learned if your behavior doesn’t change. All significant learning follows a pattern which begins at the bottom of the ladder as you move from unawareness to taking action. The six steps are: