Tools Every Dentist Needs

April 1, 2002
In this second installment of her series, the author discusses the vital principles that every dentist must embrace to communicate effectively with patients.

by Sandy Roth

In this second installment of her series, the author discusses the vital principles that every dentist must embrace to communicate effectively with patients.

What is the greatest communication barrier between dentists and patients? Paradoxically, it is that dentists know too much, yet at the same time know too little. Indeed, dentists are the experts on all things clinical; their education, experience, and expertise have given them great wisdom. The problem is what dentists know about the profession can be a significant disadvantage when it gets in the way of curiosity and inhibits them from learning those things that make each patient unique. Most patient communication problems spring from oversights, misunderstandings, assumptions, and plain old lack of information. But each of these can be avoided simply by reversing the order of things. A simple switch – learning first before telling what you know – can dramatically transform the way patients relate to their dentist and respond to their recommendations. Thus, learning how to listen, and how to ask pertinent questions – rather than just giving a technical explanation about dentistry – becomes the key to communicating with patients.

In the first installment in this series, we established that a lack of clinical skills is seldom the problem when a practice is not functioning at its potential. Patients rarely "evaluate" the quality of their dentists' clinical services; most simply don't have the background to truly judge clinical competence. It's how they are treated – rather than the clinical treatment itself – that matters most to patients. Whether patients feel appreciated and respected determines the strength of your relationships, and, ultimately, the success of your practice.

Most dentists want to be viewed as caring, credible, knowledgeable, and wise so that they can influence their patients and gain acceptance of recommended treatment. How frustrating it must be to dentists when patients shrug off their clinical opinions with little consideration. You are skilled enough to detect a problem that was unknown to the patient. Left untreated, the problem would increase in severity, cause discomfort, be more difficult to resolve, and more costly to fix. You identify the problem, describe its causes and implications, and outline your solution, only to hear the patient respond, "Perhaps next time. It doesn't hurt yet." These situations happen all too often and ultimately make dental care more problematic for patient and practitioner alike. While its often said that the best dentistry is no dentistry at all, the next-best dentistry is early, conservative, and preventive. Yet, dentists universally struggle with patients with whom they cannot communicate at these early stages.

In this second installment of our 2002 Communications Workshop for Dentists, we will explore a series of vital principles that every dentist must understand to communicate effectively with patients. You will notice again that each of these principles has more to do with how you think than with what you say.

Patients must feel understood and respected before you can influence them. You are the expert on clinical dentistry, but your patients are the experts on their lives. Dentists are entitled to a clinical opinion based on clinical findings and their implications. They are not, however, entitled to an opinion about what the patient's life priorities should be. While you will always know more than your patients about dental diseases and problems, it is wrong to presume that you know better than your patients how dental care should fit into their lives. When you do so, you cross a boundary; your clinical opinion will have less impact than it might have otherwise.

Has a friend or coworker ever given you unsolicited advice about a problem? This friend probably meant well. Perhaps he had listened to you complain about the situation or observed your struggles with an issue and simply wanted to help. Too often, outsiders think they understand the full extent of a situation based on a snapshot that reveals only a few bits of the story. So, in an attempt to help, and believing that he could see things more clearly than you, he told you what you should do. It is unlikely, however, that you immediately followed his advice. In fact, we almost never act on the advice of others under these circumstances. That's because only we know all the pieces of the puzzle. We reject this type of advice primarily because we believe outsiders don't or can't understand. Since they don't have the full picture, their advice is valueless.

Similarly, patients will dismiss your recommendations if they think you don't have the full picture. While you may understand clinical findings, you likely don't understand how stressed your patients might be about their job, their marriage, their finances, their children, or a myriad of other issues. Your first job is to understand as much about your patients as possible while recognizing that your range and depth of knowledge will always be incomplete.

The road to understanding begins with curiosity and genuine interest. It's the first communication skill you must master if you are going to be effective in creating functional relationships with your patients. Curiosity is a mindset rather than a scheduled event. Certainly, there is a point where dentists must act on what they've learned; however, most could easily increase their curiosity quotient 10 times without losing any credibility.

What is the effect of increased curiosity? When you are interested and curious, you are more likely to ask good, relevant questions. However, curiosity must be followed by active listening; continue to ask questions until you understand your patient. When patients feel understood and respected, they will be more open to your opinions and influence.

We hear the phrase "low dental IQ" all the time. And while it primarily refers to the patient's lack of dental knowledge, it also infers that the patient places a low value on dental services in general. If you (or your staff) believe your patients are stupid or have bad dental values, it will be evident in how you treat them. People sense when they are being patronized and generally don't tolerate it for long.

Respect does not necessarily mean agreement. You can respect a person's position or perspective without agreeing with it. You might make a different decision, knowing what you know and given the circumstances, but your life is not the same as your patient's. You must respect the decision your patient makes. Respect comes from a greater understanding of the values and principles your patient applied in making a personal choice. Respect requires understanding.

Patients are buying quality of life changes, not dental hardware. No one – and I mean no one – wants a crown, or a bridge, or a prophy, or an implant, or even a veneer or bleaching. When people ask you to provide care, they are not purchasing the hardware of dentistry. They are purchasing an enhancement to their quality of life. How you change the quality of their lives is always less important to your patients than it is to you. The services you provide are less important than what those services accomplish. This is a tremendously important distinction and one that dentists confuse regularly. It is the foundation for my earlier statement that dentists know too much, while at the same time they know too little.

Clinicians are knowledgeable about dental procedures. Their primary obligation is to conduct themselves with skill in five major areas: examination, diagnosis, prognosis, treatment planning, and delivery of care. The intricacies of dental procedures, materials, and technology may be interesting and challenging to dentists, but most patients can't assimilate such information at this level. Most are overwhelmed by the complexity of the dentist's explanations. Attempting to teach your patients how you think as a clinician will create a barrier in your relationship.

Instead, dentists need to shift into a "learning mode" when interacting with patients. Learn why your patient is there and what he or she wants from you – not in clinical or dental hardware terms, but in quality-of-life terms.

It's quality-of-life issues like appearance, comfort, function, and peace of mind that motivate patients. Some patients are highly motivated by appearance factors and seek dental care for this reason. Others are motivated primarily by comfort. Still others are in pursuit of greater function, hoping, for example, to restore their ability to chew. And, finally, many patients are motivated by peace-of-mind issues such as dental health and stability.

Most patients have a combination of issues on their minds, but each patient's agenda is unique. What patients hope your care will provide largely determines how they respond to your recommendations. Thus, when you can relate your recommendations to the quality-of-life issues that patients value, they will more likely agree to them.

Listening and learning come before telling and education. In many dental practices, the following experience is the norm: New patients are greeted; light conversation is initiated; the dentist examines the patient, then uprights the chair and tells the patient what he has found and what he can do about it. "Do you have any questions?" is followed by a short meeting with the financial coordinator to explain fees, and then with the scheduling coordinator to schedule the appointments. With little variation, the vast majority of dental practices use this approach with new patients. There is little wonder why patients don't schedule, cancel appointments, or fail to appear. The emphasis is on telling rather than on learning about the patient.

Become interested and curious. Ask. Listen. Ask some more. Listen some more. Understand. Respect. Then, tell. This process puts a significant emphasis on understanding patients before the examination begins. When applied correctly, this process can dramatically change the outcome of a case presentation.

Dentists often violate this principle in many areas of the practice. New patients are shown instructional videos about home care before anyone asks what their current regimen is and whether it is effective. Diagrams and educational tools litter the entire office. While each of these tools can be powerful at the right time, patients often perceive them as an annoying interference. These tools create an emotionally "noisy" background when peace and clarity are called for.

Patients are entitled to a clearly conveyed clinical opinion. Patients want your informed clinical opinion. They pay for your judgment and expertise. Earlier, I referred to the phenomenon of the overwhelmed patient. Many dentists struggle with patients who respond negatively to their most sincere recommendations. Patients obviously become overwhelmed when faced with a complex dental condition. Dentists wrongly assume that it is the problem or condition that is overwhelming, when in fact it is the barrage of confusing information during the treatment discussion.

Practitioners can avoid this problem by using lay language with patients. Dentists are often unaware of their tendency to shift automatically into "techno speak," and leave their patients far, far behind. It is no wonder that patients are overwhelmed!

Your language must be simple, informative, and relevant. Patients aren't stupid; however, it is your job to use words that make sense to them. Always begin by asking the patient where he would like to begin rather than choosing the starting point yourself. Ask what he would like to know and how much detail would be helpful, rather than presuming that he wants all of the facts at once. Don't jump from one topic to another. Focus first on the big picture, and fill in details when the patient is ready to proceed. Please, please, please – don't attempt to teach your patients everything you think they ought to know about occlusion in the mistaken belief that they will become enlightened about the issue. Instead, simply let them know that to make things work right, or to last a long time, or to look good or feel comfortable, you'll make sure that your dentistry fits very well with their teeth, jaw, and gums. Relate everything to your patients and what is important to them first. There will always be time to add your agenda after you have addressed their issues.

In subsequent articles, we will explore more patient communication issues. In the meantime, I encourage you to spend some time working on this month's "Building Blocks" assignment. It will help you learn how to apply these principles with all of your patients.

Building blocks - a guided practice

Your next assignment is to review each of these principles for their personal application. Begin by taking an inventory of the attitudes and beliefs you hold toward your patients. Ask yourself questions about the way you think. Do you focus primarily on teaching, educating and telling, or on learning?

The next step may be a bit frightening because I'm asking you to make yourself vulnerable to your staff. During your next staff meeting, ask your staff to critique you as a "question-asker," "listener," and "learner." Ask them to report on what you do that gets in the way of good patient relations, how effective you are at using lay language, how complicated or simple your information delivery is, etc. You will find that your staff has a keen sense of observation and the ability to detect when the patient's eyes have glazed over. Listen to their feedback and avoid becoming defensive and negative.

As an experiment, tape record a few discussions with patients and listen to them with your team. Listen for how many questions you ask and how much telling you do. Listen for jargon. How much airtime do you use? How much does your patient use? Try to discern when you are connecting with the patient, and when you're off and running on your own. Then, work with your team on how you might change your approach. As you experiment with changing your focus, continue to record discussions every week or so and plot the impact of the change. I believe you will be delightfully surprised.

Best wishes as you continue with our 2002 Workshop series. I look forward to being with you again in June, when we will turn our attention back to communications with your staff.

To learn more about how you can develop your communication skills, call Sandy Roth at (800) 848-8326, or email her at [email protected] for a catalog of learning resources.

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