Th 119454

Experience success in every case presentation

Feb. 1, 2003
If you are providing comprehensive restorative dentistry, you know the challenge of examining new patients and making your case presentation to them.

by Susan S. Maples, DDS, MSBA

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If you are providing comprehensive restorative dentistry, you know the challenge of examining new patients and making your case presentation to them. You also know the excitement you feel when patients accept treatment — and, yes, the disappointment when they reject it. No matter where you are in your dental practice, it's never too early to release yourself from the feelings of rejection. It's time to learn how to transform your case presentations into a generous offering rather than a sales pitch.

The need for acceptance

Do you think you'll outgrow the highs and lows that arise from the outcome of case presentations as your practice evolves? Unfortunately, even the most successful dentists experience these feelings throughout their career. I recently participated in a master's level study meeting, in which 10 dentists and two facilitators met to share their expertise related to case presentation and restorative dentistry. The participants made the weekend a rich experience, full of curiosity and free of judgment. Only now, however, am I beginning to understand the full impact of our exchange.

While listening to these high-achieving practitioners tell their stories, I learned that each had suffered from great fear and insecurity at some point in his or her practice. I was reminded, once again, of the tremendous fear of rejection that many dentists face on a daily basis. In sharing our clinical expertise with a patient during a case presentation, it can be difficult to separate sharing ourselves from the culmination of our life's work.

This is especially true when we work diligently to prepare a full diagnostic presentation, including a complete exam, periodontal chart, occlusal analysis, study models, diagnostic wax-up, photographic series, digital imaging — the works! Ultimately, we finish the presentation and anxiously await the patient's reaction.

For most dentists, training in dental school and in advanced courses reinforces the desire to educate patients. We want them to help them see for themselves the higher standard of health they can achieve. We do our best to influence their judgment, all the while placing our own self-worth in the patients' hands while we await their acceptance or rejection. We feel energized when they say yes, and depleted when they say no. We view their decision about treatment as a direct measure of our professional success. And, for those of us with an inborn desire to please everyone, the effects of being accepted or rejected are felt even more intensely.

The fear of rejection

Although judgment is a two-faced phenomenon, we tend to see only one side. We all recognize criticism or rejection as judgment, and we know all too well the pain that results from being judged. Yet, we often fail to recognize approval and acceptance as judgment, because they feel so good. Even when a patient nods along in complete agreement as we present a case, he can quickly remove his approval, leaving us to feel even more dejected than if he had rejected us outright.

Naturally, our fear of rejection colors our communication during the case presentation. We may be anxious, tense, or hyper-aware of whether our message seems to be agreeable to the patient — and, as a result, our body stiffens, our voice shakes, and we fidget like nervous teenagers. In a state of anxiety, we become our least authentic, least empathic, and least creative selves. We so want our case presentation to be accepted (or perhaps, we so want to be personally accepted) that we become hopelessly self-conscious.

With so much riding on the patient's decision, it's not surprising that rejection often causes resentment to emerge. We feel resentment about the time wasted in presentation, the patient's lack of understanding, and the staff's lack of personal involvement in the case. When we believe that our dedication and devotion to others are not reciprocated, our resentment deepens.

Give and take

Sadly, the whole process seems to be about us — the dentist — instead of the patient. In fact, the very idea of a case "presentation" suggests a soliloquy or demonstration of our expertise. Moving beyond our own vulnerability absolutely requires that we shift the focus back to the patient. This shift may not come easily, because it is so difficult to change ingrained behaviors.

The process of shifting focus back to the patient involves engaging in conversations with them that go much further than a logical explanation of our clinical abilities. We know from our own experiences that the messages we save and replay in our own minds are those that hold special meaning for us when we hear them. All of the rest goes in one ear and out the other — and the same holds true for our patients. The crux of the case presentation lies in figuring out what information has specific meaning to the patient and why. This requires the dentist to take from the patient as well as give to them during the case presentation.

In receiving from the patient, the dentist can reap many personal rewards. In her book, Kitchen Table Wisdom, Rachel Naomi Remen states, "One of the reasons physicians feel drained by their work is that they do not know how to make an opening to receive anything from their patients. The way we are trained, receiving is considered unprofessional. The way most of us were raised, receiving is considered a weakness."

By entering into a genuine and equal exchange with a patient, we can benefit immeasurably. First, by truly listening to another person, we always come to know ourselves better. Second, by helping patients choose health goals that feel right to them, we remove ourselves from personal judgment. The choice is about the course of action that works best for the patient, not about us. What a relief it is to remove ourselves from their decision!

Celebrating every outcome

Most dentists in the master practitioners' study group had read the book and/or attended Dr. Paul Homoly's course, Isn't It Wonderful When Patients Say "Yes": Case Acceptance for Complete Dentistry. Dr. Homoly's work proved to be a breakthrough for many of us. He clearly helped us to differentiate our logical (and often technological) communication from our emotional communication. He then identified the need for both in a case presentation. Dr. Homoly reminded us about the difference between quality and suitability. He also helped us uncover the most important issues of case acceptance: fit and readiness for the patient, not for the dentist.

Emotional communication means having a conversation with your patient that spans many levels, but becoming this personal with a patient makes many of us feel uncomfortable. Delving deeper into patients' feelings — their real picture of themselves, the motivations behind their healthy (or unhealthy) behaviors, the visual image they see when they look in a mirror, the other priorities in their life that take precedence over their dental health — learning these things may provide us with more information than we think we want to know. Yet, these elements are essential to determine your patients' fit and readiness for exploring comprehensive care.

Happily, when we enter into an authentic exploration of the patient's desired outcome — one that reflects his or her feelings and point in life — we release ourselves from judgment. As one dentist in the masters' study group summed it up: "Now, every case I present has 100 percent acceptance. My patients accept 100 percent of what they want because the treatment plan is essentially designed by them — according to their own personal fit and readiness — not by me in their absence. My job is to help them understand their choices and the consequences of those choices. Then, I get out of the way while they make a decision. Remaining unattached to the outcome is the key."

When patients express a desire to explore a comprehensive solution, our dentistry becomes a sacred offering, not a sales pitch. With nothing to prove, we are finally free to celebrate our patients' choices and help each to see the person he or she wants to be in the mirror.

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