Mastering the art of communication

July 1, 2000
3M Dental is proud to sponsor the Dental Economics year-long "Mastering the Art of Communication" series.

Part 7

The Art of Beginning Relationships

3M Dental is proud to sponsor the Dental Economics year-long "Mastering the Art of Communication" series.

Sandy Roth

If you could somehow get inside each new patient`s head before an examination, what would you want to know? Perhaps you want to know what prompted this patient to call your practice rather than any other dentist in your community. And maybe you would find it helpful to learn exactly what set of circumstances led him or her to pick up the phone at that particular time.

These two questions - why you and why now - are the door through which every new patient enters your practice and the foundation upon which your relationship will be built. The degree to which you take advantage of this opportunity will significantly impact your ability to build a successful long-term relationship. Each new patient has the potential to become your engaged, collaborative partner, or its opposite: one who is disinterested in any personal involvement. Can you influence how this relationship develops? You bet.

New patients are like blank slates to you. All have desires, issues, experiences, barriers, self-imposed limitations, concerns, fears, expectations, and curiosities which will eventually be revealed. When you and your team structure an approach to new patients that enables you to learn about their issues early in the relationship, you are more likely to serve the patient in a meaningful way.

People want to be understood. The time you and your team use in this effort will be well spent. Either you make it your business to understand your patient from the beginning or you will be forced to repair not only damaged teeth, but broken relationships as well. Which, do you believe, is harder to mend?

In this seventh installment of our series, Mastering the Art of Communication, we will explore how strong communication skills and a facilitative approach can positively impact the relationship with your new patients. If you have followed this series from its first installment in January, you will likely remember that I have emphasized listening as one of the most important elements of communication. You will find this to be doubly true when working with new patients.

Let`s begin our journey by outlining a few foundational principles:

- Dentistry is as much a behavioral profession as it is a clinical one. Your communication skills directly impact your clinical ones. Helping people with their choices can be more challenging than the dentistry itself. Patients must trust both the process and the practice before they can make an informed decision.

- Dentistry has a patient service mission. Dentistry is a business, and businesses must be profitable. However, profit motive should not be the sole raison d`etre. The ultimate goal for any practitioner should be to improve people`s lives through health-and image-enhancing services.

- You must learn your patient`s outcome. Patients are motivated by a combination of one or more of the following: a wish to improve appearance, a drive to achieve comfort, an interest in having their mouths function well, and a desire to achieve peace of mind and confidence. If you don`t know what is important to your patients, you won`t be able to help them. Lack of empathetic responsiveness may drive the patient off to someone who will listen and respond.

- Patients are experts on themselves. You are the expert on clinical dentistry. Uphold this distinction at all times. Your patients want and have paid for your professional opinion. They are entitled to it. But patients usually believe they know themselves better than you do. They are rarely wrong.

- Involve your patients. Your patients are more likely to be influenced by your clinical advice when they feel respected and included, and believe that you have their best interests in mind. You must therefore involve your patients as you learn about them, examine them clinically, diagnose their problems, and help them make treatment selections.

- Do not move faster than your patient. It is inappropriate to provide anything other than palliative treatment to a person who is not in a position to freely choose a course of treatment. My belief is based on behavioral, rather than clinical, principles. There must be a proper examination prior to any nonpalliative treatment, including hygiene. Until a patient relays expectations and fully comprehends what the dentist knows about the condition and its treatment options, he or she cannot own the problem or participate in creating a solution.

If you agree with these foundational principles, you likely are concerned with what you learn about your new patients from the beginning. The patient`s initial telephone call provides a great opportunity to begin this process. The person who receives the call must not only have good communication skills, but also the facilities and time to properly engage in this important conversation.

What is required? Usually five minutes or so of uninterrupted and undistracted time in a private place. During that time, your team member will be in a position to learn exactly "why us and why now?" These questions are easy to ask. "Thanks so much for calling us, Mrs. Jones. Tell me, how did you learn about our practice?" The team member should listen attentively and without interruption for anything that indicates what the patient knows about the practice and how it influenced his or her decision to call.

Be careful not to judge patients at this or at any other point. Some patients are referred by your favorite clients; others by those you enjoy less. Some have seen your sign and others may have found you in the Yellow Pages. Neither is any better or worse than the other. It is just information at this point.

Once you have learned a bit about how this new patient came to select this practice, you can shift into learning the patients motivation`s and expectations. The door is opening, and you are geting a picture of what is important to this patient and how best to help.

Urgencies and the comfort appointment

If the patient has a problem that requires the dentist`s immediate attention, your team member`s focus must shift to determining the exact nature of the problem and arranging for a comfort appointment. Dentists must decide if they are prepared to accept "urgencies" as new patients. Some choose not to do so. Their existing customer base, new patient flow, and referral systems are sound. They are not willing to interrupt planned dentistry or reserve unscheduled urgency time to accommodate someone who is not an existing patient. If, however, the practice is looking to broaden the patient base from several sources, it makes sense to look at how this type of patient can evolve into a regular one.

An urgency arises when a person is experiencing discomfort. A patient could be suffering severe pain from an internal problem. Or the problem could be "urgently" cosmetic - a broken front tooth, for example. Or the patient may be worried that a minor problem is getting worse. Whatever the case, this person has called your practice to get relief. How you respond to this initial call can influence whether this person is a one-time visitor to your practice - or a patient for life.

The initial goal is to relieve discomfort. This does not necessarily require you to provide definitive care for the problem. In fact, providing anything other than palliative treatment supports an ongoing urgency orientation. This is where the comfort appointment becomes a powerful tool in your quest to develop a temporary patient into a permanent one.

The office phone rings. A team member answers the phone and learns that a new patient has a toothache. Proceed carefully; language and approach are very important. If one merely says, "I`m sorry you have a problem. We have some emergency time set aside at 2 p.m. Can you come in then?", a great opportunity to begin redefining the role of the dentist in this patient`s life will be missed.

How can your team member best respond when a patient with an urgent problem calls? Outlined below are steps to ensure that the initial call sets the stage for a successful comfort appointment:

(1) Express concern about the patient`s problem.

(2) Learn about the nature of the problem by asking questions.

(3) Be clear in identifying how you are prepared to help by describing the comfort appointment.

(4) Review the fees for the comfort appointment and identify how you expect the fees to be handled.

(5) Make sure the patient finds this approach agreeable before confirming the arrangements.

Let`s review how the conversation might progress:

"This is Julie Smith calling. I`m a new patient and I have a terrible toothache. I need to see the doctor right away - it`s killing me!"

The team member should respond with empathy, and focus on discovering the exact nature of the problem:

"I`m sorry you`re having a problem, and I hope we can help you. Tell me everything you can about what is going on."

The patient describes the problem and the team member takes good notes. All staff should be trained to ask clear questions so they can distinguish between a broken tooth, an endodontic problem, a wisdom tooth, and other types of problems that can cause discomfort.

Once the team member has a basic understanding, the following response would be appropriate:

"Julie, Dr. Wonderful tells me that those types of symptoms are often associated with (general concept). It will be important for her to determine if that is, indeed, the reason for your problem. If you would like us to see you today, our goal would be to get you comfortable as quickly as possible. We won`t ask you to make any big decisions while you are in pain. We can arrange a comfort appointment for 2 p.m., and I`ll brief Dr. Wonderful thoroughly beforehand. When you arrive, I`ll review your medical history. Then Sally, the doctor`s assistant, will take a film of the tooth so we can see what is going on below the surface. Dr. Wonderful can then examine the tooth, look at the radiograph, and determine the best way to relieve your pain immediately. Her goal will be to make you comfortable without eliminating any options. Does that sound like it will work for you?"

Once the patient responds affirmatively, the team member can continue:

"Great. Now of course, since this is not something you planned, you would probably like to know about the fees and how we will ask you to handle your account today. The fee for your comfort appointment is $XXX. This covers the examination, radiograph, and the basic treatment to make you comfortable. We will ask that you come prepared to take care of that fee in full today. I want to make sure that is agreeable for you before we confirm your appointment.O

Once the team member obtains agreement from the patient, she can proceed:

OI?m glad we can help you today. Once you are comfortable, Julie, we can talk about the next step, which would be learning why this problem happened and developing a plan to solve it. We can do that by making arrangements for a proper examination of your entire mouth so that you and Dr. Wonderful will have the information you need to do the job right. We can talk more about that when you are feeling better. Can we confirm your appointment for 2 p.m.?O

If patient and staff member have been clear and honest with one another, this will likely be the start of a beautiful relationship. But what if the patient doesn?t agree to any of the points? Or if he or she won?t discuss the symptoms? What if the time won?t work? You must decide about the variables. If a patient will not work within these very reasonable guideline, a solid, long-term relationship is unlikely.

I don?t advocate becoming rigid and unreasonable. It does make sense, however, to set aside planned time for comfort appointments to avoid infringing on time set aside for planned dentistry. It also makes sense for the staff to prepare more fully so that only a minimal commitment is required of the dentist during comfort appointments.

Resist the temptation to allow openings in your schedule to justify providing more definitive care for an urgency patient. People can?t make good decisions for themselves when they are in pain; palliative treatment preserves the most options for a more rational decision later. Finally, it is reasonable for you to expect payment for your services. This is not a mean thing to do; it is proper and fair.

Next month, I?ll introduce you to a behaviorally oriented process for integrating nonurgency patients into your practice. In the meantime, I encourage all of you to review how you work with urgency patients and experiment with your approach. I will be interested to know if these ideas help you.

Use voicemail to your advantage

I often hear voice mail messages that say, "If you have a true emergency, please call the doctor at ...." Because most people dislike voice mail, especially when they are in pain and want relief, this type of message can create ill-will and frustrate your patients. Instead, try the following: "If you are calling about a matter you believe requires the urgent attention of the Doctor, please call ..." This type of message is more positive. Of course, you must do what you promise. If the doctor cannot respond, the voice mail message should provide alternatives for finding help.

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