Although technological advances, growth, and specialization in health-care delivery have led to great improvements in the treatment of disease and disability, they also have resulted in the impersonalization of health services.
-- National Commission on Allied Health Education
Dentistry is a part of health care in the United States; therefore, we can conclude that dentistry is part of the impersonalization reference. The National Commission on Allied Health Education has simply confirmed what patients and communication consultants have been saying for years.
Dental professionals must realize that dentistry is first a behavioral art, and second a clinical science. The behavioral aspects of human communication are often taken for granted. It is not smart to assume that if someone speaks, a message is sent, and if another listens, the message is received.
Many in the medical profession act as though sending and receiving messages is all there is to human communication. Some of these attitudes are apparent in these statements:
- “I know how to talk with this patient; I treated him last year.”
- “How could she have misunderstood me? I told her everything.”
- “Obviously she wasn’t listening when I went over the treatment information.”
- “I explained the fees and treatment, and she still complained to the receptionist.”
These statements reflect a failure to appreciate the complexity and sensitivity of human communication, resulting in hurt feelings, misunderstandings, and complete breakdowns in communication. Dental personnel who continually fine-tune their communication skills will serve the dental team and the patients well.
Dental professionals spend a lot of time communicating. In a classic study, adults in a variety of occupations kept a record of the time they spent in the four types of verbal communication: talking, writing, reading, and listening. Participants concluded that at least 70 percent of their day involved one or more of these communications. The study broke down the percentages of activity:
- Listening - 42 percent
- Talking - 32 percent
- Reading - 15 percent
- Writing - 11 percent
Since the early 1950s, studies have supported the importance of listening. Listening makes up a large part of the communication process and is a primary means of acquiring information, feelings, attitudes, and understanding. We’re not born with an ability to listen effectively, nor does it develop naturally. Rather, effective listening is a learned skill that requires considerable energy, effort, and attention. Yet most people don’t listen. When done properly, listening combines what we hear, our attention, understanding, and what we remember.
Four stages of listening
Larry Barker, a recognized authority on listening, theorizes that four stages occur sequentially, usually with little awareness, but in rapid succession:
➠ Hearing - Hearing is the physiological first stage of the listening process, the audible part of communication that doesn’t involve conscious perception. Unless you’re deaf, you hear.
Listening occurs when you attach meaning or understanding to the hearing process. A dental patient may acknowledge sound without meaning. Listening comes with exposure, education, and repetition. For comprehensive listening, one must advance beyond the hearing, noise, and sound. Heard in the proper context, a moan, grunt, or groan upon greeting a patient has meaning. But to hear and properly process these sounds, one must have a healthy auditory system and not be too tired.
➠ Attention - As multiple sounds bombard our eardrums, we may acknowledge some sounds and ignore others. When we listen to a patient, we may block out distracting sounds around us. We can train ourselves to block sounds that may impede understanding - the buzz of the office light, for example.
Sound has meaning. It’s also selective. A loud or unusual sound may disrupt a conversation regardless of our control, conditioning, and training. Even when we focus on a particular sound, the listening process isn’t complete. Attention requires the dental team’s concentration and conscious discipline. Team members must want to greet patients when they enter the office, and clinicians must enter the operatory ready to focus on the patient. In short, paying attention requires the mind, mouth, and eyes to work in sync.
➠ Understanding - Understanding requires the listener to attach meaning to sound. Because people are affected by different perceptions, experiences, language associations, and context, sounds may have personal interpretations or common meanings.
Understanding occurs with time, exposure, clarification, and repetition. For example, dental terminology, which is second nature to you, may sound threatening to a patient. An MOD is general terminology to you, but a patient may think it stands for the March of Dimes. A big part of listening is that the message sender and message receiver share the same meaning. A more comprehensive health history or more thorough verbal interview may help you understand a patient’s needs.
Listening takes effort, planning, time, and foresight. Remember, unless you’re listening to yourself (a distracting yet legitimate topic called intrapersonal communication), more than one person is involved in the process.
➠ Remembering - The final stage in the listening process isn’t addressed by all writers and researchers, but recall or information stored in your memory bank improves your listening capability. Even partial remembering or recall enhances listening and patient and staff relations. Remembering important events and dates about each patient (and noting them in the patient file) helps you personalize your approach and credibility, build rapport, and establish a comfortable environment for communication.
Researcher Ralph G. Nichols has studied extensively the behaviors of a poor listener, many of which are considered dangers or barriers by authors and researchers. Nichols has identified behaviors or bad listening habits, but his research applies primarily to public speaking forums. Listening is different for different people, even in the same situation. A good listener knows how to adjust to various situations and audiences. It is smart to constantly monitor your level of listening and your attitude.
You can control barriers if you recognize them. For example, consider how you react to a speaker’s physical appearance and speech patterns rather than listening to what is said. We live in an image-conscious society, in which patients don’t always look or speak according to another person’s comfort level, bias, or prejudice. A patient’s condition or attitude toward dental professionals may affect his/her appearance, body language, or vocal tones. A patient’s walk, body posture, voice patterns, accent, attire, size, or color may prevent you from listening. Age, nationality, appearance, or language need not be barriers. After all, every patient entering your office is a guest.
Pitfalls to avoid
Beware of these behaviors which interfere with effective listening:
• Faking attention - Most of us don’t want to appear rude or bored and may pretend to listen. Unfortunately, in the operatory, we miss opportunities to learn valuable information and behavioral insights. If you fake attention or remove yourself from the patient, you shut down the four stages of listening. If you find yourself shaking your head in agreement when your mind is a million miles away, discipline yourself to get back on track.
The faker may assume that appearing to listen satisfies patients, but in most instances, the only person deceived is the faker.
• Allowing certain words or phrases to interfere with listening - Words, spoken or written, conjure associations that result from direct or vicarious experiences. The word “hygienist,” for instance, might be associated with the words cleaner, nurse, educated, arrogant, rough, preacher. To get past negative meanings, do some perception-checking with the patient. Ask these questions:
- “Have you received treatment from a hygienist before? How was it?”
- “Before we get started, do you have any questions of me or what we’ll be doing?”
- “In your last office, were you comfortable working with a hygienist?”
Too many words distract patients. We recently surveyed 1,125 patients, asking, “What words or subjects would you rather not hear in the dental office?” The top 10 responses were: shot, root canal, needle, “We’re running late,” “Be right with you,” “Oops,” root planing, the girls, drill, and gross scaling.
You must become desensitized to some words, ignoring distracting ones and listening for the overall message. Keep in mind that words mean different things in different parts of the country. The word girl, for instance, can be OK, or it can ignite hostility and defensiveness. Unfortunately, an emotion-laden word can quickly end listening.
• Failing to eliminate or compensate for noise - Two kinds of noise exist: physical and psychological. Most of us think of the physical, or external, kind - a phone, a crying patient, hall noise, loud talkers. Psychological noise - anxiety, negative stereotypes, sleeplessness, previous memory, preoccupation - is internal. Physical and psychological noise inhibits the listening process. Messages may be misunderstood or completely lost. The physical sound of a handpiece may distract a patient, or the psychological sound of mental fear may upset the patient.
There are more than four barriers. Take a minute to develop your own list. Most people know when they’ve shut down or stopped listening, because they turn inward. Try to improve your listening skills with your family, although it may be easier to listen to strangers.
How to improve your listening skills
Many studies discuss listening techniques. My own research during the past 32 years has allowed me to interview many dental personnel. Using questionnaires, personal observations, and interviews, I’ve drawn some conclusions as to why listening or communication can shut down in an office.
Effective listening begins with a serious interest in what other people think, but what you think and practice are also important. With this in mind, improve your listening techniques in the following ways:
- Stop talking and listen.
- Force yourself to listen to difficult topics.
- Create an interest in dentistry.
- Determine why you’re communicating with patients.
- Determine your role in the listening process.
- Adjust to your patient.
- Fight or control distractions.
- Set your “self” aside. Be inconvenienced.
- Be tolerant.
- Hold your fire and keep emotions in check.
- Balance your speaking rate and your thinking rate.
- Be kind. Don’t dominate the interaction.
- Suspend judgments.
- Be patient. Avoid interruptions and tuning out.
- Learn to read verbal and nonverbal cues.
- Remember that posture affects listening.
- Develop empathy and concern for others.
- Periodically state what you’ve heard.
- Treasure the moment - it’s gone tomorrow.
- Desire to be a listener.
- Care about yourself and other people.
With so many distractions around us, it is becoming more difficult to pay attention, and that places a great burden on the listener. A good listener opens doors to new and beneficial experiences. As a dental professional - and a good listener - you play a prime role in educating and motivating people. Learn to listen with your ears, eyes, senses, mind, and heart. Don’t make listening a lost art in your life!
References available upon request.
Larry Wintersteen founded Wintersteen & Associates (www.wintersteen.com) in 1974. Wintersteen is highly motivated and committed to excellence in personal and professional growth through practice image, patient communication, team building, and self-actualization. He stresses the importance of self-discipline, sensitivity, motivation, honesty, expansive thinking, and balancing. You may contact Wintersteen via e-mail at firstname.lastname@example.org.