Building your patient’s trust

Oct. 1, 2006
In a recent survey of 1,000 adults, 25 percent said they stopped seeing a physician due to communication problems, 60 percent wanted doctors to offer more options, and 40 percent wanted them to better explain what they were doing.

In a recent survey of 1,000 adults, 25 percent said they stopped seeing a physician due to communication problems, 60 percent wanted doctors to offer more options, and 40 percent wanted them to better explain what they were doing. The same applies to dental patients. If patients are made to feel like bugs on their backs with their mouths open, they will rebel. When patients’ needs are not met, their response can range from simply being uncooperative to filing a lawsuit. A survey of defense attorneys revealed that of all medical lawsuits filed in the past five years, 35 percent could be traced to a doctor’s poor communication and another 35 percent to a doctor’s poor attitude. The evidence is clear: You must talk to patients - not merely to avoid lawsuits, but to build relationships that are patient-centered, rather than doctor-centered.

Here’s the difference - a doctor-centered relationship focuses on biomedical facts, clinical data, technical details of treatment plans, and reinforcement of rules and guidelines. A patient-centered relationship, however, focuses on the patient’s wants and needs, questions about the diagnosis, fears of treatment, and concerns about time, cost, and follow-through. The patient-centered approach is what you need for true practice success.

The $25,000 question is where to start. First and foremost, to see things from the patient’s viewpoint, it is vital to understand that people arrive at your practice with different, unique needs. In what we call the “level zero” stage, patients arrive with some degree of anxiety and mistrust of the dental process. They may avoid connecting with you and your staff and say only what they think you want to hear. If you ask this kind of patient, “Would you like to keep your teeth for a lifetime?” the response might be, “Of course, whatever you say.” Meanwhile, there’s a burning caldron of questions, concerns, fears, hopes, and desires right below the surface.

If you get past level zero, next comes level one. At this stage, patients experience and communicate surface problems, difficulties, and dissatisfactions, such as, “It hurts,” “I can’t chew,” or “Can you fix my two crooked teeth?” Most practices communicate on level-one needs and no further.

However, if you probe deeper, you encounter level two. Here you find the patient’s conscious or subconscious needs, desires, and concerns that reflect a deeper need for dentistry to cure not only a specific, localized dental problem or minor dissatisfaction, but to improve life in a more wide-sweeping way. Here the patient may say, “I don’t want to feel self-conscious any more,” “I don’t want to look like my grandfather when I’m 60,” or “I don’t like to eat in public and embarrass myself.”

Although dentists typically deal with level-one needs, the truth is that patients make decisions from a level-two perspective. The level-two needs are more compelling. If the money, time, and effort involved in solving a problem seem greater than the perceived positive outcome, the patient will either reject treatment or fail to follow through. The level-two patient grasps wider implications of dental treatment to his or her general well-being and therefore commits happily.

Three opportunities for you and your team to uncover level-two needs are the pre-clinical interview, which you conduct prior to the new patient exam; the clinical exam, in which you use a “co-discovery” approach; and the consultation, where you reveal and gain commitment to the short- and long-term treatment plan. Communicating on level two creates in patients a commitment not only to treatment, but to a relationship with the dentist and team that can withstand financial and other obstacles to ideal care.

How much time do you spend on your preclinical interview before the chair goes back? The goal of the preclinical interview is to uncover the patient’s wants and hopes. It also sets the tone for an exam that the doctor does with patients, not to them. Many dentists ask preclinical questions that only reveal level-one needs, instead of the relationship-building level-two needs. In order for the patient to accept treatment willingly, you must ask questions revealing four motivators that we call APEA - questions concerning what the patient wants to achieve, preserve, eliminate, and avoid. Exposing these motivators reduces the patient’s resistance to change and allows the person to move forward.

For example, a level-one question might be, “What are your most pressing concerns about your dental health?” Follow that with a level-two question, “And how have these concerns affected your life?” Another level-one question might be, “What would you like from me as your dentist?” Follow that with the level-two question, “Why is this important?” Don’t be surprised if patients are unable to answer level-two questions. According to the surveys, they are not used to being asked such questions. Their answers are a process of discovery for them, as well as for you.

After uncovering level-two needs in the preclinical interview, refer to your patient’s responses during the clinical exam. Explain how each aspect of the exam addresses their needs. Involve them in the co-discovery of their clinical condition. For example, if Mary does not want to feel self-conscious about unattractive teeth, and you are ready to perform the periodontal exam, you might say, “Mary, you shared with me earlier how self-conscious you feel about your smile. In the periodontal exam, we’ll be looking for signs of gum infection that results in gum loss and can lead to tooth loss, which would increase self-consciousness. I’ll be calling out numbers. If you hear a four or higher, it means that there is an infection that will need to be treated. The good news is that we can reverse gum infection when it’s caught in time, so you won’t have to worry about feeling more self-conscious.”

Your third opportunity to communicate on level two is during the consultation. Use this time not only to discuss treatment options, but to discuss any questions, concerns, or hopes the patient did not express previously. Imagine how cared-for the patient will feel if you simply ask what he or she would most like to discuss. Take the patient’s motivators into account when presenting treatment (remember APEA?). If the patient was interested in achievement or preservation, center communication around the positive effects. For example, “Imagine what it would be like for you to choose anything on the menu and eat without pain?” If the patient wanted to avoid or eliminate undesirable conditions, then address the undesirable effects with words such as, “By waiting, you risk the condition getting worse. Imagine if you had to restrict your food choices even more.” By knowing each individual patient’s needs and wants, you can focus communication to meet them.

Once you apply the principles, ask patients how they feel about their experiences. I guarantee a dramatically different response from the survey quoted above. All it takes to build loyal, committed patients is to bring out their needs, wants, and fears concerning their oral health, then to address them in a personalized, caring way. Try it and see!

Amy Morgan is chief executive officer and lead trainer of Pride Institute, the practice management firm helping dentists better their lives by mastering the business side of their practices. For more information on Pride’s seminars, management study programs, and products call (800) 925-2600 or see

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