Case acceptance and the lizard

March 1, 2004
Since October, we've been exploring Emotional Intelligence (E.I.). Most star performers attribute the majority of their success — 75 percent — to E.I.

Bob Frazer Jr., DDS, FACD, FICD

Since October, we've been exploring Emotional Intelligence (E.I.). Most star performers attribute the majority of their success — 75 percent — to E.I. As Daniel Goldman said in Working With Emotional Intelligence, "E. I. is our capacity for recognizing our own feelings and those of others, for motivating ourselves, for managing emotions well in ourselves and our relationships. It involves four key domains: self-awareness, self-management, social-awareness, and relationship management."

Last month, "Taming the Lizard" compared the seat of emotions in the limbic system — the amygdala — with a lizard sitting on a rock scanning the environment. When aroused, it asks only three questions: Can I eat it? Can I mate with it? Will it eat (hurt) me? And then it reacts instantly. Although such responses may be essential for survival, they can quickly short-circuit other decisions that necessitate cognitive reasoning. For those kinds of decisions, we have the prefrontal cortex (new brain) that can best be compared with a filing clerk — very competent, but slow and deliberate.

For dentists and their staffs, the "lizard" can be a detriment during case presentations. (A quick aside: We hate the phrase "case presentation" since it connotes a passive patient and an active doctor employing manipulative selling tactics, and because it conveys need instead of value ... great when selling whole life insurance and used cars, but not in health care! We prefer "co-diagnosis" and "consultation.") Let's explore case acceptance and "the lizard."

During a workshop on building E.I., we gave three groups this scenario: "A week ago, you completed a comprehensive examination on a 56 year-old salesman. It went well. Now you are in a follow-up consultation. This patient needs major reconstruction, plus nonsurgical periodontal therapy. Earlier he expressed some hesitation when you discussed gum treatment with him because his father had painful gum treatment years ago and lost his teeth anyway.

"He tells you he does not want to go through gum therapy since his gums rarely bleed. Furthermore, he believes a good cleaning and consistent flossing will do the trick. You know this is untrue. Several of his teeth need crowns and onlays. These teeth also have 6 to 7 mm pockets and show early furcation invasion. The patient also refers constantly to his 'excellent dental insurance.' Your treatment plan totals $9,500.

"The patient wants to do everything but the periodontal treatment, and he asks what the cost will be without it. He does not seem gruff or upset, but you are concerned that if you push him, he will agree to treatment — and then go elsewhere. How do you confront this fellow and your dilemma?"

How did our workshop participants respond? Most began in the wrong place and responded only to the patient. Just a few resonant doctors began by confronting their feelings (the E. I. competence of self-awareness.) They recognized they were distracted by the patient's reference to dental insurance. They admitted they had not fully understood the impact of his father's experience on the patient. They also were concerned that they failed to convey the harmful consequences of leaving the patient's perio condition untreated, and that they did not adequately explain the benefits of modern, nonsurgical treatment. Most participants were afraid they would lose the patient if they came on too strong.

In this scenario, the lizard prevailed, not only with the patient, but also with the doctor and staff. So what is one E.I. way to respond? First, recognize your feelings. Remember the open loop of the limbic system: You will sense the patient's emotions and he will sense yours. Then, with a calm demeanor and tone, tell the patient what you believe he is trying to communicate.

In the example above, the ideal response would be to convey understanding about the patient's reticence. Then be transparent (an authentic openness to others — self-management) with your feelings and beliefs about the necessity of proceeding with fine dentistry in the presence of periodontal disease. Reassure the patient that you can treat such problems comfortably and predictably.

In next month's column, I'll include more about elevating E.I. and case acceptance.

Dr. Bob Frazer Jr. is the founder of Frazer & Associates, a strategic leadership firm with custom programs that help dentists achieve the top 5 percent status in financial achievement and life balance. Superb communication skills have propelled Dr. Frazer to a 28-year international speaking career in dentistry. His entertaining, content rich programs flow from 30 years of real-life experience as a dentist who built an exceptionally successful rehabilitative and aesthetic practice in Austin, Texas. For information on an audio conference on this subject, or to receive "... 7 Ways to Grow Your E.Q.," contact him at (512) 346-0455, by fax (512) 346-1071, or by email: [email protected].

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