Jerome S. Mittelman, DDS
What is the answer to the DPMO insurance problem? Well, there`s organized dentistry and, certainly, never-ending patient education. But the most important answer is the doctor/patient relationship. It is important for us to develop rapport with patients to gain their cooperation in treating them. But, the continuing threat of third-party intrusion into our professional lives makes it mandatory for us to promote good relationships with patients to survive in private, fee-for-service practice.
While organized dentistry plays a role in helping us maintain control of third-party payers, we cannot depend on it any more than the British dentists could depend on the British Dental Association. What is needed is introspection - for us to look within ourselves for the answer - to help patients want, demand, and be willing to pay for the dental care they need. We`ll see that this requires a great deal of patient education. To do this effectively, we first must build a relationship that makes our interest in patients` well-being self-evident. Because we have so little actual time to do this in day-to-day practice, we have to use every opportunity.
Three qualities help build this trust. The dentist who understands this and works to make these behavioral characteristics part of his/her thinking and behavior will have the advantage. Psychologists refer to those three qualities as accurate empathy, nonpossessive warmth, and genuineness. Let`s take a look at each quality individually.
Accurate empathy
Carl Rogers has said that the doctor who communicates empathetic understanding and unconditioned positive regard for the patient`s well-being as a genuine person builds a relationship with "necessary and sufficient" conditions to promote therapeutic change. His entire attitude centers on the patient. Accurate empathy involves the doctor`s sensitivity to his patients` current feelings and his ability to communicate this understanding in a way that is harmonious with the patients` feelings at that time. He does not - and should not - share the same emotions. But, the doctor should have an appreciation and awareness of those feelings.
We do not reach our patients many times because we simply are too preoccupied with their dental problems or the techniques of dental treatment. We give lip service to treating our patients as the whole human being each one is, and then we premedicate, anesthetize, and go to work. Or, we charge off and create a parent/child type of doctor/patient relationship, sermonizing and defeating our purpose to help. We do this because we fail to be sensitive to where the patient is, mentally and emotionally, at the time. Listening plays a large part in sensing just what frame of mind our patients are in, how they feel about themselves and their situation. Patients sense if we have made the effort to understand them. They sense when we care.
Nonpossessive warmth
Positive regard for an individual must exist, wherein the doctor and his staff accept the patient?s experiences as part of his individual personality without imposing conditions. We must accept each patient as a person with human potentialities, and value each apart from any judgment of behavior or thoughts. Doctors don?t have to accept a patient?s behavior, but we must accept the patient.
Our own insecurities challenge this relationship, and the tendency to project our own attitudes upon the patient weakens the nonpossessive warmth relationship. Impa-tience with others can bar development of deep rapport. A dentist concerned about the oral health of his patients and who develops this nonpossessive warmth more likely will build a more sensitive rapport. The dental team that matures and grows is more capable of offering this caring attitude to patients. The attitude communicates itself to patients nonverbally and indirectly, but profoundly. It generates trust.
Genuineness
Many people appear to be artificial. They act out roles. They say things that seem appropriate, but do not appear to mean what they say. They are overly tactful. They hide behind conventional facades. They give those about them a feeling that they are insecure.
By contrast, others we know are more spontaneous and say what they mean. They act without being defensive and don?t retreat into a role or pretense. They are real. These are the characteristics of genuineness. The doctor who is genuine develops openness. Patients need not be preoccupied with interpreting what the doctor means when he/she speaks. Patients of doctors who are genuine in their demeanor have no doubts about their doctors? actions and, for that reason, they trust them. Their strength invites confidence. This is the climate in which sincere rapport can be developed.
The answer
Dentists searching for the answers to third-party interferences into their professional relationships need to look for the answers within themselves. They need to assemble a staff of like-minded people to help implement Otrust-buildingO within the practice. We have found that when we successfully build a community of feeling with patients, they are inclined to accept our treatment suggestions for more complete dentistry. When they refer patients, their trust and enthusiasm for this kind of openness provides new people with a positive set of expectations and mindset. These people will be more likely to make more appropriate decisions about the dental care that they need.
Jerome S. (Jerry) Mittelman, DDS, has been in practice for 37 years and is in his 30th year of publishing and editing The Mittelman Letter. Dr. Mittelman and his wife, Beverly (CNC), edit and publish The Holistic Dental Digest PLUS. He has lectured on practice management in over 30 states and overseas, and has published over 50 articles nationally. He was a founding member of the American Society of Preventive Dentistry. He can be reached by e-mail at [email protected].
