Clinical scripts for effective communication

There is no disputing the power of the spoken word. When you inadvertently say the wrong thing to someone, it often becomes uneraseable from his/her mind. In writing novels, we have a basic and universal rule that every word must have a purpose or else it is removed. If that is so important in fiction, why should we think it less important in the very real world of dentistry?

Dental analogies effectively bridge the language barrier between you and your patients.

Roger Levin, DDS, MBA

There is no disputing the power of the spoken word. When you inadvertently say the wrong thing to someone, it often becomes uneraseable from his/her mind. In writing novels, we have a basic and universal rule that every word must have a purpose or else it is removed. If that is so important in fiction, why should we think it less important in the very real world of dentistry?

Patients remember what you say. Boy, do they remember! Sometimes the mind aches as it tries to forget. Consider the following story:

A wanderer in the old days of Egypt came upon a young man who was forever looking for a fast and easy way to make more money. This young man had done well for himself and was now looking with even more fervor and greed. The wanderer made an offer to the lad, "I can sell this magic lamp and secret formula only once, for a thousand gold coins, and I guarantee that, together, they can turn sand into gold." Naturally, the young man was interested. "You guarantee the formula?" "Or your money is returned," the wanderer countered. The lad succumbed to the offer and the deal was struck. "The only condition that will make the formula not work," added the wanderer as he handed over the lamp and incantation, "is if, while rubbing the lamp, you happen to think of a monkey with a red tail. Then, the formula will not work."

You can bet this young fellow will forever have a red-tailed monkey on his mind!

Dr. Lindsey D. Pankey, unarguably one of America`s most influential dentists, said that the key to a successful dental practice that allows dentists to use their technical ability to their greatest potential is the ability to communicate. Unfortunately, most dental language is well beyond patients` understanding, hampering the communication process.

Enter the use of dental analogies or short stories.

When your patient asks a question or gives an objection to a treatment plan presentation, your response may be unforgettable to that patient, for one reason or another. Curiously, this unforgettableness seems to be directly proportional to the extent to which the answer favorably affects the patient`s mind.

So, how do you avoid argument and still successfully manage off-guard questions like: "Why didn`t my last doctor tell me that?" Or, "Why aren`t you open Saturdays or evenings?" Or, "Why can`t you just clean my teeth in one visit?" (And the questions just go on and on, don`t they?)

You use short stories.

Gerry Spence, the buckskin-coated lawyer made famous by television coverage of the O.J. Simpson trial and one of America`s most successful attorneys, once wrote that storytelling is in the genes and that listening to stories is also in the genes. Therefore, the most effective structure for any argument will always be a story.

That`s not to advocate that you argue with patients, but if your answers are routinely as memorable to your patients as the red-tailed monkey was to the young lad, you should expect that they won`t be forgotten and that the questions will not be repeated. More importantly, your true mission as a dentist will begin to be understood by your patients and your treatment plan acceptance rate will increase. What a glorious reward, indeed!

Unforgettable answers are available in the form of dental analogies, laymen`s stories that somewhat parallel particular dental problems or questions. There are literally thousands of them, depending on the patient and the problem. Doug Young, a well-respected speaker and consultant to the profession, wrote, "Language is such an important aspect of communication ... As a speaker, I know how effective dental analogies can be."

Educators at the dental schools of The University of Mississippi, the University of North Carolina at Chapel Hill, The University of Louisville, the Medical College of Georgia, the University of Florida, and Indiana University all express intent to include the growing popularity of dental analogies in their curricula of patient education. Considering that much of cutting-edge dentistry arises from the teaching arena, obviously the dental analogy`s time has come! In fact, one dental school dean said, "Your book (on analogies) seems to fill a void in our treatment planning literature ..."

Dental analogies are not difficult to use. The book Dental Analogies contains over 100 different ways to answer patients` most difficult-to-understand dilemmas using stories or analogies.

Another example of one you might consider would be when your patient is really devoted to you and would rather you not send him to specialist for a more-involved problem. A simple explanation would liken the referral to a family practice physician referring a patient to a cardiologist; while many family practitioners treat some heart disorders, referrals are in order for the more serious cases. Dentistry and its necessary referrals are no different.

Patients don`t look with disfavor on laymen`s talk. They appreciate your deviation from the mumbo jumbo of dentistry. If you were to say to Ms. Allen, "Varium et mutabile semper femina," she would look at you with her eyebrows raised, and possibly for doubly-good reason, if she spoke Latin! If you persist in speaking dentalese, you may just as well speak in Latin.

Dental analogies bridge the language barrier between the one with the knowledge (you) and the individuals without the knowledge (the patients). The treatment plan presentation is often your one opportunity to help patients see their chance for optimum dental health. Prepare and tell a story. As Gerry Spence said, "Prepare. Play and prepare. Prepare and win."

One question at a time

Ponder this question. "Why do I always have to wait when I go to the doctor?" Patients sometimes just don`t understand, do they? No matter how hard we work for them, it seems to often turn them against us. In fact, the very fact that you are a good practitioner may compound the problem.

Consider this answer to such wonderment: "We are sorry for the delay, but sometimes our busy office can be likened to your child`s school room. When the teacher asks, `Does anyone have any questions?` several hands naturally go up. If she is a good teacher, she will take the time to answer each individually. We do the same here with our patients - individual attention. Even with emergencies, we work hard to keep on schedule, just as your child`s teacher does."

When you compare the patient`s situation to a more familiar one, it defuses the situation, often humbling the patient in the process. Certainly, she wants proper care for her child. Now she knows that minor delays are actually reflections of your attempts to properly provide for your patients` needs. And, if a patient is mildly miffed at having to wait several weeks for a return appointment, you can always respond (with a smile, of course), "I guess our office is like a good movie ... the line tends to be a bit longer!"

Do barnacles make the ship go faster or slower?

Most offices have various media in place for patient education, be they videos, intraoral cameras, pamphlets, CD-ROMs, teaching models, etc. However, it can be difficult to assess whether patients truly understand the message that`s being relayed with some of these tools. When you add the power of the spoken word to each educational means in the way of analogies, every one of them gains value.

Consider that a 25-inch image of his/her own periodontal disease may embarrass a patient and serve only to affront. A concomitant explanation likening it and it`s solution to a similar layman`s problem takes the edge off and creates familiarity. Consider this response: "Calculus (tartar) builds under the gumline like barnacles under a ship`s hull. While the barnacles only slow the ship down, calculus speeds up the loss of teeth."

This analogy, like many others, places a more familiar spin on the problem of periodontal disease; and, as Julian Jaynes wrote, "the feeling of familiarity is the feeling of understanding."

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