Delivering tough conversations in dentistry with integrity

Four techniques to say what needs to be said, when no one wants to say it

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Four techniques to say what needs to be said, when no one wants to say it

by JoAn Majors, RDA

For more on this topic, go to and search using the following key words: tough conversations, integrity, permission, innocence, accusatory, JoAn Majors, RDA.

“I’d like to see you in my office at the end of the day.”

This is one of those requests that gives you chills, sweats, even nausea. Often the one who receives this news is not the only one feeling discomfort. What is it about a request like this that makes everyone involved dread the moment? How can a simple request evoke such emotion?

Unfortunately, this is the way most people have learned to handle concerns: take care of business, lay down the law, or deliver a tough conversation.

When it comes to delivering tough conversations, starting with the right question and attitude can change everything about the encounter and outcome. Many people simply cannot handle these types of conversations well.

There are four guidelines that will allow even the most timid at heart, as well as the brutally honest, a way to offer unpleasant information while maintaining integrity and having empathy.

Let’s take a look at a few scenarios. It is important to remember a few guidelines and understand that it does not matter if the conversation is between a doctor or administrator to a team member, doctor or administrator to a patient, or a team member to team member. Starting with a question allows the other party to listen and participate at their rate of speed, not yours.

You must be willing to wait for the answer. This allows the other party to actually choose to engage in the conversation.

The following four techniques can be used with doctors to their referral sources, doctors to their labs, or a practice to vendors.

1) Ask permission to coach

When you have an issue with a team member and need the individual to listen and participate in certain actions, you must engage the person in the process. Call the team member to your office. Find something to compliment the team member on before delivering the tough news at hand.

For example, “Susan, you are one of our best team members when it comes to friendliness to our patients. Do I have permission to coach you in another area?”

She will most likely say “yes” because this is less brutal, and it gives you the freedom to discuss her constant tardiness, inability to put her personal phone away, inability to get off Facebook on office time, or whatever the issue is.

By having said “yes,” Susan is now involved and engaged in the process. It is a symbiotic relationship, not a reprimand.

2) Ask permission to be honest

In a situation where a team member wants to confront an issue with someone in management, the procedure works similarly although the words are different.

For instance, team members who want to address the administrator/doctor, also want to maintain a good work environment. But these conversations can be tricky.

Timing is important in these conversations, and you never want to make someone look bad or foolish. This will not serve you well, so be discrete. Step into the person’s office or schedule a time to discuss your concern(s).

For example, Susan might say to John, “John, do I have permission to be honest with you?” He will respond with less concern about the outcome because Susan has been respectful in her request. Besides, who would say, “No, I want you to lie to me”?

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Often people will seem puzzled that you ask. Don’t fill in the silence. Wait for their response. No matter how uncomfortable this might seem, it will create the results you want by allowing both parties to listen differently.

3) Leave out the limiting terms

When speaking to someone about their habits, behaviors, or personal life, it is of utmost importance to leave out the limiting terms. For instance, if you are going to discuss a sensitive area, it is normal to want people to like you, so you use less impactful words such as we, little, sort of, and kind of.

Let’s take a doctor to patient and administrator to team member scenario. Dr. Likeme says, “Mrs. Smith we have a little spot on your X-ray.” Her thought, if “we” have the spot and it’s “little,” then the doctor gets the treatment! The administrator or doctor says to the team member, “Susan, we have a little problem with your tardiness.” The thought that follows, if “we” have the problem and it is “little,” don’t call me!

How about this? “Mrs. Smith, there is a spot on your X-ray I am concerned about and that you should be, too.” This allows the patient to own the spot and concern. For the doctor or administrator and team member, “Susan, there is a problem with your continued tardiness; I am concerned and believe you should be, too.”

Both of these scenarios allow the person to hear the concern. These should only be shared after asking permission to be honest. We have already proven that this question allows the party to be engaged at a different level. It also cuts down on a person’s defensive mechanism.

4) Assume innocence – don’t use accusatory language

When having tough conversations in or out of the dental office, do not assume you know everything about the individual or the behavior being displayed. It is often more than meets the eye and the very reason one should always assume innocence. When you ask for permission to coach or be honest, presume that the other party has no idea there is an issue or problem — assume innocence.

Just because Susan is habitually tardy does not mean she is doing it to disrespect you, the team, or practice. Don’t assume that you know why this is happening. Susan could have a dying mother or a new diagnosis that is causing her to have blood work done often in the morning. Susan could have an issue that you should investigate.

Assuming Susan is innocent is much more productive for everyone involved. If your team member is not doing what is expected of him or her in the workplace, assume innocence and ask permission to coach, and then ask if he or she can fulfill the request. Just ask. It is not only the question, it is the cure for misguided and bad relationships in the practice and elsewhere. If you wonder what is happening, then just ask. But when you ask, don’t ask with an attitude. Assume innocence and be curious … like a small child!

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Remember, doctor or administrator to team, should use permission to coach. Team member to administrator or doctor, should use permission to be honest. Use words that don’t limit the impact of the information.

Finally, assume innocence and stay away from accusatory language. Like all important conversations in the practice, document the conversation, use exact language, and advise you will be documenting it.

These four techniques will cut down on the defensive mechanism we all use when we know bad news is coming! Focus on the fix, not the flaw; this can help you encourage others to greatness!

In the next few months, watch for other articles designed to encourage team members to have accountability and effectiveness. We will cover the next phase of this conversation: where do we go from here, how do we decide the next step, how do we measure and be held accountable to our agreement going forward. In addition, we will offer guidance to your team and to you in other critical areas.

From costly cancellations/no shows to verbal skills that create value to patients for technology such as CT scans, as well as conversations about insurance that do not undermine your practice and philosophies, the right approach will make it easier.

If you would like to suggest a topic or area of concern that you think is critical to team success and accountability, send your suggestions via email to me at

JoAn Majors is a registered dental assistant, published author, and professional speaker. In addition to her speaking, she has the team training faculty position for the Misch International Implant Institute. For more information on JoAn’s seminars and her latest book, “EncourageMentors: Sixteen Attitude Steps for Building Your Business, Family and Future,” visit or call (866) 51-CHOICE. The time is now; the choice is yours!

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