Mastering the art of communication

Dec. 1, 2000
3M Dental is proud to sponsor the Dental Economics year-long "Mastering the Art of Communication" series.

Part 12

The Art of Communicating With Your Dentist

3M Dental is proud to sponsor the Dental Economics year-long "Mastering the Art of Communication" series.

Sandy Roth

3M Dental is proud to sponsor the Dental Economics year-long "Mastering the Art of Communication" series.

Dental practices are unlike most other businesses. Typical service organizations have owners, managers, R&D staff, HR departments, sales and marketing divisions, and production and line workers. Dental practices, on the other hand, most often have a single person overseeing all of these functions. Not only is the dentist likely to be the founder, executive officer, financial manager, personnel department, strategic planner, and stockholder, he or she is also the primary producer. Considering these myriad obligations, it is no wonder many dentists are out of touch with and inaccessible to their employees. In many cases, staff members are more challenged by issues surrounding their employer than they are by patients or co-workers.

Gender differences are significant. The overwhelming majority of dentists are male - although this is expected to change dramatically over the next decade. The employee base for dental practices, however, is almost exclusively female, a statistic not likely to change for some time.

My observations have led me to conclude that male dentists and their female staff are often on different pages. In this final installment of our year-long series, Mastering the Art of Communication, I have chosen to address one of the toughest issues facing dental practices today - communication between the dentist and his team.

Let`s begin by looking at the factors that impact the dentist-staff dichotomy:

- Dentists are fundamentally more clinically oriented than behaviorally oriented. After all, they chose the hard science of dentistry over the numerous options available in behavioral science. Certainly, dental students are aware that they will be working with others, but their primary interest is more likely scientific and clinical. Many dentists are as unprepared for the demands of running a business and managing staff as first-time parents are when a newborn arrives. Dentists are not naturally gifted in interpersonal dynamics, making communication with the team difficult at best.

- Dental schools fail to prepare students for their roles as employers. There`s little enough time to provide adequate training in the mechanics of dentistry. Although more schools are adding practice management and communications modules, they are often optional, poorly attended, and quite limited in scope. Thus, most dentists begin their professional careers with little innate ability and only a modicum of training to prepare them to work with staff members. (If you would like to know more about ways in which you can learn to be a more effective communicator, leader, and manager, send me an e-mail at [email protected] and I will send you a prospectus for our Behavioral Study Club for dentists.)

- Women still shoulder a disproportionate responsibility for home and family. Responses to a question posed recently on the Ladies Home Journal Web site suggest how serious this challenge is for many team members. To the question, "Given how tough it can be to balance the demands of work and family, if you could afford to quit your job to stay at home with your children, would you?" an overwhelming 66 percent responded, "Yes, in a minute." Only 22 percent responded, "No, my job is too fulfilling." The final 12 percent indicated they would continue to work "because the kids would drive me crazy if I were home with them all day."

Most team members feel likewise. This creates two serious challenges for the dentist. First, he will likely find that almost 80 percent of his staff (four out of five) either would not be there if they could afford it, or they work primarily to avoid feeling trapped at home. Dentists expecting a high level of commitment from their staff often find this fact the source of much disagreement and frustration.

You will note that I have specifically chosen to use the pronoun "he" in addressing these issues. Female dentists report that they, too, are more responsible for home and family than their spouses. Gender does in fact make a huge difference. Therein lies the second challenge: A male dentist is more likely to feel (and be) less responsible for home and family than his female staff. As a result, he often is annoyed when employees take time off to attend to sick children, leave at the stroke of the hour to collect little ones from day care, or dash out at lunch to start the crock pot, run a load of laundry, or take care of errands.

- Dentists want their staffs to be reliable and predictable. Given the huge array of responsibilities most dentists shoulder, the last thing they want is an employee with a problem. Thus, they avoid issues that create disruption or take extra effort or time, particularly if they feel inadequate to the challenge. Inter-team problem solving is frequently left to the staff alone - the dentist prefers not to get involved. This explains why the doctor has two very different reactions when hearing a team member`s delighted announcement, "Doctor, I`m pregnant!" Certainly, the dentist is pleased for the employee`s own happiness, but that is always coupled with an emotional thud at the practical implications of disruption on the horizon.

- Dentists are often oblivious to the needs of their staff. Dentistry is, for all intents and purposes, microsurgery. Loupes and earplugs block out distractions while the dentist`s attention is directed to a patch of oral geography. With his mind so preoccupied, he may utter a harsh statement or shoot "the look" without the slightest realization of the hurt and embarrassment that follow. Similarly, the dentist lives in the clinical area throughout the day. He is often unaware of factors that impact the work in other areas. His staff`s appeals for new computers, remodeling a shabby reception area, or enlarging a cramped workspace often go unaddressed for years, causing frustration and anger.

- Dentists are frequently "conflict adverse." The distance between a dentist`s sense of self worth and treatment-plan acceptance or rejection is often very small. Dentists want people to like them and will go to great lengths to avoid conflict. An employee may get the cold shoulder for months with little or no direct indication that the dentist is displeased with her performance. The modus operandi for many dentists seems to be: Ignore the situation long enough, and it will go away. In some cases, of course, it does: The employee quits. But having rid himself of one unaddressed problem, a dentist is more likely to repeat the pattern than break it.

My intention in outlining these issues is not to berate dentists, nor is it to send a message that dentists must change. Dentists come by these characteristics legitimately. The modal type or style, which lends itself to clinical mastery, exacerbates other, less desirable traits. If we can acknowledge a few simple realities and understand their implications, we can support team members in communicating more effectively with their dentists.

The dental staff can have a substantial list of gripes. When I invite team members to identify issues they are unable to solve, they are candid in outlining them. Here are some points often raised:

... He is always running late. He talks too much. He adds treatment that wasn`t planned or plans for less time than we really need. He runs over into lunch and at the end of the day. Patients are unhappy and so are we.

... We were promised a performance and compensation review when we were hired, but it has never happened.

... I have no idea how I am doing. I never get any feedback at all ... Would it kill him to give us a pat on the back once in awhile, instead of always focusing on what we are doing wrong?

... He never backs us up. We agree to a certain approach, but when a patient complains, he caves in and we look like idiots.

... Nothing ever changes. We talk about making changes, but that`s all we do. Talk! ... or ... Just as we get used to doing things one way, he changes them again. He`s never satisfied.

... He`s always second-guessing us and he won`t let us do our job ... We don`t know what is expected of us.

The genesis of many of these frustrations can be found in the observations at the beginning of this article. The nature of dentistry and the obligations for the dentist lead to these types of challenges. In most cases, team members get angry and dig their heels in, expecting the dentist to change and blaming him if he doesn`t. But not only will the dentist be unlikely to substantially change his style, we probably wouldn`t want him to. Such a change would require dramatically different skills that would potentially put the dentist`s clinical focus in jeopardy. Just as team members would find it hard to incorporate the vastness of the dentist`s training, knowledge, and experience into their thinking, the dentist will find it hard to integrate such diverse perspectives.

What are we to do? Although I encourage dentists to become more intentionally conscious of the impact of their actions, the bulk of the power in changing these situations lies with the staff.

The strategy is simple, yet not easy to apply, for it requires staff members to first set aside their anger and blame. This necessary step will clear the path for more open discussion and make it safer for the dentist to listen - really listen - as well as understand and participate. Here are a few guidelines for team members who wish to have better communications with their dentist:

(1) You must first develop understanding and respect. If your position is always one of disapproval, the chip on your shoulder becomes the issue. You will provoke only resistance and hostility. Ask yourself: Does the dentist really behave this way on purpose to make me miserable? Does the dentist have undermining me as a mission in life? Does the dentist enjoy making me wait?

If you are honest, you know the answer to each of those questions is a resounding "no!" So, what is going on? Might the dentist be confused, fearful, very sensitive, or even clueless? Probably so. Honesty requires that we set aside harsh accusations, and leave room for curiosity. Instead of lashing out, act on that curiosity and ask questions. What is in your mind when these events occur? Help me understand what you are thinking and feeling when you back off from something we agreed to do. Tell me about how you see time in the moment when you are working with a patient. If the dentist is called upon to defend himself, he may not do so with grace. If, however, he is invited to share his thoughts and feelings in a nonjudgmental atmosphere, your interchange will help you understand him better. And understanding leads to respect.

(2) Disband the gang. Often, the staff has had extensive discussions about their frustrations - in the parking lot, after hours, and in secret sessions in the lab. They use the same language and cite the same examples. They finish sentences for one another and exchange furtive glances during the discussion. If the staff develops an "us against him" coalition, they will surely meet resistance and suspicion. Moreover, "ganging up" makes it difficult for members to participate and respond as individuals.

Although one person may not have issues with the dentist`s behavior, she may feel compelled to support those who do. Maintaining the coalition and its legitimacy can become more important than finding a solution. Speak for yourself and insist that others do as well.

(3) Ask not what your dentist can do for you. Ask what you can do for your dentist. When President John F. Kennedy took the oath of office in 1961, and delivered a similar challenge, he called upon Americans to embrace their responsibility to make the world a better place. Earlier in that address, he also said, "So let us begin anew - remembering on both sides that civility is not a sign of weakness, and sincerity is always subject to proof. Let us never negotiate out of fear. But let us never fear to negotiate." Approach a discussion with your dentist with a civil spirit, sincerity in your purpose, and a determination to influence the outcome. If you approach the discussion aware that although you cannot change others, you can change yourself, you will discover your power. You can make a difference - with your attitude, your skills, and your determination. But you can`t make a difference if you sit back and wait for someone else to take the lead.

(4) Determine to make yourself highly skilled and valuable to the practice. If you don`t know how you make a difference, shift your focus from complaints to personal impact. Your dentist is more likely to trust your judgment and motives when you are a significant contributor than when your impact is largely unfelt.

Perhaps working outside the home isn`t your first choice. But if you must, then it might as well be something you take seriously and treat as an obligation. Of course, your family will be foremost in your priorities, but that doesn`t mean you can take a free ride at work. Doing your job means more than bringing your body to work.

Your awareness of ongoing events and their implications, trends and patterns; opportunities with patients, and efficiencies in operational matters is vital information the dentist needs. Letting things pass because there are imperfections in others doesn`t cut it. Tune in and participate.

(5) Be assertive - not aggressive. Perhaps it is time to bring back the assertiveness training sessions we had in the 1970s. That was a time when women, young and old alike, learned important skills to become a viable force in their worlds. Timidity does not influence, and shy people are easily overlooked. If you want to have a say, learn the basic skills of framing your thoughts, delivering your message, and standing your ground. Remember that your position is enhanced when you have first sought to understand through questioning and listening. The time will come for you to convey your perspective. You must ask for your dentist`s respect and attention, especially if he is unaccustomed to giving it.

Insist on clear expectations and convey yours as well. Differing perspectives and expectations generate most conflict and disagreements. Dentists are notorious for overlooking clearly defined expectations, in part because they are themselves unclear about what each role entails.

If a set of expectations has not been presented to you, draw one up for yourself. Then present it to your dentist and other team members. Don`t ask the dentist to do all of the work, particularly if you want greater clarity for yourself. Roll up your sleeves and put your thoughts on paper for others. Create a proposal. Suggest a plan. Be the instigator of positive change, and you will likely have raving fans.

(6) Learn how to support others and provide feedback. Years ago, the wonderful folks at the Group at Cox in Stony Creek, Ont., including Wilson Southam and Doug Young, offered a concept they called "The Committee for the Success Of." Each team member had a committee of supporters, whose obligation was to ensure that each person had the resources and network to succeed in his practice role.

How committed are you to ensuring that your coworkers perform at a high level? The dentist cannot be solely responsible for providing feedback and coaching. But many team members believe it is not their place to get involved in the performance of others. Make it a point to introduce these issues at meetings. When mature support replaces tattling and complaining, the entire practice benefits.

(7) Make yourself a partner in success. Sometimes, dentists feel they are the lead dog pulling the sled, and that the rest of the pack is taking a ride. You can change that. You`ve got ideas - share them! Ask for team meetings if they are not a regular part of the plan. Ask for agenda time at team meetings. Encourage your co-workers to bring their thoughts. Create a positive spirit in your meetings; don`t let them degenerate into a gripe session. Plan the agenda rather than waiting for someone else to do it. Take notes. Follow up. Remind others; hold them accountable and be accountable yourself. Volunteer to take on a task and do what you promise.

Give your dentist clear feedback about what works and what doesn`t. If your dentist is insensitive to others, let him know how his behavior impacts you and how it discourages your fuller participation. Ask how you can bring that to his attention without embarrassing him or triggering defensiveness. Collaborate on how to help him listen. Ask him what he is aware of, but fails to acknowledge. Encourage him to be forthcoming; support him when he is. Help make it safe for him to be vulnerable. Cultivate an environment that makes it easier for the dentist to attempt change. Discourage others from cynical responses. And don`t play off one another. Be honest, forthright, and intentional.

Communicating more effectively with your dentist won`t be the easiest thing you have ever undertaken. Remember, the dentist wants to be a good leader, a good coworker, and have a strong business. He just may not know how.

You can help. In this month`s "Guided Team Meeting," my friend Teri Goss and I provide a simple strategy for creating a discussion along these lines.

A final note: Thank you for joining me throughout this year as we looked at Mastering the Art of Communication. I am thankful to Joe Blaes, editor of Dental Economics, for the opportunity to share these thoughts with so many dentists and their team members. I am also appreciative of the positive comments so many readers shared throughout the year.

I intend to be a frequent contributor to these pages, so please let me know what would be helpful, interesting, and challenging in 2001. My best and most sincere wishes for prosperity and happiness to each of you. I look forward to contributing directly to your success. If you would like to speak with me directly, you may phone me toll-free at 1-(800) 848-8326, or send me an e-mail at [email protected].

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