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Take time to understand patients

Oct. 1, 2009
It's a basic law of human nature: if you want people to understand you, they must feel that you understand them first.

by Nate Booth, DDS

For more on this topic, go to and search using the following key words: human nature, elements of conversation, understanding, Dr. Nate Booth, case acceptance.

It's a basic law of human nature: if you want people to understand you, they must feel that you understand them first. Said another way, understand before you seek to be understood. As dental professionals, your team needs to understand your patients' life situations.

Accepting comprehensive implant treatment plans is a big deal for many people. They have mortgages to pay, kids to raise, and gas tanks to fill. The investment in comprehensive dentistry must fit into their budgets. The more you understand their life situations, the better you can help them proceed with care, either immediately or at a later date.

You also need to understand their concerns and desires. All of your patients walk in the front door with unique stories encompassing their concerns and desires.

The first part of their stories occurred in the past — the dental problems they experienced, the care they received, and the success of that care. The second part of their stories is occurring in the present. This is the condition of their mouths and their life situations right now. The third part of their stories addresses what they want for their future dental health and appearance.

“If you don't understand what makes people tick, they won't tick.” — Robert Swan

The best way to understand a person's story is to listen, observe, and ask great questions. During the first visit, you will have several chances to pose questions. The first opportunity is when a member of your team sits down with a patient (ideally in a private area) and has a before–the–examination conversation.

Before–the–examination conversation

Use the information garnered during the first phone call to have a “small talk” conversation at the beginning of the patient's first visit.

Then, preview the conversation to follow by saying, “Maria, we want to provide personalized care for all our patients. We want to learn your concerns and desires so we can help you have the dental health and appearance you truly want. In order for us to give you that kind of care, I would like to ask you a few questions and write down the answers. Would that be okay?”

Here are the important elements of the conversation.

1 “We like to get to know our patients. Tell me about your family.” Listen and ask follow–up questions. Then ask, “Tell me about your work.” Listen and ask follow–up questions. Then ask, “Tell me about what you do in your spare time.” Listen and ask follow–up questions. Learn at least 10 personal facts about each patient. Don't discuss anything dental–related for the first five minutes of your conversation.2 “In addition to (information you've learned so far), how can we help you today?” Always start with where they are, not where you think they should be. As an example ask, “In addition to the broken filling on the upper right side that you mentioned in your phone call, how can we help you today?” If the answer involves interest in a specific service such as implants, ask, “Are you interested in exploring the possibility of having implants? We can talk to the doctor about that in a few minutes.” If the answer is yes, the patient has taken one small step to case acceptance.3 “What kinds of dental treatment have you had in the past?” If appropriate, follow up with “Why was that done?” Here's an example. The patient says, “I had a root canal done on an upper back tooth about five years ago.” You ask, “Why did you have the root canal done?” The patient answers, “I had a big metal filling on the tooth. It got decay underneath it, and the nerve became infected.” You ask, “Do you have any other big metal fillings in your mouth now?” The patient replies, “I think I have a couple of them.” You say, “I'll make sure the doctor checks them out for you. We don't want that happening again. Is that okay?” If the patient says yes, he or she has taken a small step to case acceptance.4 “Have you ever had a negative experience in a dental office?” If the answer is yes, you reply, “Tell me about that.” After the patient explains the situation, you say, “Wow, that's too bad. We'll do our best to make sure that doesn't happen here.”5 “Have you ever had any gum problems or gum surgery?” If the answer is yes, you reply, “Tell me about that. Do your gums ever bleed when you brush your teeth?” If the answer is yes, you reply, “Oh, that's too bad. I'll make sure our hygienist knows about your condition. She can help you with your disease. Okay?” If the answer is yes, the patient has taken a small step to accepting your perio therapy program.6 “Have you ever lost any teeth?” If the patient answers, “Yes, in addition to the molar on the upper right side, I've lost all my back teeth on the bottom,” you reply, “Have you replaced the missing teeth with anything?” If they answer, “Yes, I have a removable partial denture,” you reply, “How's that working for you?” If they answer, “It rocks all the time and doesn't fit like it used to,” you say, “There are other options for replacing those teeth. Would you like to talk to the doctor about them when she sees you?” If the answer is yes, the patient has taken a small step to having implants.
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7 Give patients a hand mirror and ask, “What improvements would you make in the appearance of your teeth if we could easily change anything?” They may say, “I wish they were whiter and weren't so crowded. I have a new position at my bank, and my smile is really important now.” You reply, “There are several ways that can be improved. Is that something you want the doctor to take a look at?” If they say yes, they've taken a small step toward having cosmetic dentistry.8 “On a scale of one to 10, with 10 being extremely important, how important is it for you to keep all your teeth for a lifetime?” If they answer, “It's very important — a 10!” you reply, “Good for you. We'll keep that in mind when we discuss any dental care you need.” If they answer, “Maybe a two or three,” you ask, “Why so low?” They may respond, “Both my parents lost their teeth before age 50, and I've lost eight teeth already. I don't have much hope for keeping mine.” Of course, it's best to learn this information early rather than late, since now you have an education and possible referral process on your hands. If you learn about this attitude late, you waste everybody's time.9 “I'm curious. What do you look for in a dentist and his /her team?” Discover what they want, assure them they will receive it, and make sure they do. It's interesting that over 80% of the time patients comment on relationship issues such as friendliness in an office, not clinical expertise. The vast majority of people don't care how much you know until they know how much you care.10 “Is there anything that would stand in your way of getting the proper dentistry you need?” This is where money may come up. I hope it does because you want to talk about money early.

To download a copy of the above questionnaire, go to

Additional distinctions

Often, the most important parts of patients' stories are a couple of levels down and require a little digging. Here are some questions that will help you do this:

  • “Anything else?”
  • Tell me more about that.”
  • Give me an example of . . . ”
  • When does/did that happen?”
  • Where does/did that happen?”
  • Why does/did that happen?”
  • I'm curious. Why do you say that?”
  • Can you be more specific?”

As you ask these questions, always be thinking, “What parts of the patient's story can I blend into the story I tell at the treatment conference?” As an example, let's say your patient tells you she had a root canal done on a lower molar five years ago. The tooth had a big metal filling that got decay underneath it, causing the nerve to become infected. It would be wise to refer to that fact when recommending onlays and crowns for her remaining and broken–down amalgams.


One of Webster's definitions of love is “Deeply understanding and caring about another person.” So, understanding is the first part of love. We don't talk enough about love in dentistry. We get preoccupied with clinical procedures, practice management, and finances.

I believe love is a vital factor in your practice's success. If you love your team and they feel it, they will do their best work, not just good work. If you love your patients and they feel it, they will be predisposed to accept comprehensive dentistry and refer their family and friends. So get out there and share the love. It all begins with your understanding them first.

Dr. Nate Booth is a speaker, consultant, and author who provides dentists with the information and systems they need to thrive in their dental practices. Booth teaches at the South Beach Dental Institute, and is a practice–management advisor for ChaseHealthAdvance. He is the creator of the inoffice, DVD–based program, The “Yes” System: How to Make It Easy for People to Accept Comprehensive Dentistry. For more information, go to, or call (800) 917–0008.

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