Beware of your dentist's spiel!

Jan. 1, 2005
The title of this month's column comes from a role-playing scenario during a "Building Emotional Intelligence" workshop. My co-presenter, a licensed counselor, said, "Boy, ...

Bob Frazer Jr., DDS

The title of this month's column comes from a role-playing scenario during a "Building Emotional Intelligence" workshop. My co-presenter, a licensed counselor, said, "Boy, when dentists get into their spiel, they don't hear anything else!" He observed doctors sharing their expertise too quickly, before the patient felt clearly understood.

Cognitive learning - lecture and reading - won't raise E.I. You must actually practice new behaviors. Interactive audio training programs, recording your discussions, and journaling are effective ways to grow E.I. Another effective method is through supported, interactive scenarios where you deal with people with real-life issues.

Imagine you are at our E.I. workshop. What would you do if a 38-year-old woman entered your practice for a prophy and exam? You've been called in for the exam. Your hygienist has discovered that the patient, Sue, moved to your city two years ago. She was on three-month recare for nine years prior to moving; therefore, she is overdue! She had periodontal surgery 10 years earlier and reports that during her last visit, all looked good with the exception of three isolated areas around the upper molars.

Your hygienist finds significant periodontal breakdown around the upper molars, necessitating at least root-planing and close follow-ups. Also, Sue's hygiene is less than adequate. Although your hygienist recommends a more complete exam, Sue insists she just wants to re-establish three-month recare. After a good summary hand-off, your exam confirms the need for definitive treatment to correct the deteriorating problems and prevent further furcation invasion. Your cursory exam also reveals the need for a crown on a broken amalgam. You feel a professional duty to inform Sue of these problems, as well as the need for a complete exam and radiographs.

How would you open your dialogue with her? What would you say once you discovered Sue's desired superficial exam is inadequate? How would you deal with her polite, but melancholy, demeanor and reluctance? Remember, she spent years being very attentive to recare! What emotions would you be having? More importantly, what emotions is Sue experiencing? How quickly would you discuss the logic of a comprehensive exam? What questions could give you greater clarity and allow you to connect with this patient?

In this workshop scenario, most of the doctors assumed Sue's reluctance was logical and primarily cost-based. So, most of them said they would explain why spending money now would pay dividends in the long run. These were conscientious dentists who sincerely didn't want the disease to advance and cost more in the long term. This is admirable, but it is feeble and highly ineffective when dealing with emotions logically!

The scenario protagonists (patients or staff members) receive separate notes describing their unique circumstances and emotions. Part of a scenario's best outcome is for the "confronter" - in this case, the doctor - to uncover what's going on that might be blocking the patient. Usually, the block is emotional.

Unbeknownst to the doctor, Sue had just been through a difficult divorce and was now providing primary support for her children. She arrived feeling guilty for not coming sooner, embarrassed by her personal situation, and just wanting to hide. The doctor should have welcomed Sue back to good dental care, "forgiving" her for the hiatus, and then gently uncovered her feelings. Instead, the dentists and hygienists focused too quickly on her dental problems and how to correct them. Of our eight scenario groups participating in the role-playing, only two uncovered her embarrassment, guilt, anxiety, and insecurity before offering solutions. Dialogue such as, "Well, welcome back! We're glad you have chosen to return for care!" or "What brought you to our city and our office?" might give you some insights. A question such as, "What do I need to know about you and your dental health to best serve you?" can be insightful.

When and if feelings of guilt or anxiety are expressed (watch your patient's face - 90 percent of emotions are expressed in the face), reflect what you sense the patient might be feeling, as in, "Sue, you seem somewhat anxious about what may have happened to your gum health over the last two years." My point is not that you have to be accurate about what Sue is feeling. Rather, you are trying to understand her first as a human being. Then, discuss the dental problems she is confronting. Remember, the dental technician celebrates digital radiographs, but the patient celebrates the outstretched hand!

Dr. Bob Frazer Jr., FACD, FICD, is founder of R.L. Frazer & Assoc., whose custom programs help dentists achieve top 5 percent status in financial achievement and life balance (fulfillment with significance). Thirty-one years of quality practice and superb communication skills have propelled him to a 29-year international speaking career. For information on "Building Emotional Intelligence Workshop," 4-28 to 4-30 in Austin, or a powerful five-hour audio series, "How to Build the Exceptional Life & Practice" with a special DE reader's discount, contact him at (512) 346-0455 or email him at bob@frazer

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