Dentistry from the heart

Feb. 1, 2000
Has the following ever happened to you? You get an emergency call. A loved one is suddenly stricken with a serious illness. You rush to the hospital. Tubes and monitors are attached to your helpless-looking loved one. Various doctors become involved in the case. A cardiologist, let`s say, examines the patient and calls in a cardiac surgeon to do the same. The cardiac surgeon perfunctorily shakes your hand; makes little eye contact; utters a brief, technical lecture on the patient`s condition; an

Don`t hide behind the technical jargon. Emotional communication with your patients is essential.

James R. Pride, DDS

Has the following ever happened to you? You get an emergency call. A loved one is suddenly stricken with a serious illness. You rush to the hospital. Tubes and monitors are attached to your helpless-looking loved one. Various doctors become involved in the case. A cardiologist, let`s say, examines the patient and calls in a cardiac surgeon to do the same. The cardiac surgeon perfunctorily shakes your hand; makes little eye contact; utters a brief, technical lecture on the patient`s condition; answers your questions in a detached, clinical way; and then rushes off. You instantly dislike this doctor. On the other hand, the cardiologist smiles warmly, places both of his hands around yours in a comforting handshake, looks directly at you, explains in medical and layman`s terms what has happened to your loved one, reassures you that the condition can be treated (let`s say your loved one is not going to die), and answers your questions in a caring and understanding manner. You instantly like this doctor.

Although both doctors have given you the proper technical information, and you do not doubt either one`s competence, are they of equal standing in your mind? Or are they of very different value to you? Which doctor will you and your loved one want to deal with in this time of crisis? Which one will be easier to talk to? Which one`s judgment will you be more likely to accept? The doctor who has won your confidence has not done so because of technical superiority, but because of emotional communication.

When you are the caregiver, how successful are you at winning your patients` trust? The answer, studies have demonstrated, goes beyond clinical considerations to what I call "dentistry from the heart."

But let`s back up. First of all, why do your patients need to trust you? Despite the great deal of talk about evidenced-based care, there are very few statistics by which to quantify treatment in terms of a patient`s culture, oral hygiene habits, or other environmental, sociological, or genetic factors. Treatment decisions still rest with the dentist`s judgment. Mr. Smith will have radiographs, not because of the dental characteristics of his ethnic group, geographic location, diet, or brushing patterns, but because of the dentist`s examination, clinical training, experience, and recommendation. In order for Mr. Smith to accept treatment, he needs to trust his dentist.

How does Mr. Smith`s dentist talk to him? Most likely in technical terms. Dentists like to talk dentistry. We are experts in the engineering and metallurgy of our materials, as well as in the technicality of disease processes and treatment. Communicating this information to patients is very appropriate. They should be aware of the technical aspects which might interest them. However, influencing your patients to accept needed treatment requires that you communicate on two levels: technically and emotionally.

First and foremost, the patient wants to be recognized as a human being and not just a set of teeth. This sounds good, and we`ve all heard it before. However, very few of us apply - or know how to apply - this information in our daily communication with patients. When we recommend a needed crown in order to restore a badly broken down tooth that will require pins, a build-up, and a root canal filling besides the crown, we are addressing some very technical issues.

When patients question the treatment or the fee, the dentist typically repeats and elaborates on the technical matters, rather than addressing the emotional factors that are usually the real issue. When the patient hesitates, or reveals qualms or misgivings about the treatment, the dentist needs to get more emotional. Let`s see how this works in case presentations and patient objections.

Address the patient`s concerns

By asking a series of carefully designed questions when patients first enter the practice, you can find out their reasons for coming to you in the first place, as well as their concerns about dental treatment. One patient may want a better smile; another may yearn to eat favorite foods comfortably; still another may want to avoid the tooth loss a relative has suffered. One patient may be concerned about the cost of treatment, another about the time involved, and still another about the pain he or she fears will accompany the procedures.

Uncovering these motivations and concerns makes the new patient feel "seen" by you as a person. The process initiates the building of a strong relationship. If the patient later objects to treatment that you have clearly presented, it will almost always be because these motivations and concerns were not addressed - not because the person needs more technical information.

Instead of reiterating the need for the root canal, the quality of the crown material, and the function of the pins when Mr. Jones hesitates at accepting treatment, talk about his wish to enjoy going to a restaurant once again and how your treatment will help him be able to enjoy that. Or discuss his concern about the cost, and indicate what you can do to make the treatment affordable.

Patients purchase the things that they want. Dentistry, too, should fulfill not only their health needs but also their personal desires. By addressing the patient`s desires - such as to avoid pain, to conserve money, or to have a better appearance - you can establish a treatment plan that is appropriate not only from a health standpoint, but also from an emotional one. We need to present Mr. Jones with treatment that will not only restore his teeth, but also give him more eating pleasure. We need to improve his oral health and the quality of his life. To accomplish this, we must address dental issues on both of these levels - the technical and the personal. We must have a "heart" talk.

Tell the patient how you feel

Dentistry from the heart also means telling the patient how you feel. When Mr. Jones balks at the treatment, we need to resist the temptation to slip back into the comfort and familiarity of our technical universe. In order to influence patients to do what is right for themselves, we need to communicate on a deeper level, which means to address their feelings and our own. First, acknowledge that you understand the patient`s objection. Tell Mr. Jones that you hear his concern about cost, time, or whatever the issue is. Then tell the patient how this makes you feel.

Here are some things you might say when the patient objects to treatment:

> "Mr. Jones, I`ve presented the treatment that I would want in my own mouth, and hearing your objections, I`m concerned that I`m not communicating to you in a meaningful way."

> "Mr. Smith, because I care about your health, I feel disappointment that you`re not taking my advice, and I`m concerned that your personal needs will be compromised."

> "Mr. Johnson, you have selected me as your dentist, and I have presented to you my professional opinion. I don`t feel good about your decision to delay treatment. I am greatly concerned about the negative effect this will have on your oral health."

The jury is in on the matter of "heart" talk: When dentists are honest and straightforward about their own feelings, rather than just reverting back to the technical issues, they build a stronger relationship with the patient. Our experience proves that case acceptance increases when dentists openly discuss their feelings.

The truth is that the use of highly technical language often confuses the patient. We tend to talk over the patient`s head. The technical jargon, combined with the "doctor" title before our names, intimidates many people. And they are not apt to display their ignorance by requesting an explanation of what has already been said. Instead they will nod their heads and say, "OK, I`ll think about it," and then withdraw from us. This is how overuse of technical communication can place a barrier in the relationship and be a hindrance to case acceptance.

The key is to define any technical terms, or use layman`s words instead, and avoid excessive detail, except for the scientifically curious patients who want it.

Make it easy to accept treatment

Overuse of technical words is not the only way in which we can inadvertently place hurdles in front of our patients, making it difficult for them to accept treatment. This brings me to another aspect of dentistry from the heart, which is the "utility" of the dental experience in the patient`s view.

Utility is a term from economics that means the ease, useability, comfort, satisfaction, or pleasure a buyer experiences during and after the process of acquiring something. The higher the utility, the more value is imparted to the buyer`s purchase, and the more the buyer wants to pay the price for the outcome. When customers come to a winery for a tasting, there is a high utility. The sights, sounds, smells, and tastes are far more pleasant than they are in the dental office.

The dentist`s challenge is to improve the utility of the dental experience to add value to the patient`s experience. Technical jargon, confusing terms, and difficulty following the dentist`s explanations lower the utility. Conversely, it is raised when the patient is seen on time, greeted warmly, offered coffee, kept informed of what the dentist is doing, etc. While a dentist made temporaries for a patient, his assistant brought the patient a fruit smoothie from a nearby shop - a pleasant surprise that raised the utility for the patient! A strong relationship with the dentist increases the value of the dental experience to the patient (and also to the dentist).

Patients buy on trust

The technical discussions are very appropriate. However, dentists also need to communicate on a deeper, emotional level. This is something we are not taught in school and which may be challenging in the beginning. However, when we communicate emotionally, we show empathy for the patient`s desires and concerns, we reveal our concern for the patient`s well being, and we express our caring deep down - all of which builds trust. And it is trust, rather than technical issues, that leads to increased case acceptance and to a more satisfying experience for both dentist and patient.

According to studies, people assume that dentists are technically competent if they have a license. The patient cannot directly judge your technical competence. People are taking your competence for granted and buying on trust.

Unfortunately, medicine has already paid the price for not building trusting patient relationships. The average fee for the medical visit continues to slide, hence the physician spends less and less time with the patient. Nowadays the physician barely says hello, because he or she often has only five minutes to allot to the patient. Sadly, the scenario that I described with the cardiac surgeon is all too common. Doctors on the run in a hospital hallway are even hurriedly telling families that their loved ones have fatal diseases, and the entire experience is extremely dehumanizing for the families, the patients, and the doctors themselves. Let`s be sure that we do not follow suit. This is why dentistry from the heart and its pre-condition - a private, fee-for-service practice - is so important.

For more information about this article, contact the author at (800) 925-2600.

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