by Randall Shoup, DDS
Dentists are creatures of habit, often painfully so. They adopt change only slightly faster than a glacier moves through mountains. The evidence for this reluctance to change lies in all of the gadgets and supplies overflowing surgery drawers and cabinets that are used once, never to be touched again.
Need more evidence? Just look at the countless practices with office systems or team issues that have never been truly resolved. These issues reappear at every team meeting and have been discussed forever. They never go away. Probably the most disheartening example of this growth stagnation is how the dentist deals with the patient. The techniques that a dentist uses to interact with patients were likely leftover from dental school. It's also possible that how the dentist and team communicate with patients may simply be the way the previous dentist did things in the office.
Each dentist, will fall into a zone of "comfortable repetition." Dentists love routine and predictability. They work hard to perfect techniques and procedures and this is one of the elements that make dentists great. With a predictable routine of comfortable repetition, a dentist successfully avoids his/her most dreaded circumstance: conflict.
Dentists hate conflict. If they can't avoid conflict altogether, they become artful at ignoring it. How often have dental practices harbored that one (or more) employee from hell? These employee(s) may be noncompliant, moody, single-minded, contrary, or even downright mean. These employees rule the roost and woe is it to anyone, Doctor included, who crosses their paths.
These employees become entrenched in a practice and dynamite can't blast them from their domain. The dentist drops his/her head, lowers their eyes and treads lightly through the day, hoping not to trip the switch of this human land mine. Conflict avoidance is the order of every day. Will the dentist fire this employee? Not ever! "Well, she really does a good job most of the time." "She really is a good friend with most of the patients." "She knows the computer system inside and out."
These rationalizations mask the real issue: conflict avoidance. The inability to deal with conflict directly is insidious and damaging, not just with employee relationships, but in another crucial area as well: treatment and case presentation. The same dynamic that mires a practice in the status quo is actively at work limiting the success of treatment presentation and acceptance. It's common to find practices with hundreds if not thousands of dollars worth of undiagnosed and uncompleted dentistry. Patients parade through the office with mouths full of old and deteriorating restorations, blissfully unaware of the gravity of their situations.
In my consultations, one of the most common complaints I hear is, "My patients have a lot of work to be done, but they just won't do it." Dentists are eager to blame the patient for the situation instead of looking at their own inadequate communication skills and conflict avoidance behavior.
Because dentists are poorly trained in communication, they already are way out of their comfort zones the instant they open their mouths to discuss treatment with patients. It only takes one or two rejections to completely destroy a dentist's confidence. The dentist then retreats into conflict avoidance and is hesitant to propose treatment again.
A dentist who gets burned by rejection becomes an active member of the "Let's put a watch on tooth No. X" club. The dentist who puts a "watch" on any tooth usually is scared to propose comprehensive dentistry. The "watch" dentist will wait until teeth break because that situation is a no-brainer. When a patient shows up to the practice with a broken tooth, there's no conflict in proposing treatment. The question becomes not whether to fix the tooth but how to fix the tooth.
The "watch" dentist treats one tooth at a time and is easily convinced by a patient to refill a tooth with even a bigger filling. The problem is not with the patient but with the dentist. The "watch" dentist will use language that literally kills the seriousness of the patient's condition. It's common to hear the following exchange:
Patient Smith presents with a huge MODBL alloy on tooth No. 3. The DL cusp is fractured away and tooth is a veritable roadmap of fractures.
Dentist: Well, Mr. Smith, looks like you fractured a little piece off the inside of your tooth.
Smith: Yeah, Doc, it's rough to my tongue and I can't stop playing with the hole. It doesn't hurt — it just makes my tongue sore.
Dentist: Well, there is a really big filling in that tooth now and it might be better to think about a crown on that tooth.
Smith: Gee Doc, it's not sensitive or anything. I can chew just fine. Can't you just fix the filling?
Dentist: Yes I can just fix the filling but I see other cracks in the tooth and at some point those other cracks can break off.
Smith: Well how long do I have?
Dentist: It's hard to say. You could go for a while like this, but it's not a good situation.
Smith: Well, Doc let's fix the filling for now, and I'll think about having the crown done later.
This conversation is so common. Here are some guidelines to follow when making a treatment presentation.
Patients want the dentist to be confident, straightforward, and definitive. Using words like "just," "little," "maybe," "might," "sometimes," "could," "at some point," "it's hard to say," and "but" destroys any confidence the patient has in the dentist. It's far more productive to use words and phrases that generate confidence. "This tooth has suffered a severe fracture." "When we see this situation, the tooth is seriously injured." "Teeth in this condition demand to be restored with as much strength as can be made." "This is a serious situation." "I am surprised the tooth did not completely shatter given all of the fractures throughout the rest of the tooth..".
Patients can sense insecurity just like the little kid in "Jerry Maguire" who asks the question, "Did you know that bees and dogs can smell fear?" Patients can smell fear, and if the dentist shows any trepidation, it's all over.
Help the patient own the problem
In the previous example, the tooth was rough to the patients tongue, but it did not hurt; therefore, there's no problem. The dentist used minimizing and trivializing words that softened the message. The dentist never laid the severity of the situation on the patient and force force to accept the problem as his own. The patient was artful at minimizing the situation. His resistance created conflict and the dentist caved to even this minimal pressure.
My friend, Paul Homily, talks about conditions and disabilities. Dentists are trained to diagnose and discuss conditions. Dentists know how to fix "conditions." Patients, on the other hand, don't care about conditions until they become disabilities. The only disability this patient suffered was a sore tongue. The dentist is responsible for guiding the patient from condition to disability.
The greatest tool in making the patient take ownership of the condition and converting a condition into a disability is the intraoral video camera. People believe pictures. When a dentist can display that patients tooth on a 17-inch monitor in living color, it is a powerful motivator. The picture of the decrepit tooth staring the patient in the face leaves little room for debate.
Dentists talk too much. Dentists love throwing an endless stream of words at the patient, believing at some point the patient will throw their arms up in the air and say, "I give up, stop talking, I'll do the crown." Not so. The more a dentist talks, the less likely a patient will say "yes" to treatment. The success rate of treatment presentations is inversely proportional to the number of words used. The fewer words spoken, the greater the success.
Close the deal
The most powerful phrase a dentist can utter at the end of talking treatment is, "What do you want to do?" That's it. There is no more. After you say those six words, you may not speak again.
This prohibition alone will cause the demise of most dentists. They can't stand the silence. They crack under the awesome pressure and compulsion to speak. After asking the patient, "What do you want to do?," just listen. The patient is processing information. Some people process information slowly, and some patients process information quickly. The dentist must wait. Simply sit by that patient's side and attentively wait.
The patient may ask a question such as, "How long can I wait to fix this?" The only answer should be, "You can't." Not one word more. Wait again. The patient may say, "I can't afford a crown." Don't answer — the patient is fishing, and if the dentist bites at the "I can't afford dentistry" bait, then he or she can land you like a carp and fillet you for dinner. Patients can afford dentistry, but they may elect not to pursue it. No matter how many questions the patient asks, the dentist must simply return to those magical six words, "What do you want to do?"
It isn't easy to muster the fortitude to make these simple changes in approaching your patients. A simple solution does not diminish the magnitude of the problem. Developing confidence and delivering an effective case presentation is a difficult challenge. The greatest hurdle to overcome in this change process is believing in yourself. Believing in the system and believing in the process is 90 percent of the battle. Each person's behavior is always consistent with what they believe.
If dentists truly believe their patients can't afford dentistry, and if the dentist truly believes that his treatment plan presentation will be met with resistance and defeat, he will be correct. On the other hand, if a dentist truly believes that the patient can afford dentistry and believes in the system of presenting treatment, the success rate will be astounding.