CHAPTER 6 Communicating Effectively in Dental Practice

Richard Nathan, DMD, MS

Following is a typical conversation heard at a 5-year dental school reunion:

“It’s the craziest feeling. It seems like it was only yesterday that we graduated and went off in all directions. Boy, I remember how scary that time was!”

“Yeah, things worked out pretty well so far for most of the class.”

“For some more than others. Remember Michael? I mean, he was clinically average, certainly no G. V. Black. Well, I was talking to Charlie, who has a practice about a mile from Michael. It appears that our average-with-his-hands classmate’s business is going gangbusters! Everyone in town ends up at Michael’s practice. Charlie, who was arguably the best dentist in our class, is having a hard time getting business going. He’s even lost patients to Michael! I don’t get it.”

Here are two dental practices that started up at the same time, with den tists who have identical training and who treat the same patient population. Yet, after 5 years, one is struggling to cover payroll and the other has a very busy and rewarding practice. So what would cause one dentist to do so much better than another?

There are, naturally, many possible explanations. A new dentist may overextend his or her practice with a big space, an extensive remodel, state-of-the art equipment, and a large staff. And, in too many instances, an excessive personal lifestyle may also play a part. Yet, the problem is not always overextension, bad luck, or poor decision making. In many cases it is the lack of a skill as important as clinical expertise that is not often taught in dental school. It’s a skill everyone needs in order to facilitate personal and business relationships: effective communication.

Communicating with Patients

If you can’t communicate with your patients in a manner that motivates them to follow your treatment plan, the result is fewer patients on whom to practice your clinical skills. In other words, if you can’t communicate, it doesn’t matter how good of a dentist you are.

On the other hand, if you communicate with patients in a way that instills trust and confidence, they will talk glowingly about you at a cocktail party, the grocery store, and family affairs—people like to share the wealth. It’s like finding a trusted car mechanic. Most people don’t know what’s going on under the hood of their car, so if they find someone they respect and who is honest with them, they will tell everyone they know about this gem. Trusting a dentist is even more important for most people than trusting a mechanic, yet the principle is the same. Patients spread the good word if they believe in you. However, if they think they’re just another procedure in your schedule, they won’t return, and they may even spread some not-so-good words.

Communicating with Your Staff

Successful communication doesn’t just involve conversation with a patient. How you communicate with your employees and how they in turn communicate with your patients is also critical. Remember that each staff member is an extension of you. Both you and the staff must exude the kind of warmth and caring one extends when inviting a new friend to dinner.

Of course, hiring the right people is the first step in ensuring that you have a staff that communicates well. But, no less important is setting the right example with your words and actions. You are the captain of the ship. Believe it or not, your crew looks to you as a role model. Treat the staff and patients with the same respect and dignity that you expect when you are an employee or a patient.

Another reason to communicate well with your staff is that patients pay attention to how you treat your staff. Trust is lost when patients see a dentist acting one way with them and a very different way with the staff. Trust is hard to build but easy to lose, and verbally mistreating staff in front of a patient is one of the easiest ways to lose it.

Moreover, from a purely practical standpoint, staff members will leave you when you don’t communicate effectively, empathically, and sincerely. No salary is high enough to compensate for being treated without dignity and respect. Remember how valuable your staff is—they perform important tasks that you don’t want to perform or simply don’t know how to perform—and treat them accordingly.

The office is like the human body. Each organ has its own function. Yet, each organ is simultaneously dependent on the other organs for the whole system to function at peak performance. The staff is the lifeblood of the practice and the reason for its success. Don’t take anyone on the staff for granted. Turnover is very costly for the employer and unsettling to your patients because they know that high turnover rates are a reflection of the dentist. Long-term staff is an indication of a boss who inspires and evokes loyalty, which will keep patients and attract new ones.

Listening

One of the fundamental aspects of developing effective communication skills is another ability for which dentists have little training—listening.

Listening to Understand

In The 7 Habits of Highly Effective People, Stephen R. Covey makes a cogent argument for the importance of listening with the intention of understanding. ¹ This type of listening is the critical first step toward mutual understanding, trust, effective communication, and—ultimately—problem resolution.

Covey states that an essential principle is to “seek first to understand, then be understood.”¹ This principle is analogous to the way in which we treat a patient. If a new patient walked into your office and complained that he’d had severe pain in the left mandible for 2 days, you wouldn’t immediately pull out an elevator and forceps and extract his mandibular left third molar. What if the tooth could be saved with root canal or periodontal surgery? What if the pain is referred from a maxillary molar? Obviously, a radiograph is required, tooth vitality needs to be assessed, and periodontal probing should be performed before proper diagnosis, treatment, and prognosis can be determined. Dentists are trained to diagnose first and then prescribe.

Just as creating an effective treatment strategy is dependent upon fully understanding the patient’s problem, being understood when you communicate is dependent upon understanding the perspective of the person with whom you are communicating. The vital element to understanding another person in professional and personal interactions is listening. Listening to understand means setting aside your wants and needs long enough to understand what the other person seeks from your interaction. Once the other person is allowed the space to open up and be heard, he or she is in a better place to understand much more of what you are saying, and you are better able to say what you need to say within the context of the other person’s concerns and point of view.

Everyone needs to be heard. It’s as basic a need as shelter, food, and love. When you take the time to listen and to “let your patients in,” you initiate effective communication. It’s about hearing the other person’s story without filtering its meaning through your own lens. Becoming more receptive to what is said begins when you choose to “seek first to understand.”¹ The ultimate goal is to be able to articulate and understand the other person’s viewpoint as clearly as you can articulate and understand your own.

Two things happen when this is achieved. First, your original point of view will shift once you learn and understand the other person’s perspective. Second, you gain trust and respect and, thus, become more influential. This is critical to any case presentation. You must understand the patient’s needs and desires before prescribing treatment if you want to gain compliance from the patient.

Listening to understand is critical to any situation in which communication and, particularly, conflict resolution is required, whether it is with a patient, staff, other health care professionals, or the larger world outside the office—colleagues, specialist referrals, dental technicians, supply representatives, financial officers, dental school faculty, or local businesses.

Establishing Trust and Mutual Understanding

If you really listen to patients during an initial consultation and let them explain their situation, they will sense that you respect who they are and what they need, and they will begin to trust you.

Attentive body language is a function of effective listening. Body language sends strong nonverbal signals of interest, and there are many gestures or cues that suggest empathy and result in reciprocal attention. Conversely, unfocused body and eye movements project a sense of distraction. As you listen to a patient, be still with a fixed gaze that sends the message that you care and don’t want to miss a word. An open body stance with unfolded arms conveys a sense of being mentally open to what is being said, and leaning slightly forward toward the speaker conveys interest in what is being said. Be patient. Don’t interrupt. Give space to expand. Listen until the thought is fully finished, even if you are eager to interrupt. There are always competing distractions in the office such as phone calls, but make it a policy never to be interrupted when you are with a patient. Show that you are only interested in the patient at that time.

Being a good listener is not easy. I remember a case presentation I mismanaged at the beginning of my career. A new patient came in for a consultation, and, after reviewing the radiographs and clinical readings, I presented a detailed explanation of the problem and treatment plan to the patient.

“Well, Mr Smith,” I began confidently, “it appears from my extensive examination that you have generalized severe periodontal disease that has caused many of your teeth to become loose. In fact, some of your teeth have to be extracted. I noticed from your dental history form that you haven’t been to a dentist in more than 10 years, which, of course, is why t/>