Stop speaking and start communicating to improve your dentistry

August 15, 2019

Words impart knowledge, but they also shape feelings and play an important role in communication and decision making.

In our first year of dental school, we learn to speak the specialized language of dentistry. Good for us, not so good for the public after learning that “regular people” could no longer understand me. So, I spent the second year of dental school teaching myself to speak English again. This problem isn’t unique to us. In fact, Alan Alda wrote a book titled, “If I Understood You, Would I Have This Look on My Face?” subsequent to a dental visit. While written for physicians, he was inspired to write the book following a misunderstanding with a dentist. He went even further by creating the Alan Alda Center for Communicating Science at Stony Brook University. Do you think this might be an important issue?

“Speaking” is easy – everyone does that – and may produce a result.   “Communicating” isn’t so simple. “Communicating” properly is a rich, complex, thoughtful behavior that’s much more likely to be effective and produce desirable results. What makes these two similar seeming functions different?

Communication is a process, and it’s not dependent on what you say but what people hear, understand and feel as a result. Based on all of that, they’ll make decisions. Their decisions may be positive, negative or elusive, as in, “I want to think about it.” Once you’ve spoken, your job is to be present for the response, listening to the words, watching body language, interpreting the reply and asking questions if the response isn’t clear. You should not be busy thinking about the next thing you’re going to say, or you’re not paying attention to the patient and will miss potentially important information.

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Words impart knowledge, but they also shape feelings and play an important role in communication and decision making. For an example of this, consider the words “root canal treatment.” I suspect you had no emotional response to those words. However, there’s typically a very different reaction when you say that to a patient. So, when we speak to a patient, how do we know if we’re communicating, or even what we’re communicating? Everyone is different. If we’re going to communicate effectively, that is, promote understanding and elicit a positive feeling in order to create a desirable result, then we need to enter each patient’s universe individually. We can’t afford the luxury of assuming that everyone can and will enter our universe. Yet, I see doctors and staff members do this routinely.

So, first, we have our choice of words. I’ll admit it took me some time to feel comfortable using the word “gums.” But, if that’s what the public understands, then that’s the term I use. Other words come with their own emotional charge. I never ask my assistant for a “needle,” but might ask for a 27 “tip,” and I avoid the word “long.” Lists of other common replacement words are available online.  Further, in selecting your words, consider your audience. I use different words in working-class neighborhoods than when speaking with judges, lawyers and CEOs.  Also, take responsibility for your communication. Ask, “Did I make myself clear?” not, “Do you understand me?”

While everyone is unique, to be truly effective in dealing with people, we do need to understand one universal truth: everyone wants to feel heard and understood.  People can say the most outrageous things, but if that’s their truth, then it needs to be acknowledged, and they need to feel accepted; otherwise, they’ll get defensive and you’ll have conflict instead of a conversation. Acknowledging their truth doesn’t mean you agree with what they said, just that they’ve been heard.  Good communication with patients is a free exchange of ideas, like tossing a ball back and forth. Each side needs to be willing to play, enjoy the game and get something from it. Criticize how I threw the ball to you, imply I’m lousy at the game and I’m not going to want to play with you anymore, or perhaps ever again.  Having looked at how to speak, let’s look at what to say.

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As dentists, we love to talk. We love to explain procedures, as if that will lead our patients to accept treatment. There’s a phenomenon known as “need to say” versus “need to know.” Avoid the need to say and focus on a patient’s need to know. Engineers are different than housewives, and different kinds of information are important to different kinds of people. It’s important to address the individual patient’s needs to know if we’re going to make our conversation relevant and successful, and asking questions along the way helps us to know where to take the conversation. Therefore, if a new patient needs root canal treatment, my conversation might sound like this: “Mrs. Smith, this tooth has a big cavity and a problem with the nerve inside it. I’m concerned that if we don’t treat it soon, you will wind up in pain with a toothache. Have you ever had one of those?” The patient will answer, letting you know how to continue. “This is an important tooth to keep, so in order to keep the tooth, we will need to treat the nerve problem first. We do that with something called root canal treatment. Are you familiar with that?”

I want to explore the patient’s reality and see and hear her or her response. More than one patient has said, “Oh, I would never do that!” It’s common for us to assume why Mrs. Smith said that – pain! Not necessarily. Ask, “Why is that?” and address any concerns. Besides pain, answers commonly include, “I’ve heard they’re expensive” or “I did that and lost the tooth, anyway.” Alternatively, patients have said, “Oh, yeah, I had one a few years ago. It was fine.” If an explanation is necessary, it can be as simple as, “You’ll be numb and comfortable, and it will take about an hour. It’s important that we see you soon after that so we can rebuild and strengthen your tooth, and then it will look and feel like new.  Do you have any questions for me?”

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Second in importance to a patient’s need to feel heard and respected is addressing his or her priorities. If a patient made an appointment for a broken filling and he or she walks out with an exam and cleaning, you have likely lost that patient. Our “doctor” title carries authority, and a patient may go along with our instructions while not having the courage to object. Even if he or she agrees with us, it’s our responsibility to “read between the lines” and look and listen for any hesitation or resistance. We are the authority, but they are the patient. 

Dentistry is our universe and it’s a comfortable place for us. When a new patient walks in the door, he or she presents with a black box full of experiences, questions and concerns. Some will be spoken, many will not. Those questions include, “What will I need, how will it feel and what will it cost?” Those unknowns create anxiety, and anxiety is a barrier to the process of good communication.  Knowing this, you have the ability to control the process, with something like, “Mrs. Smith, I plan to do an examination and see how you are doing. If you need any treatment, we’ll talk about that, review treatment option, and we’ll discuss fees so you know everything you need to know. How does that sound to you?”  I’ve seen patients suddenly smile and relax as we proceed.

The reality is, everything communicates with our patients from our marketing to our websites, our staff on the first phone call to our building, our office and our staff on their arrival. They’ve taken a step into our universe, and we want it to be as comfortable for them as visiting an old friend. We want to take responsibility for building a trusting, long-term, successful relationship. You can be the best dentist with the nicest facility and the best staff. But, the measure of your success will be determined by the quality of your communication both in business and in life. It’s just that important.