Partnering in Health Part 3: The Power of the Medical History 

May 11, 2024 Mary Osborne RDH

By Mary Osborne, RDH  

The late Dr. Bob Barkley said your dental degree gives you the right to practice dentistry, but you have to earn the right to influence your patients. How do we earn the right to influence? How do we get that invitation we need to be invited into influence? 

There is a powerful tool you already have in your practice that can enhance your relationships from the initial visit through continuing care: a Health History. The Medical History forms most offices use are designed to efficiently gather information from patients about existing and previous conditions and diseases. Patients quickly check boxes. But it can do so much more. If you use health histories as opportunities to begin a dialogue with your patients you can also connect with them in the context of a mutually interesting topic — their health! 

I might begin a conversation with a new patient by saying “In this practice we believe that the health of your teeth is related to your overall health. I know you filled out this health history form and we can talk about the specifics of that, but I wonder if we could begin by taking a few minutes for you to tell me a little bit about your health in general.” Beginning with a conversation in that way it takes us out of focus on disease and opens the door to talking about health; what they know about their health, how they feel about it, and what they do to maintain health. Similarly, when a patient comes in for a hygiene visit instead of asking if there are any changes in their medical history, I might ask, “How has your health been since I saw you last?”  If we listen carefully to their stories about health, we will gather important clinical data, and we will also begin to understand their values. We will begin to co-discover what is important to them. 

The concept of co-discovery is frequently seen as having to do with helping the patient see current clinical conditions that we see. In that way, it’s a very useful tool. But I’d like you to begin to also think about co-discovery as a way of being in relationship with your patients. When you take a few minutes to have a dialogue about health you learn about your patients, as they learn about themselves. It is an opportunity for you to learn about their experiences, concerns, and perceived barriers to health—and it’s also an opportunity for patients to learn about themselves. 

In her book, “Kitchen Table Wisdom,” Dr. Rachel Naomi Remen says, “When you listen generously to people they can hear truth in themselves, often for the first time.” If you’ve had a conversation like this you know the magic that occurs as a patient realizes things about themselves they’ve never thought of before. As they speak out loud they hear themselves for the first time. I have found that if I show up as an understanding fellow traveler with a desire to learn, it opens the door for them to begin to see me as a trusted advisor. 

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Mary is known internationally as a writer and speaker on patient care and communication. Her writing has been acclaimed in respected print and online publications. She is widely known at dental meetings in the U.S., Canada, and Europe as a knowledgeable and dynamic speaker. Her passion for dentistry inspires individuals and groups to bring the best of themselves to their work, and to fully embrace the difference they make in the lives of those they serve.

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Partnering in Health Part 2: There Is No Suffering We Cannot Care About  

May 6, 2024 Mary Osborne RDH

By Mary Osborne, RDH  

Think for a moment: Is there a change you think you could make in your life that would contribute positively to your health? Is there anything you could be doing—or not doing—that could improve your overall health and wellbeing? Most of us can think of something we could do, or do more consistently, to improve our health. Next, ask yourself if the reason you have not made the change you need to make is because you do not have enough information. Our clinical training taught us that if we give people the right information they will change their behaviors. It’s easy to get disappointed in ourselves and our patients when that turns out to not always be true.   

Reflecting on our own past and current health challenges is a way to remind ourselves that health is a journey, not just a set of strategies. What makes perfect sense to us now, may not have been relevant 20 years ago. Often we have heard the relevant information before but were slow to act on it. We may have conflicting priorities, such as time, or money. We may have had fears or doubts. When we can look at our own journey with understanding and compassion we are better able to see our patients that way.   

I remember a patient who came to us with a lot of dentistry that needed to be done. As we talked with her about recommendations for treatment, her eyes welled up with tears. “It’s nothing,” she said when I asked her what the tears were about. Eventually she shared with us that she and her family had been saving up to build a deck on their house. Doing the dentistry she knew she needed would mean they could not build the deck. There was a time when I might have thought, “What’s more important, a deck or your dental health?!?” But I was moved by her struggle. I can’t judge what a deck may mean to her and her family, but I can relate to her sadness in letting go of something they had been saving toward.   

As you advise patients, it’s helpful to share that are you on a path to better health yourself, and that it is not always easy. In this way we can step outside of the role of “expert” and come to our conversations as fellow travelers. And when we do come as fellow travelers, we bring our empathy, our humanity, and we allow ourselves to feel compassion. We are likeable.  

One of my favorite books is Dr. Rachel Naomi Remen’s Kitchen Table Wisdom: Stories That Heal. She quotes the psychologist Carl Rogers, who said:  

Before every session, I take a moment to remember my humanity. There is no experience that this man has that I cannot share with him, no fear that I cannot understand, no suffering that I cannot care about, because I too am human. No matter how deep his wound, he does not need to be ashamed in front of me. I too am vulnerable. And because of this, I am enough. Whatever his story, he no longer needs to be alone with it. This is what will allow his healing to begin. 

Because we are on a journey of becoming healthier just like everyone else, we can sit side by side with a patient. We can say, “I get it. It’s not always easy.” We can allow ourselves to feel compassion—that urge to genuinely help someone, and gently invite them to understand they are no longer alone.

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Mary is known internationally as a writer and speaker on patient care and communication. Her writing has been acclaimed in respected print and online publications. She is widely known at dental meetings in the U.S., Canada, and Europe as a knowledgeable and dynamic speaker. Her passion for dentistry inspires individuals and groups to bring the best of themselves to their work, and to fully embrace the difference they make in the lives of those they serve.

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Partnering in Health Part 1: The Missing Piece 

May 1, 2024 Mary Osborne RDH

By Mary Osborne, RDH 

There was a time when I thought “partnering in health” was just about getting people to take better care of their teeth. 

Many years ago, I had a patient who was excellent with her home care, but she showed up periodically with an acute periodontal infection. We asked about stress and her overall health, but she was not aware of any issues. We would treat the infection and she would be fine for a sometime. We knew she worked for National Public Radio, and one day we made the connection that her infections showed up concurrent with NPR’s fund-raising drives. That shared realization allowed us to help her see that her stress was affecting her dental health and her overall health. She was open to conversations about lifestyle changes that would help her be healthier. My relationship with her influenced my thinking and my ability to connect with my patients from a perspective of Whole-health Dentistry. I came to understand that I had been missing opportunities to influence the way people think and feel about health. I knew that I wanted my patients to see me as “a partner in health.” 

Unfortunately, most of our patients come to us with the perspective that we are fixers of teeth, not partners in health. 

In the culture today people are bombarded with information about what is healthy. From friends and families, social and news media, and a wide variety of health care practitioners, everybody expresses opinions on how they are supposed to take care of themselves. Why, then, are we surprised when our patients don’t know whom to trust? Why are we surprised when they shrug their shoulders or appear confused? It’s not always a case of conflicting facts but a case of various perspectives that people don’t know how to navigate. 

Think about where you place your trust. How do you decide whom to trust about decisions—whether it’s about your health, or about your finances, or about how you raise your children? When I ask myself that question, two criteria surface. They need to know their subject and to know me. I want that person to know what it is they’re talking about. I want them to be well informed. I also want someone who knows me, who understands my values. I want that person to have a sense of who I am and what is important to me. 

As we get to know our patients over the years, most of them come to see us as trusted advisors when it comes to their dental health—but fewer see us as trusted advisors when it comes to their general health. If we jump too quickly to making recommendations about their overall health, we are more likely to meet resistance. If we want to cross the bridge into influencing our patients’ overall health and wellbeing, I believe we need an invitation to cross that bridge.   

The Missing Piece in our quest to influence the overall health of our patients is the failure to invite patients to share their perspectives on health. Beginning a conversation with a new patient with the question, “What can you tell me about your health in general?” is an invitation for them to talk about their experience of their health, not just details. Instead of “reviewing” health histories, what if we “explore” health histories? As we connect and get to know each other we can learn to listen beyond information to hear attitudes, beliefs, fears, biases, concerns, barriers, etc. As you understand their perspectives on health issues that come up in conversation, it’s easy to ask if they would like your perspective on that issue. These conversations often lead to more questions and answers that invite more and more invitations from our patients to be their partner in health. 

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Mary is known internationally as a writer and speaker on patient care and communication. Her writing has been acclaimed in respected print and online publications. She is widely known at dental meetings in the U.S., Canada, and Europe as a knowledgeable and dynamic speaker. Her passion for dentistry inspires individuals and groups to bring the best of themselves to their work, and to fully embrace the difference they make in the lives of those they serve.

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The Art of Influencing Our Patients Part 4: An Opportunity to Collaborate

June 23, 2023 Mary Osborne RDH

After practicing dental hygiene for more than twenty years, I went to work in the office of Dr. Doug Roth who was attending courses at The Pankey Institute. He had a copy of Dr. Bob Barkley’s book, Successful Preventive Dental Practices. Reading that book was a revelation for me. Although I never knew Bob Barkley, his work so resonated for me that I had the feeling he had read my thoughts about working with patients.

I had believed for some time that more was possible in dentistry. I had worked with good dentists and felt as though I took good care of my patients in the time I was allowed to spend with them. We were kind, thorough in our exams, and conscientious in treatment recommendations. Sometimes they took our recommendations, and sometimes they did not. I did not think there was much we could do to change that.

As a result of Bob Barkley’s book and the courses Doug was taking at the Pankey Institute, we incorporated a new model for bringing new patients into the office. Instead of moving patients quickly through an exam and treatment recommendations, we invested time and attention to get to know patients in a different way before we recommended significant treatment. I had no idea of the depth of connection we could have with patients, and the impact we could have on their health and well-being!

We spent “engaged” time with patients over a variety of appointments. We came to understand that the clinical tasks we had to accomplish were a small part of caring for patients. We began to see every interaction, with every patient, as an opportunity to get to know them and what was important to them to help them make healthy choices.

Over time we discovered with our patients:

  • The status of the dental health
  • The challenges of their current conditions
  • The implications of these conditions if nothing was done to intervene
  • Interventions they and we could do to change the trajectory of disease.
  • A possible preferred future of choice
  • Considerations involved in various treatment choices.

When we met patients where they were instead of where we thought they “should be” we found that some were ready sooner than others. We stopped giving patients solutions to problems they did not yet own. We came to understand that if we gave patients the time and attention they needed to own their existing conditions they were more curious about what Dr. Barkley called their “Probable Future” and more likely to pursue a “Possible Future.”

Without this spirit of collaboration and intentional patient development, we cannot do our best work.

Our influence develops throughout a process in which the patient is learning, in touch with their body, and engaged in thinking about the implications of the various aspects of their oral health. Because the conditions we discover today and our patient’s choices will impact their future health, we have a moral obligation to share what our experience tells us is likely to happen (the probable future) if they do nothing or if they choose a stop-gap treatment.

It is also our responsibility to help them see a preferred future that is possible for them when they are ready.

By engaging them in the exam process, creating opportunities for them to experience learning about their health, and welcoming them into collaboration, we enable them to partner with us in shaping their future. We must help them understand the implications of any choice they might make including its limitations, so they are fully informed to make true choices.

We have been trained to be efficient, and most dental clinicians have pride in their efficiency. But by prioritizing being “effective” over being efficient we make better use of our time and theirs. We experience an increase in trust, in our patient’s confidence in their decisions, and a more comprehensive view of treatment. Patients begin to see dentistry as a vehicle to create optimal health, function, and esthetics. Patients are more likely to keep their appointments, follow through on suggestions, and pay for our care with gratitude.

When we invest time in the early stages of our relationships, everything down the road flows more easily.

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Mary is known internationally as a writer and speaker on patient care and communication. Her writing has been acclaimed in respected print and online publications. She is widely known at dental meetings in the U.S., Canada, and Europe as a knowledgeable and dynamic speaker. Her passion for dentistry inspires individuals and groups to bring the best of themselves to their work, and to fully embrace the difference they make in the lives of those they serve.

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The Art of Influencing Our Patients Part 3: An Opportunity to Engage

June 19, 2023 Mary Osborne RDH

Many times, patients have some sense about their overall health, but have no idea about what is going on in their mouths. They tell us they’ve never looked in their mouths. Our challenge is to engage them during the exam process in such a way that it raises their curiosity and awareness.

Our goal should be for patients to be so engaged in the exam that they continue to pay attention to their mouths, even when they leave our office. As they are driving home, we would like them to be touching their facial muscles. We would like them to be paying attention to how their teeth come together when they take out a nightguard in the morning. We would like them to notice if there are points of bleeding when they floss. As they go about their lives, we hope they pay more attention to all the things we talked about.

Think of engagement as being like the gears on a bicycle. If the gears on your bicycle are not engaged, the bike will not move forward. You may be inclined to pedal harder, but you are still going nowhere. Similarly, if a patient is not engaged, you might be inclined to give them more information. But you might as well stop talking because you are probably going nowhere.

Engagement has been described by educators as when the student is working at least as hard as the teacher.

We all know what patients look like when they are engaged. They ask questions, they touch their faces, they lean forward, or they point to images on the computer monitor. They give us signals that they are paying attention. On the other hand, when a patient’s eyes glaze over and they blankly nod, it’s a good indication they are not engaged. When you notice that polite smile, stop talking and look for a way to engage them in the process. You might ask them a question. “I know I’ve been giving you a lot of information, and I’m curious, what are your thoughts about what we have discovered so far?”

One of the things I like to do when I begin the exam process is to ask the patient to hold a mirror in case I have some questions for them as we go through the exam. Most patients will take the mirror and put it on their lap. I look for the first opportunity to ask any kind of question that involves the mirror. I might ask them to bring the mirror up to their face and show me in the mirror an area they mentioned as a concern. I might ask them to point to changes made in their mouth by orthodontics and restorations and inquire about how they feel about those changes. Once they do, they are more engaged and understand that what they are telling me has relevance. They begin to see themselves as part of the process with expertise about themselves.

We want to engage as many of the patient’s senses as we can…seeing…hearing…touching… tasting. As I examine the mouth, I might say, “I notice that when I slide the perio prob into this deeper space between the tooth and the gums, there is bleeding. Do you ever see or taste bleeding there?” Their personal involvement in the exam gives rise to questions that are opportunities for them to connect what is going on in their mouth with their self-care behaviors and the choices they will have about seeking treatment from us.

We don’t want our patients to just comply with our recommendations. We want them to be actively engaged in understanding, planning, and working toward improved health. We want them to feel responsible for their choices and to partner with us in improving their health.

Engagement leads patients to take ownership of their health and make healthy choices.

After the next exam or consultation you do with a patient, consider:

  • How engaged was the patient?
  • How much “work” were they doing relative to how hard you were working?
  • What did you do to activate engagement?
  • If you could do it all over again, what “one more” question could you have asked the patient?

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Mary Osborne RDH

Mary is known internationally as a writer and speaker on patient care and communication. Her writing has been acclaimed in respected print and online publications. She is widely known at dental meetings in the U.S., Canada, and Europe as a knowledgeable and dynamic speaker. Her passion for dentistry inspires individuals and groups to bring the best of themselves to their work, and to fully embrace the difference they make in the lives of those they serve.

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The Art of Influencing Our Patients Part 2: An Opportunity to Develop Patient Understanding & Confidence

June 16, 2023 Mary Osborne RDH

In dentistry, we’re clear about the connections among the teeth, the muscles, the bone, and the joints—and how all these pieces are related to esthetics. We understand how those pieces fit together. Unfortunately, most patients don’t come to us with that understanding.

Dr. Bob Barkley used to talk about patients not understanding “the web”—the connection of how all the pieces come together.

Just as with a delicate spider web, if you touch any one aspect of it, you change everything. Bob Barkley would say to his patients, “I know you are concerned about that one tooth. That’s your job to be concerned about that one tooth. My job is figure out and to help you understand how what’s happening with that one tooth is related to everything else that is going on in your mouth.”

The exam is a process by which we can do exactly that. We can help our patients understand the connections in their mouths. The exam is also an opportunity to encourage our patients to have confidence in us. Confidence building starts with the new patient exam and continues in subsequent interactions. The more thorough the examination we do, the more in touch we are with what is really happening in our patients’ mouths and the more confident patients will feel about our ability to help them.

Our thoroughness and knowledge aren’t the only aspects of the exam that develop patients’ confidence in us. The gentler we are in our touch and the more careful to include the patient or others in the room during exams are important. These aspects of the exam communicate our character and the way we tend to approach our work. Patients anticipate our care and approach will be similarly open and comfortable during future consultations and procedures.

People don’t take risks when they don’t feel confident. Unfortunately, many patients do not have confidence in making decisions for themselves when they sit in a dental chair. They think of significant dentistry as a risk. For best long-term results and positive relationships, we always want the patient to feel as strong and confident about their choices as they can.

Repeated comfortable interactions are needed for them to develop their confidence. Every time we find something good in their mouth, every time we point out health such as healthy gum tissue or a beautiful restoration, and areas not needing restoration, we are reinforcing healthy choices they made in the past. This can be a confidence booster to help them move forward in making next choices.

The examination process is an opportunity for the clinician to:

  • Understand what the patient is experiencing emotionally and physically,
  • Provide sensory learning experiences (see Art of the Examination: Part 1),
  • Help the patient draw connections for deeper understanding of their health
  • Explore options for what the patient might choose to do.

The examination is an opportunity for the patient to develop understanding of:

  • The clinician’s ability to help them.
  • The current condition of their teeth and other oral structures.
  • The impact on them of what they are learning.
  • The choices they can make to improve their health.

Every examination is a next opportunity to develop our patients’ confidence in us and in their ability to make healthy choices for themselves.

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Mary is known internationally as a writer and speaker on patient care and communication. Her writing has been acclaimed in respected print and online publications. She is widely known at dental meetings in the U.S., Canada, and Europe as a knowledgeable and dynamic speaker. Her passion for dentistry inspires individuals and groups to bring the best of themselves to their work, and to fully embrace the difference they make in the lives of those they serve.

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The Art of Influencing Our Patients Part 1: An Opportunity for Experiential Learning

June 12, 2023 Mary Osborne RDH

All dental schools teach a system for doing a clinical examination. The goal is typically to gather as much information about current clinical conditions as possible, as efficiently as possible. It is an important aspect of patient care. The science of the exam is useful, but it misses the art of the examination. In my experience, it is often a missed opportunity

In dentistry, we are always trying to figure out the best way to influence our patients to make healthy choices for themselves. When I left Hygiene school, I thought it would be simple to influence patients. I thought that if I did a good examination, a good diagnosis, and then made a good presentation, patients would go ahead and do the treatment.

What I experienced when I was in practice was different. Over time, multiple conversations, and multiple interactions—in their own time and in their own way, patients would move forward with treatment. Sometimes it seemed random, but what I’ve come to understand now is that every interaction was an opportunity to influence the patient.

Every single interaction, with every single patient, by every single member of the dental team is an opportunity to influence.

I think most of us have learned over the years to be skillful at providing information. We know how to “Teach and Tell” what we are finding and recommending. But there is an aspect of that process that has to do with experience. What we have not always paid attention to is how we can go beyond information to create learning experiences for our patients.

When I see a baby touching grass, I imagine that the experience of learning about grass through the senses is entirely different than learning by being told about grass. Creating opportunities for people to interact physically with their own bodies is an opportunity we have in a number of different situations. We can do this during a consultation, but we really have this opportunity during an examination.

If we place priority on effectiveness over efficiency, we will do our exams with the intention of creating physical-sensory experiences, which can be as simple as having them touch their muscles as they touch their teeth together, sliding their jaw forward and side to side, finding a relaxed jaw position, tapping their teeth together, clenching, feeling fremitus with their tongue or finger, feeling the difficulty of flossing between tightly packed teeth, and taking us on a tour of their mouth in a mirror while telling us about their concerns. It’s natural to say, “Tell me more about that. Show me where.”

Consider the new patient exam as the initiation of an experiential learning process to influence our patients to make healthy choices.

The new patient exam is not “the one” opportunity we will have to influence patients. We’ll have many more opportunities, but it sets the tone for every conversation you will have with your patients about their health, about the conditions present in their mouth, about the implications of what is going on in their mouth, and some of the choices they might be able to make.

Job one is to engage the patient in discovering just how intriguing their mouth is and why the health of its various components matter for long-term comfort, function, beauty, and overall health.

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Mary is known internationally as a writer and speaker on patient care and communication. Her writing has been acclaimed in respected print and online publications. She is widely known at dental meetings in the U.S., Canada, and Europe as a knowledgeable and dynamic speaker. Her passion for dentistry inspires individuals and groups to bring the best of themselves to their work, and to fully embrace the difference they make in the lives of those they serve.

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Staying in the Question – Part 3

June 13, 2022 Mary Osborne RDH

Ask One More Question

One of the ways I have learned to Stay in the Question is to practice asking one more question before I give information. Learning to ask one more question has helped me to be more effective in several ways

1. The practice of asking one more question helps us save time.

My experience is that we spend a lot of time giving patients information they may not want or need. We can waste our time and theirs by giving information they have not asked for.

There was a time when if a patient asked me if x-rays were “really” necessary, I would go on at great length about the value of the radiographs, what we could see on them, and what we might miss if we didn’t take them. But I learned to respond, “It sounds like you might have some concerns about having x-rays,” and ask, “What is your concern?” By asking one more question, I was able to answer the patient’s question or concern very precisely and quickly.

2. Staying in the questions helps us understand what the patient wants from us.

Patients don’t always know how to communicate with us to get their needs met. They ask what they know how to ask. Sometimes their question is “Will my insurance cover that?” Sometimes their question is “How long will it last?” or “Will it hurt?”

Asking a follow up question to any question or concern they express allows us to better understand their needs and expectations. If a patient asks, “Will it hurt?” I could reassure them I will be as gentle as possible. Alternatively, I could say, “It sounds like you are concerned about the pain of this procedure. Have you had a painful dental experience in the past?” Responding to a specific fear will always be more powerful than a general reassurance.

3. Asking one more question allows us to give information clearly, to give information that is useful to them.

After seeing patients over years, it is easy to fall into giving the same information repeatedly. We all have our scripts we fall back on that describe a particular disease or procedure. Having a ready-made script may seem efficient but in the long run it can cause us to miss opportunities to be more effective with our patients. We can spend a lot of time giving them reasons why we think they should have treatment instead of providing more precise information relevant to their needs and their wants.

Aristotle said, “The fool persuades me with his reasons. The wise man persuades me with my own.” We don’t need to guess how to persuade our patients. I’ve learned that, when I stay in the question, patients tell me exactly what they need from me to be able to make decisions.

4. Asking one more question creates an opportunity to build trust.

There was a time when I thought having all the answers for my patients would make me seem competent and gain their trust. I’ve come to understand that I will never have all the answers and that, in dentistry, it is just as important for patients to trust our motives as it is for them to trust our competence. When we take their questions and concerns seriously, follow up with genuine curiosity, and listen deeply to their responses, they are more likely to feel our care and concern. They are more likely to trust that what we want is what is best for them.

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Mary is known internationally as a writer and speaker on patient care and communication. Her writing has been acclaimed in respected print and online publications. She is widely known at dental meetings in the U.S., Canada, and Europe as a knowledgeable and dynamic speaker. Her passion for dentistry inspires individuals and groups to bring the best of themselves to their work, and to fully embrace the difference they make in the lives of those they serve.

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Staying in the Question – Part 2

February 18, 2022 Mary Osborne RDH

Staying in the question — staying curious about what more you can learn about each dental patient and the intention to help each patient be more curious about their own situation, enables dentists and dental hygienists to be more effective in helping their patients.

What Do You Think You Know?

The next time you are reviewing the chart of a patient you are frustrated with, try this exercise. Instead of going too quickly to thinking, “What is wrong with this person? Why don’t they get it?” – ask yourself these three questions:

  1. What do you know about this patient and their situation, specifically because they told you this? They actually said it.
  2. What do you think you know? This has to do with the guesses you have, your intuition about what is going on. What do you think the patient has implied by what they said? Recognize which of your thoughts are guesses because those assumptions might or might not be true. If you act based on what is not true, you may miss opportunities to learn more about what is important to your patient. Asking yourself what you think you know is a way of challenging your assumptions.
  3. What do you want to know? What are you curious about? How can you take some of your “think you know” thoughts and move them into the category of “what you do know” about your patient.

The more you do this exercise, the more you become aware of the difference between what you know and what you think you know, and the more curious you will become about your patients. The more I have done this exercise, the more I have come to know that what I do know is small compared to what I do not know. I sometimes I realize I know very little about what is important to them.

Is the Patient Curious to Learn About Their Situation?

I have come to realize that the first question the patient asks is just the first step in their learning process. Sometimes they need help framing some of their more important questions. Or sometimes, a question is their attempt to share a little of their story, their struggles, their fears, their embarrassment. Often, I realize they have emotional discomfort I can address with empathy. In that moment, empathy is more effective in helping and leading the patient to higher health than the clinical information I could provide them.

Understanding that most patients have some level of anxiety about their oral health and oral health visits, I have learned to pause and ask a question before plowing ahead with information they may not want or need — or may not “hear” if they are anxious.

For example, if I see wear patterns on teeth when I do an examination, I could tell the patient what I see. I could say, “I see you grind your teeth.” But that type of statement is often perceived as accusing, not empathetic. What I have found to be more effective is to show the patient what I see. If the patient does not say anything that indicates she would like more information, I might ask her, “How long has that wear pattern been there?” or “What do you think has caused it?” I never want to deprive her of information. I want to give information when she has a little more curiosity — when she wants to know it and will hear it.

Sparking curiosity with a question often leads the patient to ask a question that reflects what is most important to them at that time. Discovering what is most important to them enables us to optimally make use of our time during that visit. We can provide information that is important to them, that they want. Or we can focus on providing the empathy they need to develop a relationship of trust.

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Mary Osborne RDH

Mary is known internationally as a writer and speaker on patient care and communication. Her writing has been acclaimed in respected print and online publications. She is widely known at dental meetings in the U.S., Canada, and Europe as a knowledgeable and dynamic speaker. Her passion for dentistry inspires individuals and groups to bring the best of themselves to their work, and to fully embrace the difference they make in the lives of those they serve.

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Staying in the Question – Part 1

February 7, 2022 Mary Osborne RDH

The art of helping our patients develop ownership of their present condition and their desires for their dental health is built on the foundation of listening. But much of the time, we do all the talking and provide all the information.

Several years ago, my friend and I were coaching a young hygienist when her patient asked how she could get her teenage son to spend more effort caring for his teeth. I was ready to dazzle them with all the tips I had learned over my 20+ years in Hygiene but my friend Linda cautioned us to “stay in the question.” She was curious to know what the mother in the chair was really asking. That was the first time I became aware of the concept of staying in the question.

The model I learned in my clinical training—the model of teach and tell, really isn’t enough to help patients make choices about their dental care. And over the years, I learned that when I assumed I knew what a patient meant by a question and gave information I thought they wanted… I was wrong. My assumptions got in the way of my ability to really help my patients.

Are our patients asking for help or for information?

When I learned to combine the ability to stay in the question with my knowledge about dental health and dental care, all my conversations became a bit easier. I have come to realize that that mother with a teenage son, like so many of our patients, was asking for HELP but not information.

Today I can think of several questions I might have asked that mom before I jumped in to giving her information. I might have asked, “Well, what have you tried so far?” Or I might have asked, “What motivates your son in other areas of his life?” I might have asked, “What is he doing to care for his teeth?” I might have asked all those questions but asking even one of those questions, might have enabled me to better help.

Sometimes asking just one question before offering information is enough to open the door to real learning.

Staying in the question is both a skill and an attitude.

We need to skillfully ask authentic questions that are not designed to manipulate people into doing what we want them to do. If the questions help us understand our patients better, they are authentic questions. If the questions help them talk through and move through any barriers they perceive, they are authentic questions. If the questions open their minds to possibilities, they are authentic questions.

But staying in the question is not just about asking questions. It’s about an attitude of curiosity, of coming to the conversation with a desire to know more. It’s about releasing the attitude that we know everything we need to know to help the patient move forward.

Staying the question requires a genuine belief that our patients have information that we need to help them better.

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About Author

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Mary Osborne RDH

Mary is known internationally as a writer and speaker on patient care and communication. Her writing has been acclaimed in respected print and online publications. She is widely known at dental meetings in the U.S., Canada, and Europe as a knowledgeable and dynamic speaker. Her passion for dentistry inspires individuals and groups to bring the best of themselves to their work, and to fully embrace the difference they make in the lives of those they serve.

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