Have you ever recommended treatment to a patient and then gotten the “deer in the headlights” stare with the sound of silence in the room?

This is usually an indication the patient was listening to what you had to say … they just were not ready to HEAR what you said!

Knowing Your Patient and Learning When They Are Ready

One of the aspects of the Philosophy of Dentistry as taught by Dr. LD Pankey is the concept of “knowing” your patient. Do you really know what your patient’s circumstances, objectives, and temperament are?

When you really understand your patient, you are able to meet them where they are. You will then know when they might be ready to hear the recommendations you have to improve their dental health.

Knowing your patient starts with asking the right questions and using active listening skills while getting to know the patient. What are their values, fears, expectations, perceived needs? Do they have an appreciation of dentistry and value what it has to offer? A.K.A., what is their dental IQ?

Do they need more education about their current condition? Does their budget now include dental care? Are they ready to make an informed choice about their treatment options?

I oftentimes find myself initially putting out the “fire” for a patient (ie. repairing a broken cusp or chipped front tooth, getting the patient out of pain) and then easing the patient into care in our office in a way that makes them feel taken care of.

I may take several years to build trust with the patient, educate them about optimum oral health, and help them understand the root causes of their condition. Over time, the patient usually starts to ask more questions and dental health becomes a high value for them. They eventually say something like, “Hey doc, I’m READY … when can we get started?”

Developing your clinical skills is very important to providing excellent dental care. But I find it’s equally important to develop your communication skills such that you can really get to know your patient and know when they are READY to own their condition and get started with the necessary treatment.

A bedrock value of Dr. Pankey and those who have chosen to follow his visionary teachings is that the welfare of patients is first and foremost. 

Putting the patient’s needs first is the lens through which all other professional decisions we make as caregivers must pass. If something doesn’t pass the test of being in the patient’s best interest, as ethical dentists we must give it a serious review.

Why Technical Skills Alone Are Not Enough

The response to this commitment by many dentists is to dedicate themselves to perfecting their technical skills, whether that be during their dental school days or in frequent post-graduate studies. Dr. Pankey encouraged this, harkening back to the days of his parents’ dry goods store, saying it is necessary to “have it on the shelf.” 

While a necessity, simply being a good technical dentist is not enough. We live in a world of marketing sensory overload and patients experience a tsunami of messages when trying to make healthy choices. How can a good dentist stand out from the crowd and benefit more patients?

Empathetic Understanding Is Key

Dr. Pankey’s mantra was “Know Your Patient, Know Your Patient, Know Your Patient,” but limiting that knowledge to the patient’s clinical condition short-circuits the concept’s power.  Knowing the patient’s circumstances is priceless and allows you to understand some potential barriers they may have to moving forward with treatment, as well as when now is the right time to pursue optimal dental health.

Combining excellent clinical knowledge, an empathetic understanding of a patient’s circumstances, and earning the patient’s trust can open a powerful pathway to optimal health for our patients. Knowledge, understanding, and trust, coupled with our dedication to what is best for the patient, allows for the possibility of true partnership.

Treasured learning from Dr. Pankey and the Pankey Institute are the tools to partner with our patients – to walk with them, hand-in-hand, on the path to optimal health. The marketer sees the patient as a prospect – someone who will bring business and profits. The technician sees the patient as a collection of defects that need expert fixing. It is the master dentist who brings skills, both technical and behavioral, to partner with patients as they guide and support them toward their vision of health.

Denial in dentistry is often more subtle than how it appears in other medical professions. Because the denial doesn’t stem from a life-threatening situation, it isn’t as apparent to us or to our patients.

How we respond in a situation where patients react illogically to our recommendations can make all the difference in our effectiveness at helping them. Ultimately, trying to force feed convincing information leads nowhere. It simply encourages our own doubt in ourselves or leads to inaccurately judging a patient’s level of motivation.

There is an alternative to backing off and laying the discussion aside. This alternative depends on an understanding of the process of denial and enables us to enter into that process with our patients.

What is Denial and How Does it Affect Our Patient Care?

Many of us have experienced denial wrenchingly in our personal relationships or less severely with difficulties like having too much stress or high cholesterol. By definition, we don’t see our behavior or feelings in these moments as denial.

Remembering this will help you relate to your patients with a greater degree of empathy. Also, don’t forget that denial is normal. It can’t be avoided or overcome, so it’s much more helpful to approach it empathetically.

One of the most common ways I see denial showing up in dentistry is when patients avoid treatment we have recommended. The fact that these treatments don’t usually involve anything life threatening doesn’t mean they aren’t a significant loss for the patient. What seems like an insignificant diagnosis to us (bite problems or decay) can feel like a loss of a measure of health to them.

There is much to be said on this topic, but the most important thing to do first and foremost is to think of your role as one that is not just informative. The patient is in denial not because they doubt the validity of your assessment. They simply don’t believe the implications are true for them.

Patience is the true means for helping patients through denial. They will come to recognize what they can’t see clearly after guided conversation and appropriate questioning.

How do you recognize denial in your dental practice? We’d love to hear from you in the comments! 

3 Ways to Help Patients Articulate Their Expectations for Successful Dental Treatment

Patient expectations are a tricky thing in dentistry. They vary from patient to patient both in the level to which expectations are considered and in the content of those expectations.

You can ensure good relationships with your patients if you define expectations before providing treatment. Exceeding expectations doesn’t require you to be perfect. It simply requires paying attention and showing an enthusiastic desire to fully meet their goals.

Before you can deliver on your promises, you first have to figure out what exactly the patient wants.

3 Ways to Figure Out Patient Expectations

Meeting and exceeding expectations is tricky because patients usually don’t know outright what will make them happy. They may not know how to articulate what they’re thinking.

Your guidance is most effective when offered during the comprehensive exam appointment. It’s important to gather views and opinions rather than solely data.

1. Ask About Their General Health

This can tell you what a patient’s aspirations are for their health. Interestingly, the clinician’s perspective on what a patient ‘needs’ may not match up with what they actually ‘want.’

Unless the treatment is detrimental to their health, why get in the way of what they value just because it doesn’t line up with what you would personally choose?

An example of this is a situation I encountered where a patient had asked about bleaching. The dentist felt her teeth were already white enough and discouraged her from bleaching. He later learned from one of his hygienists that she was the type of person who highly valued small differences in her aesthetics (i.e. she ran five to six miles every day for fitness).

He decided to reopen the bleaching discussion now that he better understood her values.

2. Ask If They Regularly See a Physician

This does more than give you the name of your patient’s physician. It starts a discussion about how the patient chose their physician and what they like or don’t like about the care they receive in that practice.

Pay attention to any comments that indicate a high or low level of trust for healthcare providers. You can also learn about their scheduling convenience and cost containment preferences, as well as how much they value a doctor’s willingness to take the time to listen to them. Ask them to tell you more about their answers and how they apply to expectations of your practice.

 3. Ask About Their Previous Dental Experiences

Similarly, this gives you more than just concrete data. It’s a chance to learn what their attitude is toward dentistry and how their past experiences have shaped what they expect of you.

For example, if the patient tells you they go to the dentist regularly but still get cavities, this might lead you to wonder why they think decay continues to occur. You can ask follow-up questions such as, “Would you like to change that pattern?” or “What part do you see me playing in preventing decay?”

Ultimately, clarity is the key to good relationships with patients. Endeavor to understand them on a deeper level and you will deliver care that exceeds expectations.

What questions do you ask patients to provide better care? Please let us know in the comments!

Struggling to move your desired amount of dental work off the charts and increase your case acceptance? Usually, the issue isn’t that not enough of your patients need treatment, it’s that they have been ineffectively diagnosed or haven’t accepted procedures for a multitude of reasons.

I’m here to show you three painless methods that will get more patients to say ‘yes’ so you can provide the best care possible.

3 Case Acceptance Methods to Increase the Odds

1. Emphasize a Patient’s Wants Over Needs

Focus on helping patients want better dentistry and a more complete solution. Humans inherently spend money on their wants over their needs. Americans spend much more on alcohol, tobacco, and gambling than on dentistry. Help transform their perspective of dentistry from a necessary evil to a desirable solution. Be patient. Allow them the space to understand the consequences of inaction. At some point, they will “want” to know a solution.

2. Develop Curiosity Over Passivity

Ask about the problem and stay in the question. Many patients will begin to come to their own conclusions if we develop their curiosity. Let them co-discover and view things using the intraoral camera or hand mirror. This gives them the chance to really learn about their mouth. Telling them what you see is passive education. Helping them figure it out is more active and creates ownership. Avoid discussing solutions or talking about problems excessively unless they ask.

3. Help Patients Take Ownership

Here’s the honest truth: Patients are not aware, concerned, or interested in the long term consequences of not seeking treatment. They mistakenly believe that having no pain or dysfunction equates to health. If all we do is give them an exam, develop a treatment plan, and tell them what they need, we will fail to convey the value of a procedure to their life. We have to continue to probe by asking questions about the problem and its progression. When they recognize the ultimate untoward outcome, finally taking ownership, we know case acceptance is on the table. A telling sign is when they ask, “what can I do about that?”

How do you increase case acceptance? We’d love to hear from you in the comments!  

One pattern I’ve noticed lately in calls with my clients is that many dentists and their teams are frustrated about training new hires. Adding a unique personality to an already cohesive group can seem like mixing oil and water at first. When a new team member is brought into your dental practice, there needs to a consistent plan in place to avoid or manage problems as they arise.

 Starting the Conversation on Training New Hires

The frustration I’ve come across is consistently based on new hires not catching on, not doing things the ‘right way,’ and not doing things as fast as dentists would like. The seasoned team members are irritated and everyone is annoyed by the amount of work it takes to train.

One of the conversations I have with my doctors is about understanding the difference between exposing a new team member to a task or philosophy and having them actually learn it in the way they are most suited to. I ask:

1. At what point would you say they’ve started to have a certain level of competency where they can do the task?
2. At what point would you say this team member has mastered what it is you want them to do?

The hope is that you bring a team member on board, they watch what’s going on, you show them a few times, and they will automatically and miraculously have a high level of mastery. But this is not the case for most people.

Pay Attention to Individual Learning Styles

There are many different learning styles that can affect how a person takes in and processes information. Some people want to read about it, some need to watch it five times, and others have more hesitation about how fast they get it.

Acknowledging different learning styles is a huge component to successful individualized training. You have to understand how different people will become effective and learn what you want them to.

3 Steps of Dental Practice New Hiring Training

I like to look at the training process as a continuum:

1. What was the first exposure and have they been exposed to how you actually want to have the task done?
2. What will it take for them to have a measurable level of competency? Is there a training checklist in place? Who is responsible for helping this team member learn?
3. What would it look like if and when they ever attain a level of mastery to the point where they could be responsible for teaching another person?

Bonus Tip: Most people really struggle with only oral types of instruction. Having things in writing and experiential learning are both helpful.

Most importantly, it’s crucial to enact the basic training continuum: exposure, competency, and mastery.

You have to have an actionable plan and you need to know who is accountable for it. If you’ve been unsuccessfully training a new team member, this process has a high level of predictable success, assuming you’ve hired well to start with.

What tasks do you find new hires struggle with the most in your dental practice? We’d love to hear from you in the comments!

(Link to Getting Team embers to ‘Pull On the Rope’ Part 1)

Questions That Will Improve Team Engagement

Employees in a dental practice need to feel valued on multiple levels to do their best work.

In Part 1 of this series, I discussed the importance of team engagement and how it affects a business’ success. Below, I dive into the fundamental needs that can change your team’s satisfaction with their day-to-day employment.

Understanding the 4 Team Needs That Will Change Your Practice

Wagner and Harter’s 12 elements from “12: The Elements of Great Managing” are divided into four categories based on the concept of a triangle and Maslow’s Hierarchy of needs. The first two have to do with basic needs, the next four with individual. If those are met, the next four have to do with teamwork and the final elements are related to growth.

Basic Needs

Example: The first element that must have ‘yes’ as an answer is, ‘I know what is expected of me at work.’

This is the most important category. When people know what’s expected of them, their basic needs are met and it’s easier to move on to their individual needs.

Individual Needs

Example: Element four is, ‘In the last 7 days, I have received praise for doing good work.’

This is about recognition for team members that do good work. You must make sure they’re in an environment where that type of response is supported.

Teamwork Needs

The next need is teamwork. I find it interesting that Gallup asks about best friends. Certainly something I see with my own team is that when team members are actively engaged in relationships with each other, they come to work engaged because of those friendships. They don’t call in sick because they want to spend time with their friends at work.

Another example: Element seven is, ‘At work, my opinion seems to count.’

I’m a fantastic micromanager and I always think I have the best ideas. The more I’ve given up on that, the more I’ve noticed my team members are happier with what they’re doing.

Growth Needs

And lastly, growth.

Example: The final element is, ‘In the last year, I have had opportunities to learn and grow.’

Employees need to feel challenged in their tasks, not bored or stuck in stasis.

My encouragement is to look through the Gallup Q12 Index questions and consider whether you have had similar conversations with your team members individually. Ultimately, if your team members can respond affirmatively to these questions in your practice, then I’m sure you will discover that they are ‘pulling on the rope.’

How do you help your employees have a more fulfilling work experience? Please leave your thoughts in the comments!

3 Types of Team Members Who Make or Break Success

Keeping team members engaged throughout the year is a struggle if you don’t have a communication-based framework in place.

During a recent course I received many questions about how I get my team members engaged. This left me reflecting on lessons I’ve learned over the years from research by the Gallup organization.

Read on to learn what causes disengagement and how you can avoid the downfalls of a disgruntled team in your practice.

The 3 Types of Team Members

In the book, “12: The Elements of Great Managing,” Rodd Wagner and James K. Harter use research from Gallup to describe the three types of team members that exist in corporate America. I believe these types are applicable to dentistry as well:

1. Engaged: They have the magical ingredient of passion.
2. Not Engaged: Pretty much checked out. They put in time but there’s no energy in their work.
3. Actively Disengaged: They’re not only unhappy, they actually undermine what engaged team members try to accomplish.

How Engagement Determines Business Success

What the authors found is that the ratio of engaged to actively disengaged employees is quite different in highly productive corporations versus average corporate America.

Engaged team members in average corporate America were 30% versus 63% in highly productive organizations. Similarly, not engaged was 29% in the highly productive versus 50% in the average. Most shockingly, the actively disengaged employees were more than twice as high in the average corporate office: 8% versus 20%.

This had me thinking of the analogy of a 10 person bicycle. Three people are pedaling really hard at the front. Five people have their hands on the handlebars but their feet are up in the air and they’re not pedaling. Then there are two people way in the back who are actively holding onto the break. This either means a stalling ride or one that could be much faster if everyone were like the first three.

The 12 questions in the book and their corresponding need categories are useful for sussing out what matters most to promote engagement. They show us what can we do about low morale in our dental offices.

Look for Part 2 of this blog series next week where I’ll outline the four team needs that will change your practice.

What do you do when you notice team members are disengaged? Comment below with your thoughts!

(Link to Getting Team Members to ‘Pull On the Rope’ Part 2)