Survivor, Practice-style: Triangulation


This has been a topic of conversation lately. And while it may be fun to watch on Survivor, the gossip, taking sides, stirring of s@#$%t that takes place in a practice can be toxic and damaging.  I dug up an article that Sandy Roth wrote a while back and with her permission, pass it on to you:

Triangulation and Forming Alliances: How to eliminate it

Why can’t we just get along?  I suspect one of the reasons is that we don’t know how. First, the fancy definition: Triangulation occurs when one person, having an issue with a second person, takes that issue to a third person. Now for the street version: Triangulation is talking about people behind their backs.

Triangulation is a serious problem for many teams, and it can often get a group in big trouble. Although triangulation is a behaviorally immature approach to disagreement, many adults engage in it without understanding the full implications of this choice. When I observe this behavior, I ask about it. Often, team members are simply unaware of what they are doing. They have learned to gripe but not to address their problems directly; so they simply do what they have always done.

•  Triangulation solves no problems

The only route to solving inter-team conflict is a full, honest and open discussion of the issues with every person’s active participation. All problems ultimately belong to the group and not a secret subset of team members. Here’s why. Let’s say Jeanne and Jane have a difference of opinion. When their individual efforts fail to resolve this difference and either party secretly takes her frustration or anger to a third person, that third person is now involved in a clandestine discussion. This unhealthy dynamic now “infects” the entire team. People always know who is mad at whom and who is part of a faction.

•  Triangulation creates new problems.

Triangulation fractures the group by putting a greater emphasis on differences than on understandings. It almost forces people to focus on the negative aspects of their culture. Moreover, this strategy creates an environment of distrust and disrespect, which tends to undermine healthy aspects of relationships. Practice attention must then be shifted from patient care to team dynamics. What a waste.

•  Triangulation creates false alliances.

Jane is angry with Maggie and goes to Susie to dump. “Have you noticed Maggie doing such-and-such?” Jane asks Susie. Now, Susie hasn’t noticed this, and initially she has no beef with Maggie herself. “No,” she answers. “Well, I have,” adds Jane. At this very point, Susie will most likely make a choice between aligning herself with Jane or standing in defense of Maggie. Susie will find it difficult to disagree with Jane. After all, Jane has come to confide in her — an act of “friendship.” And just because Susie hasn’t seen something doesn’t mean it hasn’t really happened. Human nature will more often result in a secret alliance between Jane and Susie against Maggie which is based on  incomplete information and a pact to tell no one else. If she tells Maggie, she has violated Jane’s “confidence.”

The confidential information Jane has shared is now almost impossible to ignore. (Don’t think of an elephant.) Even if Jane drops the conversation at this point, Susie is now predisposed to seeing Maggie in the negative light of Jane’s characterization. She is now more likely see those things which confirm Jane’s picture of Maggie and selectively ignore information to the contrary.

  Triangulation encourages factions

Under the guise of “checking it out,” a team member triangulates with a third party (Sometimes this person is the dentist). First, let’s agree that this is tattling. If the initiator really wants to check things out, he or she can go to the only person who can answer the questions. The real purpose of this behavior is to gain allies. The more people who agree that you are right and the other is wrong, the stronger you feel and the more righteous you become. Once the number of allies begins to grow, the opposition is forced to counter. Before you know it, the practice is split and there is a full-scale civil war.

So what are the alternatives?

  Always go to the source

The cleanest way to handle any problem is to go to the source. Yes, this can be tough, but eventually the problem will have to be aired anyway and it won’t get any easier under the unhealthy circumstances triangulation creates. Forget about rehearsing, making sure you are “right” before you raise an issue or gaining evidence. None of these excuses justify triangulation.

•  Never agree to keep triangulation confidential

If someone asks you to enter into unhealthy alliance by sharing secret information with you, simply refuse to keep it secret. The proper answer to “If I tell you something, will you promise not to tell anyone else? “ is “NO.” For what honorable reason would someone call your attention to a problem if she didn’t want some help actually solving it? If the real reason is to get your support in the civil war, refuse to be drafted. You can agree to help the person raise an issue, but you must never agree to be a secret-agent.

•  Ask for facilitation if you need help

If a co-worker tells you about an issue she has with a team member ask the following: “How did you raise that issue and what happened as a result of your discussion?” Too often, you will hear that there was no discussion. At this point, encourage your friend to raise the issue immediately and offer to facilitate the process. Facilitate does not mean gang up. Facilitate means to insure that each party is heard and understood.

•  Return the problem to the group if  necessary

Of course the team needn’t handle every issue. But when reasonable attempts to resolve disputes prove unsuccessful, it is time to ask for support from the entire team before the relationship deteriorates needlessly. Be sure to ask team members to listen to the issues and avoid taking sides. The only side which matters is the onein the best interest of the practice as a whole and the patients whom you serve. Principles, core values and promises to patients matter. Egos must get out of the way.


Laying Down the Law With Patients


Laying Down the Law With Patients

While it’s clear that our patients have expectations – sometimes valid, sometimes unrealistic – we have expectations too!  And how often is it that our patients disappoint us because they don’t do what we expect of them? While this blog article could turn into a full-on gripe session about those darn patients and how they constantly let us down, I believe how we think and what we do or don’t do, have a great impact on how our patients act and if we want them to change, we have to change first.

Here’s the deal; First, there are some things that we don’t get a vote on and there are other things we do. Second, how can we hold our patients to accountable to any expectations if we don’t come right out and have an honest conversation about them? Expectations are reasonable only when they are clearly conveyed, discussed and agreed-to by both parties.

So, what are the valid expectations? In our opinion, we believe there are only four things you can ask of your patients. I think you will strongly agree;

1) SHOW UP – and on time

I could devote a book to this subject. How often does a patient let you down by no-showing, or arriving late (and thinking it’s OK, I might add)?  How dare they? First, this is a professional business arrangement. It can’t be treated casually. Having your patient sign a form with your “office policy”  is not good enough.  (How many people read it anyway?) You must look your patient in the eye and tell her you have reserved this time with “fill-in-the-blank” just for her, you will be fully prepared when she arrives, and ready to get started. “Can I get your commitment to that?” THAT will get their attention.

What doesn’t work?  A recall system or any other communication that conveys the message that you “request the courtesy of  — hours notice in the event of cancellation”. You’ve, in essence, given them a ticket to reschedule. And putting them in the penalty box by “fining” them for not showing will just put a strain on the relationship without addressing the problem.  Instead, speak to the obvious;

“Bob, we were expecting you this morning for your appointment with Dr. Norris and honestly, we are disappointed you didn’t make it. We had that time set aside just for you.”

How can you assure this won’t happen in the future?:

“ I can arrange your next visit in one of two ways; a deposit of $fill-in-the-blank will reserve your time or, I can call you on a day when an opening avails itself to see if that will work with your schedule.”

Same thing with people who habitually show up late.  Speak to the obvious;

“Lisa, I’m glad you finally made it. I only have 35 minutes of time left before my next patient arrives so, I promise I will get as much accomplished as I can. It might mean we will need to schedule another time to have you come back to finish what we can’t take care of today.”

Message: you’re late, I run on time. I will not inconvenience my next patient, you will still pay for your full appointment, and you might have to come back again. Reasonable? I think so.


Aside from insurance claims, there should be no reason for you to have any outstanding accounts with patients. Period. How is it that practices get into the accounts receivable business with patients in the first place?  Unspoken or unclear understandings about 1) the fee and 2) the terms for paying the fee.

No dentistry should be performed without an actual discussion about the cost associated with the treatment recommendation, what the patient will be expected to pay, how that fee can be made, and a mutual agreement with the patient on the terms. Something as simple as:

“Gentry, the fee for the treatment you have chosen is $fill-in-the-blank and our first preference is that be paid  (in full at the first appointment or a % to reserve the appointment and remainder on the first appointment, etc.). Will that arrangement work for you?” If it does, great. You are done. If it doesn’t, you find an alternative that works for both of you.

Remember, it is better to NOT do the dentistry than to do the dentistry and NOT get paid.


What would we want our patients to be honest about?

#1 on the list: Let us know how you are feeling and what you are thinking.

You can’t read your patient’s mind. You need to know if he is apprehensive, if he isn’t sure the treatment you’ve recommended is right, or if finances are an issue. That is why having a dedicated and gifted facilitator on your team can help you connect with patients at a deeper level and help them voice what might otherwise be left unsaid.

#2 Lifestyle, health issues or recreational/prescription meds. These have a huge impact on what your recommendations might be and the outcome.

#3 Don’t make an appointment if you don’t intend to show up, or agree to treatment if you aren’t sure, etc.

These could be uncomfortable conversations. Coming right out and asking your patient to be honest may imply that you think they are lying. So, how do you convey this very important value? You can suggest the ways in which you hope they will tell you the truth. If you use context to frame the idea, it will make the conversation go more smoothly;

“Some people are reluctant to share personal lifestyle information with us such as their recreational drug use or the state of their health but these issues have tremendous impact on how we might treat someone or the outcome of treatment. I want you to encourage you to be as open as you can with us and know that we will respect your honesty and never make judgments based on what you tell us. In exchange, we will never mislead you or withhold information that we believe is in your best interest.”

Or encourage honestly by speaking to the obvious…

“Something tells me you aren’t fully committed to the treatment we have recommended. Before we go any further, please share with me what you are thinking and what concerns you still have.”


We’ve all had them. The patients who show up on your schedule and you break out in a sweat. You plan a strategy to be in the lab when she arrives. You avoid engaging her in conversation and ignore the terse comments. In my opinion, that is NOT OK. If there are patients in your practice who are bullies, they need to be called on it.

When my kids were little and one of them would come to me complaining, “Mom, Casey’s chasing me”, my reply would always be, “Then stop running”. The same is true with nasty-tempered patients.

Yes, it is uncomfortable to address someone when they are behaving badly but it can be done with grace and one of two things will happen: it will either defuse the situation and she will recognize, apologize or explain herself OR she won’t get it and the relationship will end. Either way, you win.

Here’s the grace part:

“Hilda, I get the sense that you aren’t very happy about something, and if it’s something we’ve done to make you that way, we would want to know about it. What’s going on?”

You will know very soon by her response where to take the conversation next.

“ Goodness, I had no idea. Thank you for being honest with me. Let’s see what we can do to make it right.”


“You know, Hilda, it is becoming clear that despite our best efforts, we may not be able to make you happy. I am more than willing to transfer your records to another provider if you like.”

Conveying your expectations makes such good sense because it prevents a myriad of problems before they occur. And you will find that there are many remedial systems that can be eliminated when you front-end your relationships with a conversation about expectations.

Having direct conversations with patients about these expectations requires team members with courage, confidence and finesse. It requires level thinking, maturity and most important, time. That is a big investment but pays off quickly by eliminating many of the issues that cause us stress. 

Practice Perception Part II: What messages might your staff be sending?


In the first installment of Practice Perception, I asked; Does your physical plant represent your practice mission? We looked at the elements that contribute to painting a fuller picture of what your practice is about and is often the primary way patients can assess who you are and your level of professionalism and expertise.

Of course, there are other factors that contribute to your practice image.  One of the most powerful influencers is your staff. They can be a primary reason why patients are attracted to or end up leaving your practice.

Inside the practice, you certainly would want your team to be on their best behavior and represent you in a positive light. However, you can’t assume they will behave or act appropriately without being specific about your expectations. Make sure your employee manual contains specific guidelines for things as basic as the following:

PERSONAL APPEARANCE – include specifics on what you will or will not tolerate regarding: jewelry, piercings, tattoos, hair, personal hygiene, oral health, cologne or perfume, or tobacco smoke or smell.  

CLOTHING – if you supply uniforms, this should not be an issue. If you don’t, you must be specific about what is and is not appropriate.

CHATTER – quite often, dentists complain that the staff banter gets in the way of patient care. Patients who hear staff talking amongst themselves while they sit idly waiting will feel ignored. The hard and fast rule should be that the content of staff conversations in places outside the staff break room should be focused exclusively on patient care. In addition, remind your staff there should be no bad-mouthing or negative comments to other staff members or patients at any time.

PRIVACY – and of course, any conversations relating to patient care should be private and discussed in a place where they would not risk being overheard by others.

TEXTING, CELL PHONES AND SOCIAL MEDIA – team members gripe all the time about patients who use their phones during their appointments. Imagine how patients feel when a staff member diverts their attention from patients to text or use their phone or check their Facebook. It is rude and inappropriate. Period. Patients should not see or hear a staff member’s personal phone – not even a buzz when it’s placed on silent.

You cannot stop team members from using Facebook or other social media outlets outside of the practice, but you can remind them that what they post about their job or the practice is up for scrutiny. Depending on the comment, it could present the practice in a bad light. Comments can also cross privacy boundaries.  In order to protect themselves and the practice, you should request that they refrain from commenting on anything related to the practice.

ATTITUDE – you have probably experienced your share of passive-aggressive behavior by your team. It manifests itself in ways in which you may not be aware until it is brought to your attention by another team member or a patient; being surly or short with someone, slamming doors or banging things, ignoring others, sarcasm and responding in an overly exaggerated sweetness that is “put on”. Patients pick up on these behaviors and it reflects poorly on the practice and you as their leader.


How many times have you been in public and seen one of your patients?  Whether it’s at the grocery store, gas station, sporting event or the countless other places you might go, you are keenly aware of how you might be perceived by your patients outside the practice. Your staff?  Not so much.  

When they aren’t working, your staff are probably not thinking about patients seeing them in a less-than-flattering light. And there’s not a whole lot you can do about it. However, you can encourage them to be on their best behavior. Remind them that they can be a powerful influencer to encourage patients to stay active in their dental care by the warm greeting or response they give patients outside the practice.

Enforcing these expectations can be difficult but it is essential that your staff understand  how vitally important they are in influencing practice perception. They are a huge part of the equation.

Reality Check: A Commentary on 10 Reasons Why Your Dentist Probably Hates You Too


Reality Check: A Commentary on 10 Reasons Why Your Dentist Probably Hates You Too

This week, a blogger stirred up dentists and patients alike with her most recent entry: 10 Reasons Your Dentists Probably Hates You Too.  It was clever and funny and written tongue in cheek but it had a ring of truth that rang out loudly for some. It is clear from some of the responses that the points she made resonated with dentists who are frustrated with their patients.  A big thank you to Laura, the author, for your wisdom, insight and graciousness! I wanted to dissect her points and comment on them from a behavioral perspective. Here goes:

1) The first thing you say when you sit down in my chair is, “I hate the dentist.”  Really?!?  Did your parents teach you any manners?  Did they ever teach you that it is impolite to tell someone you hate them the moment you greet them?  What I really want to say back is, “aww, I hate you too.”
First of all, it would be easy to take offense. But don’t – it is not about you. When patients make comments like this, don’t assume you know what it’s about. Ask them. Behind the comment lies a whole host of different reasons – some of which the patient might not even be aware of until you take the time to ask. Replacing your judgment with curiosity allows you to truly find out what is holding your patients back and starts the process of behavior change through discovery. Never mind whether the answer makes sense or not. However they respond, it’s a legitimate issue-for them.  Don’t stop there. Find out more. For instance, if they comment that they don’t like the sound of the drill, ask why? Stay in the question – what is it about the sound that bothers them? Are there things we can do to make that less of a problem for them? – you get the idea…keep being curious!!!

2) You come to your appointment, and it’s obvious you haven’t brushed your teeth in days.  I’ve had some people with great hygiene come in and apologize because they’ve just eaten lunch and couldn’t brush.  This is not what I’m talking about.  I mean food and thick plaque everywhere.  After 10 years of seeing blood and rotten teeth and some really nasty things, this is still the 1 thing that makes me dry heave.  You know when you come to us that we have to be in your mouth.  Would you clean your home before having company?  Additionally, I have spent hours literally bending over backwards repairing your teeth.  Could you at least pretend that you are caring for the work that I have struggled to complete for you?
Speak to the obvious. If what you are finding tells you that they don’t spend a lot of time caring for their teeth, make an observation – not a judgement. “There seems to be food and thick plaque throughout your teeth. This tells me that you may not be brushing very often. Tell me about that”.  Then be quiet and listen.  Don’t go into the telling mode. Find out what they know and what they don’t know. Use it as a discussion opener for achieving better oral hygiene.

3) After we have spent hours of meticulously repairing your teeth, you complain about the bill.  Would you walk out of the grocery store with a bag full of groceries and expect not to pay?  I’ve just helped you to continue to smile and eat comfortably, two pretty valuable things that help your quality of life.
Dentistry is a “below the line” expense. After a person pays for all their  “necessities”, they would rather spend what little they have left on something they enjoy. Dentistry is rarely that and they aren’t happy about re-allocating funds or spending their discretionary income for it. This is their way of expressing their unhappiness. Invite them to talk about it, empathize with them, and don’t take it personally.

4) I tell you that you have a cavity and you need a filling, and you wait months or even years to get the necessary work done.  Eventually the tooth starts hurting.  Two weeks of pain go by, and you call me on a Saturday night while I am at dinner with friends because your tooth that needed a filling a year ago and that started hurting 2 weeks ago is suddenly an emergency.
Pain is a great motivator. But patients create the thing they fear the most by not acting until they are in pain. You get to decide whether you accommodate patients who choose not to act until they are in pain. You don’t have to support that behavior if you don’t want to. You know the State Farm commercial  where the guy (Jerry) calls his old agent when he’s in an accident – “Oh Jerry, I’m so sorry. I would love to help but remember you dropped us last month”….Same in the case of an “urgency” (Key word here is urgency because if it was truly an emergency, they would go to the ER). You empathize, offer the options you have and they get to decide. With your support, they could experience a shift in their thinking in the future – ie: “Jerry, you expressed that you wanted to avoid pain at all costs. If you don’t ever want to go through that again, we recommend (fill in the blank).”

5) You come to me so I can help you, but you make it hard for me to do a good job.  You wince and make faces when it’s not hurting.  The idea that I’m hurting you makes me just as uncomfortable and stressed as you are.  If it hurts, please tell me, and I can help you with that.  But if it’s because you don’t like the whole experience, you are only causing me to work in undesirable conditions, making it harder to do my best.  And when you push your tongue in the way, or you don’t open wide enough, it makes it physically impossible to get my work done.  Don’t you want it to be easy for me to do the best job for you?
Those darn patients get in the way of doing dentistry! Being a dentist would be great if people weren’t attached to their teeth but that’s not the case. Sometimes there are things you just have to deal with. As for the hurting, are you SURE you aren’t hurting?   Again, you can speak to the obvious – “Linda, I can’t help but notice that you are wincing. I want to make sure that you aren’t having any discomfort”. Ask them to hold up a hand if they want you to stop at any time.

6) You call and say, “my tooth didn’t hurt before you worked on it.”  You came to me with a cavity.  I did not put it there.  You did.  I am simply fixing a rotten hole that was in your tooth.  To do so, I must use a tiny drill to cut the rot out of your tooth.  If I took a drill, cut a hole in your femur bone, and then filled it in with a foreign material, don’t you think it might be sore for a while?  Same concept.
Great example.  This is where knowing your patient’s expectations and preparing them for what to expect can prevent a lot of issues later in the relationship. You could use a similar analogy and explain they might experience some discomfort, and if they do, explain what they should do about it. If they expect it, it won’t be a surprise. If they don’t, even better!

7) When we try to take an x-ray, you won’t bite down on it.  We have to do this to see what is going on with your tooth.  Without knowing the problem, we can’t properly treat you.  I know, in some cases some people really can’t do it; but some people could and won’t just suck it up for 15 seconds.  I’ve had x-rays too, and they hurt and dig into my gums, but I just do it.
Acknowledge the brief discomfort, move on. If it keeps them from letting you get an xray, let them know that your diagnosis will be based solely on what you are able to see from the outside and it will be incomplete. Their choice.

8 ) You tell me that you bought my car for me after having a crown done.  Contrary to how it seems, you actually didn’t buy me a car.  You bought yourself a crown.  I have spent hundreds of thousands of dollars on an education, and have spent hours making this crown fit precisely in your mouth, so maybe you helped me make a portion of a student loan payment.  But you certainly didn’t buy my car.
Agreed.  Rude comment. Even if they said it to be funny, there is something behind the statement. I believe it’s OK for dentists and their teams to challenge patients on this stuff –  ie: “Wow. What would make you say that, Mr. Smith?” or “Do you believe the fee for your treatment is out of line?” Then be quiet and listen. Yeah, it takes time and skill. By becoming curious, gaining trust and being honest you can change the patient’s perception of the dentist.

By the way, they aren’t buying your “crown”.  They are buying the solution to a problem – something that will make their life better.

9) You no-show an appointment or cancel last-minute.  Some things are unavoidable, but when it’s because your hairdresser got a last-minute cancellation and you had to take that appointment instead, this is just rude.  Not only am I unable to fill the 2 hours of my schedule that I reserved specifically for you, but someone else who wanted to get in had to wait 2 weeks for his/her appointment.  And on that note, when you have the first appointment of the day, and you show up late for your appointment, I am late for every other patient the rest of the day.
This is a two-parter. The no-show or cancel at the last minute issue deserves a blog all it’s own. As for the patient who shows up late, if you are always late, you teach your patients the bad behavior of being late. If you strive to stay on time, your patients will begin to show up on time.  There are occasions where your schedule will be off and when you acknowledge it, apologize and explain how concerned you are for your patient’s time, they appreciate that. If the patient shows up late and it does not allow you to do the procedure in the remaining time, you have two choices – do it and run late or explain that you are unable to complete the procedure and will have to reschedule. Your patient will be annoyed and you will lose revenue for that day but it will be less likely to occur in the future.
There will always be exceptions – patients who are always late – to everything! Again, speak to the obvious. “Betty, it seems like you are always running a bit behind to your appointment. This doesn’t seem to be working very well. If we don’t have adequate time, we aren’t able to provide you with the care we promised. How should we handle it from this point forward?” Have them help solve the problem and hold them to it.

10) When I tell you that you grind your teeth, you deny it, as if I am accusing you of having a horrible disease or being a baby murderer.  It’s not that bad to be a tooth grinder.  I’m just pointing something out and maybe offering a way to prevent more problems in the future.  This observation is concluded from signs or symptoms that are based on real science, not myth.
OK.  I’m beginning to sound like a broken record. Patients believe what they believe – find out WHY.  Replace your assumptions and judgment with curiosity.  Example:
“Helen, the wear I am seeing on your teeth is something I typically see on patients who grind their teeth.”
“Oh, I don’t grind my teeth”.
“OK.  Then we have a mystery.  What else do you think might be causing this wear?”
“I dunno.”
“Well, let’s talk about your lifestyle and see if we can figure this out.”. You can learn more from what THEY tell YOU than from what YOU tell THEM. Help them through the discovery process.

Have you begun to see a pattern in my responses? All of these challenges can be minimized if we apply behavioral principles to the situation.

1) Patients voluntarily call/walk into your practice with a problem they are hoping you can help them solve.

2) Patients are pre-disposed to liking you. They would not come to your practice if they didn’t or felt like you were incompetent or not a good fit for them.

3) Almost every patient is a recycled one looking for a place that will provide what they haven’t gotten in the past. If you listen closely, patients will tell you how they wish to be treated. It’s how you respond that will make all the difference. If what they are asking for is reasonable, responding with something as simple as “Mrs. Jones, I’m sorry you had that experience. You can be sure that we will do everything we can to make sure that doesn’t happen here” can start you on a long and successful relationship.

4) Patients price-test everything before they buy.  Dentistry is no different than tires for the car, a new dishwasher, groceries for the month or tuition to private school. They believe that it will buy something that will make their life better. Dentists need to present their dentistry with some context. Not “you needa crown” but instead “if you want (fill in the blank) then you need (fill in the blank)”.

5) Almost anyone can afford what they truly want and almost no one wants everything they can afford. Patients get to decide how they allocate their money and what they choose. We can’t want it more than they do. Set your judgement aside. We can only gain their trust and try to influence their thinking.

6) You don’t know what you don’t know. Don’t make it up. Don’t shift into your smart dental telling mode but instead into your curious learning mode. You will learn how to help your patient better.

7) If a dentist wants to stay sane and positive over his or her lifetime in the profession, it requires a commitment to learning behavioral skills. This area is rarely taught in dental school and it is often not considered in many practices but it is one of the most important factors in being successful. Consider surrounding yourself with a behaviorally gifted staff who can work with your patients in a different way. And consider adding a dedicated full time facilitator (patient coordinator) to spend the necessary time getting to learn your patient’s story and how they hope you will make their life better. By learning the patient’s OUTCOME, helping them PRICE TEST, and offering what will make their life better in a way they can understand, you will become more successful with patients and it will enrich your professional career.

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Getting Patients to Open Up

While our world revolves around dentistry, it often occupies a very small space in our patient’s lives. Just like you, your patients struggle with life issues every day – and most of them have nothing to do with dentistry. But how do you know whether the cause of their distress is something related to dentistry or something else?

In this blog I will address the moment in which your patient is giving signals that they are upset and how you might respond. Earning your patient’s trust and allowing them the opportunity to express themselves will bring you one step closer to developing a successful relationship…

There are times when you get a sense a person is struggling with something. Their posture, actions and comments give you a clue that something isn’t quite right. He might hang his head, furrow his brow, breath deeply, look anxious, sweat, or make comments under his breath. Does this sound familiar? Oftentimes when witnessing people in this state, you might become uncomfortable. While you might readily address it with a child or spouse, you might be reluctant to raise it with people you don’t know very well.

If you find yourself observing patients who are anxious, or struggling, or angry, or conflicted or confused, you might be inclined to let those moments pass by without addressing them. It takes you outside your comfort zone. You may feel like you are “prying”. You might not feel like you have time to devote to the conversation. Then there are times when you just don’t want to go down that path. Whatever the reason, if you let the moment pass, you miss great opportunities. If you don’t pursue what is going on for a patient, you are missing valuable information that could help you become more effective with him or her. The reason may have nothing to do with the practice or what she hopes you can help her with but the more you know, the less you will make it up and get it wrong.

Team members tell me they don’t quite know how to initiate the conversation and this becomes the reason they let the moment pass. So here are some tools that will help you develop the skills and confidence to begin the conversation and provide you with more valuable insight.

The FIRST STEP is to learn to look for the nonverbal signs. Take a moment and think about all of the visual clues you see when people are upset, agitated, angry, impatient or confused. Write them down.

You likely listed furrowed eyebrows, slumped posture, agitated movement, making quick or strong gestures. Now, think about the audible cues you might hear and write those down. Did you list sighing or breathing hard, the tone in their voice, mumbling or talking under his or her breath? The more you think about this and write the signs down, the more likely you will be able to identify them when they occur. The important thing is to notice these signs when they happen so you can become aware of your patient’s emotional state. Some people use these physical and audible cues to tell others they are struggling, hoping they will ask what is going on. Others are unaware they are sending these subtle messages.

Once you recognize the signs, STEP TWO is to speak to the obvious. Make an observation about their behavior or body language in a non-judgmental way. Something as simple as, “Becky, I couldn’t help but notice that you seem a bit upset today”, or “Bob, you appear a little agitated” is enough. Spend some time coming up with phrases that can speak to the obvious and are observations of what you might see while not being judgmental.

The THIRD STEP is to follow up your observation comment with an invitation to discuss it. Depending on the circumstance, you might say something similar to, “Care to talk about it?”, or “Anything I can do?”, or “I hope we didn’t do something to upset you”. Make the words your own but the focus is to invite them to share with you how they are feeling.

Once you observe, acknowledge and invite, BE QUIET AND LISTEN.  This is where the magic can happen. You will be amazed at what you might hear simply by offering an opportunity without judgement or coercion.

If the person chooses to share how he is feeling, be prepared to fully commit to this and allow the person to get whatever it is off his chest. If he denies there is a problem or declines the offer, let him know you are available if he changes his mind. A simple, “OK. Let me know if I can help” is sufficient. Remember, a level of trust needs to be built for anyone to share their thoughts and feelings with someone else. For some, it takes much longer to get to that point and when you honor that, people will come one step closer to feeling that trust.

It is important to understand that you can not be their therapist and there is a point in which you must establish a boundary and disengage. The focus should be on determining if a person is, in fact, upset, angry, nervous, annoyed and if so, finding out why. If the source of the problem is you or the practice, you have an opportunity and a responsibility to work alongside the patient to resolve it.  If the issue has no relationship to the work you are doing together, acknowledge their feelings, thank them for sharing and move on.

It is natural to feel a little uncomfortable addressing a person’s emotional state but until you acknowledge it and offer to listen, you will not know what it is about. If left unaddressed, it may become a road block between you and your patient. The more you know, the more likely you can come closer to helping your patient and the more successful the practice will become. Find out more here: