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?”
“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.
Here are my TOP TAKE HOME MESSAGES:
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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Once a month, we teleconference with a group of dedicated Patient Care Coordinators, Facilitators – team members whose primary role is to work with patients and help them make choices about their care. During our Facilitator Study Club, these smart women come up with some great case studies for our learning and contribute great ideas for being more successful with patients.
Our November discussion had to do with the most appropriate ways to follow-up with patients without being aggressive or overbearing. They wanted to know; when is too much? And what are the most effective ways to connect with patients outside the practice? What came out of our discussion were some helpful ideas that I wanted to pass along.
First, what may be appropriate for one patient may not work for another patient. There are some generational and lifestyle differences that may determine the way in which a patient responds. For instance, an older person might appreciate a personal phone call. The elderly woman who lives with her cats might be much more receptive to a call and return a phone message than the busy single mom who works full-time. The graduate student may respond to a text or email while your voicemail message will go unanswered.
How do you know what might work best and when? You ask – preferably at the beginning of the relationship. Simply state that there will be times when you will want to follow-up with them about treatment or appointments and ask what he or she prefers. If treatment isn’t scheduled on the day the patient is in the practice, ask them when, how, and how often they wish you to follow-up.
If you are following up in the hope that your patient schedules treatment, it will require more than a phone call or text. We all have busy lives and forget about things so you will want to provide more details than simply; “We are concerned about your dental care and are calling to schedule your treatment”. An effective tool, regardless of your patient’s age or lifestyle, is a letter. Patients often don’t easily comprehend examination findings at the time they are discovered, and usually aren’t presented with a review in a way that is easy for them to understand. The environment for learning about their condition is less than optimal. The office offers distractions. They may be fearful, worried about finances, or not very motivated at the time. And even though your examination may have been quite thorough and engaging, what was discussed is often lost with the passage of time. A letter with a simple recap can help jog their memory and encourage them to reconsider your recommendations. We have also found that although they may not respond the very day they receive it, the letter rarely goes in the trash. They set it aside for reference when they are ready to take action.
The key things to remember when composing the letter are:
1) Be sincere
2) Make it personal and relevant
3) Write it in easy-to-understand language
4) Encourage action
It needn’t be long and detailed. The point is to recap where you left off with the patient, what they expressed concern about/interest in (OUTCOME), and the implications of doing nothing. Also, hand write the address when you send it. This insures that they will open it. Here’s an example:
Notice that the letter asks the patient to call the practice. This hands the responsibility back to the patient. Even though the letter encourages the patient to call the practice, you may opt to make a follow-up call/text/email about a week or two after the letter is sent. A simple, “Just following up on the letter I sent you” will do, with an invitation to call if they wish to make an appointment or have additional questions.
Give it a try and see whether this helps bring some results. Let me know what happens.
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