It’s common knowledge that most patients do not look forward to dental work. On the other hand, it is a small number of patients who have significant fear or anxiety about dental care, the kind that prevents them from getting the procedures they need and want. So for this small group of people what systems do you have in place. The traditional things we do to help patients be comfortable are not going to make enough of an impact for people who are truly apprehensive about dentistry.
By Mary Osborne RDH
I wrote recently about moving our conversations with patients away from insurance benefits, and into conversations about the benefits of health. While we cannot ignore the role insurance may play in the choices patients make, I’m concerned that we sometimes lose sight of other factors which contribute to the process of making healthy choices. While we have no control over the future of dental insurance, we can influence all the other aspects of the equation.
CSJ + PO + FF + MOP = Health
Care, Skill and Judgment + Preferred Outcomes + a Fair Fee + the Method of Payment = Health
Today I will speak to the first part of the equation: Care, Skill, and Judgment. This refers to what we bring to the process, and this factor alone is completely within our control. Each practice has its own brand of Patient Care, and it varies from one practice to another. Y
Thanks Mary Osborne for the following post!!
I’m tired of talking about insurance benefits. So much is being said today about “changes in health care,” but the conversation really tends to be more about changes in insurance benefits. I think the time is right for those of us in dentistry to lead the way into a different conversation; a conversation about health.
We have a lot to learn about health; a lot to explore with our patients. Beyond education there is a place for authentic dialogue; an exchange of ideas in which there is learning on both sides. Beyond a mechanistic model of health is a true understanding of vitality, of what it means to thrive.
Today I had the privilege of seeing a new patient who came in concerned about an area of gingival recession that appeared to her to have been getting worse. She shared with me a story about having recently seen a general dentist, to whom she had been going routinely, who told her she didn’t need to be worried about her gums. As the rest of the story unfolded she shared that she was looking for a new dentist because she had felt her concern was dismissed, even assumed to have been silly. I have been practicing dentistry for long enough that I can imagine in my mind’s eye what happened at the other office. I can even see and hear myself doing something similar over the years.
The challenge is that as dental professionals we become very comfortable with both dental disease and with common dental issues that are not problematic. This comfort often gets in the way of our ability to remember that for each patient their concern is real, it is their mouth or teeth, and they do not have years of experience to tell them something is routine or easily treatable. From things like amalgam tattoos to recession, craze lines and decalcification spots patients get curious and worried over things they notice in their mouths. Often a misplaced smile, or lighthearted attempt to dismiss concern can be inappropriate in response to a patient.
The most important thing I have learned over the years it to first listen fully. The second step is to acknowledge what you heard including the emotional subtext, and ask for verification. I will always take the time to examine the area in question making sure to be thorough. Lastly I will share with the patient my beliefs about what is happening and the information necessary for them to move from fear or concern to comfort. Whether the patient today decides to move forward with grafting or to simply allow us to monitor the area of recession, what I know is she left feeling heard and respected for being proactive about her health.
Over the last few months in lectures and articles I have discussed the concept of managing patient expectations about the longevity of restorative dentistry. Multiple times during these conversations a dentist has pointed out that we have coined the phrase “permanent” crown or restoration or filling. What does the use of the word “permanent” communicate to our patients, and is this misleading. These are great points and something worth addressing. I am clear that words are powerful and I pay close attention to their impact. In truth it is not just our patients that are impacted and create beliefs because of the words we use, but our teams and our own behavior.
I had the privilege today of working with a patient on a comprehensive esthetic exam with photographs. He has had significant wear on his lower centrals for years. In addition he has been watching his upper right central get shorter and thinner, until it finally broke off at the incisal edge. At his recall exam I began a conversation with him about his front teeth and asked what his thoughts were about his teeth. He answered that he would love to have them look better and if he was going to do anything he wanted things to look great and have better symmetry. Given the time limits of a recall exam, and curiosity about what he meant, I invited him back for a comprehensive exam.
I had a patient in the office today for an adjustment of his anterior bite plane appliance. When I came in and asked how he was doing he said “great, but I think I melted my mouthguard”. Curious I asked if he had it with him and he reached in his pocket and pulled out a melted remnant of his anterior bite plane attached to the composite. As we looked at it he said “I’m not sure what happened, I followed the directions and only had it in boiling water for 45 seconds to try and tighten it.” For years I have shared the instructions with my patients for tightening their own anterior bite plane appliances at home, this is the first time I have had a patient melt one. I guess that isn’t a bad percentage, but it has made me rethink post-op instructions and how to help them be more clear.
Last week I shared a post and video from Mary Osborne entitled “Staying In The Question” and talked about the value of improving our listening skills int he dental profession as a key to helping our patients move forward with care. In this video segment Mary expands on the concept of Staying In The Question and explains a great exercise to do at team meetings to practice being better listeners. I have taught with Mary for years, and we always include the exercise she shares in this video. Over the years I have been amazed time and again at the impact it has on people. Often in our courses dentists and their teams will make a commitment to do this exercise at every team meeting, partnering with different members of the team each time.
We spend so much of our time learning to speak, write and read proficiently, and almost none of our time learning to be better listeners. Yet the art of helping our patient;s develop ownership of their present condition and their desires for their dental health is built on the foundation of listening. We talk often in dentistry about patient education and we provide all of the information and do all of the talking. The truth is the best learning occurs not when we are listening but when we are speaking. With this in mind when we are doing all of the talking with a patient we are the ones learning, no wonder we know dentistry inside and out!
In this video Mary Osborne (www.maryosborne.com) answers a question posed to her by Dr. Mike Melkers. Mike’s question was what he was doing wrong if after an exam and a treatment presentation a patient doesn’t move forward with the recommended treatment.
How many times over the years have I asked this same question of myself? I am glad to have Mary’s answer to share with you. Thanks Mike and Mary for putting this together!