Your day is winding down as you go through the charts, making notes and treatment plans. It’s been a good day—very productive, the crowns seated with no problems and the schedule ran on time. Your receptionist comes into your office and notifies you that Mrs. Peterson, a long-standing patient, has requested that her records be transferred to Dr. Maxwell’s office and that she wants you to call her. Suddenly your day has disintegrated and your stomach is giving you signals of dread or trouble. This is difficult to understand because you’ve always provided excellent treatment to Mrs. Peterson. You’ve done three crowns, one of them an anterior and she said she loved it. You feverishly scan through her chart, searching for some sign that your treatment was anything less than ideal. As your memory has told you, her course of treatment in your 11 years of having her as a client, has been nothing but superb—perhaps some of the finest restorative work you’ve done. Now she wants you to call her. This is actually the job of Marilyn, your receptionist, to deal with people on the phone. You dislike this part of dentistry because it’s your job to provide the highest quality of treatment and you’ve hired others to handle the personal interactions. At last you call Mrs. Peterson, who thanks you for calling. You are not sure exactly what to say, but you begin by asking her if any of her teeth are bothering her. Mrs. Peterson informs you that her teeth are fine, but that she has chosen to leave your practice. When you ask why, she tells you that she hasn’t sensed for quite a while that you are aware that she’s even there. She tells you that she doesn’t feel you’ve cared for her. Shocked, you can only think of the hours spent in treatment planning her case and the time spent on meticulously instructing the lab on how the crown for tooth #9 needed to be shaped. You are at a loss for words. She thanks you for your work and indicates that she has heard from friends that Dr. Maxwell is exceptional in providing care, which is what she is seeking.

The conversation ends and your are mystified. How could you have done any better and what can Dr. Maxwell, the new dentist down the street, possibly have to offer this client that you haven’t already given her? The answer lies within the words of her conversation. Having spent four years in dental school learning the technical skills to bring people’s mouths back to health, we in the profession may tend to forget that dentistry is still within the realm of the Health CARE Profession. It is not the Health PRODUCTIVITY Profession, or the Health PERFECT MARGINS Profession. It is still a health profession that provides CARE. Mrs. Peterson even told you this, yet you missed the message, because too often “treatment” becomes confused with “care.” They are not the same, and most risk management experts will tell you that more lawsuits are brought on due to factors that involved the manner in which a person was treated as a human rather than the manner in which that person was treated as a patient. Nothing goes as far toward building rapport with a patient than paying attention to communicating with them effectively. Let’s look at some techniques.

THE QUESTION BEHIND THE QUESTION

Regardless of how we may view ourselves, dentists are, to many people, still “the doctor,” or the authority figure. People holding these attitudes will often be unable to approach you with a direct question. Instead, they will either infer their question or try to ask it in such a peripheral way that we completely miss the main point. I call this phenomenon “the question behind the question.” A simple example of this might be the patient, who upon being presented a treatment plan for a crown, asks the question, “Can’t this tooth simply be filled?” I have often observed that dentists will answer that question directly, going into a rather detailed and lengthy explanation about why a crown is the superior choice. These are not answers to the question posed; they are mini-seminars on a dental topic. In fact, this patient may have actually been thinking, “There’s no way I can afford this treatment.” However, perhaps due to ego, or shame or fear, he may not be able to bring this fact to light and instead resorts to the question that implies his dilemma, but does not state it clearly. If this person’s actual agenda has to do with finances, the chance of him hearing your “dental” response is minimal.

In my pediatric practice, the most common situation of this sort is when a parent, usually the Mother, brings a child into my office because of “decayed front teeth.” As professionals, we all recognize this prevalent pattern as Early Childhood Caries and we are prepared to provide a virtual seminar on the topic for the parent. The Mother will often ask me, “Does my child have soft teeth?” It is my firm belief that not every person posing this question is ignorant. Often, the Mother actually knows exactly what has caused the problem and has an enormous sense of guilt about it or might be very fearful for what her child will be facing to have the teeth treated. Just as in the first scenario, this person will not be attentive to a protracted lecture about bottle syndrome or anything else. She has already exceeded her comfort zone by simply bringing the child the office to confirm her worst fears.

In both of these cases, the astute practitioner will try to determine the actual main concern of the patient prior to beginning the dental reprise. This is not always easy since some people will continue to try to hide it and others are so deeply into their feelings that they fear letting them out. I have had success in separating the literal question from the question behind it by posing a question of my own. It may need to be customized according to each situation, but, in essence, the technique involves simply asking them for more information. In the first situation, I may be uncertain if this man is concerned about the crown itself, the actual procedure, the number of visits, the cost, the cosmetics or something I can’t even guess. I simply ask him, “Can you clarify your question for me a bit more?” In this way, it begins to open the door for him to convey his principal concern. You may be able to hear the genuine concern, or you may still need to pursue it. If you succeed in getting to the core issue without the patient losing his dignity, you will have shown a level of caring that will go far beyond the crown that you might place in his mouth.

In the second case, it may be easier to imagine that this Mother has feelings of guilt or fear. I would consider her question behind the question easier to determine than in the first case. When I feel that I have sensed this underlying issue, I will address it directly, such as saying, “I can imagine you have been worried about this for quite a while.” When I make a statement of this sort, the Mother will often open her own floodgates (which can be verbal, or can be in the form of tears) and pour her heart out. It is important for her to feel that you have noticed her human feelings before she is ready to listen to dental information. Again, if you can notice that something is going on other than an ignorant dental question, you will quickly be perceived as someone who really “cares” for the person.

LEARN FROM NEGATIVE FEEDBACK

There are, of course, two main forms of feedback. In the first, positive feedback, we all feel a swelling of our inner self—an affirmation that lets us know we have done something well and that it was appreciated. Very few people would ever say anything about positive feedback other than, “I can’t get enough of it.” It may be worth more to the successful practitioner than the financial rewards or work. In spite of this, my experience with positive feedback is that I sometimes don’t even know what it was that I did right! A client may say, “Your office is so great!” and I am happy to know this client was satisfied.  If that client has not been explicit in the way we were “great,” this comment has not taught me very much.

When it comes to “negative” feedback, some doctors may switch to the Mr. Hyde side of his personality and become defensive or even belligerent. While I would never suggest that receiving negative feedback is always as easy or as much fun as positive, I would say that it often brings more useful and helpful information to the recipient. This experience has grown out of my attitude toward receiving the information. Once one understands that this form of feedback is actually a gift from the speaker, everything changes. I do not necessarily solicit such gifts, by the way, but I have learned to open my mind and my ears when a client has a “complaint.” When a negative comment comes to me, I have learned to not react, justify, explain or refute the comment. Instead, I have learned that by asking for more information, the speaker will usually state in far greater detail some aspect of the practice that actually might require more attention. I now make a point of trying to see the person’s point from his or her perspective in order that I can reach a greater understanding of the problem. I always thank people for the feedback and tell them that although I don’t necessarily enjoy hearing feedback like theirs, I certainly learn from it and I would prefer they bring their concerns to me rather than to a neighbor.

Perfectionists that we are, dentists may delude themselves into believing that their practices are perfect. They well may be perfect—for the dentist, that is. However, the lifeblood of the practice still depends on satisfied clients, not a satisfied doctor. It is in this reaching out to the clients as actual people that will result in a loyalty to our offices that will far exceed the smoothness of the margin of a crown or the color match of an anterior composite restoration.

As for Mrs. Peterson, this situation presents an opportunity to discover something about your practice that you might need to know. If you had asked her for more information about her feelings for not being cared for, she would have expressed concerns to you about the words that your receptionist used in discussing her missed appointment of two weeks ago. Mrs. Peterson’s son had just been in an automobile accident the morning of her appointment and was at the hospital, talking to the ICU doctors about his prognosis from his serious injuries. She would have told you that she didn’t appreciate coming home to a message from your receptionist about how one hour had been reserved for her and the office would have liked a phone call to let us know she wasn’t coming. She would have told you that she was so upset about her son that her dental appointment just wasn’t on her mind. Just as in the other cases, she wasn’t in a frame of mind to get a “lecture,” even if brief. By pursuing this “negative feedback” you might have learned something important about your protocols or your standard terminology. You also might have kept her as a patient by thanking her for this important information and then sending her son flowers in the hospital. Those actions would have shown her you really cared for her. That was what she wanted all along.