A dentist's most important skill

By Dr Mark Hassed

There is a never ending array of courses that we, as dentists, can do — implants, endodontics, crown and bridge, orthodontics, cosmetic dentistry, composites, occlusion and even how to give botox injections.

All those skills are very useful but if there’s a single ability that determines your success as a dentist, more than any other, it’s how well you communicate with patients. Your level of expertise with clinical dentistry is utterly irrelevant until a patient says “yes” and accepts your treatment plan.

Over the past several years I’ve been very fortunate to have visited a large number of practices and observe literally dozens of dentists as they work with patients. During that time I’ve not been able to find any correlation whatsoever between clinical excellence and financial success. In fact, I’ve seen financially successful dentists who are quite poor technically and I’ve also seen very highly technically skilled dentists who struggle financially.

The common factor that I did discover is this: All financially successful dentists communicate well with their patients and, without exception, financially struggling dentists communicate poorly.

Financial success, however, is not the only benefit of communicating well.

Skilled communicators get to practice a far nicer form of dentistry. Every day they perform their best and finest services on appreciative patients. Their clinical abilities get utilised to the full with challenging, interesting and satisfying work. On the other hand, lowly skilled communicators find themselves constantly extracting teeth unnecessarily and doing cheap, patch up dentistry.

How does a practice belonging to a master communicator look to an outsider.

How much do you tell the patient?

Often dentists worry that if they tell the patient about everything they need, they will “scare them off”.

This leads to chronic under-diagnosis and under-treatment.

The correct method is to diagnose and present everything to the patient. The secret is to do it without any pressure and always offer an alternative.

In that way the patient gets the opportunity to have optimum dentistry but you won't “scare them off” if they can't afford it.

When you visit such a practice, the first thing you notice is how serene it is.

The second thing you notice is how happy the patients seem.

The third and, to me, most important thing that you notice is that the majority of patients book in for significant treatment. Master communicators talk briefly with their patients, the patients become clear on what they want and then the patients make an appointment to have their mouth fixed.

That’s the real the crux of the issue. When dental communication is done properly, it’s rapid, clear and successful — the patient understands, the patient makes a decision, the patient proceeds with treatment.

Treatment consultations in great practices are neither arduous nor time consuming. On the other hand, when communication is done poorly the process takes ages, the patient becomes bewildered and then the patient leaves to “think it over”.

Ironically, many dentists who communicate badly think that they are masters at case presentation. There are two reasons for this.

Firstly, many unskilled communicators have developed a style that is not tested because they rarely ask the patient for a decision.

Patients leave the practice holding pamphlets and a printed quote, earnestly promising to “think it over”. It’s only six months later when the dentist suddenly says to the nurse “Whatever happened to Mrs Jones?” that anyone gets an inkling that the case presentation didn’t go as well as they had thought. Sometimes, they get an idea about the failed case presentation even sooner when there is a records request from a nearby dentist.

Secondly, many unskilled communicators under-diagnose. They instinctively know that they cannot sell what the patient needs so they diagnose what they think the patient will accept. For example, a patient may genuinely benefit from a full mouth rehabilitation but instead the dentist only tells them about 3 fillings and a clean. Or, the patient may genuinely benefit from a crown but the dentist merely patches the tooth with a filling. This under-diagnosis gives the appearance of full case acceptance but it is an illusion obscuring the dentist's inability to inform patients about what they need.

Making problems for yourself

Implants are a remarkably pain-free form of treatment. Patients often don't even need a panadol.

But, when you are explaining implants to patients you can worry them and cause them almost without exception to ask about pain.

That happens if you use the term “…screwed into the jaw…” when describing the procedure.

If, by contrast, you use the term “…placed into the jaw…” you seldom get asked about pain.

Amazing what a difference one word can make.

How do you know if you have a problem communicating with patients? A simple way is to look at the mix of services that you are doing.
If you're a general dentist and are doing less than 20 items per month of indirect restorative dentistry (inlays, onlays, crowns, implants, veneers etc.) then you are not communicating well. Good communicators in full-time practice do approximately 50 items of indirect restorative dentistry per month or more. I've even seen superb communicators who do a hundred items of indirect restorative dentistry per month.

Another way to tell whether you have a problem is by how long you talk with patients. Poor communicators have a slow, laborious communication style built on “rapport” and “educating” the patient. Treatment consultations drag on for 20, 30, 40 minutes or even more. Poor communicators may be amazed to learn that it's possible to present major treatment, and have it accepted, within 5 minutes of sitting down with the patient. Master communicators know that getting case acceptance doesn't require a long courtship and many wasted minutes.

The fact that you can get case acceptance quickly is very fortunate because the cost of running a modern, well-equipped, well-staffed dental office can be around $300 per hour or more. At that rate, talk is not cheap! If you take 20 unnecessary minutes trying to convince a patient of the merit of your treatment plan or, even worse, squander 20 minutes chatting about the weather or personal things in an attempt to get rapport then that's $100 gone.

In fact, long-winded attempts at building rapport may be entirely self defeating. You start to resemble a used car salesman pretending to be friends with the patient to make the sale. By doing this, you run a serious risk of setting off the patient’s “crap detector”.
Now, here's some good news — You don’t need to be a natural born communicator or have outstanding talent to communicate well in the dental office. You can become a good communicator by learning and practicing some easily mastered skills and principles.

I myself learnt these skills and principles by listening to many, many hours of communication courses by a dozen or so masters. At the beginning I was a terrible communicator but over time I became more and more successful. This convinced me that, if you are prepared to put in some effort and find skilled teachers, then anyone can become an excellent communicator. I don’t care how few items of indirect restorative dentistry you do right now. If you find a follow a system then you will produce excellent results. Your “numbers” will improve dramatically, you’ll be more financially successful, you’ll get to do more good quality dentistry, your stress level will go down and you’ll have happier patients.

So, I encourage you. Take some courses on communication skills and watch your practice flourish.

Perth 2 December

The art of case acceptance returns to Perth. Don't miss it.

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