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Heart-based patient communication: Pushing back with the positive!

April 6, 2017
Lorna Smith, RDH, offers five positive ways to approach patient communication.

By Lorna Smith, RDH

We all have those wonderful, accepting, and grateful patients who respect us and appreciate our recommendations. We love to see their names on the schedule. Some of us would say that those patients are the ones who keep us going. We follow their lives—through dating, marriages and babies, illnesses, and so forth. We become their friends as well as their oral health-care providers.

As much as I love seeing those glorious patients, it’s the fierce ones who really challenge me, and they get me to challenge myself. The skeptical ones, the fearful ones, the defiant ones, and the ones who don’t yet own their disease. Yes! Doesn’t it sometimes feel that we are experiencing “pushback” from both sides? We are trying to convince the patient to accept our periodontal treatment recommendations, return more often for hygiene care regardless of insurance limitations, and improve their home care (or just care, at all). The patient tells us they don't want any lectures, don't want any X-rays, want to “just do a cleaning,” and only want to do what their insurance covers. Sometimes, we feel like we are beating our heads against a wall.

Personally, I love it when I hear this from patients! This is my opportunity to find a new way to connect. I ask myself, "What are they really trying to tell me?" I try to figure out how to turn tension or apprehension, or a tug-of-war into a great patient appointment. Most of all, how do I enable a patient to receive the care they deserve and protect their overall total body health?

As dental hygienists, our job is to be a preventive co-diagnostician with the dentist, identify and treat periodontal diseases, help detect tooth decay, oral cancers and lesions, and to “play detective” in coordinating all of that with the oral/systemic link in mind. Whoa!

But, what if our job is also to connect with patients in a more basic and profound way? Like making them know that we have their ultimate best interests at heart and that they can trust us to present to them the most complete and caring treatment plan, but also involve them in every part of the conversation.

The beautiful thing is that it doesn’t matter how we connect with our patients—only that we do. We can try anything we want. We can choose our attitude, our approach, and our response to patients anytime and every time.

This is my mission! This is my passion! This is a great opportunity to make a difference and approach the appointment in a way the patient might never expect, to hit back with positive and flexible alternatives and solutions no matter what they throw at us. If we look at each interaction we have with a patient as an opportunity to accept them just as they are (instead of how we want them to be), we can gain the most amazing results. By reminding them of the freedom and privilege they have in making their own health-care decisions—and by giving them the tools to do so by educating them at their own individual “heart” level—they always choose what they feel is right for them at the time. If we are speaking from our hearts, the appointment will always go the way we want it to.

Yeah, I’m an optimist. But it has served me well, and I’m sticking to it!

So, let's talk about connection! Bond. Partnership. Union. Hook-up. Good energy. The thing that makes it all happen! Where do we start? Here are five things I use on a daily basis that might work for you too:

1. Grab ‘em by the eyes

Always “smiling” patients in the eye can communicate so much and tell us

so much. This especially works great for those patients who are nervous or who have negative expectations about how the appointment will go (or who are meeting you for the first time). All the positive energy and reassurance that we want the patient to feel can be transferred to a patient’s “being” immediately just by smiling into their eyes. Works for me—every time!!

2. Do you trust me?

Wow! Trust. The whole enchilada. (Sorry. I lived in Mexico for two years)

Some patients have felt strong-armed, unheard, or unseen during their past dental experiences.

What about this?

“Today will go exactly as you like. I will make sure you are comfortable with everything we are doing. If anything that bothers you, just let me know, and we won’t do it. You’re the boss!” Just saying this allows the patient to feel they have some control in an otherwise very vulnerable situation, and we find that we end up being able to do everything we wanted to do and more. On top of that, we have gained their respect because we respected them.

Even if we have to ease them into the appointment and don’t get everything accomplished that we intended, maybe our main objective that day is to earn their trust and have them leave with a genuine sense that we care. We can tap into our instincts and intuition. If we feel like we are not connecting, we can pause. Step back. Try another angle. We can follow our intuition and suggest “checking it next time,” if warranted—giving them some breathing room. Almost always, when we see them again, we can move them forward into treatment. Maybe if we don't try so hard to “convince,” they end up hearing it in their own time.

3. Mix it up!

Most of us do the perio charting first, for example, with a new patient. But sometimes it may make more of an impact to start the procedure first. Then, as soon as bleeding is noted, stop, show the patient the bleeding and inform them that a closer look is warranted because “I am concerned about what I am seeing.”

What? Yes. We can change it up according to who we are with, and we can personalize the patient's appointment. We have the power!

How about this?

“May I show you what I am seeing here? Great. See how I can touch this area of your mouth and there is no bleeding? Look what happens here in this area. It’s bleeding quite a bit here, so I’d like to stop and measure your gums to see how far down this infection goes.”

Then, sitting the patient up, eye to eye (there it is again) we can show them their charting and just have a conversation such as:

“I would like to tell you what I’m thinking about what we found, then you can tell me what you’re thinking about what I’m thinking, then we can think about it together and come up with a plan!”

Something like this usually gets a laugh and allows an opening where we can share with them a greater understanding of the disease process and what is actually going on in their body. Informing a patient that they have a disease is never easy. Bringing the patient into the equation as an equal participant in the diagnostic process gives them a feeling of being part of the solution.

4. Four to one

Ok, so this is something I learned a long time ago and it has helped me every day: For every one negative thing we have to say, find four positive things to point out during the patient appointment first. (OK, fine. As many as you can).

“I’m so glad you came back for your three-month appointment as we recommended. Wow, this area has improved so much since our last visit! I can see how much you have been focusing on the upper left, and the X-rays we took today really allow me to see a lot more. Let me show you some bleeding we still have on the lower right and we can talk about what we can do to get the same result here.”

I have to admit, I have used this technique in other areas of my life too.

5. Is it contagious?

If it’s positive energy, let’s hope so! Whether it’s positive or negative—energy spreads. So, what if with every patient we thought, "I am going to see this patient in the best possible light"? It can create miracles! What if we choose to see past our patients’ fears and apprehensions and focus on our welcoming presence instead? We can see all obstacles as opportunities to adjust. By the end of the appointment, they are looking forward to seeing us again. And they don't even know what hit ‘em!

If we are really brave, we can ask ourselves, "Am I really just seeing parts of myself in what irritates me about my patients? What am I supposed to be learning here?”

So—here we go! A typical day could sound like this:

“I don’t want any lectures today!”

(“No problem! I totally agree! Is that the way you have felt at times? How about if I just tell you what I am seeing and we can discuss it any way you like?”)

“Are you going to poke me with that thing?”

(“You mean this measuring tool? Has that bothered you before? Tell me more about that. If it bothers you, just say the word and we can fix it.”)

“I don’t want any X-rays!”

(“Yeah. I can understand why you might feel that way. What are your concerns about them? You know, let me just see when the last ones were and why we would need them for you in particular, and then we can talk about it.”)

“My gums have always bled.”

(“Yes, I see that noted in your records. Since healthy gums don’t bleed, I’d love to help figure out why. There can be many reasons contributing to it. My main concern is your overall health, so would that be OK with you? Great!”)

“I only want to do what my insurance covers.”

(“I can totally understand that. If it’s OK with you, I can just tell you what I am seeing today and we can go from there.”)

“I’m just here for a cleaning.”

(OK, no problem. I am happy to do that for you. At the same time, I will let you know if there is anything else I’m seeing.”)

“Nobody ever told me that I have an infection before.”

(“Bleeding has been noted in your records before, and the great thing about this is that it is all treatable! I can share with you what we would recommend to remove the disease and you can ask me anything you would like. Is that OK?”)

We can surprise ourselves and our patients every day! We are the ones!

Lorna Smith, RDH has been a practicing dental hygienist for over 20 years, 18 of them in San Francisco. Lorna loves to share her passion and enthusiasm for the profession and, in addition to practicing in her home office, she travels to train other dental offices in the implementation of periodontal management programs. She can be reached at [email protected].