Have you ever recommended treatment to a patient and then gotten the “deer in the headlights” stare with the sound of silence in the room?

This is usually an indication the patient was listening to what you had to say … they just were not ready to HEAR what you said!

Knowing Your Patient and Learning When They Are Ready

One of the aspects of the Philosophy of Dentistry as taught by Dr. LD Pankey is the concept of “knowing” your patient. Do you really know what your patient’s circumstances, objectives, and temperament are?

When you really understand your patient, you are able to meet them where they are. You will then know when they might be ready to hear the recommendations you have to improve their dental health.

Knowing your patient starts with asking the right questions and using active listening skills while getting to know the patient. What are their values, fears, expectations, perceived needs? Do they have an appreciation of dentistry and value what it has to offer? A.K.A., what is their dental IQ?

Do they need more education about their current condition? Does their budget now include dental care? Are they ready to make an informed choice about their treatment options?

I oftentimes find myself initially putting out the “fire” for a patient (ie. repairing a broken cusp or chipped front tooth, getting the patient out of pain) and then easing the patient into care in our office in a way that makes them feel taken care of.

I may take several years to build trust with the patient, educate them about optimum oral health, and help them understand the root causes of their condition. Over time, the patient usually starts to ask more questions and dental health becomes a high value for them. They eventually say something like, “Hey doc, I’m READY … when can we get started?”

Developing your clinical skills is very important to providing excellent dental care. But I find it’s equally important to develop your communication skills such that you can really get to know your patient and know when they are READY to own their condition and get started with the necessary treatment.

A bedrock value of Dr. Pankey and those who have chosen to follow his visionary teachings is that the welfare of patients is first and foremost. 

Putting the patient’s needs first is the lens through which all other professional decisions we make as caregivers must pass. If something doesn’t pass the test of being in the patient’s best interest, as ethical dentists we must give it a serious review.

Why Technical Skills Alone Are Not Enough

The response to this commitment by many dentists is to dedicate themselves to perfecting their technical skills, whether that be during their dental school days or in frequent post-graduate studies. Dr. Pankey encouraged this, harkening back to the days of his parents’ dry goods store, saying it is necessary to “have it on the shelf.” 

While a necessity, simply being a good technical dentist is not enough. We live in a world of marketing sensory overload and patients experience a tsunami of messages when trying to make healthy choices. How can a good dentist stand out from the crowd and benefit more patients?

Empathetic Understanding Is Key

Dr. Pankey’s mantra was “Know Your Patient, Know Your Patient, Know Your Patient,” but limiting that knowledge to the patient’s clinical condition short-circuits the concept’s power.  Knowing the patient’s circumstances is priceless and allows you to understand some potential barriers they may have to moving forward with treatment, as well as when now is the right time to pursue optimal dental health.

Combining excellent clinical knowledge, an empathetic understanding of a patient’s circumstances, and earning the patient’s trust can open a powerful pathway to optimal health for our patients. Knowledge, understanding, and trust, coupled with our dedication to what is best for the patient, allows for the possibility of true partnership.

Treasured learning from Dr. Pankey and the Pankey Institute are the tools to partner with our patients – to walk with them, hand-in-hand, on the path to optimal health. The marketer sees the patient as a prospect – someone who will bring business and profits. The technician sees the patient as a collection of defects that need expert fixing. It is the master dentist who brings skills, both technical and behavioral, to partner with patients as they guide and support them toward their vision of health.

Denial in dentistry is often more subtle than how it appears in other medical professions. Because the denial doesn’t stem from a life-threatening situation, it isn’t as apparent to us or to our patients.

How we respond in a situation where patients react illogically to our recommendations can make all the difference in our effectiveness at helping them. Ultimately, trying to force feed convincing information leads nowhere. It simply encourages our own doubt in ourselves or leads to inaccurately judging a patient’s level of motivation.

There is an alternative to backing off and laying the discussion aside. This alternative depends on an understanding of the process of denial and enables us to enter into that process with our patients.

What is Denial and How Does it Affect Our Patient Care?

Many of us have experienced denial wrenchingly in our personal relationships or less severely with difficulties like having too much stress or high cholesterol. By definition, we don’t see our behavior or feelings in these moments as denial.

Remembering this will help you relate to your patients with a greater degree of empathy. Also, don’t forget that denial is normal. It can’t be avoided or overcome, so it’s much more helpful to approach it empathetically.

One of the most common ways I see denial showing up in dentistry is when patients avoid treatment we have recommended. The fact that these treatments don’t usually involve anything life threatening doesn’t mean they aren’t a significant loss for the patient. What seems like an insignificant diagnosis to us (bite problems or decay) can feel like a loss of a measure of health to them.

There is much to be said on this topic, but the most important thing to do first and foremost is to think of your role as one that is not just informative. The patient is in denial not because they doubt the validity of your assessment. They simply don’t believe the implications are true for them.

Patience is the true means for helping patients through denial. They will come to recognize what they can’t see clearly after guided conversation and appropriate questioning.

How do you recognize denial in your dental practice? We’d love to hear from you in the comments! 

Struggling to move your desired amount of dental work off the charts and increase your case acceptance? Usually, the issue isn’t that not enough of your patients need treatment, it’s that they have been ineffectively diagnosed or haven’t accepted procedures for a multitude of reasons.

I’m here to show you three painless methods that will get more patients to say ‘yes’ so you can provide the best care possible.

3 Case Acceptance Methods to Increase the Odds

1. Emphasize a Patient’s Wants Over Needs

Focus on helping patients want better dentistry and a more complete solution. Humans inherently spend money on their wants over their needs. Americans spend much more on alcohol, tobacco, and gambling than on dentistry. Help transform their perspective of dentistry from a necessary evil to a desirable solution. Be patient. Allow them the space to understand the consequences of inaction. At some point, they will “want” to know a solution.

2. Develop Curiosity Over Passivity

Ask about the problem and stay in the question. Many patients will begin to come to their own conclusions if we develop their curiosity. Let them co-discover and view things using the intraoral camera or hand mirror. This gives them the chance to really learn about their mouth. Telling them what you see is passive education. Helping them figure it out is more active and creates ownership. Avoid discussing solutions or talking about problems excessively unless they ask.

3. Help Patients Take Ownership

Here’s the honest truth: Patients are not aware, concerned, or interested in the long term consequences of not seeking treatment. They mistakenly believe that having no pain or dysfunction equates to health. If all we do is give them an exam, develop a treatment plan, and tell them what they need, we will fail to convey the value of a procedure to their life. We have to continue to probe by asking questions about the problem and its progression. When they recognize the ultimate untoward outcome, finally taking ownership, we know case acceptance is on the table. A telling sign is when they ask, “what can I do about that?”

How do you increase case acceptance? We’d love to hear from you in the comments!