By Mary Osborne, RDH  

The questions we ask on a health history form have more to do with disease history than health history, right? The focus is on disease right away. I like to shift that focus to health by saying, “I see that you’ve filled out this history and I’d like to talk to you about specifics, but I wonder if we can begin by you telling me a bit about your health in general? How healthy do you think you are?”  

I have found that if I start with health, I’m more likely to have a patient talk about health. If a patient says, “I think I’m pretty healthy,” I can ask, “What do you do to take care of yourself?” I can relate by acknowledging that I am trying to take better care of myself and how it isn’t always easy. Or I can pick up on something that is important to the patient, such as a concerted effort to get enough sleep or stick to healthier foods or to bicycle many miles a week. I can say, “Tell me more about that. It sounds like you feel better when you do that.”   

The questions you ask shape the conversation. And by the way, that does not just apply to reviewing a health history with new patients. It applies to every single interaction, with every single patient, with everyone on the team.   

When someone comes for their routine hygiene check, I might ask about their recent vacation or how their kids are doing, but I also always ask questions that open a conversation about health. Instead of starting with, “Have there been any changes in your health history since I last saw you?” I like to ask, “How has your health been since I last saw you?” Instead of asking, “Have there been any dental problems that you want us to pay attention to,” I ask, “What have you been noticing about your teeth recently? What are you noticing when you brush or when you floss?”  

We have to deal with disease. That’s a part of our job but moving toward health is more enriching. It’s positive.   

If you want to be seen as a partner in health, then moving the conversation in the direction of health is much more powerful than focusing on disease. The truth is everyone has a personal health story. There are things they are happy about and things they are sad about. When we take a little time to explore that story with questions, we and our patient gain insight into their experiences, attitudes, and feelings about their health. We and our patient get a better understanding of their motivations and the strategies they employ to become healthier. If we invite them to share their perspective with us, they will be more willing to hear our perspective, and we can extend an invitation: “Would you like to hear my perspective about that?”  

I recognize that inviting and engaging the patient in expanded conversations about their health may take a little more time, but it is effective time. Over the years, I noticed that when I thought I was being most efficient, I was generally being less effective. And in the long run, I ended up spending more time understanding what the problem was and trying to give more information without getting enough feedback to know if I was being heard or influencing the patient.   

One of my favorite things to hear from a patient is “You know, I never thought about that before.” I remember a woman who told me that she had been a smoker, but she had quit smoking. And I asked her how she did that. What prompted her? She said it was when her daughter was born that she realized that she didn’t want the smoke around her daughter. In her health review and preclinical conversation, she mentioned one of the things she did for exercise was tap dancing lessons, so I asked her how she got into that, and she said, “I figured I could spend time with my daughter, get exercise myself, and set a good example for my daughter. Wow, I guess my daughter is really a good influence on my health, isn’t she?” 

Those are the light bulb moments that light up my day.  

By Mary Osborne, RDH 

There was a time when I thought “partnering in health” was just about getting people to take better care of their teeth. 

Many years ago, I had a patient who was excellent with her home care, but she showed up periodically with an acute periodontal infection. We asked about stress and her overall health, but she was not aware of any issues. We would treat the infection and she would be fine for a sometime. We knew she worked for National Public Radio, and one day we made the connection that her infections showed up concurrent with NPR’s fund-raising drives. That shared realization allowed us to help her see that her stress was affecting her dental health and her overall health. She was open to conversations about lifestyle changes that would help her be healthier. My relationship with her influenced my thinking and my ability to connect with my patients from a perspective of Whole-health Dentistry. I came to understand that I had been missing opportunities to influence the way people think and feel about health. I knew that I wanted my patients to see me as “a partner in health.” 

Unfortunately, most of our patients come to us with the perspective that we are fixers of teeth, not partners in health. 

In the culture today people are bombarded with information about what is healthy. From friends and families, social and news media, and a wide variety of health care practitioners, everybody expresses opinions on how they are supposed to take care of themselves. Why, then, are we surprised when our patients don’t know whom to trust? Why are we surprised when they shrug their shoulders or appear confused? It’s not always a case of conflicting facts but a case of various perspectives that people don’t know how to navigate. 

Think about where you place your trust. How do you decide whom to trust about decisions—whether it’s about your health, or about your finances, or about how you raise your children? When I ask myself that question, two criteria surface. They need to know their subject and to know me. I want that person to know what it is they’re talking about. I want them to be well informed. I also want someone who knows me, who understands my values. I want that person to have a sense of who I am and what is important to me. 

As we get to know our patients over the years, most of them come to see us as trusted advisors when it comes to their dental health—but fewer see us as trusted advisors when it comes to their general health. If we jump too quickly to making recommendations about their overall health, we are more likely to meet resistance. If we want to cross the bridge into influencing our patients’ overall health and wellbeing, I believe we need an invitation to cross that bridge.   

The Missing Piece in our quest to influence the overall health of our patients is the failure to invite patients to share their perspectives on health. Beginning a conversation with a new patient with the question, “What can you tell me about your health in general?” is an invitation for them to talk about their experience of their health, not just details. Instead of “reviewing” health histories, what if we “explore” health histories? As we connect and get to know each other we can learn to listen beyond information to hear attitudes, beliefs, fears, biases, concerns, barriers, etc. As you understand their perspectives on health issues that come up in conversation, it’s easy to ask if they would like your perspective on that issue. These conversations often lead to more questions and answers that invite more and more invitations from our patients to be their partner in health. 

Patients gravitate toward and stay loyal to dental practices in which the dentist and care team love what they do.  

When you are enthusiastic about your work and how you do it, you can’t help but talk about it, can you? You can’t help but show it.

This enthusiasm affects patients in multiple ways. 

• Your happy office is a delight to visit under most circumstances. 
• The confidence you exude makes potentially stressful visits more comfortable and allows patients to trust in your care.  
• Their curiosity in dentistry and what you can achieve together is peaked. They ask more questions. This, in turn, sparks the patient’s desire to make changes in their health and smile. 
• Because your happiness has spread throughout your care team, the support patients receive throughout their experience is exceptional. 
• You surround them with so much positive energy they feel free to get to know you too. 
• Consistent happy experiences lead to patients feeling like they are among family and friends. 
• And, you’ve all seen this. Patients want to emulate your happiness in their own lives. They want to be like you. 

What is happiness anyway? The definition that I like is “the ability to feel satisfied with your life, to enjoy yourself and others, and to have fun in the present.” This certainly is what your patients enjoy when they visit. 

So, what brings about happiness in dental practice? Perhaps, you’ll agree: 

• Doing what you love to do most of the time, applying your talents and strengths 
• Being outwardly focused on the well-being of others 
• Effectively motivating and leading others to optimal health 
• Being true to your own personal values 
• Ever be it dynamic–Pursuing your own vision of practice (in the case of the dentist) and a coherent practice vision to which you contribute (in the case of team members) 
• Working in a care team that is high functioning with high EQ 
• Effective systems that facilitate doing what you love most 
• Ability to successfully problem solve and adapt with confidence 
• Patients who appreciate what you do together  
• Continuously mastering higher standards of care 
• Multiple moments of true connection with others every day 
• Understanding of yourself and others 
• Satisfaction with your life outside the office 
• Optimism and gratitude