The Pre-Clinical Interview – Part 1 

Laura Harkin, DMD, MAGD 

I am a third-generation, restorative dentist in New Holland, Pennsylvania, which may be best known for its blue, New Holland tractors. I own my grandfather’s and father’s dental practice where I am the sole provider for approximately 1,000 patients. My dental team consists of two hygienists, two assistants, and two front office administrators. 

I graduated from dental school in 2008 after short careers both in the actuarial sciences and as a stay-at-home mom. In 2010, I purchased my practice and signed up for my first course at The Pankey Institute. Note, my father also studied at the Institute when it first opened its doors in the early 70’s. One of my greatest challenges, early in my career, was learning how to diagnose oral conditions, develop and present treatment plans, and execute that treatment via phases. I found it quite overwhelming to simultaneously manage multiple, complex cases. Now, I love sharing my experience and the approach I’ve found works best for me. 

Above all, I’ve learned that in the midst of daily pressures in dentistry, we need to maintain our own health and strength to properly treat our patients and lead our teams. Surrounding ourselves with knowledgeable, positive, and compassionate colleagues helps! 

Knowing ourselves is as important as knowing our patient. 

Dr. L. D. Pankey’s Cross of Dentistry supports the belief that knowing oneself is of equal importance to knowing a patient whom we choose to treat. This challenge forever evolves because no person remains unchanged with time. I frequently evaluate my strengths and weaknesses as a provider, team leader, and mentor. At the same time, I ask myself what aspects of patient care and business management I excel at and most love to do. I can then choose my specialist team accordingly and empower my office team to best support me. 

Together we ultimately provide a better product and higher level of care. 

To prepare specifically for the treatment planning process, my team helps me gather key information and clinical records from a patient for a comprehensive evaluation. After a thorough analysis, I carefully craft written documentation which will help educate my patient, my team, and the specialist team I’ve chosen. An added benefit is its ability to serve as legal documentation.  

I always ask a team member to join me during treatment plan presentations. They bring another set of ears and eyes so that we may better understand a patient’s motivating factors as well as the challenges they may face in receiving treatment. We encourage open and honest conversations and understand that treatment plans evolve to fit the needs of individuals. 

How do we get to know our patients? 

In addition to gathering a thorough health history and dental history, we are seeking to learn more about our patient’s chief complaint, perception of their current state of oral health, desires for treatment, and barriers to care. 

We listen intently for clues to identify a patient’s communication style. I’ve always heard that we have two ears and one mouth for a reason. I practiced with my father for two years and once, after observing me, he said, “Laura, you do far too much talking. You need to really listen to what your patients are sharing.”  

I’ve had to develop the skill of active listening. To stay in the question and become comfortable with silence takes practice. Some observations that I try to make in order to effectively communicate and build a relationship with a patient are as follows: 

• Do they seem to enjoy conversing or are they responding with short answers in order to get through the interview quickly? 
• Do they readily ask questions and express thoughts, or are they quiet and need to be invited and prompted to share? 
• Are they amiable? 
• Are they distrustful or fearful due to past dental experiences? 

We need to intentionally verbalize our empathy when we’re in conversation with a patient to help them recognize that they’re being both heard and understood. 

It is beneficial to understand a patient’s background. For example, what have they done in life? What do they love to do? Who is important in their life? Sharing in these conversations will help build a rapport, lead to improved doctor/patient communication, and can help to begin a trusting relationship. 

Does the patient have limitations such as the ability to drive to appointments, afford dentistry, or find time for treatment? Do they need to discuss their oral health condition and treatment options with a trusted family member before making a decision? 

Understanding these answers helps us to not only provide respectful and resourceful solutions but also limit inaccurate assumptions. This knowledge is especially helpful in my third-generation practice, where I have many elderly patients who are dealing with health issues, multiple medical appointments, and scheduled drivers. Their desire is to simply make a careful decision for an oral rehabilitation which fits their objectives and abilities. 

Do we hear the desire for treatment? When speaking with an existing patient, I can often recognize signs of interest to move forward with previously recommended treatment. At that point in time, I often ask, “Why now?” The answer helps me clarify their chief concern(s) so that we can move forward fittingly. 

In Part 2 of this series, we will explore additional techniques to clarify our patient’s desire for oral health and long-term, oral stability. 

Culture Fit Versus Culture Add 

Robyn Reis, Dental Practice Coach 

When you are hiring team members, you are likely thinking about how those you interview will fit into your practice culture. Do their values align with yours? Do you share similar backgrounds and philosophies? A business’s culture is a system of shared values, beliefs, and behaviors that influence how people dress, act, and perform their roles. Most practice owners work hard to have everyone get along, support one another, and work as a team to give every patient a wonderful experience. So, it’s only natural to want to find someone who fits into that culture when a position opens up. 

In the HR world, recruiters have a different approach – they are moving away from “culture fit” towards “culture add.” What does this mean exactly? A great mentor of mine, Sheri Kay, says it best, “People come together in their similarities, but they grow together in their differences.” 

On the pages of Harvard Business Review, Forbes Magazine, Fast Company, Inc., and Entrepreneur, you will read that more and more companies are moving away from the traditional culture fit that creates a monoculture where everybody has shared similarities and there is no growth. Instead, they are recreating a culture that is open to new ideas, open to conversations where people poke holes in traditional ideas and say, “Hey, what if we did this? This is what we think we want to do. Now let’s figure out why it will or will not work.” 

In recruiting a hygienist for a client, one of the candidates stood out to me. In addition to her clinical hygiene education, she also had a financial background which represented a “culture add” for this particular practice. She had a greater understanding of goal setting, the finances of the business, and how to create a profitable hygiene department. She ended up being a fantastic and productive member of their team. 

When you are in the hiring process, do you think about adding to your culture? Diverse backgrounds correlate with more diverse problem-solving and decision-making processes. In studied corporations, diversity leads to increased profitability.  

In dentistry, diverse backgrounds can lead to the attraction and retention of diverse patients. Diverse backgrounds can fill in operational holes in your business model. Does a candidate have a background in psychology, finance, education, customer service, computer IT, office administration in another industry, or marketing? Does a candidate speak a second language that will be an asset in your community? Is a candidate artistic, an exceptional writer, a community volunteer, or actively participating in other activities? 

During each interview, seek to learn what the candidate could add to your practice culture in addition to culture fit. After talking about a candidate’s resume and interests, talk about situations that occur in the practice and current needs. Ask if the candidate has ever been in similar situations and how they handled them. Do the answers indicate personality traits and strengths that will add to (complement) the team? Ask the open question, “Based on your personal experience, what insights could you add to this situation?” 

In today’s competitive market for talented team members, consider what a new hire with additional skills could add to your culture and what these new contribution possibilities could be for an amazing patient and team experience. Happy hiring! 

In our office, we routinely take our patients’ blood pressure, and we have a variety of cuffs. Most commonly, both hygienists use one of the convenient, digital wrist cuffs. A few months back, they noticed a trend of higher BP readings than they thought were appropriate. We wondered if the wrist cuffs were giving us accurate readings. We did a little research and I decided to reach out to my own primary care physician to ask her advice.

I learned two important things about taking blood pressure:

1. My physician recommended that we give our patients three to five minutes sitting up in the dental chair, relaxed, and not moving. While pleasant chitchat to reduce anxiety might help, we were advised to steer away from asking any medical history questions and other questions that might produce a bit of anxiety before taking the patient’s blood pressure.
2. One of the challenges with wrist cuffs is that the cuff is supposed to be at the level of the heart. In a dental chair, the patient is likely to rest their arm on their leg unless we instruct them to do otherwise. She advised that we have the patient take the arm that is wearing the cuff and place it across their chest to hold it at the level of their heart. To be at heart level, the hand shouldn’t come up to the shoulder but be horizontal with the elbow.

My physician asked me if we have arm cuffs that go above the elbow. I told her that we have two digital arm cuffs. She said she prefers using the arm cuffs herself because they tend to be more accurate than a wrist cuff, especially in picking up subtle variations.

This great information has enabled us to take blood pressure readings with more confidence and would be valuable to share with your team members who measure blood pressure. 

In your dental practice, it’s important to create a restorative partnership with your assistants, hygienists & front office team. Make the handoff between your team seamless, build a stronger team & create lasting patient connections. Check out our three Pankey Team Courses that are coming up: Team Series. 

A quick, easy way to create a mission statement for your dental practice involves your team. Last year, I called a team meeting to discuss what we want the practice to be like each day for ourselves and our patients. I wanted us to discuss what we could focus on.

We sat around the table in our break room. I asked the team members to take turns going around the table throwing out one word, two words, or a phrase that they felt described our practice. After a moment’s reflection, someone started the process. They had words. They had phrases. They developed whole sentences. And the beauty of this was that I didn’t have to say anything. I just sat there and listened.

If you are asking a team to be part of a mission, I think it is important that you allow them to create the mission. By the end of the meeting, we had a mission statement that we wanted to reflect on and revisit. A week later, we had a conversation about the statement. The team changed a couple of words, and then, Voila! We had our mission statement. It was a mission to which everyone had contributed.

Our next discussion was about how we wanted to be reminded of our mission and how we wanted to make patients aware of the mission. The team decided to put the mission statement on the break room wall, where we would see it daily, and to frame it for the reception area wall, where our patients could see it.

We also met to discuss our values. The team went around the table, listing our practice values. After collaboratively sorting the values, the team developed a list of our top values. This list also has been framed and displayed in the reception area.

We want to share our values and mission with our patients because they are like family. Our top priority is helping them understand their health, so they can make better decisions to improve their health.

Curious to know the wording we settled on? Our mission statement follows: “Devoted to impacting our patients’ lives by investing in their health while establishing relationships through our exceptional care in a safe and comfortable environment.”

In your dental practice, it’s important to create a restorative partnership with your assistants, hygienists & front office team. Make the handoff between your team seamless, build a stronger team & create lasting patient connections. Check out our three Pankey Team Courses that are coming up: Team Series.

Tip 1: Develop the Habit of Clearing Your Mind as Your Move from Patient to Patient

One of the hardest challenges in dentistry is moving from room to room and being able to refocus and give each patient your full and undivided attention. Here’s a little trick I do to increase my presence as I move between rooms and patients.

As I move down the hall between operatories, I habitually self-talk. I silently say to myself, “The patient I just left will be fine with my dental assistant.” I intentionally turn off thoughts about the patient I left, and as I cross the threshold of the next operatory, I am interested in only that next patient. It is not easy, and the more intentional I am at bringing it into my consciousness, I believe the better my focus can become.

Interruptions of this type occur throughout the day as I need to stop what I am doing with one patient to check in on the patient in the Hygiene room. Fortunately, I have a long enough hall between my operatory and the Hygiene room to “practice” my little self-control meditation.

Tip 2: Identify an Analogy that Is Understandable for the Present Patient

I know I am not the only dentist who has patients who are not moving forward with the treatment I have recommended. Recently when interacting with a patient who was not moving forward with occlusal therapy I got to watch his understanding shift about the recommendation I had made. The difference was in explaining it in a language he understood. I credit Dr. Rich Green for mentoring me through this understanding. I related it to a real-life experience he already had.

The patient had been in my practice for a little while. We had identified that he had some occlusal disease. He had wear on teeth, some clinical attachment loss, abfractions, teeth that ran into each other, awareness that he brought his teeth together, and at times muscle tension.

One day I asked him, “Can you help me understand why you are not moving forward with occlusal therapy?”

He said, “You know, I just don’t know if it is going to benefit me.”

I happened to look down at his feet and notice he had good running shoes on. I said, “Those are fancy running shoes. They’re pretty cool. Do you wear them because you like how they look or because of another reason?”

He replied, “Actually I wear them because they are very supportive. I often have back muscle tension, and I need to wear really good shoes.”

I said, “You know, the dental orthotic that I’ve been calling an occlusal appliance is no different than wearing really good running shoes. Wearing a dental orthotic is like putting inserts in your shoes to create balance, decrease fatigue in the muscles, and provide me with the opportunity to learn what’s going on at the tooth level, the muscle level, and the joint level. Wearing the dental orthotic is likely to help you understand why you are experiencing discomfort at times, what those patterns are, and when they occur. And it just might be therapeutic in relieving muscle tension you have been experiencing and protect your teeth while we discover what is going on.”

He nodded and said, “Okay, I get it. I understand now. When can we start?”

Tip 3: Ask a Well-Crafted Question

Asking well-crafted questions allows us to better know the patient and get more complete information. Asking powerful questions also makes patients more aware that some of what they are experiencing is not healthy…is not normal.

For example, I often notice patients are not reporting pain as we do risk assessments on their muscles and joints. So, I ask the patient to rate the level of pain at which they take pain medication when they have a headache. “On a scale of 1 to 10, when would you pick up the bottle of Advil and take a pill to treat the pain?”

There are people who will take Advil when pain is at a 1 or 2 and others who will only take it when pain is at a 12. I’ve learned that there are people who have low pain tolerance who will call whenever they have pain in a tooth and other people who tolerate higher pain for months because they think it is normal.

By asking patients to rate their pain tolerance level, they become self-aware of symptoms they might be experiencing that align with the signs you observe and are discussing. They become more aware of what is normal and abnormal. If they have the tendency to not move forward with treatment until they are in acute pain, they become more aware that delaying treatment is not in their best interest. They realize the discomfort they have been experiencing is abnormal and they do not have to…should not tolerate it.

Change can be difficult even when it has benefits for everyone.

Some people are simply averse to any kind of change. As a result, we may encounter pushback from staff while attempting to initiate changes in protocols, practice policies, or practice systems. Anticipating and preparing for potential negative feedback is the best way to defuse staff concerns and smooth the way for needed change.

There are two prerequisites to navigating change successfully. First, the staff must believe that we have their best interest in mind. This is a matter of trust that is developed over time. Secondly, the staff must feel safe in offering unfiltered feedback before and during the change initiative. As the leaders of our practice, we are responsible for creating a practice environment that makes both of these essential prerequisites possible.

The following suggestions will prove helpful in developing a change strategy.

1. Be prepared.

Before introducing any change initiative, we must have clarity regarding the necessity and advantages of the proposed change. Painting a clear picture for the staff that includes the specifics and anticipated benefits is an essential first step. Anticipating the staff’s concerns and potential questions as well as our response will help in creating a smooth presentation. Set the expectations for how everyone might feel throughout the different stages of the transition, for example: resistance, frustration, skepticism, excitement, relief, and high energy.

2. Seek early adopter support.

Identify those people that are likely to support your ideas and seek their help in moving a change initiative forward. Most likely, these will be the leaders of the clinical and administrative staff. Collaborate with them in creating the best possible change model. By allowing them to contribute their input, they are much more likely to buy into the concept.

3. Present the change Initiative with humility and transparency.

“My way or the highway!” is the worst possible way to present any significant change. We gain acceptance by being as transparent as possible and patiently addressing staff questions and concerns. Seek collaboration and request input. Be more coach-like by using open-ended questions to draw out their underlying concerns, for example, “What concerns you about this?” and “What would need to happen for you to feel better about this change?”

4. Ask for their help.

There is something about asking for help that creates buy-in. Let your team know that you cannot achieve the desired result without their help. If the intended change is experimental in nature, let the staff know that it is reversible if the desired results are not achieved. Ask them how they think that they can positively contribute and re-affirm how important their role is in the process.

5. Consider scheduling more frequent staff meetings during periods of change.

Depending on the nature of the anticipated change, more frequent staff meetings may be necessary to address concerns and problems that may arise. For example, changing practice computer software seems to be problematic and frustrating for both clinical and administrative staff. Allowing more time to address the technical issues and frustrations of the staff has proven to the most effective means of addressing both issues.

6. Check in frequently with the staff:

Although checking in with our staff should be a common practice, it is most beneficial during periods of change. Simple questions like “How is it going?” or “What do you need from me now?” are a quick and simple way of letting your staff know that you recognize and appreciate their efforts in making the change a reality.

7. Celebrate the staff’s accomplishment:

Whenever the change is fully implemented there should be time for celebration. Consider doing something special for the team as a means of recognition for a job well done. An appropriate bonus and/or a special event away from the office are ways of expressing gratitude. Never pass up celebrating a team’s successful effort in achieving change.

A great doctor-patient relationship is the key to delivering quality care. The ideal model to help people move toward optimal oral health is based on a behavioral approach that we can use every day. This approach is allowing the patient to drive outcomes.

An illustrative example:

There is a stark difference in a patient’s emotional response between being told, “You need a filling,” and saying, “You have decay in your tooth. How would you like us to address that?”

The principles of this approach are not difficult.

1. You need to honestly commit to always placing the best interest of the patient first. You cannot fake this. All of us know when others are not sincere.
2. Letting the patient drive the outcomes is a habit developed from committing to this approach and intentionally choosing your words to put the ball in your patient’s hands, then waiting for their response and listening well to clearly understand the outcome desired by the patient.
3. Is the outcome congruent with your philosophy and standard of care? Does the patient need more information and time to come to an understanding of what is in their best health interest? How might you lead them there? Most folks really do want the best for themselves and their family. They will make good decisions if we provide the proper environment and education.
4. You, the patient, and your team must be comfortable with the means necessary to get to the outcome desired. Both you and the patient must be comfortable with the time, energy and dollars involved in reaching a mutually agreed upon goal. A key element in eliminating stress and dependence on insurance, is painting the picture for your patient that they are in control of the outcome–not their insurance company. You and the patient have the patient’s best interest at heart, not a third party. I say this again. You are working on behalf of your patient, and with this approach, they are in control, not an insurance company.

Does this approach take more time and effort up front? Yes. However, once you adopt this approach you will be forever glad you did. Patients who enter your practice through this system will value you, your staff, and your care. They will commit to more and better dentistry and pay with gratitude. You and your staff will have lower stress and more fun because you are dealing with people you understand at a deeper level. Long-term, these people will refer new clients just like them.

I didn’t invent this model. I learned it from great mentors like L. D. Pankey and half a century of folks participating in The Pankey Institute and passing forward the priceless and timeless value of this approach.

Mentorship from the Institute will help you on your way to long-term success as a thriving dentist. As my colleague Dr. Barry F. Polansky often writes, “Mastery in dentistry is a continuous journey.” It’s a lifetime of learning, practicing, and reflection that enables us to more easily and fully transform the health of others who present themselves for our care. The journey, itself, propels us forward into greater and greater connection with our patients and our true selves.

Pankey Institute mentoring and encouragement made all the difference in my life and the lives of countless others. When I try to sum up the dental professionals and patients this “approach” has positively impacted, I get lost in counting the millions we have touched as a community dedicated to putting the dental patient’s best interest first.

One evening I was seated next to a new acquaintance at a dinner party. As we began the conversation, I learned Bob was a retired CFO of a manufacturing company with $250 million in sales. He had traveled extensively and had had many experiences in dental offices.

In our conversation, Bob discovered I was a dentist teaching at The Pankey Institute. I thought I would move the conversation off of dentistry and have the opportunity to climb into the mind of a CFO of a $250 million dollar company, so when he asked what I taught, I responded with “I teach Finance.” He looked surprised and a bit disinterested, but he said, “You know, the thing that impresses me most, about dentists, is how quickly they make decisions.”

Trying to find the compliment in the statement, he had just made and hoping he thought dentists to be of high intelligence, I queried, “Quick decisions?” He went on to tell me, and sometimes show me between bites of food, the crowns I had already noticed. He said, “It always impressed me, when I went into the dental office with a broken tooth, how the dentist would have a quick look around and then tell me I needed a crown. Sometimes he was ready to do it on the spot!”

Other things had come out in our conversation. He was an accomplished golfer with a six handicap. He had three homes, and each home had an identical set of golf clubs. All were recently updated, matched, swing-weighted custom sets. My mind was spinning as I thought about the gap between those matched sets of clubs and his unmatched set of teeth! How could I get his attention?

Doctor Pankey would often say to me, “Communicate with others by making your examples relevant to the other person’s experience or frame of reference.” The light bulb came on, and I said, “Tell me about how you made decisions as a CFO in your business.”

“Well, I take a good look at the short and long term impact of the decisions, the cost of capital necessary – both short and long term, and the risk/reward potential to the bottom line of the company.”

Now I was in full swing, “Sounds like you study the problem and/or opportunity with reflection and quite a bit of detail. You slow down and take the necessary time to uncover the best decision.”

“Well, yes, of course, they would be important decisions, and they would take time!” Bob replied.

“Quite honestly, Bob, that is exactly what I and others are attempting to teach dentists at The Pankey Institute. We are asking dentists to intentionally slow down and become more reflective, affective, and effective with their patients.” I could see he was thinking about this.

“Bob, let’s compare you and your teeth to your sets of golf clubs.” He was intently listening. “It’s as if, when you were a young man, God gave you a set of new golf clubs. We, as dentists, call them teeth. You used them through the years as you refined your golf game and in time you broke the 9-iron. You went to the pro shop and tried to get a new one. It was a 9-iron, of course, but the grip, the shaft and the swing weight were not quite the same as your original set. It was okay, because you knew how to adjust if you remembered to accommodate for the differences.

“As time went on, you had the same experience with your 7-iron, the 4-iron, the pitching wedge, and your favorite wood. In time, you were adjusting your swing and muscles every time you swung a club. You noticed there were times when certain muscles would get sore and even the soreness would get in the way of your swing chewing. Finally, you decided to get refitted with a whole new set of clubs. You went to a professional who put you through a whole series of tests and thorough evaluations to diagnose and plan the best solution, which fit your uniqueness. And, you not only got one completely new set of golf clubs, you got three.

“Many dentists would see you as a very busy man who wants to get out of the dental office with dispatch. They respond in a crisis mode to your crisis events. But, like clubs, teeth need to be customized and “matched” to work together so you aren’t constantly accommodating as teeth break and are restored. What we are encouraging dentists to do is to slow down and be as thorough as you would be in your decision making in your business. It’s better for you—actually better for all concerned.”

Bob’s face lit up, “So that’s what you teach?” “That’s what I teach,” I responded

With that “aha” smile, Bob said, “Would you be so kind as to give me your business card with the name of a dentist who thinks like you do? In fact, I’d like three – one for each of the locations of my golf clubs!”

Doctor L.D. Pankey would often say to me, “Communicate with others by making your examples relevant to the other person’s experience or frame of reference.”

Years ago, I had been asked by a young dentist to come to his office and help him with the implementation of his new learning with occlusion applied to bite splints and equilibration. I suggested he line up a few patients for us to work on together during my visit. When we arrived at his office early in the morning to talk about the patients we were going to see together over the next two days, I asked him to bring me up to speed on where he was in treatment with the patients and the conversations he had had with them. We also looked at full mouth models, models of bite splints, and radiographs. I asked him what he wanted me to do with the first patient who was coming in that morning.

He said, “I want to watch you sell him a bite splint!” A little surprised, I asked him to tell me about the patient. He said he was a new acquaintance. They played golf together and occasionally gambled as they played to keep their interest up in the game. They also gave each other a hard time about handicap ratings. He mentioned he felt a bit embarrassed because he thought he knew what was best for his new friend and had kind of hustled his friend on the golf course to be a patient. Now he was feeling a bit guilty about having his new friend come in as a patient, and he could not bring himself to a have conversation concerning the benefits of a bite splint.

Charlie (the friend) appeared, and the dentist introduced me. Charlie and I stood about the same height. We looked each other in the eye, and we smiled at each other – a good beginning. In my mind, I was repeating slowly to myself, “Find a relevant connection.”

I said, “Thanks for taking the time to come in and meet me on such a beautiful Spring day, as I pointed to a comfortable chair for him to sit in.”

He offered something about how golf could be a bit boring if you played it too much. Still looking for a relevant connection, since my “stated task” was to sell him a bite splint, I asked him about his work, and he said he was retired from directing filmed commercials. I asked him what he did with his new found time aside from golf. He smiled a big smile and said he ran about five to seven miles a day. I smiled as I remembered the years when I ran three to five miles a day during the week and seven to ten miles on weekends. A light bulb went on, in my head, and I knew a question I could ask to engage him and tweak his curiosity.

I asked, “How often do you buy new running shoes?” And without hesitation, he said, “Every four hundred miles.” I then asked, “How did you discover that interval?”

He reached down with his right hand and rubbed the lateral surface of his right leg from the mid-thigh, across the lateral surface of his knee, to the lateral surface of his calf, while telling me of the discomfort he would experience in his muscles when the bottoms of his running shoes became worn.

I made the statement, “You must run with the traffic!” Surprised, he asked, “How do you know that?”

I told him I experienced the same thing when I ran on a road with the traffic, especially when the road had a bit of a “crown” on its surface. I thought I had found a relevant connection, and I let it sink in a bit. Then, I told him his dentist friend wanted to offer him a new pair of shoes for the top of his teeth in the form of a removable bite splint. It would be like getting a new pair of running shoes. It would be professionally custom fitted to the tops of his teeth, which would please your chewing muscles and create greater comfort, just like a new pair of running shoes pleased his leg muscles and knee joint.

Charlie looked at his dentist friend and then at me before standing up. With a big smile he said, “I will make an appointment with the receptionist.” Hmmm… Isn’t that Interesting!

Staying in the question — staying curious about what more you can learn about each dental patient and the intention to help each patient be more curious about their own situation, enables dentists and dental hygienists to be more effective in helping their patients.

What Do You Think You Know?

The next time you are reviewing the chart of a patient you are frustrated with, try this exercise. Instead of going too quickly to thinking, “What is wrong with this person? Why don’t they get it?” – ask yourself these three questions:

1. What do you know about this patient and their situation, specifically because they told you this? They actually said it.
2. What do you think you know? This has to do with the guesses you have, your intuition about what is going on. What do you think the patient has implied by what they said? Recognize which of your thoughts are guesses because those assumptions might or might not be true. If you act based on what is not true, you may miss opportunities to learn more about what is important to your patient. Asking yourself what you think you know is a way of challenging your assumptions.
3. What do you want to know? What are you curious about? How can you take some of your “think you know” thoughts and move them into the category of “what you do know” about your patient.

The more you do this exercise, the more you become aware of the difference between what you know and what you think you know, and the more curious you will become about your patients. The more I have done this exercise, the more I have come to know that what I do know is small compared to what I do not know. I sometimes I realize I know very little about what is important to them.

Is the Patient Curious to Learn About Their Situation?

I have come to realize that the first question the patient asks is just the first step in their learning process. Sometimes they need help framing some of their more important questions. Or sometimes, a question is their attempt to share a little of their story, their struggles, their fears, their embarrassment. Often, I realize they have emotional discomfort I can address with empathy. In that moment, empathy is more effective in helping and leading the patient to higher health than the clinical information I could provide them.

Understanding that most patients have some level of anxiety about their oral health and oral health visits, I have learned to pause and ask a question before plowing ahead with information they may not want or need — or may not “hear” if they are anxious.

For example, if I see wear patterns on teeth when I do an examination, I could tell the patient what I see. I could say, “I see you grind your teeth.” But that type of statement is often perceived as accusing, not empathetic. What I have found to be more effective is to show the patient what I see. If the patient does not say anything that indicates she would like more information, I might ask her, “How long has that wear pattern been there?” or “What do you think has caused it?” I never want to deprive her of information. I want to give information when she has a little more curiosity — when she wants to know it and will hear it.

Sparking curiosity with a question often leads the patient to ask a question that reflects what is most important to them at that time. Discovering what is most important to them enables us to optimally make use of our time during that visit. We can provide information that is important to them, that they want. Or we can focus on providing the empathy they need to develop a relationship of trust.