The fine art of patient engagement

Nov. 12, 2013
My first job as a dental hygienist was in Pompano, Fla. I arrived early in my new uniform with butterflies in my stomach and a smile on my face.

How to make your patients feel like stars

By Laurie Samuels, RDH, CHC

My first job as a dental hygienist was in Pompano, Fla. I arrived early in my new uniform with butterflies in my stomach and a smile on my face. I could not have been happier or more excited to be working in my profession. I knew I still had a lot to learn about dentistry, but I was extremely confident that when it came to communication skills I would have no worries. After all, I was very good at talking about myself!

I am quite sure that during my years of clinical practice I made many mistakes while trying to communicate with my patients, but I had successes, too. Over the years, I honed my skills and began to really understand the patient experience and how to serve patients and make them feel like stars.


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As a new hygienist, I loved all aspects of the profession, including the challenges I faced. Of course, I was passionate and I wanted to share with patients all the detailed information I had worked so hard to learn in dental hygiene school. I was often too enthusiastic and I tried various techniques to teach patients. These included the interactive approach, the demonstration, the car salesman, and the professor.

I learned several important lessons during these years:

  • One method does not work for all patients
  • I could not save everyone (or every tooth)
  • Not every patient was going to like me

My experiences helped me develop a thick skin and be less sensitive. They also compelled me to dig deep and figure out what was most effective. Instead of decreasing my desire to inspire my patients, I worked harder. I realized I was not going to work to make friends with patients, but that I had a serious job to do and there was not much time for social conversation.

This realization was a turning point for me. The successes I had allowed me to grow and become a better communicator. One thing all patients want and deserve is to be the center of attention. They like to know that we are fully engaged, and that they are what matters the most.

You will not hit a homerun every time, but you will get a chance at bat, so be creative and playful.

Being professional refers to your conduct, goals, and code of ethics. You have a big responsibility, and your patients have put their trust in you. How you dress, look, and speak reflect you and your professionalism.

The patient experience begins with the greeting. This is important and sets the tone for the visit. When you greet a patient, exude confidence and energy, but remain grounded, maintain good eye contact, and extend a handshake. A firm handshake is an acquired skill and may take some practice, but it will help you connect with your patients. I know it sounds funny, but practice your handshake with your friends and family. Consider how this is different from opening the waiting room door, calling out the patient's name, and looking down the hall as if to say "this way." Your greeting can set you apart from the rest.

During the visit, when you have something important to share with your patient, sit the person up in the chair. This may seem like a waste of time, but this enables the patient to realize something unique is about to happen. It is important for you and your patient to be on the same level and maintain good eye contact. Now that he or she is sitting up and you have his or her attention, it is time to work on listening skills.

A good way to improve your listening skills is to repeat what the patient says by asking him or her a question. For example, your patient has gingivitis, moderate bleeding, some bone loss, and has not been seen by a dentist for 18 months. You sit up the patient and explain that you are concerned about the health of his or her gums and the onset of periodontal disease. The patient responds by saying he or she has noticed some bleeding and sees no problem and has no pain.

You can say, "So, I just want to be clear. Are you saying that when you brush and floss you notice there is blood, but you don't think that is a concern?" Be very quiet and let your patient think about this. If there is a pause, just let it be. You will be surprised by what comes next. When the patient responds, you can do the same thing again, drawing him or her out and focusing on the issue one step at a time. This is a pivotal moment, and slowing down the appointment to make this point and letting the patient think about what he or she says has a huge impact.

Imagine you are using the ultrasonic scaler, the suction is going, your patient is a bit tense, and you are giving your patient a running commentary about the condition of his or her mouth. The impact is totally different than the previous scenario. By stopping what you are doing and sitting up the patient, you have created space for a discussion and your patient will realize that this is something important. Be curious and ask questions that require the patient to think and respond. Instead of being just a listener, the patient is now part of a conversation, and ultimately part of making a good decision about following the recommended treatment plan.

There are different ways to communicate, and on a few occasions I sounded like a car salesman, with an onslaught of information and too much pressure. Obviously, this did not work well and turned some patients off completely. Even though my intentions were pure, I missed the mark by talking too much and being authoritative. It came across as: "I am the expert and you need this to improve, feel better, fix your broken teeth, and have healthier gums." I wanted the best for patients. I was being honest and I meant well, but they did not see that at all; they only felt the high-pressure approach.

Having some humility is desirable for health-care providers. Be calm, courteous, polite, and modest. Humble people are never arrogant or proud and never belittle others to make themselves look good. This helps patients feel comfortable in an environment that is often uncomfortable or intimidating.

We often see patients who are defensive and afraid of being judged. I'm sure you've experienced this, especially with new patients. I have found a way to help them feel less stressed. Patients come into the office feeling guilty about their teeth, and therefore defensive. They may say, "My parents never took me to the dentist" or "I never really had money to spend on my teeth." I like to tell my patients that there is "not one thing either one of us can do to change what happened before you sat down in my chair." However, the ball is now in their court. If they want to make a change, now is the perfect time, and I'm there to help in any way possible with no guilt or judgment. This works wonders for many. Often I see patients exhale and relax, naturally letting go of negative thoughts.

Another key communication skill is learning how to navigate objections. Most people do not like to be told what to do, so there are many ways to be creative with your language and help patients realize that treatment is beneficial for them. Instead of telling them what they need when they say they are not interested, you can use words such as consider, evaluate, or contemplate, to make space for your patients to think about your suggestion and come to the desired decision. Ask questions related to the objection, leading patients forward slowly, revealing how fixing their dental problems will be beneficial. I believe the three most common objections are fear of dentistry, money, and time. You may need to peel back some layers of what a patient does not want, such as pain, expense, and time lost from work, and find out what they really want. It may be they always wanted whiter teeth, straight teeth, or the ability to bite into an apple. Highlight what they want and how you can help them achieve that goal.

Patient engagement and making your patients feel like stars are not just about a "feel good" experience. We also have to be skilled at guiding patients through the often-complicated process of understanding, accepting, and completing treatment. Make sure they follow through with other specialists by giving them a call to see how the visit went, and always document the call so all staff members remain informed.

In order to take patient engagement to the next level, you need to have the whole staff on board. These high-level communication skills come with practice, and the patient experience is catapulted to the next level when each hygienist, assistant, office administrator, and dentist uses the same techniques. Perhaps you can initiate an office meeting to discuss and practice these skills.

Selling is not a four-letter word. Selling is an art, especially when you are selling good health. It is important for dental professionals to realize our value and think about the true worth of disease prevention, beginning with the oral cavity, and beyond to the whole body. With all the data now proving there is a link between oral health and systemic health, we should be stressing this to our patients. This critical factor should not be ignored or taken lightly. I highly recommend that each hygienist share this information with patients in a way that resonates with you personally and aligns with the philosophy of the practice. I think we can play an important role in helping our country get a grip on the rising levels of obesity and the chronic diseases that follow.

For your own benefit, keep track of your patients and the treatment you've recommended. Try to find out how many follow through with treatment. This way you will be able to measure success and adjust your techniques if necessary. It can also serve as a tool when negotiating for a raise or new job.

Stay professional and give your patients the highest level of care and an experience they will remember. Make them feel like stars. When was the last time you had a medical/dental provider make you feel like you were a star and all your needs were met? When you do this for your patients, they will walk out the door knowing they just had the best dental experience in their lifetime.

In today's job market, it is important to set your office and yourself apart from the pack. Standing out in a positive way can be very important when you're searching for a job or asking for a raise. If you are skilled in patient engagement because you've learned excellent communication skills, you will be a valuable asset in any office. This will also be extremely useful if you have the desire to transition into a new career. Making your patients feel like stars may ultimately make you a star. RDH

Laurie Samuels, RDH, CHC, is a certified health coach, and her website is www.Bellahealthyliving.com.

Here are five secrets for making magic happen in the operatory:
  • Be professional
  • Make the greeting count
  • Put the patient first
  • Find out what the patient wants
  • Improve your listening skills
  • Be humble
  • Be curious
  • Learn how to deal with objections
The End

The end of the appointment is as important as the greeting. If a patient needs to see you again, make the appointment while in the operatory. This is a great way to show patients you are concerned about their care, and it creates a consistency of experience. If you do not have time to make the appointment, walk the patient to the desk and ask directly, "So what day will work for your next visit?" This way, when you hand the person over to your front office staff member, you can say, "Mr. Jones is coming back to have ________, and he would like to come on a Wednesday morning at the earliest time available. Would you please look and see how soon you can schedule him?"

Then turn to Mr. Jones and tell him that he is in good hands with "Eileen," who will assist him from there. Then say you are looking forward to the next visit, and you are sure he will be very pleased with the improvement. Finally, look him in the eye and shake his hand again. You now leave him in the competent hands of the front office staff that has all the necessary information to move forward. By being informative, professional, and supportive, you have made your patient the center of attention.

For even more personal service, I suggest creating a prescription-style pad for your recommendations. This should have your name, title, office email address, and office information. I like these to be like Post-Its, so patients can place them on their bathroom mirrors. Hand write your instructions for each patient. Many people become overwhelmed and forget multiple instructions. Brochures are good support, but your written words will score a homerun.

No gossip on the red carpet

I love to chit chat with my patients, but with all we have to do in the operatory, there's not much time for that. At one of my last recall appointments, I was very disappointed because I really wanted a good patient experience. But the hygienist started talking as soon as her scaler hit my enamel. She went on and on about herself, and I had concerns about my teeth!

When she finished, I asked her if I had any pocketing around teeth Nos. 4 and 5, where I have some rotation and a slight food trap. She said she had not probed because "the dentist does that," then she quickly picked up the probe to check the area. I have to say I was surprised, especially because she had plenty of time. (No inflammation or bleeding was found.)

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