Linda Daigle Mello, RDH
Many dental practices feel challenged when dealing with difficult patients. It is not easy to ignore the difficult ones when their names ominously glare up from the schedule. They have a way of capturing your attention and disrupting your entire day. The moans and groans at the morning huddle don`t stop there. The stories are carried over for weeks and become legends within the practice.
When asked to help dental teams deal with these difficult patients, I will hear a story that may sound like this:
"Mrs. Shamrock came into our practice today, and all she did was complain about money. She thinks our fees are too high and she isn`t willing to come in for cleanings more than two times a year. She needs so much dentistry, and we just can`t get her to do it. I know money really isn`t a problem for her. I know she can afford it. She travels all the time and she drives a nice car. If she spent her money on her teeth, her mouth wouldn`t be in this condition."
Or perhaps something like...
"Mr. James is a jerk. He tunes me out completely when I tell him he needs to floss. Every appointment is the same. He often is late or tells me he needs to be out in 30 minutes. There never is enough time to help him understand that his mouth is falling apart. He just doesn`t care. He acts like I am his cleaning lady or something. He doesn`t even care about his teeth!"
The question we ask is, "What do we do with people like this?"
I ask you to step away from the above scenarios for a moment and indulge in a brief exercise that will take you into a place of curiosity. For a moment, attempt to set aside any and all judgments you have about Mrs. Shamrock and Mr. James. Be curious, and simply wonder about them. Ask yourself the following questions (writing them down and listing real examples can be very useful):
- What qualities do you personally have that you most like?
- What qualities do you most appreciate in other people?
- What qualities would you prefer not to see within yourself?
- What qualities would you prefer not to see in other people?
- What does it take for your least desirable qualities to show up? Give an example of when your least desirable qualities came out.
- What do you believe caused Mrs. Shamrock and Mr. James to show their least desirable qualities?
One dental team created a list that went like this:
* Qualities most admired in self: Kind, caring, warm, good listener, nonjudging, sense of humor, patient, educated, healthy, honest, and hard working.
* Qualities most admired in others: Cooperative, compliant, easy to work with, kind, good listener, sense of humor, patient, understanding, educated, honest, timely and healthy.
* Qualities least admired in self: Short-tempered, challenging, judgmental, stubborn, opinionated, has difficulty prioritizing.
* Qualities least admired in others: Disrespectful, challenging, judgmental, stubborn, opinionated, late, dishonest, and unhealthy.
* When do your least desirable qualities show up? When I am not getting what I want. When others judge me. When others tell me what I should do. When I am not feeling heard. When others place their own agenda on me. When I don`t have a say in what is happening
Many of us have difficulty communicating our real feelings, especially when we are placed in compromising positions (I view dentistry as a compromising position). Could it be that there is more to Mrs. Shamrock and Mr. James than just being crabby? I wonder if they`re attempting to communicate something to you that may be going unheard. Are they getting what they want? Are they being judged by you or anyone else on the team? Do you ever tell them what they should do without first engaging them in conversation? Are you hearing what they are trying to tell you? Do you have an agenda in mind? Are you open to their agenda?
Now go back to the two scenarios I mentioned earlier. What judgments did you have about Mrs. Shamrock and Mr. James? How do these judgments relate to what you learned from the exercise above? How do you view them now?
I believe that there is a space between what people tell us and our response to what they tell us. I`ll call this space "curiosity." Think about it. When someone tells you something, are you even a little curious before you respond? You may have to isolate an instance. The curiosity may be so brief that you have completely ignored its presence. It is that time when you might say, "Why is she asking me that question?" Or, "What is she thinking?" I believe those questions are very appropriate - appropriate when asked without any judgment intended.
Webster defines curiosity as: a need to know or learn something. We have an obligation to learn as much about our patients as possible. We obviously have an obligation to gather clinical data. But we also have an obligation to know what patients are thinking - to understand what limits them, what motivates them, priorities, boundaries, their wants and needs for dentistry, as well as what they do not want from dentistry.
How can we begin to help our patients if we do not come from a place of understanding? How will we truly understand if we do not allow each other to stay in that place of curiosity? The relationship must be nurtured by wonder. Being curious will only take place if we stop ourselves from jumping into an answer. Before you answer any question, ask your patient a question about what you just heard.
A conversation with Mrs. Shamrock might go something like this: "I am hearing you say that you want to have your teeth cleaned twice a year, Mrs. Shamrock. What I am not clear about is what you believe those cleanings will accomplish for you and whether or not that is what it will take for you to meet your dental health goals. Could you help me better understand what it is you are asking of us?"
I also may stay on the subject of finances by stating, "Mrs. Shamrock, it is clear to me that you are upset about paying for your treatment today. Could you tell me more about that? I wonder if the treatment went as you had planned or if it somehow did not meet your expectations? Would you be willing to share what you had in mind for today? How can we create a treatment plan together that will help you to achieve your dental goals and also help you to plan financially?"
A conversation with Mr. James may go something like: "Mr. James, I know you have given us 30 minutes to spend together today. That is a concern for me, since I know we may not accomplish everything I had in mind. I wonder what you felt was important for you to get accomplished today? What part of the appointment do you find less valuable? What would you like me to focus on as I am completing my examination with you? How would you like to participate in the examination? If I find areas that appear unhealthy in your mouth, how would you like me to inform you about them? What might get in the way of us spending more time on our next visit? Could we agree to a full hour next time to complete the examination? What would it take for you to find more value in our time together?
Obviously, asking all of the questions above at once may be a little too "long-winded." The objective is to satisfy your curiosity. As you may have noticed, there is no room for a "yes" or "no" response to any of these questions. If you try "open-ended" questions in your conversations, they can lead to great discussions with people we may have misjudged. But open-ended questions only work if you stay in a place of curiosity and are willing to listen to the response ... even if it is a response you were not expecting.
Being curious about people is healthy when we allow the process to flow naturally. Curiosity simply moves us deeper into relationships. The most difficult part of staying curious is that you must not allow yourself to come up with the answer on your own. There is no room for assumption in this space. You cannot hear one opinion from patients and assume you know what it is they are really trying to project. I have a good friend, Mary Osborne, who often says, "Keep asking questions until you are sure there are no longer any questions to ask." Perhaps the last question you might ask is, "What else could you tell me so that I can better understand where you are today"?
Because we have learned in dentistry that we must move to a solution, we tend to hurry the process by creating answers on our own (without our patients` participation or consent). This is not intentional; it is merely survival in most practices. The difficulty with curiosity is there isn`t always time to share what we are most curious about. The most expeditious way to process information is to leave patients out of the discussion and assume you know what they want. Take the time to pay attention to the whisper of curiosity. Creating questions based on that curiosity will create healthier and stronger relationships with your patients. You must take time if you want more out of your relationships.
What would it be like if you asked questions without passing judgment? What if you believed that people were coming to you to sort through ideas that seem confusing? If we were to stay in this space of curiosity for a moment, prior to our answer, what do you think would change? What are you curious about? What questions do you think you could ask Mrs. Shamrock before you jump to a judgment?
This is what I am curious about:
I wonder why she is focused on the money part of dentistry. I wonder if she is feeling OK about the dental treatment she has had with us up until this point. Are there previous feelings of mistreatment by our of-fice? I wonder if she feels safe enough to tell me how she really feels about the care she expects to re-ceive. I wonder if she finds value in the dentistry we offer and the service we provide. I wonder what expectations she has of us. I wonder how her health has changed since she has been with us. I wonder how healthy she thinks she is now. I wonder what she believes is possible. I wonder if she is willing to pay for what she wants for herself. I wonder what gets in the way of her spending money on herself.
Shifting the way you communicate may feel risky and perhaps a bit challenging. But, clearly, there is a price you pay for stopping short of communicating who you really are and what you really feel. The way you always have communicated may not be enough. Creating a framework for healthy communication happens from a place of sincerity and authenticity.
Linda Daigle Mello, RDH, is a clinical hygienist, consultant, and speaker based in Nashua, N.H. She recently produced the audio series and workbook, The Power is In the Question.
