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"Yes" and "and"

May 1, 2011
Improvisation with every appointment

Improvisation with every appointment

by Elizabeth Nies, RDH, EA, AS

Can you remember the first time someone asked, "What do you want to be when you grow up?" Folk singer Harry Chapin talked about dreams in his hit single, "Taxi." In the song, he wants to be a pilot but instead drives a taxi. The message is that we often get what we ask for, but not necessarily in the form we expect. I always wanted to be an actress, and I became one while learning the lesson of "yes" and "and" improvisation.

You see, she was gonna be an actress, and I was gonna learn to fly,
She took off to find the footlights,
And I took off to find the sky.
And here, she's acting happy,
Inside her handsome home,
And me, I'm flying in my taxi.

Taxi, by Harry Chapin

As a child with a very active imagination, I spent hours in my make-believe world. Sometimes I pretended to be a librarian reading stories. It always amazed me how those people could hold that book up with one hand so we could look at the pictures while they read. Other times, I was a chef with my Play-Doh cookie factory. Another favorite scenario was the tour guide at any venue my imagination could create. As a child growing up in my New Jersey neighborhood, I hung with a posse of fellow actors of all ages. As fourth graders we spent weeks writing and rehearsing plays. Of course, our parents raved about our talent and the stars we were destined to become.

Then reality struck! I could become an actress but my father forced me to get a career as a safety net. My dental hygienist sister secured a position for me as a dental assistant on Saturdays during high school. When asked, "What do you want to do?" my answer was dental hygienist because I loved my sister's treatment room. Everything that pulled out and the round porcelain tray was so cool then (ancient now). So off to hygiene school I went. To my surprise, even though the education and testing process was grueling, I really enjoyed being a dental hygienist, a fantastic one-woman show. I was able to continue my acting dream through the Community Theater.

Fast forward to age 25. I was working clinically four days a week on Park Avenue on the Upper East Side of Manhattan. I continued studying acting on the weekends and performing in some off-off-OFF Broadway productions. (I wanted to skip the starving actor part of acting.) Improvisation was always the most fun for me because it taught me how the art of saying "yes" and "and" allows a story to continue with everyone participating.

Let me explain the equation

"Yes" = No matter what is said to you, acknowledgement of the statement must occur. "And" = After you have acknowledged what was said, you guide the scene/conversation in the direction you want it to go. Those lessons have served me well in my ability to really listen and hear my patients.

The television show "Whose Line Is It Anyway?" is the type of improvisation I participated in every Friday night in Greenwich Village. If you enjoy watching that show I have to tell you, the people on stage have 100 times more fun performing it. It is unrehearsed and different every time.

The key to the show actually working is based on the "yes" and "and" equation. Someone from the audience shares a word or scenario. For the purpose of this article, fear of the dentist will be the topic. The players on stage say yes to anything that their fellow players say.


  • Player One opens the scene by dropping to the floor and screaming, "My tooth is killing me!"
  • Player Two puts her foot on Player One's stomach and says in a strained voice with a German accent, "Hazel, we have another whiner in front of the office door. Help me drag her inside!"
  • Player Three then runs over on all fours sniffing and growling, causing Player One to jump up and run inside the office.
  • Player Three then gets a bone from Player Two and the scene ends.

This scene worked because everyone on stage was in agreement and no matter what happened or what was said, they agreed with it. If Player Two tried to fight with Hazel to act like a human and Hazel continued to be a dog, the theme of fear of the dentist would be lost. It would feel awkward to the actors on stage as well as the audience. It is amazing to watch when things are executed correctly, and this is one of the reasons the program is so popular. Improvisation takes people out of their comfort zones and forces them to dig deep into their knowledge base and share it with others in a humorous or dramatic way.

Fast forward to 2010

I am still a dental hygienist performing four days a week in Idaho, with reservations made six months in advance. A dental hygienist is on stage all day performing eight-plus times a day. We all use the "yes" and "and" improvisation technique from the moment we greet our patients to the time we walk them to the receptionist and take our final bow. Every appointment has similar components to a play or a good movie. The simplest play needs a beginning, middle, and end.

The main conflict and characters are exposed or revealed. This includes any information about the characters, conflict, or world of the play. When writing a play, the first act is called the exposition.

Our dental hygiene play often opens the same way. We greet our patients and size up their moods, which sets the tone for the appointment. In the first five minutes we usually find out how their health has been, what emotional state they are in, how they feel about being in the office, and what they expect from us. We never really know what that scenario is going to be, so we say "yes" and "and" and guide the appointment. When we are truly engaged by actively listening in the first five minutes of the appointment, we have all the information we need to move to the second component of the play – the complication.

Complication is the second act of a three-act dramatic structure, in which the plot thickens and peaks at the end.

The chair tilts back and we collect data on the health of our characters' mouths. Have they been flossing? Are they getting to every area of the mouth? What lifestyle changes have they made or do they need to make? What has prevented them from keeping their mouths healthy? Will they have their teeth into old age? What can I give them to allow them to have healthier mouths? How do I communicate this to them so that they hear what I have to say? How do I get them to hear more than, "You need to floss"?

"Yes" and "and" are the key to guiding the appointment in the right direction. Every question you ask, every statement you make, needs to be spoken in a way that allows your patients to feel they are part of the same team. They want to be a character in your play. When a patient says, "I only brush one time a day," and you know this is not enough by the condition of his or her mouth, you know you can't say, "Yuck. What are you thinking?" Rather, you use all the information you have gathered from asking what, where, why, and when.

If you say something like (this is the "yes" part), "You always brush in the morning and it seems like you do a really good job," (here is the "and" part) "but it is important to brush at the end of the day not only for your mouth but your entire body." Patients usually respond with a "yes" and "and" and don't even realize it. "I will try to brush at night, but I may only do it for one minute instead of two." This allows them to be a willing participant and play along with you in resolving this conflict. This is the longest component of our appointment and the longest part of any play. The final component of any play is the resolution.

The resolution is the third act of a dramatic structure in which the conflict comes to a conclusion – the protagonist either gets it or not.

The chair tilts forward and your patients (the protagonists) adjust their position. You wait to see if they have understood what they need and what their next step is to get it done. No matter what they say, you answer with a "yes" and "and" by summarizing your recommendations and leaving them with a "Yes, I can do it" feeling. You then walk them to the front desk and say your farewells. The curtain drops and the play ends. But wait! We have an encore. Patients then make their next recare appointment in six months. It was another successful performance!

So I have been in the spotlight for years. I am living my dream. Just as in the song, we really do get what we want. Often it is just a matter of looking at things a bit differently.

Elizabeth Nies, RDH, EA, AS, is a graduate of Fones at the University of Bridgeport, class of 1984. Here previous RDH article was titled, "Assisted Hygiene: Boldly Going Where So Few Are Willing to Go," published in August 2007. She has been practicing dental hygiene for 27 years. Active in the ADHA, she is currently the president of the Idaho Dental Hygienists' Association. Liz can be contacted at (208) 866-4271 or [email protected].

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