Did you hear about Debbie?

Feb. 1, 1998
Ever notice how some dental offices have that kind of relaxed "coffee and donuts" atmosphere? The staff is warm, friendly, and really in touch with the patients` emotional and psychological state. The hygienist is alert, receptive, and truly skilled at conversing with a different patient every 45 minutes. It comes with the job. Communication has never been the problem. The problem arises when we have too much coffee and donuts, when we inadvertently cross the line and become one of the girls in

Whether it`s gossip or a careless phrase, words cause trouble.

Joanne I. Sheehan, RDH

Did you ever shake your head

Over something you had said?

Sometimes tact comes into play,

Say it in another way.

Ever notice how some dental offices have that kind of relaxed "coffee and donuts" atmosphere? The staff is warm, friendly, and really in touch with the patients` emotional and psychological state. The hygienist is alert, receptive, and truly skilled at conversing with a different patient every 45 minutes. It comes with the job. Communication has never been the problem. The problem arises when we have too much coffee and donuts, when we inadvertently cross the line and become one of the girls in the coffee clutch. We entrust too much, confide too much and are not careful about how we word things when speaking to the patient. We assume that, because we are speaking in a low voice, the conversation won`t leave the room. Patients talk ... to each other, to their referring dentists, to anyone who will listen. And if there`s possible malpractice involved, you can bet they`re memorizing every word!

Sometimes a hygienist can go overboard trying to make an anxious patient feel comfortable. Not knowing her very well, the patient might misunderstand her attempts at humor. She might only be kidding with a comment about the doctor`s hair, but the patient could take it as unprofessionalism. New patients are testing the waters. When we maintain the level of professionalism that patients expect, we gain their trust. Again, warm and professional, my favorite phrase, comes into play. Both attributes are necessary to keep patients coming back. There has to be a balance.

We`ve all had to reword our thoughts at one time or another during our careers. RDH is read by hygienists who have just started practicing and seasoned veterans of the scalers alike. Most of you know exactly what I`m talking about. This article is a collection of experiences and scenarios of what could happen when we drop our guard. How we speak to the patient and the choice of words we use can either help the patient or get us scalded by that hot coffee.

I am better, but not like you think

Once I treated a patient who was referred to our perio office for deep cleanings and surgical evaluation. His teeth had been cleaned in a routine cleaning at his general dentist and then he was referred to us. He wanted to go straight to perio surgery, skipping the deep cleanings and re-evaluation. After the office manager, myself and the doctor in turn explained the reasons for our treatment plan, he finally and reluctantly relented.

But, as I began the procedure, he questioned me further. I wasn`t on my guard. I had used up 15 minutes explaining and was concentrating on the scaling and the schedule.

"What makes your cleaning better than the one I already had?" he demanded to know. I was amazed at his tenacity. As I worked, I was remembering "temping" at a general office where a large, deep deposit of calculus was waving at me from the patients` X-rays, but the doctor would not let me scale deep and get it (although at the time I had four years of perio experience).

"This patient is being referred to a periodontist," he explained. "They`ll get it." This time I was in the perio office, and I was only trying to do my job.

"This is a perio office and we scale deeper than is done in a routine cleaning appointment," I answered matter-of-factly. The patient must have taken offense. The way he heard it, I was knocking his long-time friend and dentist. Within two days of his appointment, he had gone back to his GP and related to him that I said our cleanings were better and more comprehensive in every way. The next thing I knew, I was drafting a letter of explanation and apology to this referring dentist, a man I had never met, trying to smooth his ruffled feathers. I was reminded of two things by this experience.

The word better should have set off buzzers and bells in my head. He said "better;" I didn`t. But I also didn`t rephrase the question before I answered it. I could have prefaced my answer with, "Why did your doctor send you here for comprehensive perio treatment?"

Never let the patient put words in your mouth. "What makes your cleanings so much better or why are your X-rays more readable than Dr. Nonames`? ..." As Tim Allen says, "back up the word-wagon" first, or you may be setting yourself up for trouble. It`s so easy to walk into the trap of saying, "Our cleanings are better because," and never realize what just happened. You`ve put the other office down. Now the patient has the choice of letting it go as your personal opinion, or nailing you with your own words ... words that had originally come from him!

That incident reminded me not to compare. I should have just told the patient what we specialize in without comparing the two offices. No one can argue with that. "We specialize in the deepest cleaning possible, at times using local anesthesia or nitrous oxide when necessary."

When you rephrase and refuse to compare, even the most difficult patients are powerless to manipulate you, and you`re in control of the conversation. At times, a patient can draw a defensive response from you with a mere gesture. Have you ever treated a patient who repeatedly and anxiously looked at his watch throughout the cleaning appointment? Did you share this patient with another office that had shorter appointments and, therefore, less scaling time? Wasn`t it tempting to say, "Our appointments are longer so we can do a better job."?

Some patients will ask you to quote office fees. Referring them to the front desk will keep you off the hook in case there was a recent fee increase and no one told you. Besides, that`s what the front desk is there for. That`s their specialty.

Doc will give you a raise if I tell him to

Talking to patients about patients in a bad way is like the girls at the beauty shop, gossiping about the lady who just walked out. The patient might feel he`ll be the object of your remarks when he leaves. It makes a patient feel uncomfortable and, worse, he might know the other patient!

Comments about another staff member in the patient`s hearing are fine ... when giving a glowing account of her efficiency and sunny disposition. If there`s a relationship problem brewing on the staff, try to keep the patients out of the line of fire.

Confiding in a long-time patient and good friend that the boss won`t raise your salary may backfire on you. An old patient may think he has pull with the boss and lean on him to give you a raise, resulting in an embarrassing and awkward situation ... and possibly a pink slip.

Be very careful when asked your opinion of another hygienist, doctor, office, or anyone`s dental work. Know that any derogatory statement you make could come back to get you!

These situations are pretty obvious, and I can hear the veteran hygienists saying, "Duh!"

Actually, hygienists who have been practicing for awhile have found ways around stepping on toes and still get their point across. Darlene Lalime, member-at-large for the Northern Virginia Dental Hygienists` Association, has practiced for 31 years. She puts the patient`s interests first while protecting herself from repercussions.

When being questioned by a patient on why he needs a series of deep cleanings now - when they`ve never been recommended by his former dentist before - Darlene tells him, "I can`t speak to that. I can only tell you what you need now."

She then proceeds to show the patient with a mirror the visible supragingival calculus. She takes an instrument and hangs it up on a ledge of calculus subgingivally, using dental floss as an adjunct to let him feel there is calculus present beneath his gums. He can`t fight with that. Darlene agrees that it`s important to choose your words.

Loose tongues, loose bridges

Sometimes, a word or phrase can come back to haunt you. Have you ever had something like this happen to you...?

One hygienist was joking with her patient as she seated him for a cleaning.

"Now remember," she said, "anything that comes off while I`m cleaning was probably loose anyway." The patient laughed and so did she, until her scaler caught and popped off a three-unit bridge. Murphy`s Law applies in dental offices too.

Becky Skaar, when she was a new hygienist in a California office, seated a handsome newlywed in his twenties. He immediately brought to her attention a bothersome sore on his lip. Becky examined the lesion and suggested it was probably a sore caused by the herpes simplex virus.

At the sound of the word "herpes," the patient sat bolt upright in the chair. "You mean my wife gave me herpes?!"

It was all Becky could do to him keep him in the chair and try to prevent this newlywed from becoming newly-divorced.

Sometimes, when we`re working the day that never ends, it`s easy to toss professionalism to the wind. We might begin to see that last patient as the only thing standing between us and the road home. One tired hygienist really lost it while treating Rita`s three-year-old son. It was his first visit in the dental office, and he was afraid. When he began to cry at the sound of the polisher, the hygienist yelled over the top of the din, "That`s right, kid, keep on crying so I can get this done ... go ahead, open wide and scream!"

Needless to say, Rita was livid, and rightly so. What an introduction to dentistry!

Quality dentistry is in the eye of the boss

These scenarios and stories depict things that might have been rephrased or left unsaid. But what about the important things that should be said for the patient`s own good? While interviewing hygienists, I came across a few who have left offices because they tried to help the patients by educating them. It was not always well received ... by their bosses.

I was told of a dentist in Virginia who warned his hygienist not to find so many cracked restorations and open margins. "That`s not what the patients want to hear," he lectured. He had the hygienist go back and tell the patient she had misspoken.

Years ago, another hygienist in New York suggested the patient get a crown instead of a five-surface patch job. It was her first office right out of school but she knew good dentistry from inadequate. What she didn`t know was that her new boss didn`t do crowns.

She was young, dedicated and enthusiastic about her new profession, but, in trying to institute the kind of quality oral health program she had been taught in school, she posed a threat to the very office that had hired her. Soon patients were calling in with questions about their last perio charting, for referrals to a perio office and the name of a good prosthodontist for that crown. This hygienist put the patient`s needs first and educated them ... too much for the dentist`s liking! Leaving that office was her first good career move.

Sandie, a hygienist working in Chicago, was also right out of school. She noted a large carious lesion in tooth #3 of a patient who swore he had a root canal six months ago for that problem. No caries had been charted for #2 and yet that was the tooth that received the root canal. When she took X-rays and brought the mystery to the associate dentist, he concluded that the wrong tooth had been treated. Because of this and the belief that her boss was using drugs, Sandie left that doctor`s office and the associate was soon to follow.

After starting at another office, Sandie was amazed at what she saw there. One patient came in for a cleaning with orthodontia and periodontal pockets, pus and class 2-3 mobility. Sandie informed the patient her teeth were loose because of these signs of gum disease. She suggested to her doctor that the braces be taken off immediately and a consult set up with a periodontist. Her boss did not concur. Then she found out it was her boss, a GP, that had put her in orthodontia in that condition. She left that office because she had totally lost confidence in and respect for her boss. Plus, she didn`t want to be guilty by association with a malpracticing dentist.

These hygienists practiced a good rule-of-thumb. That is, if you can`t respect a dentist because of the way he practices and you don`t think he has the patient`s best interest at heart, leave his employment. There`s no way you can practice the kind of quality treatment you know the patient deserves in that office. We have to look at ourselves in the mirror each morning and know that we are doing our best by each patient. Joan, a former hygienist and current office manager, says of her New York office: OWe are the best at what we do and we refer to the best. Confidence breeds confidence.O

Choosing your words is an important part of effective communication with the patient. A hygienist who knows how to get the point across and still maintain her professionalism has learned a valuable skill. The way we word things can either gain our patients? respect or destroy us. At the same time, we have the responsibility to inform and educate our patients about procedures that are indicated for their individual dental needs.

If you?re in an office where you are not happy because the patient?s needs are left unmet ... don?t go there!

Joanne I. Sheehan, RDH, graduated from the State University of New York at Farmingdale in 1974 and has practiced dental hygiene in New York, Pennsylvania, Virginia, Maryland, and Alabama. She has taught in North Caorlina and worked for the Army as a dental hygienist in Germany for three years.