Some weather were having, huh?

Sept. 1, 1999
Take conversation to the next level. Patients are really quite interesting once you find the key to their interests.

Take conversation to the next level. Patients are really quite interesting once you find the key to their interests.

Cathy Hester Seckman, RDH

Queen Elizabeth, it has been said, can converse brilliantly on any subject for 15 minutes. That`s a good personality trait for a hygienist to acquire. We see people for such short snatches of time, but it`s important that we connect with them. Conversation calms them down, makes them appreciate the office, and gives them a personal stake in their caregiver.

When we`re finished with the prophy and the dentist says, "Give me a few minutes," we don`t want to be rude and leave the patient staring at the wall, so we try to make conversation. Sometimes, it can literally be like pulling teeth. But there are ways to draw out even the most taciturn patient. People love to talk about themselves, once you get them started. It`s the starting that`s the secret. Once you have that, you can pass the time of day easily with skydivers, basketball stars, gardeners, gamblers, truck drivers, bankers, bikers, and carpenters.

One hygienist with the skills to raise conversation to a fine art is Karen Burnett of Stirling, N.J. In addition to her dental hygiene degree, Burnett holds a master`s degree in psychology.

"It`s a real asset for me to have that background," she agrees. "It has helped me tremendously in building rapport with dental patients."

When Burnett first started in dentistry as a teen-age assistant, building that rapport was one of the first important skills she learned.

"The dentist that I worked for said, `Get in there and talk to people.` It was the hardest thing, because I was very shy. I thought, `What could I talk about to a 60-year-old man? I`m 16!` "

The secret to making conversation with strangers was simple, once Burnett figured it out. "Find one thing they`re interested in. Find out what their perspective is, and it`s a tremendous help."

Sometimes you have to dig to find that key. One of our patients was a quiet, elderly man who never had much to say beyond "Hello" and "Fine, thanks, how are you?" During several three-month appointments, I`d tried the usual conversation-openers.

"How`s your summer/winter going?"

"Do you have any big plans for the holidays?"

"Have you picked your candidates for the election yet?"

"How are you keeping yourself busy these days?"

Nothing ever worked. When I asked about keeping busy, he admitted that he gardened a little.

"Oh, that`s interesting," I said brightly. "Flowers or vegetables?"

"Just some petunias and impatiens," he said dismissively.

And that was the end of the conversation. There seemed to be nothing else to say about gardening, because he just wasn`t interested.

The quiet man

From her perspective as a psychologist, Burnett explains that some people are just not very conversational. "For those people, I try not to be overly chatty. Sometimes it annoys them. But I`ve found that a very soft approach, from not too professional a standpoint, can work. If you talk to them on a personal level, they`ll sometimes respond to that."

One day the quiet man walked in and said his usual, "Fine, thanks, and you?"

"I`m in an awful mood today," I groused.

He seemed startled. "Why`s that?"

"I`m having computer problems at home," I admitted. "The repairman is coming tomorrow."

As soon as he heard the magic word, "computer," his eyes lighted up, he leaned forward, he practically wriggled with excitement. It turns out that my quiet, elderly patient lives a dynamic life online, following the stock market, chatting with grandchildren, playing bridge, and working out his family tree.

I look forward to his visits now, and he looks forward to seeing me, because we have so much to talk about. He`s good at solving computer glitches, and I give him tips on interesting Web sites. The receptionist has to pry us apart at the end of each appointment, so I can get on with the day.

Burnett suggests a broad range of topics you can use to search out your patients` interests. "Ask about their occupation, health, nutrition, favorite vacation spots, restaurants, movies they`ve seen, what their hobbies are, something about their family."

It helps to be observant, too. I always like to look at the titles of the books patients bring to the chair. One patient carried a meatless cookbook.

"You`re going veggie?" I asked. That led to a wide-ranging conversation about nutrition that went from complex carbohydrates to wheat allergies to soy recipes. When I see her children now, she always walks back with them, just so we can talk.

Patients` occupations can be fascinating, and you can learn a lot by just listening. Sometimes, what you learn can even help you be a better caregiver. A family counselor told me once I should try very hard not to talk to the patient`s right shoulder.

"What?" I said.

"Look at your position," he said. "I don`t mean to be critical, but you might find it would help to change your technique. With you sitting on that stool, you`re not in my line of sight. You`re talking to my shoulder, not my face. Eye contact is very important when you want someone to pay attention."

I swung my stool around to face him before thanking him for the valuable advice.

Vacations are always a good conversation starter for patients. Someone`s always scheduling one, or packing for one, or just getting back from one. Patients have surprised me with their descriptions of inventive vacation plans. Not only is it interesting to hear, it makes the patient feel we care about them and their lives.

One patient brought pictures of her trip to Bora Bora. An older woman cried when she told of meeting long-lost cousins in Sicily. Still another told us about his regular business trips to the wilds of western China. At one office, we followed the unfolding story for months when a young couple traveled to Thailand to adopt a baby. Even when the vacation is as prosaic as a camping trip to the Adirondacks, we`re always ready to hear about it.

An interesting way to make a living

As simple a question as, "Where do you work?" can open up a whole range of conversational possibilities.

"You`re an electrical engineer?" I asked one skinny little squirt fresh out of college. "What, exactly, do you do?"

She spent 10 minutes describing her design work in new construction. She`s the one, it turns out, who decides where to put new electric poles and how to tie into existing power grids. She loves her job, and her enthusiasm made me appreciative of her work. Now I know a little more about how electricity gets to our houses.

At the offices where I`ve worked, patients have described their jobs as nuclear medicine techs, professional flutists, chefs, golf pros, prizefighters and sign language interpreters, to my endless fascination.

When you let patients do the talking for a few minutes, you take attention away from the stress of their dental appointment, allowing them to unbend a little and connect with you on a personal level. Not only are patients more relaxed with this approach, you`re more relaxed as well. "It`s part of the enjoyment of the job," Burnett feels. "Truly, most of the people I`ve connected with this way have gotten to be friends. They set me up on blind dates, invite me to their homes. It`s been wonderful."

The fine art of distraction

A friendly, conversational approach can be a big help with patients who are anxious about dentistry, Burnett adds. "If people are nervous, use the art of distraction. I really don`t talk about dentistry a lot at first. I want them to realize I`m aware of that, but I want to get to know them first, make them comfortable. When they realize our sole focus is not just teeth, a lot of times they`ll relax with that. Then you can branch into educational dentistry gradually." Gradual is the key word when dealing with always touchy teen-agers. "If you try too hard," Burnett warns, "they`ll turn you right off." Her best approach, she says, is to ease into a conversation.

"Don`t be really chatty, and don`t approach them as an authority figure. They won`t be interested. In the middle of a cleaning, you might say something casual, like, `How`s the swim team doing this season?` or `Have you seen the new movie out this week? What did you think?` "

Burnett enjoys talking to older teens about their college experiences. "I tell them a silly or embarrassing story from my college years, and then they`ll tell me about theirs. Many have told me things their parents probably don`t know."

Younger kids like to show off, and it can be fun to ask them about school. Of course, if you say, "What did you do in school today?" they`ll reply, "Nuthin`." But you can get them to be a little more specific. I like to ask little ones how high they can count or if they can sing the ABC song. If a kid tells me he`s a good speller, I quiz him on dental words like "tooth," "saliva," and "floss."

After one boy spelled everything correctly, I said, "Wow, Jason, you win the big prize today."

"What`s that?" he wanted to know.

"You can hold this s-a-l-i-v-a ejector while I get the fluoride tray ready."

Getting them to laugh - or even groan in disgust - can make kids forget how nervous they are - and how much they hate sitting still for fluoride.

A little bit about myself

Conversations with patients don?t always have to be a one-way street, Burnett reminds us. If you?re genuinely interested in your patients? lives, they might be interested in yours, as well.

OIf a hygienist is involved in a lot of her own activities, that?s another way to get to know people. I take art classes and go horseback riding. I?m into flying, biking, and hiking. Frequently, I get to know my patients through those activities. They like to ask if I?ve been flying lately or what art project I?m working on.O

It?s not a bad idea, either, for a hygienist to keep a few pictures handy. If a patient sees a photo of your children, your favorite schnauzer, or you decked out in mountain-climbing gear, he?s likely to start the conversation for you.

What do you do with all your patients? interesting tidbits of information? The patient comes in, spends 40 minutes in the chair, talks to you for five minutes about his pizza delivery business and his recent trip to Aruba, then he leaves. At Burnett?s offices, and at mine, we write a few notes for future reference. There can be a separate piece of paper for that or you can write on an unused corner of the chart.

This patient?s note might say, OUptown Pizza guy. ?99 Aruba trip.O Then, when he comes back six months later, you won?t have forgotten what you talked about. You can breeze out to the waiting room and say, OHey, Jeff, good to see you. What did you think of Aruba?O

This accomplishes several things. It makes Jeff feel like a welcome, valued customer; it impresses him that we remembered; it gives him a personal connection with us, his caregivers; and it makes him forget to be anxious about the upcoming treatment.

Cathy Hester Seckman, RDH, is based in Calcutta, Ohio.


Conversation doesn`t come easy to all patients - maybe even some dental hygienists. Whether it`s shyness or a psychological disorder known as social anxiety, an attempt at casual conversation can even lead to a panic attack.

Social anxiety affects 15 million Americans, and mental health associations deem it to be the third largest psychological disorder in the country. Because of a general lack of awareness about the disorder, people with social anxiety often are incorrectly diagnosed as being schizophrenic, manic-depressive, clinically depressed, panic "disordered," and personality "disordered." The first book that dealt exclusively with social anxiety was just published earlier this decade.

According to the Social Phobia/Social Anxiety Association, your patients who experience social phobia have a fear "of social situations that involve interaction with other people. Put another way, social phobia is the fear and anxiety of being judged and evaluated by other people. If a person usually becomes anxious in social situations, but seems fine when he or she is alone, then social phobia may be the problem." Their preference is to be alone. Even with familiar acquaintances, they often are "overwhelmed" with perceptions about how others are viewing them.

Although evident in a variety of "public" situations, social phobia causes distress during introductions to strangers and when the phobic is forced to speak. Besides anxiety, they may experience intense fear, nervousness, a racing heart, blushing, dry throat and mouth, trembling, muscle twitches, and "automatic negative thinking cycles."

Treatment usually consists of cognitive-behavioral therapy. A 90 percent success rate is reported for most patients who complete 16 to 24 sessions. "What socially anxious people do not need is years and years of therapy or counseling," Dr. Thomas Richards, a psychologist, writes. "You can`t be `counseled` out of social phobia. In fact, socially anxious people who are taught to `analyze` and `ruminate` over their problems usually make their social anxiety and fears much worse."

Medication with antianxiety agents (the benzodiazepines) also has been proven useful, but some mental health experts are concerned about any dependence on the drugs.

Simple shyness, on the other hand, is not viewed as a mental disorder. Shy dental patients may not feel comfortable in talking with a hygienist, but they are not crippled mentally or physically by the encounter. Dr. Richard Heimberg, a researcher at the State University of New York in Albany, described the difference as: "Social phobia is shyness gone wild. It cuts people off from the good things of life - social interaction, love, family."