The talking connection

Aug. 1, 1996
Have you ever just sat, at the end of your day, and pondered? At 11 this morning, Ms. Smith canceled her appointment to begin periodontal care - again. Neither you, or any other staff member, was surprised. Her problems, though, are severe and rapidly getting worse. Damn cigarettes! She`s already having some pain. At her last appointment, you discussed her X-rays, had her watch as you spot probed after a full-mouth pocket charting, reviewed her oral hygiene, gave her educational pamphlets, stres

How to have a meaningful conversation with the executive, engineer, cheerleader, and helper

John Wilde, DDS

Have you ever just sat, at the end of your day, and pondered? At 11 this morning, Ms. Smith canceled her appointment to begin periodontal care - again. Neither you, or any other staff member, was surprised. Her problems, though, are severe and rapidly getting worse. Damn cigarettes! She`s already having some pain. At her last appointment, you discussed her X-rays, had her watch as you spot probed after a full-mouth pocket charting, reviewed her oral hygiene, gave her educational pamphlets, stressed the urgency of her condition - the works! You gave it your all because her problems are severe, and you really care.

But even as you labored - to explain, educate, motivate - you knew. The message wasn`t getting through. What could you have done? Could someone else have been more effective? The stakes are high - Ms. Smith`s teeth. There must be some way you could have reached her.

The blank look isn`t very encouraging

Effective communication is the essential ingredient in case acceptance. Unless we get our patients to embrace the course of treatment we know to be ideal for their individual needs, no matter how great our knowledge and skill, we can do nothing to help them.

I`m sure every reader has shared the frustrations of the above scenario. Some patients hear your words and respond. They accept responsibility for their problems and enter into treatment willingly. Others listen politely - but the light is missing from their eyes. If we are perceptive, we know we`ve failed to reach them. Their critical dental needs may go unmet. You`ve given the same basic information to both groups. Why this dramatic difference in its reception and effect?

Understanding the fundamentals of human relationships is essential to success, no matter what your chosen field. Without some form of effective communication, it`s impossible to form the positive relationships that lead to trust. Many books have been written concerning communication skills - the art of first impressions, understanding body language, neuro-linguistic programming, transactional analysis, and too many additional facets of human interaction to mention. Communication skills have been analyzed in exquisite detail. We will limit our discussion to the most simply understood and easily improvable facet of communication - verbal skills.

We process the words we hear in four primary ways. No one way is superior or inferior. Each mode has both strengths and weaknesses. The four merely describe the varied manners by which humans relate to the world. While all of us use each of the methods, everyone has a strong tendency to favor one or two modes.

It is naive, at best, to assume that the same verbal communication will work equally well with each of the four personality types. The presentation we repeatedly deliver is based on our own primary personality orientation. Thus, it will be optimally successful with approximately one-fourth of our audience. Few of us are pleased if our urgent message about oral health is accepted by 25 percent of our patients.

Let`s discuss the four basic personality types. As we do, determine which group represents your primary personality. You`ll also find yourself identifying specific patients within each segment.

Often, you`ll remember these patients due to the frustration of never being able to really reach them. Think also about members of your team - including the practice owner - and your own family and loved ones. By what method does each of them access information? Improved communication skills not only enhance your effectiveness with the patients entrusted to your care, but for all the people with which you come in contact.

Controllers or Directors

They have to be in charge. They are strong willed, decisive, direct in their approach, and they tend to be domineering. They make quick decisions based on what is best for them. They care little how decisions affect others. They are interested in results, not emotions. They are willing risk-takers.

They are always in a hurry. They want the straight facts and will quickly decide on a course of action. If you explain every detail of your proposed treatment, you`ll drive them away.

Analyzers or Engineers

They must have all the facts before reaching a decision. They will desire every bit of information you have available concerning their oral health problem, and they often request more. If you try to rush them into a decision, they will become frustrated.

They are unemotional, detail-oriented, and proceed with decisions slowly and methodically. They are definitely not risk-takers.

Promoters or Cheerleaders

They look at the big picture and don`t sweat the details. They are fun-loving folks, often story tellers. They make decisions quickly, frequently without benefit of the facts. They tend to be self-centered, to live for the moment, and are enjoyable to be around.

They are often most concerned with appearance, and they are definitely risk-takers. They have no interest in the details of their problems or treatment and will be turned off by such a discussion.

Supporters or Helpers

They are reluctant to make decisions. They work well with people, having tremendous concern for the feelings of others. They are very anxious about how their actions affect others and are intensely uncomfortable with conflict. They go along with other people`s decisions easily and are excellent workers. Strongly encouraging them to accept the care you know to be ideal will be very effective with this group.

Now that we have established a clinical understanding of the four basic ways in which people process verbal information, let`s see how we can use this knowledge to improve our effectiveness with patients. We will suggest the ideal approach for each group to allow them to understand and accept a needed soft tissue management course. We`ll also briefly observe how a similar approach could be employed to reinforce oral hygiene and regular re-care appointments.

The first step to enhancing our communication effectiveness is to precisely identify the basic type with whom we are dealing. Once this critical step is accomplished, we can use our understanding of how they process data to tailor our approach to their unique understanding.

The boss is in a hurry

The executive type is very busy. They are always in a hurry, go nuts if you`re running a little behind, and have a tendency to cancel appointments due to changes in their schedule.

Let`s eavesdrop on a snatch of conversation:

"Mr. Executive, I`m very concerned about the condition of your gums."

"Oh? What concerns you?"

"Please take a look in this mirror. (Or watch the intra-oral camera, if available.) See these spaces, or pockets along the necks of the teeth? They are getting deeper. Notice the blood seeping from some of the places I`ve touched?"

"Yes, I see. What can we do?"

"The most effective approach would be a deeper cleaning, numbing your gums to make it comfortable for you."

"How long does that take?"

"In your case, we could do all of the treatment in two visits."

"If that`s what I need, let`s get it scheduled."

There is one last critical bit of information. At this point, shut up and schedule. This guy`s done talking. He has no interest in the details. Tell him what he needs, how it can best be accomplished, and get on with it!

If your concern is improving this patient`s oral hygiene, or getting them to be more faithful in their re-care appointments, stress how their compliance will be most efficient, and thus save them time.

Show her the blueprints

Our engineer never misses an appointment, and she is never late. She is careful with her home care, but her tissues still don`t look good.

"Ms. Engineer, I`m very concerned with the condition of your gums. It seems the routine things we`re trying just aren`t working effectively. We`re not getting the response we need to see."

"What`s wrong?"

Finally, you have a chance to use all of the knowledge you`ve gleaned from your years of professional education. You can also get out a copy of each of those, somewhat dusty, handouts on periodontal disease. Your patient will want every detail. After a lengthy dialogue, they will probably wish to think things over. Make a note to call them in a week. Ask if they have any more questions and have some time available to visit, as they will. Don`t pressure these patients. They`ll reach a decision, but only when they are ready.

When reinforcing the need for oral hygiene or regular re-care, your approach will be the same: Provide lots of facts, answer their questions, then wait patiently for them to reach a decision.

Give me a P, Give me an E, Give me a R, Give me an I...

The cheerleader will undoubtedly be one of your favorite patients. They are fun to be around and always have a funny story. They are not, however, very reliable. They forget, fail, or are late to appointments frequently. Their oral hygiene efforts tend to be sporadic.

"Ms. Cheerleader, I`m very concerned about the health of your gums."

"What`s wrong?"

"Look in the mirror (intra-oral camera screen). See how red, swollen and unattractive these gum tissues look."

"Oh my goodness, yes! They are all swollen. What can we do! They just look awful."

"With the proper care, we can have those gums as pink, firm and healthy as they were when you were a teenager."

"Really? Then let`s do it!"

Once again, it`s time for that critical step: shut up and schedule. You can provide additional information as you proceed with treatment. But this person wants more attractive gums, and she wants them badly. Grant her wish.

With the need for oral hygiene and regular re-care - you guessed it - appeal to how much healthier the patient will look. Have fun with these enjoyable folks, just don`t bore them to death with all the details.

Need a hand? Let me help you help me

Mr. Helper is a good patient. Not a real entertaining individual, but he never misses an appointment. Nor is he late to one. He makes a real effort to comply with your oral hygiene recommendations, even though he`s a smoker.

"Mr. Helper, I`m really concerned with the condition of your gums."

Concern clouds his face as you demonstrate what worries you. "What can I do?"

"I`ll detail a precise course of action for you. If you do exactly as I tell you, I`m confident that, working together, we can improve your oral health."

With regular care and oral hygiene, you again prescribe a very specific course of action and stress the two of you working as a team. These people want to make you happy, and it`s reassuring to them to be given a specific, concise set of directions.

Everyone different is suddenly on the same page

Why go to all of this trouble? Isn`t it enough to do your job and tell people the truth? Let`s examine a few of the advantages inherent from improved communication.

Not only does the acceptance of needed care increase, but so does the appreciation of patients for what you do. They feel listened to and understood - and that makes you a special person.

You`ll find your frustration level decreasing, as it`s more fun working with patients who understand and accept the care you know to be best for them.

Of course, your clinical success rate will be much greater, now that you and your patients understand each other and work as a team. Getting patients to comprehend their problem and be on your side is the key to successful periodontal care.

The practice`s income increases as more care is provided. If you are paid by commission (as I feel every hygienist should be), you`ll give yourself an immediate raise! Even if you are on salary, few practice owners will increase wages unless they can see enhanced revenue. Document the increased productivity in your department, then sit down and demonstrate your growth to your doctor. It`s hard to deny black and white facts.

I believe the biggest benefit of enhanced communication skills to be intensified personal growth. As your verbal skills grow, your patients, fellow workers, friends and family will all perceive you differently.

It`s even easier to relate to strangers at a party using this information. You`ll discover the world is filled with interesting people whom you can understand, relate to and enjoy.

John A. Wilde, DDS, is the author of "Bringing Your Practice into Focus" and "How Dentistry Can be a Joyous Path to Financial Freedom." He has a private practice in Keokuk, Iowa, and he can be contacted at (217) 847-2816.