Your best dentistry may never get done

Recently, I had two appointments with a financial advisor. I wanted to find out if I could improve my investment returns.

The first appointment was 45 minutes for information gathering. It turned out to be 45 minutes of the financial advisor showing off to demonstrate how much he knew.

Two weeks later we met again in a boardroom. There were floor-to-ceiling windows and impressive views. The financial advisor presented his findings for two hours. Almost everything was presented in a language I did’t understand. I left saying I’d think it over but really I just said that to get out the door.

We’ve done that too

Most dentists, if they’re honest with themselves, have at some time been like that financial advisor. We have all blown a treatment consultation and not known why. There’s no more important skill in dentistry than the ability to communicate with patients. That is, the ability to help someone understand their situation and make a decision.

Over many years I’ve had the privilege of observing dozens of dentists at work. I’ve not found any correlation between clinical skills and financial success. I’ve seen clinically gifted dentists who struggle to fill their appointment book and I’ve seen dentists of below-average clinical skill who run thriving practices. The difference comes down to how well they communicate with patients.

Financial success is only part of the story. Skilled communicators get to practise a more satisfying form of dentistry. Every day they do their finest work on patients who are grateful for the outcome. Their clinical abilities are utilised on challenging, rewarding cases. Poor communicators, by contrast, find themselves doing patch-up dentistry. Their finest work never gets done.

Painful rejections

I remember the feeling from my own early years in practice. I’d graduated knowing how to do wonderful things: crowns, bridges, root fillings and so on. I’d sit down with a patient, explain that they needed a crown, tell them the fee, and the patient would say:

“Nah, just rip it out.”

When that happened a few times I stopped offering expensive treatment. It was painful to keep putting yourself forward and being knocked back. So I started diagnosing what I thought the patient would accept. Mostly I presented fillings instead of crowns. I’ve since discovered that many dentists have a version of this story. It’s scar tissue that drives under-diagnosis. A young dentist gets hurt a few times and makes a decision to stop putting themselves in that position.

The problem is that the patient who needed the crown still needs the crown. Your discomfort with the conversation doesn’t change the clinical situation. It just means the patient leaves without knowing the full picture and without the chance to make an informed choice about their mouth.

Under-diagnosis

I once watched a dentist examine a patient who needed seven crowns. She told the patient they needed two crowns and five fillings. When the patient left I asked her why. Her answer was: “I didn’t think they’d accept seven crowns so I only told them about two.” She’d made a decision about what this patient could afford or would accept without asking. She diagnosed the patient’s wallet instead of their teeth.

The correct approach is to diagnose and present everything without pressure and always with an alternative. Every patient deserves to know the full picture. What they do with that information is their decision, not yours. This is the foundation of good dental communication; a respect for the patient’s right to choose.

I see my job as showing patients what good dentistry looks like. Their job is to tell me how much of it they want, and how quickly. Some days one patient would proceed with a crown. Some days fourteen would. The number was not the point. The point was that every patient left the chair knowing what their mouth needed and had been given a choice about what to do next.

When a patient decides they’re not ready for whatever reason that decision must be accepted with grace. A sigh, a flicker of disappointment, an “are you sure?” and you’ve made them feel guilty. A patient who leaves feeling guilty doesn’t come back. But a patient who says no today and feels respected will come back and they may say yes next time.

Technical details

I took delivery of a new car recently. At the handover the salesman walked me through the car in painful detail. Forty minutes of technical specifications, features and functions that meant nothing to me. I don’t care about cars. I just get in and drive. The salesman was enthusiastic and well-intentioned. He was also completely absorbed in what he found interesting rather than what I needed to know. I listened, thanked him and went home. He had no idea either.

This is a common communication failure dentists make: the assumption that because something is fascinating to you, it must be interesting to the patient. It isn’t. Patients don’t care about technical details. They want to know what they need to know in order to make a decision. Improving dental consultation skills demands the discipline to give patients what they need to know rather than a boatload of technical details.

Excessive clinical detail overwhelms patients. It makes patients feel the way I felt in that boardroom: out of my depth and desperate for the whole thing to be over.

What good communication looks like

I visited a practice in an affluent suburb of Sydney. It’s in the kind of area where a one-bedroom apartment costs $1,500,000. There were two dentists working in adjacent surgeries.

One dentist was a master communicator. His appointment book was full of crowns, onlays, inlays, implants, veneers and full-mouth rehabilitation cases. In order to be fully busy he needed an average of 18 new patients a month. The atmosphere in his surgery was calm. The patients were at ease. His communication was clear and efficient. This dentist’s treatment consultations were short because he’d learned to give patients only what they need to make a choice.

The other dentist was a poor communicator. His book was full of check-ups, fillings and cleanings. He did very little significant work. He was getting 45 new patients a month and still couldn’t keep his book full. The receptionist told me it was like trying to fill a bucket without a bottom. He had a laborious communication style built on “educating” the patient. Consultations dragged on for thirty minutes or more. He was like the financial advisor who spent two hours talking without asking what mattered to me.

Two dentists. Same building. Same suburb. Same patients. The only variable was how each dentist communicated. It is the clearest illustration I know of the value of becoming a skilled communicator.

Bad communicators often don’t know it

Here is the most uncomfortable truth in this article: poor communicators usually believe they’re good. There are two reasons for this.

First, unskilled communicators have developed a style that’s never tested. They rarely ask the patient for a decision. Patients leave holding a printed quote and a pamphlet, promising to think it over. It’s only months later, when someone asks what happened to Mrs Jones, that the truth announces itself.

Second is under-diagnosis. Instinctively sensing that they cannot navigate the conversation a complex treatment plan requires, they simply don’t present it. Their case acceptance rate looks fine but it’s an illusion. The dentist only presented simple things the patient was sure to accept, not what the patient really needed.

How the boardroom meeting should have felt

I think about how different those two appointments with the financial advisor could have been. He could have arrived at the first meeting curious, asking my accountant to walk him through my situation, finding out what mattered to me and making my core concerns the centre of everything that followed. He could have returned two weeks later with recommendations in plain language that left me feeling confident. I would have proceeded.

That’s what a master communicator does: In a boardroom, in a car showroom and in a dental surgery.

I’m not a naturally gifted communicator. The young dentist who used to nervously mention the fee and brace for rejection, that was me. If I was able to learn how to do this well, I’m absolutely certain that anyone can.

Your patients sit in your chair uncertain, hoping to be guided and ready to trust someone who makes them feel understood. The question is whether the consultation they’re about to have will leave them feeling clear and confident, or whether they’ll be walking to their car 45 minutes later, promising to think it over, while you have no idea that anything went wrong.

Your best dentistry is sitting there, waiting to be done. The only thing standing between you and it is how you communicate.

If you’d like to go deeper on dentist communication skills with patients, my Case Acceptance course covers the full system built on four decades of real chair-side experience. And if this article resonated, The Harder You Push, The Less Treatment Gets Accepted is the natural next read.

---