Executive Summary

Sometimes dentists can make a complete hash of patient communication. But it isn’t just dentists who do that, many other professions can as well. There are lessons to be learnt from a recent visit to a financial advisor and a car dealership.

A few months ago I had two appointments with a financial advisor. I went in curious and open-minded to find out whether there was anything he could do to improve my investment returns.

The first appointment was forty-five minutes and was described as information-gathering. It wasn’t. It was forty-five minutes of him show boating to demonstrate how much he knew. My accountant was sitting in the room and yet the advisor didn’t ask her a single question. He arrived at an information-gathering meeting with no interest in gathering information.

Two weeks later we met again in a boardroom high in a city office tower, the kind of room with floor-to-ceiling windows and views that are supposed to make you feel like you’re in capable hands. He presented his findings for two hours.

The one thing I desperately wanted to discuss, was treated as a minor consideration, barely worth pausing on. Almost everything was presented in a language I couldn’t follow. I left saying I’d think it over but in reality I just said that to get out the door. He had no idea.

The mirror you don’t want to look in

I’ve shared that story with dentists. They nod and then pause. Because most dentists, if they’re honest with themselves, have been that financial advisor. They just didn’t know it at the time.

There is no more important skill in dentistry than the ability to communicate with patients. Not implants. Not endodontics. Not occlusion, or cosmetic dentistry, or any of the clinical disciplines. The ability to help someone understand their situation and make a decision is the single most valuable clinical asset you can develop.

Over many years I’ve had the privilege of visiting a large number of practices and observing dozens of dentists at work. In all that time I have not been able to find any meaningful correlation between clinical excellence and financial success. I’ve seen technically gifted dentists who struggle to fill their books, and I’ve seen dentists of modest clinical skill who run thriving, profitable practices. The difference comes down to how well they communicate with patients.

But financial success is only part of the story and not even the most important part. Skilled communicators get to practise a different and far more satisfying form of dentistry. Every day they perform their finest work on patients who are grateful for the outcome. Their clinical abilities are fully utilised on challenging, interesting and rewarding cases.

Poor communicators, by contrast, find themselves doing patch-up dentistry. The tragedy is not just financial. It’s clinical. Some of their finest work never gets done.

How it starts

I remember the feeling from my own early years in practice. I’d graduated knowing how to do all these wonderful things: crowns, bridges, endodontics 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 gradually stopped offering good treatment. It was painful to keep putting yourself forward and being knocked back. So I started diagnosing what I thought the patient would accept. I presented fillings instead of crowns.

I’ve since discovered that many dentists have a version of this story. It’s not laziness or indifference that drives under-diagnosis. It’s scar tissue. It’s a young dentist who 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 their clinical situation. It just means they leave without knowing the full picture and without the chance to make a proper choice about their mouth.

What patients actually experience

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 want to get in and drive.

The salesman was enthusiastic, thorough 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 one of the most common communication failures in the dental surgery: the assumption that because something is clinically significant or technically fascinating to you, it must be important to the patient. It isn’t. Patients don’t want to know everything you know. They want to know what they need to know to make a decision about their own mouth. Those are very different things, and confusing them is the source of an enormous amount of wasted time and lost treatment. Learning how to improve dental consultation skills begins precisely here with the discipline of giving patients what they need to decide, rather than everything you know.

Excessive clinical detail doesn’t inform patients. It overwhelms them. It shifts the focus from their needs to your expertise. And it can, quite unintentionally, make patients feel the way I felt in that boardroom, out of their depth, annoyed, and desperate for the whole thing to be over.

The fear that makes things worse

Many dentists hold back from presenting comprehensive treatment because they worry about frightening patients away. 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 had made a decision about what this patient could afford, or would accept without asking. She had attempted to diagnose 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 entirely their decision, not yours. This is the foundation of dental patient communication training, not scripts or techniques, but a respect for the patient’s right to choose.

I see my job as showing patients what excellent 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 never 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 financial reasons or personal reasons that decision must be accepted with grace. A sigh, a flicker of disappointment, an “are you sure?” and you have made them feel guilty. A patient who leaves feeling guilty doesn’t come back. But a patient who says ‘no’ today and feels completely respected in that moment? They come back and they may say yes next time.

What a good consultation actually looks like

There is a practice I visited in an affluent suburb of Sydney, the kind of area where a one-bedroom flat costs over a million dollars. Two dentists, working in adjacent operatories, seeing the same demographic of patients every day.

One was a master communicator. His appointment book was full of crowns, implants, veneers and full-mouth rehabilitation cases. He attracted an average of eighteen new patients a month and was consistently fully booked.

The other was a poor communicator. His book was full of check-ups, fillings and scale-and-cleans. Very little significant work. He was getting forty-five new patients a month and still couldn’t keep his book full. The front desk told me it was like trying to fill a bucket with no bottom.

Same building. Same suburb. Same patient base. The only variable was how each dentist communicated. It is the clearest illustration I know of why learning how to get patients to say yes to treatment has nothing to do with persuasion and a lot to do with the quality of the conversation.

When you visit a practice run by a master communicator, the atmosphere tells you something. It is calm. The patients are at ease. The majority of them book in for significant treatment. Great communication is not a long courtship. It is not forty minutes of rapport-building or a detailed clinical education. It is clear, purposeful and efficient. The patient understands their situation. The patient makes a decision. The patient proceeds. Treatment consultations in excellent practices are neither arduous nor time-consuming because the dentist has learned to give patients what they need to make a choice.

A note about rapport. Poor communicators often have a slow, laborious style built on educating the patient to establish rapport. Consultations drag on for twenty, thirty, forty minutes or more. The irony is that long-winded attempts at connection are self-defeating. You begin to resemble the financial advisor who spent two hours talking without asking what mattered to me. Rapport is not built through talking. It is built through listening and through making the patient feel that their concerns are the centre of the conversation, not a minor consideration barely worth pausing on.

Bad communicators often don’t know it

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

The first is that many unskilled communicators have developed a style that is never truly 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 ever happened to Mrs Jones, that the truth announces itself.

The second is under-diagnosis. Instinctively sensing that they cannot navigate the conversation a complex treatment plan requires, they simply don’t present it. Case acceptance looks fine. But it’s an illusion, a measure of what the dentist was willing to present what’s easy, not what the patient actually needed.

What that boardroom meeting should have felt like

I still think about how different those two appointments 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, making my core concern the centre of everything that followed. He could have returned two weeks later with recommendations in plain language that left me feeling more confident than when I walked in. I would have left that boardroom clear and ready to proceed.

That is what a master communicator does. In a boardroom. In a car showroom. And in a dental surgery, every day.

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 am absolutely certain that anyone can.

Your patients sit down in your chair carrying their own version of my boardroom anxiety, uncertain, hoping to be guided, 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 two hours 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 the conversation.

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 chairside experience. And if this article resonated, The Harder You Push, The Less Treatment Gets Accepted is the natural next read — five practical strategies that put these ideas into action.