Exceptional Dental Practice Management

Presenting Tooth Replacement Options To Patients

Whether a patient has been missing teeth for a long time, or is about to lose a tooth now, replacing missing teeth is usually a wise decision.  Patients are smarter consumers these days and that includes dentistry.  They want to know what their choices are, the pros and cons of those choices, and they want to make a good investment in something that will be comfortable and last a long time.  

Money aside, I usually think dental implants are the best choice to replace missing teeth.  I always believe that form follows function so be prepared to talk about the mechanics first.  To me, the most important point is that implants save bone.  Next, they feel more like natural teeth and you can care for them easily.  Often they can be temporized immediately in the esthetic zone and that is a big benefit.

The next best approach is often a fixed bridge.  The main reason patients like this option is because they don't like to take something out of their mouth. They will require a little more effort with home care, but patients seem to adapt to the new routine.

Finally there are the removable options.  Removable has become the sad stepsister to the other options, but there have been great strides in making removable prosthetics more comfortable and attractive.  Patients seem to love the flexible partials and precision appliances and implant supported dentures add much more stability than dentures in the past. 

I used to think of presenting replacement options as good, better, best; with removable as good, fixed bridges as better, and implants as best.  In most cases, I still feel that dental implants are best, but the other options have a lot to offer and should always be presented as an option.  Always make sure to find out what your patient wants and what they can afford and work with them to make the choice that's fits them the best.

The Four Destroyers of Communication

"Feelings of worth can flourish only in an atmosphere where individual differences are appreciated, mistakes are tolerated, communication is open, and rules are flexible - the kind of atmosphere that is found in a nurturing family."               ~Virginia Satir~

Communication can be the make it or break it point in a relationship, whether personal, or professional.  It can determine whether an acquaintanceship progress to friendship, whether a business relationship becomes a partnership, and it can enhance or destroy any of them.  

The problem is, we don't always see what we are doing, how we are affecting the other person, what their take is on us, or even that we might be wrong.  Sometimes, the other person has to knock us over the head, or dump us on our head to make us look at what we're doing.  If there ever was an Aha! moment, that's one.  The moment we realize that we've jeopardized a friendship, a job, a relationship...maybe something that means the world to us and we've just wiped it away.  Because we had to be right; we were so sure we were right.

Words can be great and I love the way you can put them together and make an ordinary statement have more power, excitement, and meaning.  Unfortunately, used the wrong way, words also have the power to make a negative, critical statement more stinging and wounding.  One thing to remember is this: a nice positive statement is nice at the moment, but starts dissipating as time goes on and must be reinforced with consistent kindness and nurturing.  A negative, hurtful statement sticks and keeps on giving.  One positive statement does not wipe out the impact of a negative one, sorry, it doesn't work that way.  People can accept praise and kindness as their due because we all want to be treated that way.  But, you're foolish to think you can wound with words and get the same dissipation of the effect.  We flinch from hurtful statements and once hurt, we examine them, roll them around in our minds and protect ourselves from more injury by attacking back, or becoming defensive.  The experience subtracts from any good will that has been built up in an increased proportion and makes it harder for trust to be rebuilt.  

I want to help you avoid the pain and anguish that accompanies the 4 following communications destroyers.  If you don't listen, you can't complain, because I'm telling you, as usual, from personal experience.  

1. Criticism - to find fault with; point out the fault of.                                 What's not to love about that?!  It's so easy to fall into the habit of criticizing.  We tell ourselves that we're trying to help.  We can see what's wrong and we just want to fix it.  Really?  Are you sure?  Maybe you just want to be smarter.  Maybe you have to make the other guy wrong so you can be right, and therefore better.  I don't think anyone actually thinks that, but we don't consider that it may be the effect on the other person.  Whenever we start a sentence with words like, "You don't...You never...I want...I feel"; we may be getting ready to unleash some nastiness.  Better think about how it's going to sound to the other guy, and how it will make him respond.  You can turn an angel into a devil by making her feel that you don't think she's good enough, smart enough, or capable enough.  And pretty soon, she's going to turn around and stick the pitchfork you forced upon her right between your ribs.  So cool it with the criticizm.  When you think something needs to be different, address the problem, not the person.  And cool down first, temper leads nowhere good.  If the problem is serious, it will still be there, and you'll be more rational about it if you wait and take the emotion out of it.  The fiery Italian side of me gets me in trouble every time.  That's right, I'm blaming the Italians.  Only kidding, I take full responsibility for my actions, regardless of my heritage.
2. Defensiveness - devoted to preventing or resisting aggression or attack; or the attempt to keep an opponent from scoring in a game or contest.                                                                                      Sometimes defensiveness is a result of getting kicked too many times, as in the case of dealing with a criticizer.  Sometimes it's just a way of not hearing what we don't want to hear.  If we react strongly enough, the other person will give up and we don't have to worry about losing a point, but often it is a mechanism to prevent injury.  When we see someone being defensive in response to us, we should first look at ourselves.  How are we talking the that person?  Are we neutral in stance, expression and word?  If not neutral, are we non-threatening?  Sometimes, even excitement about an idea can be threatening to someone who doesn't necessarily share our excitement.  Better to approach things evenly, and let excitement build together.  
3. Contempt - the act of despising; a lack of respect or reverance               Oh boy, if you find yourself here, you've got some real repair work to do.  Contempt doesn't happen overnight, it comes from repeated injury and insult.  It's painful to be on the receiving end, but consider what it would be like to be at the point where you feel that way.  You've probably gone through a lot, and now you're sick of it.  Contempt keeps more hurtful experiences away because it keeps the person causing the pain away.  If you've caused someone to hold you in contempt the only way to fix it is to prove that you see what caused the problem and that you won't do it again.  Once the contempt starts to heal, you can work together on building a new way of interacting.    
4. Stonewalling - to refuse to comply or cooperate with.                             Have you pushed it this far?  I'll bet you wish you could just have whatever it is you said, or did back again, because you would never have said or did it if you knew this would happen!  The problem is, it wasn't that last stupid thing you said or did, it was everything that built up to the breaking point.  We think we have all the time in the world to change, to get in a better mood, or to figure out better communication skills, but we don't.  And we never know exactly where the tipping point will be.  Again, tincture of time and changing your behavior is the only way to break down the walls you helped build.  Wait, be considerate, and do your work in peace.  Consistency will hopefully help the walls come down.  

So, if you've already messed up, you'll probably have to suffer while you wait for healing.  If you are on your way to a mess, stop it already!  You'll end up sorry and you'll hurt someone.  Our experience of life is a result of the choices we make about the things we can control.  We must pay attention to our words and actions because it's really all about relationships.  You can have all the money, possessions or vacations you want, but if your relationships are not right, you won't be happy.

 

What's Your Motivation?

Have you ever tried to talk to someone and thought it would be just an average, everyday conversation, and found yourself in the middle of an argument or drama?  You  walk away stunned, wondering what is wrong with the other person?  You really don't even consider wondering if it had anything to do with you, because you know you were just trying to pass on information, advice or constructive criticism, right?  Maybe you should wonder.

Often, we go into a conversation without checking ourself first.  Actually, we probably do that most of the time.  We get an idea or thought, we think it's valid, maybe even amazing, we approach another person with it, and we get a reaction that we never imagined.  

That's because we didn't stop to think about what was motivating us.  It is a rare event when we do or say anything doesn't have some self-interest involved.  Have you ever listened to someone talk about something they did for someone else?  Did you notice that somewhere in the telling, you'll hear something that gives the speaker a little pat on the back.  I do it all the time myself, so don't be afraid to admit it about yourself.  

I was at a meeting recently during which a new member of the group decided to give some "constructive criticism."  Just starting a statement with those words tends to put everyone on high alert.  It seemed that she felt we should format our discussions differently because she was used to a different format.  As she conveyed that idea, she managed to make remarks that made at least 3 people feel that she was criticizing them.  You could feel the tension spread across the room and the conversation basically became very stilted.  To top it off, she then monopolized the rest of the conversation.  So, what was her motivation?  She wanted things her way and her way meant she talked and everyone else listened.  What was the result?  A lot of resentment and hurt feelings that two of us had to spend a lot of energy reversing.  In many instances, there is no one who is willing to spend the energy recovering a situation like this and it snowballs into a mess.

Can you think of a time in your practice when this has happened?  What was the motivation?  It was probably that someone wanted to be in control, to feel important, or to put someone else "in their place."  It's amazing how quickly things can go downhill if no one steps in to call the person on it.  I think that the best thing to do is just to ask the person for clarification first.  If that doesn't make them see what they're doing, just go through a description of how their scenario or statement might pan out.  By doing this you'll get a good idea if their motivation was innocent, but misguided, or self-interested, and so might they.  I don't think that most people start out wanting to deliberately hurt others, but I do think that we often are driven by self-interest without consideration of others.  

I don't think that there are many people who set out trying to act like a jerk, but I do think that sometimes things start to go off in an unintended direction and before you know it, all hell breaks loose.  It's happened to me before and it's kind of stunning.  So, instead of just reacting, take a minute to try to figure out the motivation.  It doesn't matter whether you're the culprit, or on the receiving end, figuring out the motivation lends clarity to a situation and affects the outcome.  You may be able to just stop a situation that's going sour in it's tracks, before the real drama begins.  Since drama is highly overrated, you might want to give it a try.  That is, unless you enjoy drama, and that leads us right back to motivation again.

Well, What Did You Expect?

People don't always do what we expect them to do.  Sometimes we think things are pretty clear and then we get surprised.  Often, another person has no idea of what we were expecting and was just acting in a way that made sense to them.  

Let's think of a situation in which a patient is being unreasonable, or even somewhat abusive to a staff member.  The dentist walks in and tries to placate the patient while the staff member is fuming because he didn't put that patient in his place and let him know that he can't talk to her in a demeaning manner.  For his part, the dentist is irritated that the staff member is taking the patient's behavior personally.  He expects her to just shrug it off, but she's standing there pouting.  When the patient leaves, the dentist and staff member are less than cordial to each other.  Each one thinks the other is wrong and no one even thinks to look at the situation from the other point of view.

The staff member sees it as a matter of loyalty, perhaps.  She gives her best to her patients every day.  Doesn't he realize that she'd do anything to help the practice?  Why didn't he return her loyalty by sticking up for her?  She may start making a list of all she does for the practice and all the times that she was taken for granted.  Pretty soon she has a long list of all she does, and of all the ways her boss has proved he doesn't care.  Now, the situation with the patient lasted for about 2 minutes, but she's spent the better part of the morning obsessing about it and getting more and more agitated.  This can't be good.

On the other hand, the dentist is baffled.  The staff member has a role to play, and part of that role is dealing with patients and making all interactions with them turn out well.  Sure, that patient earlier this morning was pretty gruff, rude even, but so what?  He expects her to just deal with it and move on.  She's a good employee and he appreciates her, but sometimes he doesn't understand her.  The thing he doesn't get is why she seems to be mad at him.  He didn't say anything mean to her.  Why is she taking it out on him?  As the morning goes on and her attitude gets worse, he's starting to become angry.  Nope, this won't be good.

Finally, the morning is over and the staff member comes into the dentist's office and closes the door.  Amid tears and accusations she tells him she's disappointed that he let that patient treat her so badly.  He's astonished.  So that's why she was so mad?  What did she expect him to do?  Argue with a patient over something that was no big deal?  He cuts her off and tells her to grow up and suck it up.  It's her job to deal with all kinds of people and situations and he's not going to argue with his patients.  After all, they're the ones who pay her salary.  She storms out and tells herself he just doesn't care.

Neither one stopped to think about the other person's point of view and so the argument rages.  Neither one considers that they just don't have the information they need about the other's reasons for their behavior, so they get nowhere.  Nothing gets resolved and they both walk away nursing hurt feelings and thinking that the other just doesn't get it.  Well, that's true, they can't get what they don't know.  

Sometimes the behavior that seems completely reasonable to us, is completely unacceptable to someone else.  Telling off the patient would have been something that the staff member would have seen as a sign of loyalty and respect on the dentist's part.  Does the fact that he didn't do it mean that he doesn't respect her or feel loyal to her?  Not necessarily, it may just be something that he is not willing or comfortable doing.  Does the fact that the staff members feelings were hurt by the patient and then by the dentist make her a bad employee?  Of course not, she just wants something that never occurred to him.

Next time they could avoid a miserable morning by putting themselves in the other person's shoes.  We have to be willing to see it the way they see it, without our own expectations clouding the picture.  That doesn't mean we have to do it there way, just respect their opinion.  In other words, don't get mad, get curious.  It's a lot more pleasant than arguing and you'll build stronger relationships while you're at.  

Do You Take My Insurance?

How do you talk about dental insurance in your practice?  Does everyone in your office understand how you handle insurance?  Do your patients?  A good description of the way your practice handles dental insurance should be covered in your practice's financial policy brochure.  When new patients enter the practice someone should go over that policy with them and let them know what they can expect from the practice.  All staff should be confident in discussing dental insurance plans with patients.  The person who handles insurance in the practice must be well-versed in your state's insurance rules and regulations.

In these challenging economic times, patients want to know that they will be able to get as much help paying for their dental care as possible.  Even fee for service practices would be wise to use their computer software capabilities to quickly generate forms for their patients and to go a step further and be willing to assist to some degree with complications that sometimes arise.  Some practices extend 3 months grace period with no interest which allows patients to receive their payment and ask for an amount at the time of service with the remainder divided over the three months.  Often the patient receives their payment and pays the balances well before the three months is up.  Patients appreciate the consideration and seem to accept treatment more readily. 

One of the most confusing things for patients is the PPO plan.  Patients are starting to worry when they receive a notice from their insurer saying that their dentist is not in-network and that they will receive better coverage if they choose an in-network provider.  The wording often implies that they must choose an in-network provider and that's often not the case.  Be careful to assure them that they can still use their benefit with you and explain that while they may see less of a percentage per procedure, they will still have a reasonable coverage amount available to them.

Finally, patients often don't understand the difference between medical and dental insurance.  Dental insurance is great for preventive care and general restorative care.  For patients who are in good dental health and don't have the need for extensive restorative care, it should cover a good deal of their treatment.  Medical insurance gives the most bang for the buck when things get big.  Most medical insurance has a deductible that must be met before the patient receives any real help, but if they are facing surgery or an extensive illness, medical insurance should be a big help.

Like most things success depends on knowledge and preparation.  If everyone knows how to interpret the patients plan, how to explain it so they can understand, and how your practice handles insurance, it can be a great benefit to the patient and the practice.  The next time a patient asks, "Do you take my insurance?", how will you answer?

It Takes Two

"It takes two to speak the truth – one to speak and another to hear. "

                                                                            –Henry David Thoreau

How many times have you been in a conversation with someone and realized that they weren't really listening to what you were saying, they were just waiting for you to take a breath so that they could start talking.  Let's face it, we all love to hear ourselves talk.  The problem is this, if we only talk and never listen, we never learn anything new.  We only know our own truth, and it's not always the real truth. 

Think about a time when you've tried to give critical feedback.  As a manager, you know that a lot happens before you actually utter the words.  You've already spent lots of time thinking about the problem, documenting the behavior, and figuring out how to approach the person in a positive, yet firm manner.  You've put all that effort into this and now you're finally started the discussion.  Unfortunately, you find yourself face to face with someone who doesn't want to hear a word you're saying.  You see the shades come down as they go inside their head to prepare their defense.  There's not a chance that they will even consider the validity of what you're trying to say.  Many times, a staff member would rather quit than admit you're right and try to change.

Who's to blame?  Well, maybe both of you.  How are you bringing up the issue?  Are you being positive and reinforcing their good points, or are you jumping right in and slamming them with the bad news without any finesse?  I'm not suggesting that you baby adults, but I am saying that you set the stage for success.  When you give a staff member the opportunity to feel good about themself, they can accept that a few things need work.  Defensiveness is usually in response to an attack.  People who are being attacked react by shutting down, it's a self protective mechanism.  People let in what they can handle.  Most people can handle critical feedback, as long as the delivery is respectful and considerate.

It's the same with patients.  You have to talk to them in a way that makes them willing to listen.  You also have to listen, wanting to understand so that you can find out what they want for themselves.  If you want them to listen to you, you have to appeal to their hopes and dreams, and to what's important to them.  When you listen attentively, you can then speak in a way that shows them that you heard them and understand them.  

It all comes down to respect and honesty.  It's respectful to listen when someone is talking and it's the only way to really achieve true honesty between people.  Show that you'll do your part and you may find that others will do the same.

Yadda, Yadda, Yadda...Not!

I've been talking about phone skills lately because it's something a staff member has been struggling with in our practice.  It's one of the crucial aspects of her job, so we have to get it right.  Funny thing is, I thought she was just fine with it.  When I'd walk by, or be in my office across from her desk, she sounded good, but every now and then I'd notice some uncertainty.  That uncertainty prompted me to ask a friend who's a consultant, to do a phantom call posing as a new patient.  That's when we realized we had cause for concern.  She became stiff and unwelcoming when an unexpected question was posed.  The scripts that were meant to help her, ended up stunting her conversation.  As a matter of fact, what should have been a congenial give and take conversation, became a stilted, mechanical, awkward monotone.  Now what do I do?

I think it's a great idea to use phantom phone calls with your staff.  Just be honest about it.  You're not the cop sitting in the bushes along the highway just waiting to catch someone doing something wrong.  You have to make it clear that the phone calls are a teaching tool.  That gives you the responsibility of presenting the results in a productive way.  If you go to the person and say, "You sounded horrible!", you're going to be faced with tears at the very least, or watching her walk out the door at the worst.  Tell her you've asked someone to analyze her phone style and that you've got some information that you'd like to go over with her so that you can help her increase her phone skill.  Be positive, it's hard to hear that you've been judged and found lacking. I also use a recorder that attaches to the phone.  That way she can either listen and judge herself and see what she likes and doesn't like, or we can review it together.  The point is to bring the responsibility back around to her.  People change and do better when they recognize that there truly is a problem and they know what they need to fix.

In our practice we are very open in staff meeting about our strengths and weaknesses.  Our long term staff are used to it and completely comfortable with discussing issues openly.  New staff need time to get used to it, but we don't let them off the hook, we just keep reminding them that we all want to help them grow.  So, back to the phone call.

Every phone call leaves an impression on the patient who is calling, and also on any patient within earshot.  Be welcoming and warm.  Avoid slang or lazy answers like Uh huh, Umhmm, and don't buy time with Ummm.  Start listening to staff talking on the phone this week and you'll notice it.  Just pointing it out to them will get them noticing how often they do it.  Always be polite.  I know I live in the South, but I'm born a Yankee and I've adopted "Yes, ma'am and No, sir, quite easily.  It sounds good and people like politeness.  Get involved in the call, don't just let it bounce off of you.  Sit up straight and don't prop your head up with your hand.  Remember, the caller can't see you, but patients in the office can.  I also think you speak differently when you sit alertly rather than when you sit slouchy.  Be professionally casual.  What I mean is, don't be so professional that you come off sounding stiff and cold, but don't be so casual that you sound rude or ignorant. 

Here's an example of a staff member that would sound too casual:

Staff member (SM)Dr. Morgan's office.

Patient (Pt) I'd like to make an appointment.

SM - What's your name?

Pt - Linda Zdanowicz

SM - Are you a patient?

Pt - Well, I've been coming there for 20 years!

SM - Well, it's hard to remember every patient.  What's your problem?

Pt - I have a toothache.

SM - Well, we're really booked up today, we can see you at the end of the week.

Pt - What will I do till then, it really bothers me?

SM - Well, maybe you could take some Motrin or something, that's all we've got open.

Ok, maybe that's extreme, but I've been the patient getting those kind of responses in healthcare offices before.

Here's an example of a staff member who is being too stiff:

SM - Good morning, you've reached Dr. Morgan's office.  This is Julie.

Pt - I'd like to make an appointment.

SM - Can I have your name please?

Pt - Linda Zdanowicz

SM - When were you last seen?

Pt - I was there in March.

SM - What can I do for you?

Pt - I have a toothache.

SM - Please answer the following questions:  The sm then rattles off a list of symptoms.

Pt - It started last night and it's killing me, can you get me in?

SM - I'm looking at our schedule and it's really tight.  Can you wait till tomorrow, we have some emergency time open at the end of the day?

Pt - I'd really prefer to be seen today.  I don't want to go through another night like last night.

SM - If you insist on coming in today, you can come by at 3, but I can't promise you that you won't wait a long time.  We'll be working you in between our scheduled patients.  You may have to sit in the waiting room a while.  I'd bring a book or something.

Pt - Well, I'll just have to wait then, because it's killing me.

Here's a better scenario:

SM - Good morning, Dr. Morgan's office.  This is Julie, how may I help you?

Pt - I'd like to make an appointment.

SM - Certainly, can I have your name, please?

Pt. - Linda Zdanowicz

SM - Hi, Mrs. Zdanowicz, when were you last seen in our office?

Pt -  Please call me Linda, I was there in March.

SM - Oh, yes, I see you were in for your recall appointment and everything was great.  I began working here in April, so I haven't met you yet, but I'm looking forward to it.  How can I help you today?

Pt - I am having a toothache.

SM - Oh, I'm sorry to hear that!  Let me ask you some questions?  When did it start to bother you and does it wake you up at night?

Pt - Oh, yes it does!  I woke up last night with a terrible toothache.

SM - Did you take anything for it, and did it help?

Pt - I took 4 Motrin and it did calm down after a while.

SM - Oh, good!  Have you noticed anything else?  Does it hurt when you chew or when you drink something hot or cold?

Pt - Yes, all three.  It's the worst toothache I've ever had.

SM - Oh, I'm so sorry Linda.  Well, let's get you in right away so we can get you out of pain.  Our schedule is tight today, but this is important.  We can see you at 10 am.  We'll do our best to get you right in, but please understand if you have to wait a few minutes.

Pt. - Oh, I'm just grateful to get in so fast.  The last time I had a toothache at my old office, they made me wait till the end of the week.  That's one of the reasons I left.

SM - Oh no, we always see a patient who is having pain the same day that they call.  We try to treat you the way we'd want our family to be treated.

You see the difference.  In the first call the patient was more of an intrusion than a person.  In the second, the staff member was using a script and a set of rules that she wasn't going to veer from.  She got the patient in, but she didn't seem to care about her problem.  In the last example,the staff member used empathy and concern to make the patient feel welcome and cared for.

Some staff members answer the phone and when the patient starts to speak, the staff member just hears, "Yadda, yadda, yadda."  It's all the same, they all call for the same reason.  They're always complaining or wanting something.  That attitude carries through the phone line.  What you want is a staff member who is responsive to what the patient is saying.  When a staff member asks a question, but doesn't comment on the patient's response, it leaves the patient feeling like she's being interviewed.  When the staff member responds appropriately, with concern and empathy, the patient feels like somebody cares.  And isn't that something that any of us really wants?

Righteousness or Relationship

We've all been there.  We get into a verbal scuffle with someone and before we know it all hell has broken loose.  It's not what we were looking for when we uttered the first word, but all of a sudden, we're in the thick of it.  Tempers have flared, angry words have been discharged and with equal amounts of shock, dismay and anger you realize that it's all turned into something you never intended or expected it to.  Now, both parties awkwardly extricate themselves and retreat to access the damage inflicted to themselves and to consider the pain they caused the other.  How did it all happen, and how can I be vindicated?  After all, I'm right, aren't I?  And what will the other person ever be able to do to make it up to us?  The scene has been set for drama and a long drawn out misery.

It doesn't have to be that way.  Yes, people will always have misunderstandings and they will say things in the heat of the moment that they don't mean and wish they could erase.  It often seems that those are the things we are determined to store in the formaldehyde of our mind and preserve forever, ready to bring them out to examine at every next stressful opportunity.  Here's what we can do instead.  We can simply get over it.  We can look at the other person and see the innocence and love in their eyes.  We can see the hope that we will be generous with our forgiveness and place more importance on all the good that we have experienced with them.  We can embrace their humanity and forgive and go.  We don't have to be right.  We can push the bad feelings away and respect the relationship.  We don't have to go through days of strangeness, discomfort and we can just be how we've always been with each other. 

We all work in a profession that brings a certain amount of stress with it.  We will have misunderstandings, we'll say hurtful things, we'll disagree and we'll argue.  Make it your mission to let normal back in as soon as possible.  It's easy, just do it.  Wipe the hard words out of your mind and chalk it up to one of those things.    Your day will be so much better and someone will be grateful to you.

What Do You Have To Offer?

Selling dentistry?  Selling yourself?  The professional hates the sound of that, but the business person inside the professional knows that it's necessary.  And guess what?  It doesn't have to be so bad.  You don't have to put out a lot of cheesy ads, buy TV time, or offer coupons to let people know what you have to offer.  You have to begin by knowing what people want, what will make them brag about you, and then developing a vision and sharing it with your staff. 

We often figure that the sign says it all; a dentist offers dentistry, what else do we have to say?  We can even add a tooth to the sign or business card just in case there's any confusion.  When you want to buy a puppy, you go and check out the litter and they're all adorable.  They all look pretty much the same with some variation in color, but the one you choose is the one that sells himself to you in some way.  You're not going to choose the one that stays over in the corner and doesn't pay much attention to you, as if he thinks, "I'm a puppy, I'm cute, what more do you want?  If you want me, I'm here."  No, the one you choose is going to work for it.  He's going to wiggle all over, shower you with kisses and to seal the deal, he'll roll over and stare lovingly into your eyes.  How can you resist, he wants you as much as you want him.

Now, I'm not comparing dentists to puppies, but the theory's the same, patients want to be courted.  They want to feel like they matter, that they're worth pleasing.  So, first you have to decide what you are offering.  Are you going to provide fillings and extractions (that gets people excited), or are you offering a partnership in a lifetime of oral health that will allow patients to live their lives comfortably and more healthily overall?  Basically, you're offering a lifestyle. 

When your patients think dentist, what comes  to their mind first?  Is it the aroma of Eugenol hitting them in the face as soon as they enter?  Is it a disinterested receptionist blankly telling them to take a seat?  Do they then wait in limbo until an equally bland staff member shoves open the door and mumbles their name, then marches them back to an operatory?  Do they then spend time in second limbo until the dentist finally rushes into the room, hurriedly greets them and proceeds to inject and run, leaving them wishing it was all over?  Are they basically a thing in the chair during the procedure only to be treated to the same dull receptionist waiting for them to pay at the end?  It happens, and lots of people think that's just the way it is when you go to the dentist.  Why do patients tolerate it in their dental practice and why do practices accept it for themselves?  Because we don't think about what should be offered or expected.  We just go with what we've gotten used to.  Time to think again.

Here's a better scenario:  your patient walks in and is greeted warmly by your receptionist who remembers that the patient has been on vacation to see her grandchildren in Florida since her last visit.  She asks about the visit and comments on how wonderful the patient looks.  Surely, it's a result of the warmer weather and the joy in seeing the kids.  She offers her a beverage and then let's her know that the hygienist will be with her in five minutes.  In the meanwhile the patient has a variety of current, popular magazines to choose from.  If she uses the restroom it will be clean and well stocked with disposable, pre-pasted toothbrushes, good smelling soap and hand lotion and some mouthrinse.  The receptionist will have made sure that everything is in order on a routine check.  The plants in the reception area will be healthy and the patient will feel like a welcome guest.  When the hygienist is ready she will go to the patient and greet her and escort her to the room, walking next to her rather than away from her and expecting her to follow.  Once in the room, a neck pillow will be waiting because the hygienist noted that preference on the patient's chart.  They will then have a conversation about the patient's health since the last visit and the hygienist will proceed with an interactive exam and prophy.  By explaining what she is seeing and what it means for the patient, the hygienist is educating the patient and giving her the ability to make good, informed decisions about her oral health.  When the dentist enters for his exam, he's been briefed by the hygienist and he and the patient can have a good discussion about the patient's treatment choices.  This patient never feels like a thing, but like a valued, unique individual. 

When it's time to leave, the receptionist inquires about her treatment experience, professionally collects payment and makes a future appointment.  The patient leaves to meet a friend for lunch and tells her about the wonderful treatment she received at the dental office.  Coincidentally, her friend just came from a dental appointment, too.  As a matter of fact, she's the patient we discussed in the first scenario.  She listens in amazement and mentally compares her experience with the one her friend is raving about.  She asks her friend who her dentist is because that sounds like an experience she'd enjoy a lot better than what she's gotten used to.  Her friend pulls the dentist's business card out of the nice little zippered take home kit she received and another word of mouth referral is gained.  When people like what you have to offer, they tell other people about it.  But, then again, when they don't like what you have to offer, they tell other people about it.  So, have you thought about what  you have to offer?

Watch How You Say It

    We're snowed in so I'm watching TV and an On-star commercial just came on.  That's the system that's in cars now so that if you have an accident, it's monitored and someone comes on through a speaker to see if your ok, and whether you need an ambulance.  The on-star person sounded so concerned and reassuring, and I found myself wondering if the real responders sound the same way.  Obviously, someone realized that concerned and reassuring is how someone should sound in that circumstance.  I bet they all don't really sound that way though.

    I was checking messages on the office answering machine and there was one from someone who wanted to ask my boss's opinion on something for their publication.  This person sounded like she hated what she was doing.  Her voice was monotone and almost as if she expected to be rejected.  I've noticed the same thing with a toothbrush manufacturer (who shall remain nameless) whose representatives sound anything but happy to sell you anything.  I've complained before and received an expensive toothbrush for my suffering, but nothing's changed.  They still sound unenthusiastic, and sometimes sarcastic when I call to place an order. 

    Think about how your phone is being answered in your office.  Do you just assume that your front desk assistant sounds warm and pleasant?   Don't take a chance, call your office and find out.  Have a friend call and ask some challenging questions and see how she responds.  How many times does the phone ring?  Does everyone feel comfortable answering, and are they doing it right?  I called two different offices last week and was put on hold immediately without the person who answered allowing one word to escape my lips.  Sorry, that's rude.  If your phone rings so much that your patients are put on hold upon answering, you may need a second person to help answer the phone.  The phone is your life-line to your patients.  Don't let anyone cut that line on you.

    At your next staff meeting, do some role-playing.  Staff usually hates role playing so have some Hersey's miniatures on hand to loosen everyone up a little.  Participation = candy.  Yay!  Now, pair up and have one person be a caller and one be an answerer.  Everyone else votes on whether the caller stumped the answerer, or whether the answerer kept her cool and outlasted the caller.  The winner gets extra candy.  Then, ask if anyone has ideas for how the call could have been handled better.  All idea offerers get candy, too.  The candy is just for fun and to make people less shy about role playing.  The role playing is important because it lets you see how things stand right now, and gives everyone a chance to take part in making a change. Decide how you want your phone answered and let everyone take a turn practicing.  I suggest, "Thank you for calling Dr. __________'s office, this is __________, how may I help you?" and say it with a smile.  Smiling while talking really does influence the tone of your voice.  No slouching or holding the chin in the hand either, somehow that lends a note of disinterest to the voice.  In addition, it looks unprofessional to patients in the office.   Never underestimate the power of the phone call.  Every call counts, so make sure you make the most of the opportunity the caller is giving you to impress them. 

Communication - You Can't Get Anywhere Without It

I just read a really good article by Joshua Polansky in Dentistry IQ.  Joshua is a young dental lab technician who has been fortunate, and smart enough, to learn the value of communication very early in his career.  Fortunate, because it will add depth and pleasure to his work, as well as great satisfaction.  Smart, because many of us never learn that if it's not about the person or patient first, it's all just superficial, even success.  Read the article and you'll agree that Joshua is a very insightful guy.

As usual, I started thinking about how his ideas about communication could apply to my work as a manager and dental assistant.  So many times, I talk to our staff members and wonder if I made a difference or impact.  Reading Joshua's article made me realize that I often see these conversations as a way to get the information, correction, praise, etc. to the staff member, but does it really get in?  I wonder now if when I've walked away satisfied that I'd made my point, was it really just yadda, yadda, yadda to them.  I imagine that, in reality, my words may have just been skimming across their consciousness without ever penetrating.  And why not, if I'm not open to them, why should they be open to me? 

In my own defense, there are many times when we have a good exchange of ideas.  Joshua says that the technicians job shouldn't be thankless, and I have to admit that there are times that I feel that a manager's job is just that, thankless.  I sometimes wonder if anyone realizes the amount of thought and effort that go into managing the practice, or if anyone cares.  But, why should they?  I'm doing my job.   One thing that frustrates me is a staff member who tends to be dismissive of some of my ideas, even a little condescending.  My reaction is usually to feel annoyed and somewhat hurt.  After all, how would she like it if I belittled her work?  But, is that what she is really intending to do? And even if it is, isn't it my job to figure out how to resolve that?  Why should I expect her to think all my ideas are good?  Does she have a right to feel the way she seems to feel?  Does she have a right to be so obvious about it?  Does she even know how she's coming across to me?  Maybe a little communication could lead us to a better understanding.  Maybe even a better relationship.  At this point our relationship seems to be one of grudging tolerance.  It would sure be a lot more enjoyable to elevate it to the level of accepting tolerance.  We can work up from there.

Apply the thoughts in Joshua's article to every aspect of your work with your staff and patients and see how much more enjoyable your worklife can be.  Sometimes it's hard to remember that communication has two goals; to listen as well as to be heard, but if we want to succeed and enjoy our careers, I think we need to figure it out.

Listening

    I'm involved in Marc Cooper's Mastery of Office Management Program and our homework for the last two weeks has been listening.  I am amazed at how hard it is for me to turn off my own thoughts so I can manage to actually really listen to others.  I'm not happy with this realization, but better to know it so I can try to do something about it.

    If I had a dime for every time someone told me I'm a great idea person, I'd have  a lot of dimes.  Ideas just come to me.  Sometimes I even wake up in the middle of the night with 2 or 3 ideas for something that would be just great to do in the practice.  People like to hear my ideas and think that I always know the right thing to say.  So, why should I listen more?  Maybe I meant to be talking more than listening.  After all, I'm so good at it, right? 
    Well, I got a lesson in the value of being listened to the other day.  There was a situation one morning that left me feeling hurt and upset.  At the moment, I didn't really know where to go with what I was feeling, my boss didn't know a lot of the background behind the reason for my distress and so he couldn't really appreciate or understand how I felt.  It was very real to me and all the more frustrating because it threatened to put us at odds with each other, which would have made the situation all the more dismaying for both of us. 
    We got through the day, talked a little, but I still felt like a solution was not reached.  The next day I got up and felt like I'd love to just turn off the alarm and sink back into the pillow and forget about that thing called work.  I pushed myself to get moving and made it through the day with less than my usual enthusiasm, but satisfactorily as far as I was concerned.  At the end of the day I was talking to my boss in his office and he told me that he didn't like seeing me feeling the way I was, and that seeing me frazzled would affect the way the staff looked at me as a leader.  He told me he wanted to help me find a way to breeze through stress like this without  letting them see me sweat.  Then he listened to what I was dealing with, how I felt about and we talked about how to handle the next situation like this.  As I talked I could see him listening to me.  He was really considering what I was saying looking at it from my point of view.  Finally, he said, "You sound like what happened makes you feel separate from everyone."  Exactly!  He put into words exactly what I was feeling.  I didn't even know the word for it myself until he said it.  I could see him replaying it all in his mind and seeing it how I saw it.  I don't know if he agreed with my point of view, but he saw it and accepted it for what it was.  And suddenly, the weight lifted and I felt better. 

    If he had sat there and talked and told me how I should have felt and how I should have handled the problem, I would still have felt isolated.  Instead, by really hearing me and considering my view of things, he stood with me as a mentor.  He showed me that listening is a performance art of wisdom and grace.  It is not passive, but a dynamic form of interaction.  Listening validates, it says, "You're worth the time it takes to hear you out."  Listening inspires.  It builds loyalty and gives you influence with others.  Listening is mature.  It means you can control yourself and your own impulses long enough to give someone else a chance to give you the information you may need to really know what is driving their reaction.  It allows you to be wise.  With all it has to offer, listening seems like a worthwhile endeavor.  I know I can talk, in the future I'll listen more.  I want to make someone else feel the way my boss made me feel.  That is something to aspire to.

That Explains It!

"The rule is perfect: in all matters of opinion our adversaries are insane."

                                                    ~Mark Twain~

    That explains the nonsense we've been dealing with from the specialist's office I wrote about last week.  It's as good an excuse as any since it seems like they would like to keep it current, and that seems insane to me.  I got a call from their office manager today and she started out sounding like nothing ever happened.  "Works for me" I thought to myself.  The pleasantries didn't last long, however, before the end of the short conversation she managed to work in at least 3 contentious comments.  

    I'll be honest, my knee-jerk reaction was to give as bad as I got.  I'm happy to report that something wise fought it's way to the surface and overrode that initial temptation.  Something inside me just whispered, "Nah, don't do it, let her be a jerk all by herself."  Let me tell you, I grew up in Brooklyn, NY with 2 brothers.  Smackdowns come easily and I could have left her wondering what ever possessed  her to mess with a city kid.  It was infinitely more satisfying to behave like a grown-up.  Maybe I'm getting old or something, but it was.  That brings me full circle around to one of my favorite ideas from The Success Principles:  E  (event) + R (reaction) = O (outcome).  In this situation the aggressive event was met with a neutral reaction, resulting in a neutral outcome.  Do you see how the neutral reaction always gives you control of an outcome?  Same with a positive reaction, except a positive reaction has the bonus possibility of bringing about a positive outcome.  Only negative begets more negative.  Do you see the freedom that offers you?  It's like a get out of jail free card.  You always have it at your disposal.

    So, is this other office our adversary?  Only if we choose to allow them to be.  Isn't that something?  They can't be our adversaries without our permission.  If we choose to continue to be positive or neutral, we drive the relationship.  They can try to grab the wheel and steer us down a dead end, but we can determine to stay the course.  No helplessness, no victimhood, no poor us.  Yeah, I like the way that explains it.

I Don't Blame You

    Have you ever noticed how hard it can be to get your message across when you are trying to tell a staff member that something needs to be done better or differently?  Basically, people almost automatically assume that if something is wrong, it only stands to reason that someone is going to get blamed.  It's a knee jerk reaction that stands in the way of getting to a solution. 

    I recently decided to talk about blame at a staff meeting.  As I was saying that just because I may need to tell someone that there is a problem with something, it doesn't mean that I am placing blame on them, so they don't need to feel defensive, one person started defending herself for being defensive earlier that day.  When I told her that she was proving my point, she defended herself about that.  No matter what I responded, she defended.  After about 10 minutes of that, with the staff quietly observing, I asked her what solution she felt we had reached.  She thought for a moment and then began defending herself for not getting to a solution.  I stopped her and asked her if she could even identify the problem at that point.  You got it, she couldn't. 
    I reminded everyone that the original issue was about the futility of blame.  The staff member said, "Well, I guess I proved your point, didn't I?"  I couldn't have paid her to have proved it more thoroughly.  Blame is useless.  When a problem arises, I immediately want to find a solution, especially if it involves a patient.  That doesn't mean I don't want to understand why the problem occured, of course I do.  Understanding is not blaming.  If people know they are not going to be blamed, they will be much more likely to admit to mistakes so that you can help find a solution or teach them how to do the thing right. 

    Blame misplaces focus.  The focus should be on solutions when problems arise.  As managers, we have to be careful not to automatically fall into blame mode when something goes wrong.  Examine your feelings the next time a problem arises at work.  Do you feel like you need to find someone to blame so that no one thinks you messed up?  Are you reacting in anger and placing the blame on someone in an effort to get the spotlight off of you?  Blaming and shaming have long-lasting effects.  So do supporting and teaching.  Which makes more sense to you?

You Don't Say

    Ok, so I'm over the weird episode with the specialist's office last week, sort of.  No really, it'll be a gnat at the back of my brain whenever I deal with them, but hey, that's life.  What have I learned from that episode?  Good communication is the responsibility of the participant who most wants to go forth productively.  In other words, if you want to break free of the trap of immaturity, insidious nastiness, and useless blaming and defaming, if you want to move forward positively, you must make the decision to cut the crap and say, "Enough."

    There are many ways to verbally express yourself and just as many reasons.  Some folks just love the sound of their own voice.  They love to sing their own praises, or pontificate on some subject on which they feel they have some unique and amazing viewpoints.  (I know I've been guilty of pontificating.  I know it for sure because the truth is, you can hear yourself when you're doing it, you know you can, and honestly, you think you sound amazing at the time.)  Ok, enough of my confessions.  Some people love banter, my boss and I are full of banter, hopefully our patients enjoy it as much as we do.  Some people just love the give and take.  But, for some, putting someone else down, makes them feel better about themself. 

    Knowing this, there are choices to make.  Sometimes there is strength in the spoken word.  Sometimes, the ability to remain quiet is where real strength of character can be found.  And sometimes, the only way to end an out of control, spinning in circles argument is to simply and gracefully, step away.  It's so effective, because once you stop participating, there's no where left to go with it.  Now, if you can find it in yourself to agree to just move on in cooperation, you'll have the satisfaction of having done the right thing.  Even though it may seem like there would be a lot of satisfaction in shooting off the perfect come-back or having the last word, sometimes what you don't say is infinitely more powerful than a stunning rebuttal.

Critical Feedback

    There is no harder conversation to have than one in which you will be passing on critical comments.  Let's face it criticism is hard to hear.  It's also hard to give, especially if you feel that the person or people you're giving it to won't take it as you intend it. 
    I had to pass on some information to a staff member at a practice that we refer to the other day.  I asked for the staff member who was concerned in the issue, told her what the problem was and felt we'd had an amicable talk.  I wasn't annoyed with her, I didn't even know for sure if she was at fault.  I just wanted to give her the information that I'd been given about a situation and let her take it from there.  I went on and felt we were done with it.  Well, hold on a minute.  Her office manager called me back and asked me if I was having a bad day.  I was mystified at why she'd ask that and she told me she felt it might explain why I'd attacked their staff member.  Since attacking is not my style, and I'd felt we'd had a good conversation I was shocked.  I told her that I hadn't attacked anyone, but that was not to be the end of it.  She insisted that I had and what should have been an acknowledgment of a misunderstanding became a mess. 
    Now, I'm incredibly stressed because I don't understand why it would benefit either practice to continue this.  I suggested agreeing to disagree and move on, but that's not going to happen, it seems.  So, how to fix it?  I was thinking about it and I've decided that I can do one more thing.  I can take my own interest out of the situation and look at it from the other staff member's view of what happened.  Obviously, she felt criticized, whether that was my intent or not.  The other om felt she needed to defend her staff member.  Maybe she feels that will build loyalty, maybe she truly feels I offended her.          There's one thing I can do if I really want to move forward.  I can acknowledge her view of the situation and tell her that although it was not my intent to hurt her, I obviously did and I'm sorry she experienced that.  Then I'm done with it.  Now, they have to deal with the fact that I'll never be able to give them critical feedback.  It may mean that eventually we won't be able to continue a professional relationship, because if our patients won't be served well because of it, we'll have to make a change.  I for one, welcome critical feedback as much as I welcome praise.  I like praise better, who doesn't?  But, I know that giving critical feedback means that the other person cares enough to risk doing it.  Most people will just walk away when they don't like something and find something else.  I'd rather be given the opportunity to rectify a problem. 
    We have to have the ability to hear criticism without letting it crush us, or taking it personally.  If we feel it is given unfairly, then just acknowledge it and move on.  It's a sign of maturity to be able to hear that we need to make changes or corrections and accept it in a spirit of goodwill.  It's a sign of humanity to be able to give another person the benefit of the doubt if they say no harm was intended and accept that. 
    For myself, I look at this unpleasant situation as a learning experience.  I will never casually pass on a critical comment again.  I will think through my words and look for any way in which I might make anyone feel defensive.  If nothing else it will be worth it to save myself days of stress and replaying the conversation. I also value my relationship with staff in other practices.  We all work better when we work together.  In the end, stress is felt by the patients and the rest of the staff and that's not what we're about.

Criticize This

"Asking a working writer what he thinks about critics is like asking a lamppost how it feels about dogs."      ~Christopher Hampton~

"People ask for criticism, but they only want praise."
                                             ~W. Somerset Maugham~

    As a manager or owner, when you see a staff member doing something wrong that you've corrected them on a few times already, what is the first thing you think?   Maybe it's, "I showed her how to do that 10 times, what's the problem?"  Maybe it's, "Oh no, how many times do I have to show her the same thing, over and over and over...?"  It gets frustrating, doesn't it?
    I'd like to suggest that when you find yourself thinking something like that, you use it as a reminder to stop and review.  What's going on here?  Is the task very complicated?  Are you confident in your ability to explain it in a way that someone who has no experience can understand?  Have you looked at it from the employees experience?  Have you asked her why she's struggling?  That question alone could open a floodgate of insecurity and pent up frustration.
    I believe that most people want to do well.  I'm also aware that there are people out there that feel entitled to come to work, do a lousy job, and have that job protected just because we made the mistake of hiring them in the first place.  But, for this, let's pretend we've already weeded them out and are dealing with someone who wants to do it right. So, let's say you just watched your employee do something wrong for the umpteenth time.  You've shown her how to do it correctly just as many times.  You've typed it out step by step and made a nice book of guidelines for her that is sitting right there next to her.  Ok, be honest now, what are you feeling?  Frustration, disbelief, impatience, aggravation, helplessness, hopelessness?  Yeah, well, to be honest, that's your problem.  Your job is to help her "get it."  When her job gets hard for her, your job gets hard for you.  The only way to make it get better for both of you is to find a way to help her "get it."  Sorry, and it's hard for me to do this, too, but you have to put how you feel about it aside and think about them.  I imagine that the person is feeling awkward, embarrassed, frustrated, aggravated, helpless and even a little disbelieving herself.  So, you already have a few things in common. 
    What if someone was going to critique your handling of this situation?  What would you want to show them?  A patient, understanding manager who worked kindly with the employee to discover a way to help them understand the correct execution of the task?  Of course you do.  So, everytime you face this situation in the future, imagine you are being critiqued on your critique.  Treat the person as you would if you knew your handling of the situation would be on the front page of the newspaper tomorrow.  If you wanted to impress him, how would you behave? 
    Now, get down to the nitty gritty.  Really see the person and work with them to get them where they need to be.  This is what you want to have happen.  You want to help them learn to do the task correctly.  In the process, you have the opportunity to create a mutually respectful relationship and to develop influence with them.  They will have an additional reason to learn.  They want to make you proud of them.  They want to show you that they have the ability that you've shown them you believe they have.  In the process, their confidence is increased, you've accomplished what you set out to do and everyone feels good about the outcome.  So, remember, no one really needs to be criticized.  They need to be lead and taught. 

Show Me

    Patients are becoming discerning "consumers" when it comes to dentistry.  Especially when it comes to anything that involves aesthetics or cosmetics.  People want whiter, straighter, more perfect looking teeth more than ever.  Or they want very natural looking teeth.  They want to know what they are going to look like when it's done.  Most important, they want to see what you can, and have done.
    What can you show them?  This is not usually an area that most dentists have a lot of experience with, but it can drive case acceptance.  People have to be able to see something in order to want it, and patients will only agree to treatment they want.  The first step in helping patients want treatment is to explain the benefits they will receive in terms of health, better quality of life and appearance.  Beauty being in the eye of the beholder, the next step is in showing them what you can and have done.  One helpful tool is a lab wax up of their study models.  Using an actual study model in comparison to a wax up will enable the patient to not only see what's wrong, but also to envision the improvement that restorative dentistry can provide.  Many photo software programs allow you to enhance and manipulate the patient's photo to give them a better idea of how they will look after restoration.
     Perhaps the most influential aide though, is a gallery of the results of the dentistry that you have provided for others.  They want to see proof of what you can do.  Time and time again, I've seen patients say, "I want to improve my smile, but have you ever done this before?"  Why just say yes, when you can show them instead.  Take the time to document the dentistry that you're proud of.  It can be as important as the degree that hangs on your wall to your patients.  Get some quality training for yourself, or for any staff members that will be taking photos.  Consider using a professional to develop some marketing media from your photos.  Check out this website for some ideas.  Even if you're just starting out, invest the time in documenting your dentistry, even if you just buy an inexpensive photo album to start with.  Don't be caught empty handed when patients say "Show me."  It may be the last step along the path to treatment acceptance.

You ARE The Boss

    I repeat, you are the boss.  Really, it's your name on the door, your years of work that earned the DDS, your reputation, your risk, your investment, your's to succeed or fail.  So why do you often find yourself worrying about how your staff will react?  How will they react to feedback?  How will they react if you change your mind?  How will they react to changes, requests, ideas or just about anything else you want to talk to them about?  What if you want to change hours?  What if you want to change the way your hygienists treat patients?  What if you want your assistant to walk the patient to the desk?  Will they get mad, roll their eyes, or heave a big sigh and look at each other as if to say, "Poor man, he thinks he can tell us what to do.  Let's just let him talk.  We all know who's in control here." 
    So, what's that about?  Have you resigned yourself to having your requests and expectations met with lukewarm, barely noticeable reactions?  Is indifference the common attitude?  Do you walk away wishing it were different?  Do you find yourself becoming passive/agressive and slipping in little sarcastic digs as you skulk off to your cave office?  Do you tell yourself you're just no good at managing your staff and wish someone would come along and do it for you?  Ahh, but who's going to manage that person? 
    I have witnessed this first hand and it's sorrowful.  I've heard the piteous, wondering queries from good-hearted, but non-assertive dentists who wonder if this is as good as it gets.  Here's the answer, it only gets better if you wake up one day and really believe, "I'm the boss.  I have the right to make requests and expect them to be fulfilled.  I have the right to change my mind and expect my staff to go with the flow.  I have the right to expect my ideas to be met with enthusiasm and my staff to step up to any challenge I may present.  I have the right to tell a staff member the truth about what we are doing together and to expect them to join me in finding solutions to problems.  I don't have to fear resentment or ridicule when I turn my back to go back to what we all come here for every day...the care of our patients.  That's not presumptuous or pompous.  That's how it should be, but somehow, for many dentists, it seems as far-fetched as owning your own island or standing on the Olympic medal podium. 
    What happened?  When did you give control of your practice, the way you work and the way your patients are treated, over to your staff?  You've probably had some great staff members along the way and wondered why they never seem to stay.  Be honest with yourself, do the rest of your staff make life miserable for any hard workers that come along?  Are their suggestions met with disinterest or ridicule?  Do you even know?  Because what you don't know will hurt you.  What are you doing about it?  If any of this hits close to home, it's time to start.  With yourself.  Be honest, what have you ignored long enough?  What drives you crazy?  What are you hoping will change?  Ok, when are you going to step up and take control of your practice and your life?  It all comes back to you.  You are the boss.

So, What's The Solution???

   

Have you ever noticed that when employees come to inform you about a problem, sometimes they almost seem smug about it?  They, very importantly and eloquently, give you the nitty gritty in all it's glorious detail, then stand back to wait to see what you're going to do about it.  You, the proverbial deer in the headlights, are in the unenviable position of absorbing bad news in front of someone who seems to be waiting to see what brilliant solution you're going to come up with.  Inside you may be screaming, "Oh come on! Why me?? What the heck is going on, why can't a day go by without something like this?!"  On the outside, you may be thanking the staff member for bringing the problem to your attention, even though you can still hear what's clamoring on the inside.  As they walk away, and this is the best part, you glare at their back in resentment and think about how nice it must be to be the person who dumps all the problems on someone else, rather than being you, the dumpee.  Oh, if you could only see your face at moments like this.  It's not a pretty sight.  I know, I've caught a glimpse of myself in a mirror as I've turned away in disgust.  It made me want todecree that black cloths be placed over all the mirrors.

    It's your own damn fault!  Nope, sorry, I don't feel sorry for you.  Wanna know why?  Because I've been you.  There were days I hated my staff for being such big babies and never solving a problem.  Then I realized something.  I grew this staff.  I was reaping the result of the seeds I'd sown.  Now, I didn't intentionally do that, but I do think that sometimes, those of us in leadership positions tend to believe that we have the best answers to everything.  I used to be quite amazed and satisfied with myself when I first started leading our team.  I would sit back and think about all the wonderful decisions I'd made, ideas I'd come up with and solutions I'd designed and think about how lucky my boss was to have me.  Gag!  Sorry, I just made myself a little bit sick just typing that.  Anyway, I realized something was wrong with my thinking the first time a staff member came up with a great idea and I felt a twinge of resentment toward her. " Hey, I'm the idea person, aren't I?  That's my job, you just get back in there and clean teeth!"  Mind you, none of this was ever uttered, it was all mindtalk, but wow!, even I was appalled at myself so I'm glad the words didn't burst past my lips.  So, being me, it was time for introspection and change.

    The next time someone came to me with a problem, I resisted the urge to give the solution and asked her what she thought we could do to make it better.  Her answer, "I don't know, that's your job", confirmed that I had a problem.  So, another staff meeting was born.  We talked about considering possible solutions whenever we saw actual or potential problems.  I asked them to take the time to be quiet with the problem and just let ideas come.  That's where the best solutions are usually born anyway, in solitude.  Knee-jerk reactions have a 50/50 chance of working in most cases.  The reason I say that is because most often they deal with the immediate problem, but not the future ramifications of the solution.  Giving yourself even 5 minutes to consider what will happen next, and next, and next again, can add clarity to a solution. 

    The next challange is to recognize a staff members great solution without worrying that you are making your own job obsolete in the process.  Once you do that, the result will make you want to do it again.  When you see the pleasure dawning on a staff member's face that their idea was not only approved, but applauded, it makes you want to encourage them to keep it up so you can see that look again and again.  It's an "I'm ok, you're ok" moment that really feels great to everyone.  The thing to remember is that leadership isn't about getting your own way, it's about leading to the right way.  It's about making everyone think and share what they think,  so that you have more choices, more input and more good ideas.  Coming to a solution together, choosing a path together, makes everyone more committed to success because they each own a piece of it.  Wouldn't you rather be a part of the process of a solution or success, rather than a bystander?
    So, what's the solution to problems?  Share the pain and share the glory.  Get out of the "me" of it, and get into the "we" of it.  Stop talking about the team as "them" and start recognizing the team as "us". Stop resenting the bearer of bad news and start helping them be a part of the solution.   If you can even entertain the idea that you may be one of the problems, that's when you'll get to the best solutions.  You just have to be brave enough to look at yourself honestly (ouch), that's the solution. 

The Truth, And Nothing But The Truth

    Telling the truth sounds simple, but it rarely is.  Ask anyone in a leadership position what it's like to be completely honest with any employee when giving feedback in a review.  It's hard to look another person in the eye and tell them there's something lacking in their performance or attitude.  There they are, hoping that you have called them in to tell them something wonderful, and you have a bomb to drop.  Set a precedent early on and let new employees know that they can count on you to be honest with them and the butterflies will eventually subside, for both you and them.  Let them know that even though something they are doing may need to change, it doesn't mean that you don't like them or that it's a reflection on them as a person.  In other words, get them to see they can accept it as information without taking it personally.
    The truth doesn't have to hurt.  You still have to tell it, but you can immediately back it up with an offer to work together toward improvement.  Have ideas ready.  Have examples of instances when this employee has risen to the occasion.  Give examples of times when you've been faced with the need to improve.  Listen to their reaction.  Are they accepting what you are telling them, or are they focused on convincing you that you're wrong.  Keep coming back with the truth.  Include good truths, too.  Tell them about how traits you admire in them make you feel confident that they can overcome the issue at hand.
    If you've ever had to fire an employee, you know that it's a lot less traumatic if you've been brave enough to be honest with the employee about how they were doing all along.  Firing a staff member is one of the most stressful responsibilities an office manager has to carry out.  It has to be that much harder if you haven't been honest with the employee about their performance.  If you haven't told them the truth, you've cheated that person out of the chance to save their job.  If you have approached them with the truth numerous times leading up to their dismissal, they usually know that it's about to happen and are much less emotional and angry about it. 
    Telling staff members the truth about what they are doing is a matter of trust and respect.  It says that you respect them enough to handle the truth and that they can trust you to be honest with them.  If they are able to make the necessary changes in their performance, they will likely become your most loyal team members and will give you honest feedback whenever you ask their opinion.  The truth is nothing to be afraid of.  After all, it's nothing but the truth.

The First Five Minutes

My boss made a comment today that got me thinking. We were talking about a very charismatic colleague who works in another office. He was saying how great she is for their office because her first five minutes are so good. He's talking about the first five minutes of her interactions with patients, co-workers, and even staff from other offices. Everyone loves her because she makes them feel important. She's charismatic and extremely upbeat without being too much or seeming phony. That's her particular gift; we all have something that we can use to make our first five minutes great. Maybe, like my friend Julie, you're bubbly and outgoing. You leave your own problems outside the office and focus your attention on the people around you., You're a beam of sunshine and everyone basks in the warmth of your glow. Maybe you're more laid back. You're one of those people who are easy to talk to. You remember things that people talk to you about and ask for an update when you see them again. It's that little thing that impresses people and adds sincerity to your care. Whatever you've got, it's what makes you special. Share it. Use it everyday. It gets people talking and it draws success to you and your practice. Make your first five minutes great and you'll enjoy your work and enrich your patients lives.

Talking Yourself Silly

    Have you ever felt like your well thought out words of wisdom are falling on deaf ears?  Every word sounds so great coming out of your mouth, but what happens to it on the way to the staff's ears?  Obviously, some horrible change takes place as they float through the air before being intercepted and deciphered.  That's the only possible explanation for the blank stares you're receiving rather than the standing ovation you deserve.  Sometimes, you might even catch a glimpse of outright hostility.
    So what's going on?  Let's face it, we have have a certain style of doing things.  Communication is no different.  The way you are giving the staff information may sound reasonable and clear to you, but to them you may sound no more interesting than Charlie Brown's teacher, "Mwha, Mwha, Mwha."  The exciting new ideas that you think you're relaying may just sound like pipe dreams to them. 
    So, how do you get them into it?  Get into their heads and hearts.  Find out what motivates them.  What's important to them?  Listen to them.  Give them the floor and let them take the problem and come up with a solution.  Don't get in the way.  Put it to them and see what they come up with.  Lead them to the answer, but don't always spoon feed it to them.
    One thing I've found is that people are more likely to follow through on ideas that they come up with.  Make it safe for them to speak up at meetings.  Let them know that there are no dumb ideas, just some that aren't ready for primetime just yet.  Keep prompting them to go deeper into conversations and brainstorming sessions.
    No matter how tempting it is to talk through silences in staff meetings, resist.  Put an issue on the table and wait.  If no one speaks up, be ready to ask specific staff members for their thoughts and then encourage them to keep putting ideas out there.  Before you know it you may have trouble getting a word in edgewise.  There's nothing silly about that.

You Didn't Just Say That

    Have you ever sat their with your jaw hanging open because you can't believe what someone just said to you or someone else?  It sometimes seems like evolution has mistakenly eliminated the filter in people's brains that edits out foolish, inconsiderate and hurtful comments.  It's a shame, I miss good manners and kindness in communication.  I don't think everyone has to go around flashing peace signs and having honey drip from their lips, but that old admonishment that you'd be better off staying quiet if you don't have anything good to say could be brought into play a little more often.
    Sometimes we have to give others feedback that is less than easy to hear.  Do you ease the blow or do you just spit it out in it's most basic form?  If you've ever had a patient come in who looks like he needs to be introduced to a toothbrush, you know there's something a little affronting about the fact that he didn't care enough about your sensibilities to scrape some of the gunk off his teeth before you had to set your sights on that slimy scene.  Does that give you the right to be blunt about how gross it is?  Nah, you're a professional and you have to communicate professionally.  As my boss says, "You have to meet them where they are right now."  If you can talk to them in a way that leaves their dignity intact, you may just help them change their thoughts about caring for their mouth.  And that's what your goal is, right?
    How about your staff?  Do you think you have the right to just flip out some off the cuff, insulting responses?  Dismissive replies?  Hurtful criticisms?  Well, you don't have that right and you just make yourself look small if you act that way.  It really is true, people might not remember what you say, but you can bet they'll remember how you made them feel.  And if you have any sensitivity, you'll  remember too, and wonder if you'll ever erase it from their memory.  People don't come to work hoping to do a bad job.  If you have people working for you that don't care about what they're doing, it's your responsibility to let them go, but it doesn't give you the right to be rude. 
    If you're a patient do you think that you can treat the staff however you want as long as you're sweet to the dentist?  What possesses you to act that way?  Let me tell you something.  When a patient talks rudely to a staff member it is like a kick in the shins.  It's senseless, infuriating and belittling.  These people are there to take care of you.  You are not better than them.  You don't have the right to abuse them just because you think they have to put up with you.  You cause discord in the office and the dentist does not appreciate your behavior.  And you can bet he'll hear about it.  If you're a dentist and you have a patient who does this, don't let them away with it.  There's nothing that will inspire more loyalty in a staff member than hearing your boss tell a patient that he will not allow them to treat his staff members shabbily.
    Staff, listen up.  How do you talk to each other and about each other?  How do you talk to your boss?  Are you respectful?  When you treat each other with reverence, you make life wonderful.  When you respond to unpleasant patients pleasantly, you rise above the chaff.  You have one chance at every day.  Life happens and there are days when it's more challenging to be nice, but you can do it.  Just remember that at some point you'll have to look back over your actions and it feels better to look back with pride and satisfaction than to cringe with embarrassment at the way you treated someone.

Why Should I?

Dentist: "Why should I give you a salary increase?"
Team member: "Why should I work late to finish that root canal with you?"
Patient: "Why should I spend that much money on the implant you suggest?"

Why, indeed?  What makes anyone do what you think they should do?  How do you make them say "Yes, indeed" rather than "Why should I?"  The answer is to be sure that what you want is doable, supportable, deserved, or will serve a greater good. 

We've all seen team members who feel that a salary increase should be just as predictable as the rising and setting of the sun.  They don't really do anything to make it happen; it just does.  As the dentist or manager, asking them to justify their request serves two purposes.  You don't have to list all the reasons they shouldn't get a raise and they may just realize that they have done nothing to deserve one if they can't come up with anything.  It also opens the discussion for goal-setting and improvement.  When the improvements are made, a new salary discussion can take place.

So, you're working a little late and your assistant keeps making exaggerated glances at the clock.  You've gone 30 minutes past the end of the working day and she's wondering if you're going to compensate her.  Hopefully, your office manual states that on occasion you will need to work a little late to finish patient care.  I also hope that the culture in your practice is such that the team members don't look at situations this way.  If you've been talking about service to the patients and working as a team, your assistant is focused on what she is doing.  Tomorrow evening, when you are done 30 minutes early for the day, she knows you'll tell her to go on home and enjoy an early evening with her family.  If you have the right conversations and team meetings all along, these situations won't result in demands and aggravation.

You are sitting with your patient and discussing the options for replacing their missing tooth.  How will you make him want an implant which you feel is his best replacement option?  He sits down and says, "How much is this gonna hurt my wallet, doc?"  Do you start to tell yourself to just offer him a bridge or do you present the plan you know is best?" 
I usually smile and acknowledge the fact that anyone would rather spend their money on a nice vacation than on dental care.  Then I get to work educating the patient on his options.  I understand that it is my job to give him all the information he needs to make the best choice for him.  If you go into the discussion determined that you will fail if you haven't scheduled an implant before he leaves, you are serving your own interest, not your patient's.  Most of the time, if you communicate well, and the patient feels that you want the best for them, they will be more likely to choose the treatment you suggest.  You have to find out what is stopping them and then find a way to make it possible.  If you come to the conclusion that the treatment is not possible for the patient, for whatever reason, then you have to  do your best to serve him where you can.  That means meeting the patient where he is.  Sometimes you can bring the patient further along, sometimes you have to respect that they are going to stay right where they are a little longer.  If you can remember that "no" today doesn't mean no forever, you will have a dedicated patient who trusts you.  Trust is the foundation for getting patients to believe in the treatment you suggest.

When someone asks, "Why should I?" give them every reason to believe they should.

What's Up With That

If you've tried to email me lately and haven't gotten a reply, it's not for lack of trying on my part.  The emails from the address on my site keep getting returned to me.  I've tried to change the email address but it's not happening.  So, if you're one of the people who are wondering why I don't return emails, try this address:
lindaz@mchsi.com
Now we'll hope for the best.

Are We Clear On That?

    If I had a nickel for every time I've heard a dentist say, "What can I do, I'm a lousy communicator?", I'd have a whole lot of nickels.  Just admitting you have a problem, does not eliminate the problem. 
    In defense of male dentists I'll say this, the poor guys are surrounded by women.  They probably feel like they are tiptoeing through a minefield some days.  It's not the same as having a discussion with his wife.  The dentist and staff member don't have the same background, they don't have the same future and they don't have the same emotion.  The dentist is not half as wrapped up in the feelings of his employee as she may wish he was.
    Our society tends to be a little narcissistic these days.  We tell others more than we should about ourselves and expect them to be as interested in us as we are in ourselves.  That tendency also makes us less interested in others.  Thus, the communication problem.  We don't look at problems or issues from the other person's point of view.  We don't want to have to change our opinion or deviate from the path we have decided is correct.
    When we do this, we cheat both ourselves and the other person.  We don't get insights and ideas that might benefit us.  We don't let them see us for who we are, which might make them even more eager to follow our vision.  If we sit and nurse our dissatisfaction without letting the other person know about the problem, we become a major part of the problem.  We are then an obstacle to any solution to the problem.
    It is also destructive to withhold positive comments.  Employees shouldn't expect constant compliments, but everyone is inspired by hearing that they are doing a good job. As a dentist or manager, we have to make an effort to come out of ourselves once in a while to notice what the staff is doing right.  That's how you get more of it.
     Communication can be a chore.  Having to face a difficult discussion is never fun, but procrastinating only builds more tension and allows the situation to become even worse.  Don't wait until you're ready to explode, that's always ugly.  Develop clear guidelines, state expectations, give feedback regularly and you'll find your communications are easier and much more pleasant. 

Don't Assume

    By now you know that I love Gretchen Rubin's Happiness Project weblog.  Here's a tip for you.  Read this article.  Gretchen talks about seeing Gilda Radner and Gene Wilder in a drugstore in NYC.  She was surprised to see that they were talking in very serious tones.  It was right about the time that Gilda was dealing with her cancer diagnosis.  Gretchen gives a convincing argument for not judging people by the way they are acting at the moment.  You never know what they are dealing with.  Take a minute and read her article.  Share it with your team, too.  It may help you give the next grumpy patient you encounter the benefit of the doubt.

We Are What We Say We Are

    Watch your words, you may become just like them.  I love the English language.  My husband calls me the Commander, as in the Commander of the English Language.  I just really like words and I love to talk, hence, the title.  Did you ever notice that most people have a few signature words or phrases?  One that my kids tease me about is my tendency to say, "What's that about?"  I say it a lot.  I think it's because I'm inquisitive.  That's the nice word for nosy.
     I work with someone who is extremely dramatic.  (Notice that I used "extremely" rather than plain old "very".  I needed the extra emphasis.)  Her key words are devastated and horrified.  She can be devastated by anything ranging from a spot on her clothing to someone dying.  It's all devastating.  She can be horrified by a murder or a mosquito.  When she says the words, you believe she truly feels that way.  It's all super-sized and it's all very dramatic.
    I have another friend who loves everything and everyone.  Ask her how she feels and she'll tell you she's terrific.  Her kids are doing fantastic in school and her last vacation was heavenly.  She also means it.  You can see it in her face. It's all super-sized and it's all wonderful.
      Do you see where I'm going with this?  I think that you can set your mood with the words you use and you can also affect the reaction that others have to you.  Think about a time when you said, "I'm so stressed."  Saying it didn't make you feel less stressed, just the opposite.  You sink right into the feeling of the word.  Ranting and raving doesn't dissipate anger, it justifies it.  Laughing doesn't make problems go away, but it sure takes some of the impact out of them. 
    Want to make your work environment feel lighter and easier?  Watch your words.  Use encouraging, upbeat words.  Don't be phony, just be more conscious of what you say and how you want to feel.  I used to feel very pressured when the schedule was crazy.  Verbalizing that made it feel even worse.  Now I look at the schedule and try to plan out ways to make it all run smoothly.  The more I assure myself that we can handle it, the calmer I feel.  So if you want to feel upbeat, speak that way.  Before you know it, you'll feel fantastic.
   

Encouragement

    A friend of mine read my post titled, "Burned Up" and said that it reminded her of how she felt.  She works in a medical office, but for a demanding and hard to please boss.  She wants to understand what would make him happy and she'd love to go home feeling like she satisfied him.  I don't think it will happen.  He doesn't have it in him to encourage her.  He's more likely to notice what's wrong than celebrate what's right.  He is crushing her spirit and she is losing hope. She works hard and really wants to help.  I think there are a lot of others like her, trying to succeed and being crushed by the oppressive weight of someone else's inability to encourage. When a person who wants to excel is never encouraged and never given feedback that makes them feel that they are achieving their goals, sooner or later they will lose enthusiasm. What her boss doesn't realize is that as she loses enthusiasm she may also lose her desire to give it her all. 

 
Each person has an ideal, a hope, a dream which represents the soul. We must give to it the warmth of love, the light of understanding and the essence of encouragement.

Colby Dorr Dam

If bosses and managers could just look at others and realize that they affect the soul of the other, I think they would temper their words and consider the result of their actions. When we tell a hard-worker that their best wasn't good enough, it hurts.  You may have to tell them that something isn't working, but you can choose your words carefully so that you are encouraging rather than demeaning. 

 

There are high spots in all of our lives and most of them have come about through encouragement from someone else. I don't care how great, how famous or successful a man or woman may be, each hungers for applause.

George Matthew Adams

Consider this.  The gift you give another when you let them know you believe in them and applaud them, is a gift you receive as well.  Think of every acceptance speech you've ever heard for any achievement.  The recipient invariably thanks the people who helped them make it.  Very few people feel that they reached a great height alone.  They want to thank the people who believed in them.  Just about every book has an acknowledgment in the beginning.  I'm always amazed at how many people the author feels a need to thank.  None of us exist in a vacuum and none of us achieve alone.  If you've reached a position of any importance, someone helped you.  Think about someone who encouraged you.  How do you feel when you think about them?  Don't you want someone to feel that way  about you?

 

Sticky Situation

Sometimes we can find ourselves in some pretty awkward situations.  Your reaction can make things get better or make them even more uncomfortable.  If you really think about it, most situations involving personalities fall into a few categories.  I was in a treatment plan consultation today with some pretty unusual people.  There was a mother, father and adult daughter.  The father sat in the middle of the women and was a major curmudgeon.  He was very combative and I understood that he wanted to make me squirm.  I recognized that immediately and whenever he made a goofy comment I just asked him to repeat himself.  He would wave his hand at me and say, "Oh, never mind."  I just smiled and said, "Oh, I never mind answering questions."  By the time he left he thought I was just great.  I recognized someone who would respect me for not being intimidated.  He had two intimidated females on either side of him.  He was bored and I was a challenge. 
    Then there are the bullies.  They are rude, they interrupt and they dismiss.  They demand that the dentist come talk to them and expect me to slink off down the hall in surrender.  I explain that the dentist will be happy to talk to them, but since he wasn't planning on it today and has other patients, we'll have to reschedule.  No problem, my ego can take it.  Most of the time my boss will invite me to sit in on his consult so that the patient doesn't get the idea that he can call the shots.  You see, in the end, my boss holds all the cards, he's the one who's got what the patient wants.  We have a good thing going with our working relationship and it can outlast anything a patient throws at it.
    One of the most difficult is the patient who doesn't ever want the meeting to end.  Once everything has been explained and all questions have been answered they begin again with the same questions.  It's a dental twilight zone.  At this point I find it best to voluntarily offer a brief synopsis of everything that was discussed and point it all out on the treatment plan that they will take home with them. I'll suggest that they go home and digest what we've talked about and call or come back in if they still have questions after that. I then thank them for asking such educated questions and most importantly, I stand.  Body language can speak volumes and if you ever want to see the light of day again, with a patient like this, by all means use your best moves. 
    The most uncomfortable situation may be with the patient who receives unexpected bad news and becomes extremely emotional.  Be supportive and empathetic.  Point out whatever positives you can, even if it's just the good decision they made to seek treatment.  Promise to help them through and work with them to gain their trust and keep them comfortable.  In the end, you may make a huge difference in their health and their life. 
    If you think before you speak and act, sticky situations don't have to become really uncomfortable.  Stay calm and think with reason.  Take your time and gauge your responses to get the best outcome in any sticky situation.

Shame Hurts

                             Communication is an amazing thing. In equal measures, it can be a blessing or a curse.  Words can be used to elate or devastate.  That's power.  We all wake up in the morning with the possibility of the coming day before us.  How brave we are to take the chance of facing devastation.  How trusting to hope for elation.  We owe it to the people we encounter to use care in our communication.  If we are honored to be in a position of leadership or influence, the obligation to use words responsibly is even greater.  We have the potential to lift up or pound down the spirit of those around us with the words we choose. 

    I had the unhappy experience of being on the receiving end of some unkind communication today.  I had submitted an article that I was excited about, to the editor of a publication that I admired.  I had been published there before and thought I had a good relationship with the editor and his assistant.  The article had been submitted two months ago and I'd had no response.  A previous article had been rejected harshly, but I was willing to look at it as a learning experience and ignore the childishly emotional e-mail response I received.  This time it was a phone call from his assistant.  The person was absolutely condescending and superior.  There was no reason to be.  I was perfectly willing to accept that my article wasn't right for them and move on to another publication.  You see, I like the article.  I know other's will, too.  What I didn't like was the fact that both people wanted me to feel ashamed.

    What people don't realize, or maybe just don't care about when they try to shame someone, is that people set out to do the best they can.  Nobody wants to make a mistake, break something, or even write an article that someone doesn't like.  People who put themselves in the public arena in any form, expose something private about themselves.  It's ok to say, "No, thanks."  It's not ok to demean.  It's fine to correct or instruct.  It's wrong to belittle. 

    People who feel a need to shame others are really telling us something about themselves.  In this case the editor was being a bully and his assistant was trying to impress a bully.  They both needed a scapegoat.  Enter your's truly.  I am lucky enough to have a great support system.  Sure, it hurts to hear comments that are designed to shame, but I had the safety net of reassuring people who care about me to bounce me right back onto my feet again.  What if I didn't?  Many people go home to more of the same; or they may even go home to nothing at all.  What do you think happens to those shameful words?  They swirl around and take on more importance.  They seep in and become a part of that person.  They erode.  The only good they do is to act as a reminder not to treat others that way.

    On the other hand, positive communication builds up.  It plants seeds of pride and self-esteem.  It creates bonds of love and friendship.  It gives the people who face shame in other areas of their lives a coat of armor. It gives lonely people hope.  We all have the power to choose how we will communicate.  Be assured that whether you choose to tear down or build up, you will make a difference. 

That's A Good Question

  There is a post on the Dentaltown website that is talking about giving concise answers to the questions most frequently asked by patients.  It's important for all team members to be willing and able to answer patients questions consistently.  It occurred to me that it would be a good idea for practices to decide on how they want these questions answered and for all team members to understand and use the same explanations.  To get you started, I've pulled some of the questions off the Dentaltown thread and applied the answers that we generally use to them.  One thing I always tell patients when I give them information is that I want them to understand their condition and the possible treatments for it.  I also want them to understand the benefits of each treatment and the consequences of waiting or doing nothing.  Then the patient can make an informed decision and take responsibility for their dental health.

1.  Why do I need a crown ?
    Your tooth has suffered trauma or decay that has weakened it.  It is at a point where filling it again will undermine it even further, rather than strengthen it.  A crown will not only protect the remaining tooth structure, but also the health of the nerve as well. 
    Or...The root canal treatment removed the diseased tissue from your tooth, but it also removed the tooth's blood supply.  This causes your tooth to become brittle and more likely to crack.  Sometimes when this happens the tooth must be extracted.  Placing a crown will protect your tooth and the investment you've already made in it.

2.  What is a crown?
    A crown is a protective covering for your tooth, much like a thimble.  It holds the tooth together so that you can chew your food just like you did with your real tooth.

3.  What if I don't get the crown ?
    There is no way to predict how long your tooth will be ok.  You may be fine for years or you may fracture it tomorrow.  Placing a crown before a catastrophic event happens prevents your tooth breaking at a time when you can't get immediate help or during a vacation or other time when you want to enjoy yourself and not worry about pain or an ugly cracked tooth in the front of your mouth.  Sometimes, when a tooth breaks, it fractures below the gumline resulting in the need for gum surgery before a crown can be placed.  Other times it fractures in the root system and the tooth must be removed.  By acting proactively, before a bigger problem occurs you can function well and not have added expenses in response to bigger problems.

4.  Can't you just pull it instead ?
    We could, but then you'd have the bigger problem of a missing tooth.  When you lose a tooth and don't place an implant, you begin to lose bone.  Over time your remaining teeth will shift and that can also result in periodontal problems.  Saving this one tooth now can prevent multiple problems in the future.

5.  What is a bridge?
    A bridge consists of multiple crowns that are splinted together to span the empty area where a tooth or teeth were lost.  Two or more of the teeth on either side of the missing teeth must be prepared by taking away some of the tooth surface so that abutment crowns can fit over them.  The teeth that take the place of the missing teeth are called pontics.  Bridges are acceptable appliances to replace missing teeth, but they do not stop bone loss in the areas where teeth have been lost.

6.  What is an implant?
    Implants are artificial roots.  They are made of titanium and look like a screw that is placed into the bone where a tooth was lost.  The bone then grows into the threads of the implant and preserves bone.  Implants surgery is no more uncomfortable than having a tooth filled and patients report very little discomfort once their numbness wears off.  Healing takes 3-6 months and at that time impressions can be made for a crown that will be cemented to the implant.  Implants functions just like real teeth and can't decay or have toothaches.  Implants are the most natural tooth replacement available.

7.  Why do I need so many fillings ?
    Brushing and flossing are important in preventing decay.  If you brush your teeth, but never floss it is like washing your hands and never opening your fingers to clean between them.  Bacteria builds up and starts attacking your tooth.  Diet plays an important role, too.  If you eat a lot of carbohydrates and don't brush and floss properly, you are feeding the bacteria that feeds off your teeth.  Proper home care, good nutrition and regular dental visits can help you avoid fillings in the future.

8.  What is a root canal?
    A root canal is a procedure that removes the dead and dying nerve tissue from the inside of your tooth.  Once the diseased tissue is removed, the nerve space is disinfected and filled with a medication that seals the end of the root and occupies the empty space in the canal.

9.  What is a night guard and why do I need one?
    A night guard is a plastic device that is made in the laboratory and worn by the patient while they are sleeping.  It fits over the upper or lower teeth.  Night guards are recommended for patients who are causing damage to their teeth because they are clenching or grinding.  They are literally wearing their teeth away while they sleep.  A night guard covers and protects the teeth from further wear or protects teeth that have been restored with crowns.

10.What is periodontal disease and why should I be treated for it?
    Periodontal disease occurs when teeth develop gum pockets.  Those pockets are too deep for your toothbrush to get to the bottom of and clean out.  Bacteria set up camp in those pockets and grow colonies that cause infection which causes deeper pockets and bone loss.  Without treatment the condition worsens and can cause you to lose your teeth.  Once periodontal disease is present, your hygienist must do a deeper cleaning and sometimes will feel it is necessary to use medications under the gums to help kill the bacteria.  Bacteria are live organisms that are living in your mouth and causing damage.  Periodontal disease can affect your overall health as well, so it is important to take action.  Think of it as having termites eating away at the foundation of your home.  One termite probably wouldn't do too much damage on it's own, but we all know that termites don't go it alone.  Just like bacteria, they colonize and destroy.  You wouldn't sit by and allow termites to destroy your home, so you won't want to do nothing while bacteria destroy your gums and bone which are the foundation for your teeth.

11. I'm too old to spend money on my teeth.  How much longer am I going to need them?
    No one knows how long they're going to live, no matter how old they are.  But...as long as we're alive we need our teeth to eat well, stay healthy and look good.  No matter how old you are, you're too young to lose your teeth.  While none of us knows how long we're going to live, we do have a choice about how we're going to live.  Living with healthy natural teeth or optimally restored teeth is more comfortable and healthier.  It will allow you to enjoy a better quality of life.

12.  Why do I need x-rays?

     Bite-wing x-rays show if there is decay between your teeth.  Panorex and periapical x-rays allow the dentist to see the health of your roots and bone.  He can not tell if you have infection, cysts or tumors in these areas without x-rays.  The sooner decay and other conditions are diagnosed and treated, the better the chance for a successful treatment result.

Who Are Your Giants?

"If I have seen farther than others, it is because I was standing on the shoulder of giants."           
     ~Issac Newton~

    Who are your giants?  They are the people that you learned from along the way.  The ones that cared enough to be tough on you and took the time to be patient with you.  They are your teachers, your coaches, your mentors, your co-workers...anyone that you've had an impact on or that has had an impact on you.  Many times we reach a certain level of success or satisfaction with ourselves and begin to think of all we've achieved.  We can forget that there were people who showed us the way and allowed us to find our own unique path to success. 
    Your first giants were probably your parents, siblings and extended family.  My grandfather was one of my giants.  No matter what I did, right or wrong, he let me know that I was still ok with him.  My mother was a giant to me in her example of how to treat others.  No one was unworthy of her esteem and goodwill.  She was one of the givers of this world.  My husband and children are giants in their unconditional love for me.  They are the feather bed that I fall on when life's events hurt or tire me.  They are the bubbles in the celebratory glass of champagne when things go well.  They are the warm embrace that gets me through anything. My husband is the person who loves me when I'm unlovable and tells me that I'm the best. He is my constant giant. Tom Morris and Ed Brenegar were giants to me when I was at a crossroads in my working life.  They kept me aware of the fact that the world was open to me and that I could choose the path I wanted and do what it takes to enjoy my journey.  My boss, Jeff Price is one of my giants.  He keeps me grounded without pinning me to the ground.  He has given me opportunities to grow and achieve, advice that made sense rather than placating, and guidance when my path had too many rocks in the road.
    I can try to pay them all back by being the giant someone else will think of someday when they are taking stock of their life and the people in it.  When I do that, I not only help someone else, I realize how much of themselves my giants put into helping me.

Courage In Action

 "A leader must have the courage to act against an expert's advice."

            ~James Callahan~

    Wait a minute.  Aren't leaders supposed to seek out the wisdom of experts?  After all, the experts spend all their time figuring out the best way to do things and what to do when things go wrong.  Many times experts do have good advice, but many times they are just thinking generically.  People aren't generic.  There are many different personalities that achieve success in many different ways.

    Human beings make mistakes.  Yes, the experts sometimes have great advice for dealing with those mistakes, but sometimes it won't work.  That's when a leader has to rely on herself.  You may have to follow your heart rather than your head sometimes even though the roar of the crowd is deafening in it's insistence that you follow expert advice. 

    I remember an expert telling me that I would have to fire a staff member if I was going to salvage my leadership.  This person didn't seem able to accept me in my position and surely didn't seem to like me very much.  I wanted to find out why because I believed that understanding would lead to solution.  I still don't understand completely, but my desire to wait and understand led to a better relationship.  The experts would have told me to give up and move on, but in the end I'm glad I didn't. 

    Sometimes it's a mistake to ignore the tried and true, but the lessons we learn from our mistakes are valuable too.  If your heart is true and your head is healthy and your purpose is sincere, you probably are somewhat of an expert in your own right.  You probably know what path to choose.

Treatment Plans Presented Wisely

    My boss frequently hands me something to read.  Sometimes it's a journal article, sometimes it's the entire journal, and sometimes it's a book that he enjoyed and thinks I'll find interesting.  He's always right and since he knows I'm an avid reader, he realizes that it's no imposition on me to be asked to read anything.  Since I only achieved one year of dental assisting school after high school, I consider myself to be earning my degree at the University of Linda Z.  All professors welcome, but the pay stinks. 

    The book I'm reading now is titled Words That Work - It's Not What You Say, It's What People Hear by Dr. Frank Luntz.  I am really enjoying this book, but I just read a sentence that made me sit up and think, "Hey, that's what anyone who is presenting treatment plans to patients needs to think about."  Here is the sentence: "Education must precede motivation, and even information."  Actually, I got so excited by that sentence (yes, I know I'm a geek, but geeks are generally pretty happy) I didn't read the rest of the paragraph which is equally relevant to us so here it is:  "This may be painfully obvious to read, and it is certainly painful to witness when it isn't practiced, but your audience needs to know the basic generalities before you can motivate them to respond to the specifics.  You can't short-circuit the communication process.  And to be a good teacher, you have to know from where the pupil is starting.  As my boss, Jeff Price says, "Meet them where they are."
    So, if you're wondering why you aren't getting anywhere with your treatment plan presentations, maybe you just aren't educating your patients first so that they can desire what you are offering.  Many times when I'm presenting a treatment plan a patient will drop into the chair and say, "Give me the bad news.  What's this going to cost me?"  When I first started doing this I would sheepishly slide the treatment plan to them and wait for the cry of anguish.  I would then, somewhat feebly try to start educating them.  I had it backwards and yes, it was painful.  Little by little I learned that I could control the pace of the presentation and the order of it.  After all, I had all the information.  I did this by putting together a folder with the patient's x-ray, review of findings, their dental chart and information sheets with pictures and diagrams of the treatment options I'd be presenting.  I would then respond to the above statement by saying, "Here, I've prepared some things that will show you what conditions are present in your mouth and what we can do to help you.  We will talk about the fees once we have looked at this information."  I then proceed to tell them what is in good condition in their mouth and what needs work.  Then I tell them what we can do to help and finally I present the fees.  If they say they can't afford something even though they desire the treatment, I try to find ways to phase their treatment or payment options for them.  Once they realize that I put some time and effort into the presentation, most patients are interested in seeing what I've come up with.  Once educated, they may still grumble about the fee, but they understand what they'll be getting and how much work goes into it.  Presenting a treatment plan wisely is worth the effort and is more likely to be accepted by the patient.

Things That Make You Go Hmm...

   Ed Horrell's weekly newsletter gives practice owners and managers something to think about this week:


    Have you ever wondered what your customers REALLY think of your service?  My guess is that it is pretty close to what your employees think of working for you.  Most of the best in customer service realize that the way they treat their employees is the way their employees will treat their customers.

    Want your employees to listen to your customers?  Listen to your employees.  Desire for your employees to treat your customers with kindness?  Treat your employees with kindness.

    This simple process works.  Try it,your employees will love it, your customers will notice it, and you'll own your customers (and your employees, as well).

Ed Horrell

    Makes you think doesn't it?  How do you treat your employees when you're in a bad mood?  Would it be ok for them to take their moods out on the patients?  How about when they've gone out of their way giving great service?  Do you comment or just act like it was nothing?  People tend to repeat behavior that gets noticed, whether it is good or bad behavior, negative or positive feedback.  Commenting on performance is a way of saying, "I know you exist, I see what you do."  So be sure to comment on good performance.
    I once worked for an orthodontist who had great rapport with the patients.  When the patients and parents were in the office he was Mr. Personality and really interacted with the staff.  At other times, he didn't seem to know we existed.  I remember feeling that if he passed me on the street, he wouldn't recognize me.  I did a good job for him, but I wasn't inspired to think about anything that would enhance the practice. 
    My boss, Jeff Price, not only noticed and commented on my performance, he paid me a great compliment.  He asked me to manage his practice.  You can bet I do all I can to make it great.  That's why I read newsletters like Ed's along with countless books and magazines, other weblogs and attend seminars.  I want to keep hearing positive feedback and I believe in him and his practice because he believes in me.  One hand really does wash the other.  Open up and let the positive feedback fly.
 

I'll Get Back To You On That

     Have you ever said that to a patient and then completely dropped the ball?  Here's Ed Horrell's weekly newsletter with his feelings about that:

I want to talk this week about the importance of getting back to your customer when they have a problem.  Nothing is more frustrating than to have a problem with a vendor or service provider, report that problem, and then have to wonder if anything is being done about it.

If you know something about your customer's status, make sure they do too.  Don't make the mistake of not getting back to them. Leave that to your competition.  Also, try to never have a situation where your customer calls you to learn something that they should already know.  Little is as frustrating as getting this from a service provider: I was going to call you to talk to you about this. If you were going to call me, why didn't you?

Call your customer when you know something.  They'll notice it and you'll own your customer.

Ed Horrell

     We've all been there, done that.  We've all let a patient leave wearing a provisional crown without reminding them to stay away from sticky stuff only to have them return the next day with their temp imbedded in a wad of gum.  It's all about going that extra step and showing that you really care.  It's about calling the patient who had an extraction or implant to see how they're doing.  You can hear it in their voice, they are impressed that you cared enough to call after work.  Also, don't forget about patients who are waiting to hear about insurance matters.  The temptation is to put those things off because who wants to sit on hold waiting for an insurance rep only to be put on hold again by them while they re-direct your call.  Heck, I actually drifted off once, I know it stinks.  Now I make sure I have that stack of reading that's always growing, right there with me so I'm not wasting the time on hold.

     Sometimes there are delays in getting an answer for a patient.  It's important to keep the patient informed of that.  When you do, it let's the patient relax and keeps them from developing inaccurate scenarios in their mind.  You are letting them know that you understand their need to know and the urgency they feel.  Just that alone is enough to lessen their anxiety and gain their trust.  They can relax because they know that you have it under control.

     I recently had to deal with a situation where the patient had an estimate from his insurance company and once the treatment began, his coverage was changed to a different carrier and they were denying the claim.  He had his implant placed, but was not willing to proceed with the crown because of this.  I got on the phone with the insurance and got the usual delays, but I let him know of every call I made on his behalf.  This not only let him know that something was being done, it also let him know that a lot of effort was being made on his behalf.  As a businessman, he apprectiated the service he was receiving.  His benefits were approved and he is scheduled to proceed with the crown.  The important thing to note here is that the crown is just one average procedure, but in the future this patient will remember that he was well-served and will speak highly of that to his friends and colleagues.  Don't you just love a win-win situation?

Explain That Again?

     If you present treatment plans to patients or even if you are just trying to answer questions that the patients ask you, it is important to explain everything.  By that I mean both the pros and cons of the treatment suggested as well as the possible consequences of doing nothing or choosing less than optimal treatment.  Patients will have more confidence in the dentist and you if you tell them the benefits and drawbacks of the treatment alternatives you are suggested.  Don't assume that they don't care or can't understand.  Explain the treatment that is being suggested without using dental jargon.  If you are suggesting implant supported crowns as a better choice than a fixed bridge, print out the fees for both and let them see that.  Then go on to balance the higher fee with the benefits of choosing implants.  Once patients see that you are not dodging the fee issue, your reason for suggesting implants will be more believable.

     Discussing what you are seeing in the patients mouth and the treatment for their condition helps to establish trust between the patient and the dental professional because the patient feels like they are participating in the decisions about their care.  Tell the patient what causes incomplete fractures, what can happen as a result and what treatment options you recommend.  If you are comfortable leaving it alone for now, explain that as well.  I like to tell the patient that I want to give them the information they need so that they can make an educated decision.  When patients understand what the perio probings numbers you are calling out means, they can feel either the satisfaction that their gums are in good condition of the need to address periodontal issues.  Give them a mirror, take digital photos or intra-oral pictures and show them what you see.  When patients can actually see what you see, they will understand why the dentist is recommending treatment.  Then they can actively participate in decisions about their oral health and own the outcome.

Huh?

 Sometimes we can be so happy with an employee that we forget to look at her with a critical eye.  Niceness can divert attention away from performance flaws and then suddenly you become accustomed to the personality and start realizing that there are some problems that need to be dealt with.  Here's Ed Horrell's newsletter for the week:

I do business with a company who has recently hired a new recpeptionist.  I call there often and she is a nice person.

The problem is that she is virtually unrecognizable when she speaks on the phone and I can barely understand the corporate name when I call.  I have actually wondered if I have called the correct number on more than one occasion. If I called for the first time and got this reception, I would be concerend.

Make sure that your first customer contact is one you can be proud of.  Take a minute and check each way a customer can contact you. 

Ed

     In this employee's case it may simply be a matter of not holding the phone correctly.  I often catch myself with the mouthpiece down by my chin.  Either way, it can cause the caller to feel awkward and leaves a bad impression.  One of my pet peeves is poor grammar.  There is no personality so pleasant that can make poor grammar sound pleasing to my ear.  As a manager, I found it very difficult to address this when I was faced with a receptionist who didn't quite speak the Queen's English.  I wrestled with the fact that she was using the local vernacular and that maybe it didn't bother the patients as much as it bothered me.  Every time she used certain phrases it was like nails on a blackboard for me.  I gave hints and she didn't pick up on them.  Once she actually came in my office and commented on a patient's grammar that was worse than hers.  She said it sounded ignorant.  I said that I'm sure we all have things we say that we're unaware of that aren't just right.  She said she sure hoped I'd tell her if she did.  So I did.  Nothing changed.  She couldn't or wouldn't break those ingrained patterns.  I do think that if I had addressed the problem immediately, I'd have had better compliance from her.  She has moved on and we now have a receptionist with impeccable phone manners and a melodious voice.  Patients are commenting on the difference.  It's funny, but patients generally will not pass on negative impressions about an employee until after they leave.  That's why it's important not to assume that everything is OK.  Call your office and see what you think.  Have someone who knows what to look for place a phantom phone call so that you know how your receptionist sounds to people who have nothing invested in her.  She is the front door to your practice and the last chance for a good impression as well.  Make sure everything she's doing is working well.

No NVIP's Around Here

 We've all had days at work when every phone call is a same day emergency and the schedule is packed to the brim.  It's almost inevitable, you're going to run behind.  Should patients just expect that as part of the status quo.  If your's do, you've got a problem.  Here's what Ed Horrell has to say about this in his weekly newsletter:

I want to talk this week about the importance of keeping your customer informed of open problems.  This is very important and also overlooked by many service providers.

I am currently frustrated at a construction company which is doing a TERRIBLE job of keeping informed of the status of a job they are doing. I am going to be a bad reference for them when they are done and will not be their best advertising (as you know, I like to talk about customer service!). 

Their problem is that their work may be good, but their service to their customer is not. 

Don't forget that these two issues go hand in hand. 

Do good work and provide good service and you'll own your customer.

     Sometimes you have to look at changes in the schedule the way a coach would look at unexpected changes in a sporting event.  His best player gets hurt, he'll do this instead.  In the dental office if Mr. Jones fractures his central incisor at the gumline, you can look at your schedule,identify the amount of time you need, find a patient that you can count on to be flexible and call them and explain the situation.  Let them know that if they will be willing to come in next week you'll be sure to give them the same consideration when they have a problem.  For smaller glitches that get you running behind ten or fifteen minutes or longer, be up front about it.  If you know ahead of time, call the patient and let them know that things are backed up so they can arrive a little later.  If they're already in the office, go sit down next to them and explain what's happening and how long they can expect to wait.  Offer to reschedule them if that would work better for them. 
    My sister-in-law called me the other day.  She said, "Why do dentists make patients wait so long?  Don't they know how long a procedure will take when they schedule it?"  She has a full time job and has to take vacation time to go to the dentist.  She arrived at her appointment on time and sat in the reception area for 45 minutes.  No one said a word to her.  She had a meeting to attend so she went to the desk and asked to be rescheduled.  They did this, but without explanation or apology for making her wait.  She thought it was just the way all dental practices operate. Thankfully, that's not the case.
    It's so easy to keep patients informed of what's happening.  It's the considerate thing to do.  Keeping them in the loop shows them that you value their time as much as you want them to value your's.  If you want to make someone feel like an NVIP (not very important patient)let them linger in your waiting room for a long time while you ignore the problem and them.  I promise you, before long they'll find someone who values them and treats them like a VIP.  And they'll tell their family and friends all about both of you.

The Practice of Compassion

    Most of us go through our days in pretty routine ways.  We know our jobs well and we do them by memory many times.  We barely have to think about what we are doing.  It may be time to pay more attention.  Many of the problems that occur between people are due to a lack of compassion.  Approaching our patients and co-workers compassionately could affect our relationships with them and with ourself.
    When people do things that hurt us, insult us, annoy us, or that we just don't understand, we tend to react with our gut instinct.  Now, sometimes following your gut instinct can save your life, but in relationships it can fail you.  Gut instincts were meant to get us out of trouble when danger is present and that's were you need to use them.  In relationships, being on the lookout for danger might get you what you hope to avoid, trouble.  When someone says something that seems unkind or unfair, try responding with compassion first in your thinking and then in what you say in response.  It may initially make them angry, but if you can stay calm and remain compassionate they will eventually understand that you care.  Responding compassionately is like peeling back the layers of an onion.  What's on the outside is unusable and must be thrown away.  The deeper you go the better it gets.  Most of the time, that's how angry people are, too.
    When you're being compassionate, remember to be that way with yourself, too.  So many times people put themselves down in front of others.  That not only makes them feel bad, it may make the other person believe them.  If you make a mistake and say, "I'm an idiot!", too many times, people will start subconsciously agreeing.  You will walk around fuming with yourself, unable to let go of your frustration.  If you make a mistake and admit it and then treat yourself as kindly as you'd treat others, the mistake will fade away a lot quicker for everyone.
    For managers, treating others with compassion sets the tone for the practice.  The team will feel better about themselves and each other and will treat the patients compassionately.  Whether they like you, are ambivalent about you or even somewhat dislike you, they watch you and reflect your attitude and behavior.  So be compassionate and see what it does for the rest of the team and the patients.  Think before you act or respond.  We don't know what prompts the behavior of others and many times when people are acting badly, there's a reason that we could never guess.  So, maybe it's best to assume that the person is troubled by something and to be compassionately thoughtful toward them.  Make your practice one that practices compassion.

Get A Grip!

    Have you ever had a patient in the chair who thought they were in a therapy session or at a cocktail party?  They want to sit there and talk and talk as if no one had anywhere else to go or nothing else to do.   It's interesting to see how different staff members react to a patient like this.  My boss tends to get the "how the heck am I going to get out of here" slightly panicked, half-sick smile, half-helpless expression on his face while subtly doing a mini side step toward the door.  Every now and then I'll take pity on him and step in and say "Excuse me, Dr. Price, you have a call on line 11."  Since we don't have a line 11 he knows I am trying to save him from the deep pit of patient small talk he has allowed himself to be pulled into. 
    Our hygienist had one of these patients today.  This lady is an infrequent visitor who loves to do 3 years worth of talking in one 50 minute appointment.  She talks about her favorite subject, herself.  She is quite fluent in the wonders of she.  The hapless hygienist was trying to be nice, but she was afraid to take her hand out of the woman's mouth for fear of having to wait out another episode of "let me tell you more about me."  The 50 minute appointment lasted 80 minutes.  Thankfully the hygienist had a cancellation following this patient so she had time to recover.  She very proudly told me that she charged the patient for a 60 minute appointment.  I asked her how she could have maintained control of the appointment.  She said she had no idea.  I told her that it would have been appropriate to tell the patient that she loved talking to her, but that she would have to get to work and finish her cleaning since she had a schedule to maintain and that if she didn't get busy she'd have to bring the patient back to finish her prophy.  Since this would incur a second charge she didn't want to run out of time.  When all that talking started costing her money, this patient would have stopped and the hygienist could have completed the prophy. 
    We have to respect our patients and treat them kindly.  All of our patients.  If we allow one patient to cause disruption in the schedule, we are inconveniencing the other patients.  A chronically late patient should be told their appointment is earlier than it actually is or reappointed for another time.  A talker must be gently reminded of the purpose of the visit if things get out of hand.  Not all patients who do these things are inconsiderate, most aren't.  Some are just lonely.  You can redirect the course of events kindly, but definitely.  You can find other ways to make these patients feel special if that's what they need.  Keep a supply of pretty cards in the office and write a short note saying you enjoyed their visit.  That way you can keep things moving and still let them know they are valued.  When you have someone who just loves the sound of their own voice, well, you just have to get a grip on the situation. In the end you will save everyone a lot of stress and aggravation.

You Talk Too Much

    Yesterday I focused on listening.  Today I want to concentrate on talking.  There is way too much of it.  First, let's separate talking from having a conversation.  When you have a conversation, the other person gets to talk, too.  There's some give and take and if they're good at it, both people also feel like they've been listened to and enjoy the exchange.  I'm talking about talking too much.  Telling more about yourself than you should.  TMI - Too Much Information.  Verbal Vomit.  Motor Mouth.  Besides just being tiring, what's wrong with talking too much?
    Sometimes there's nothing more than the fact that you might be inconsiderate of others that would like to get a word in edgewise.  What you have to watch out for is what you are talking about.  People seem to have few filters these days.  A thought enters their head and flies out their mouth without any thought given to whether it's appropriate to discuss it in any given venue.  At work, that can have serious repercussions.  For instance, if someone is talking about a wild weekend that involved some major lapses in judgment and good taste they may be setting themselves up to be looked down upon.  Everyone may be standing around listening, laughing in all the right places and acting like they approve, but it might be different when you walk away.  Or the more they think about it the lower their opinion of you sinks.  If you happen to spit it all out in front of your manager, even worse.  She may question the wisdom of your decisions and wonder if she should trust your ability to be discreet when speaking with patients.  It's fun to get your 15 minutes of fame, but make sure the price you'll pay for it isn't too high.
    Put yourself in the listener's place.  What would you think if they were telling you this story?  Would you think they were funny, but wonder about their good sense.  No matter how well you tell a story, you can't climb in their brain and filter it the way you want them to hear it.  They have their own filter and nobody's filter is as kind to anyone else as it is to themself.  So, while you may know all the little things that make what you're talking about acceptable or funny, they may have filtered those parts out and are left with something slightly humorous and highly distasteful.  I don't want to make your afraid to speak at all, just a little more thoughtful and discriminating about what you disclose.
    When I hear someone talking about something that I think others will lose respect for them over I want to walk over and clamp my hand over their mouth.  I know it's all a part of that hungry heart that I talked about yesterday.  They want to stand out, to be seen and heard and sometimes the fantastical is the only way they know to do that.  If you see yourself in this, try to remember that like a donut on the lips that ends up on the hips, the momentary satisfaction you experience may not be worth the longer lasting damage.  If you wonder if you talk too much, you probably do.  The next time you want to blurt out something personal, listen to your inner voice.  Is it saying, "Hey, hey, hey...maybe you better not do that?  Than wait 15 minutes and see if it still seems conversation worthy.  Just remember, nobody can watch out for you as good as you can watch out for yourself.

So You Had A Bad Day

OK, I lied.  I can't control myself with these videos...yet.  I'll get over it sooner or later.  In the meantime just don't click on it if you don't want to see it.  This one is so nice though.  I think you should click on it, it'll make you smile.  Anyway, it went so good with my title and Ed Horrell's weekly newsletter that I couldn't pass it up.

"Everyone has a bad day occasionally.  We are impacted by many things in our lives which overflow into our work lives.

Often, this impacts our attitudes when we are dealing with our customers.  The result is indifference when we have something which is more important to us than it is to our customer.

The difficult, but correct, thing to do when this happens is to leave our personal issues at home.  Our customer does not care about our problems; they care about THEIR problem.

The next time you feel that your personal problems are affecting your work, try to leave them at the door when you walk into your work.  They'll be there when you leave to go home and you can deal with them then.

At work, try to concentrate on what is important to your company, your customers. 

They'll notice the concern you have for them and you'll own them. 

eh

We've all had days like this.  It's so hard to leave it at the door, but look at it as giving yourself a break.  You're also sparing your co-workers and patients the drama.  I remember an employee came to work one morning on the verge of tears looking sorrowful.  All morning the other staff members kept asking her what was wrong.  She didn't want to talk about it, but she didn't want to give up the drama either.  Of course, everyone was coming up with their own ideas of what her problem was.  She was a new employee so we didn't know too much about her yet.  All that attention was diverted away from patient care toward something as useless as trying to guess what was happening in this person's life.  It went on all day.

She basically made herself the center of everyone's attention and her problem didn't get solved.  I don't even remember what she was upset about, but I do remember the drama.  Two things could have been done to put an end to it.  First, the staff could have taken her at her word and believed she didn't want to talk about it and then gone about their business.  Next, she could have matched her behavior to her words and dropped the "poor me, look at me" routine and just cared for her patients.

I have found that most bad days are as bad as we let them be.  I'm not talking about tragedies, just the general run of the mill bad day.  Maybe what seemed so bad in the morning, might not seem half as terrible in the afternoon if you give yourself a chance to focus on your work in the middle.  I know that if I go to work in a bad mood and indulge myself in that mood, not only do I stay down, I drag the rest of them down with me.  Remember that as a manager, you often set the tone for everyone else.  If I drop the mood and come in singing, the reaction I get from everyone else usually gets the seratonin pumping and off we go on another great day.  If I dance along with the singing, well, we're so happy we just can't stand it.  Maybe that's why I like the videos so much.

Pay Attention, Please

 Happy Easter!  Ed Horrell's column is a great one today.  This is something we do with our staff and I promise you, the benefits are worth it.  Read on:

I want to challenge you to do something this week. 

Take a look at the people you work with.  Single out the one that you think best represents the values of customer service that you think should be reflected in your company.

And then take a minute and tell them what you thinik. 

More companies should have a method for peers to "catch" their co-workers doing the right thing.  If your company doesn't have such a process, simply take it upon yourself to catch others doing well and simply give them a thumbs up.

You'll find that this is catching and contagious.  When it spreads in a company, it becomes a part of the culture of a company.  Your cusotmers then sense the difference in doing business with a company that constantly stirves for values in their customer service.

These companies own their customers.

    We did it a little differently but with the same idea.  We had a staff meeting at which everyone was encouraged to go around the table and say something positive about each person.  Everyone else got to hear the comments, as well, and the great thing was that you could see that people could hardly wait for their turn to give compliments.  The funny thing was watching how the receiver had to get over an initial discomfort with hearing all these great things about themself.  One of the guidelines was that the receiver's only response could be to say, "Thank you." 
    As a manager, I notice all the staff's strengths and weaknesses.  I have to so that I know what to expect from each and how to use their talents in the best ways.  You never know what they're thinking about each other though.  Or about you.  I was relieved to hear that they all were able to say some nice things about me.  You never know.  I was also interested in my own sense of anticipation as my turn came, and how thoughtful the comments were.  They weren't just rote sentiments, they were individualized for each person.  These were things that probably would never have been expressed if we hadn't set up a specific time to do that.  I loved seeing how much we all value each other and how meaningful this exercise was to everyone.  Our team is really very lucky to have such a wonderful place to work, a kind and honorable boss, and decent people of high integrity to work with as a team.  It was good to see how aware we all are of that.
    Ed's column has me considering setting up a part of each monthly meeting to have everyone write down one thing they saw another person doing that they admired.  We could then have a drawing for a small prize.  The person with the most entries would have the advantage and it would give an incentive to be positive as well as encourage staff to pay attention to the good things their co-workers are doing.  Sounds like a win-win situation to me and that's always the best kind.

Take It SLOW

 Here is Ed Horrel's weekly newsletter:

Try this next time you experience conflict with a customer.  I have used this many times and it works.

Begin by SUPPORTING the feeling of your customer.  This is done by simply indicating agreement with what they are feeling at the time.  The key is sincerely supporting their feelings with comment such as "I understand how you feel", "I sense your anger", etc.

Then LISTEN for any facts which are stated that you can agree with without arguing those which you disagree.  As the facts which you agree with are stated, simply respond with "That's correct", etc.  If no facts are agreeable, stay with understanding their feelings.

When appropriate, OFFER a solution to the problem (or ask what you can do to solve the problem).  Do this without dealing with why the problem exists or what caused it.

Once the solution is offered, either do it or offer a WORKABLE solution, always stating that you wish you could do what was requested, but countering with what you can do (i.e. "I wish that I could give you your money back, but what I can do is......").

This is called the SLOW process (support, listen, offer, and workable compromise).  Stay calm and slow...you'll own you customer.

eh

     I'm happy to see that this sounds a lot like the article I wrote yesterday.  Let's start with supporting the feelings of the patient.  Why is that important?  Because you are validating them.  You are letting them know you understand that they are upset.
    Listening for the facts gives you something to begin to work with.  They will begin to sense that you intend to help them.  Giving them the facts, at this point, does the opposite.  It puts the focus on you, rather than on the patient.  Look at yesterday's example of our receptionist clearing herself from blame rather than focusing on the patient.  It didn't help anything.
    Offering solutions is the first step out of the problem and into peace.  It gives the patient something positive to focus on.  If the solution the patient wants isn't going to happen, be respectful.  Let them feel that they are getting the best possible workable solution.  Most people can be reasonable once they see that you care.
    Finally, I like Ed's SLOW acronym.  It reminds us to slow down to listen and consider the situation and solutions.  People tend to seize up and want to hurry up and fix a problem.  That may give the impression that you don't really care.  Giving the patient time to express themselves is like slowly opening a pressure valve.  It makes things gradually better.  Opening it up too quickly can be explosive.  So SLOW down and everything will be just fine.

Mind The Gap

    Sometimes people really are their own worst enemies.  I want to look at the way our thinking can make us miserable.  Sometimes you can get into a situation in which you just can't come to an agreement with another person.  You may walk away feeling misunderstood and abused.  They may walk away feeling unheard and frustrated.  Either way, two people just became their own worst enemies.  Not to mention what they may have become to each other.  The next mistake they can make is becoming mired in the rightness of their position.  They don't take the time to give the other person's thoughts, feelings and ideas a chance.  They are so sure that they are right that they don't see the need to explore the other side; that would just take time and attention away from planning their next approach.  Heck, they may even begin to doubt their own rightness and they're just not ready to do that yet.  So, they stick to their guns, entrench themselves in their own opinion and create a tornado of feelings, accusations, anger, pain and misery.  And then they wonder why they feel so battered.
    Why would anyone do that?  Well, my first guess (and these are all guesses) is that it makes them feel smart.  You can come up with all sorts of brainy reasons for being right.  If they start to feel that they may be wrong, they might also start to experience other uncomfortable emotions like guilt, embarrassment and regret.  I think that this would be the best time to face those feelings and rethink and readdress the situation.  I doubt those feelings will get any less intense if you postpone.  But, of course, we do postpone and keep insisting on the validity of our argument.  Another reason we might hang onto our story is that we don't like to be wrong.  It's awkward to look at another person and admit that you've got it all wrong.  You don't know how they'll react. They may mock you, rub it in or go off on a tangent of what a worthless cretin you are.  I think most people worth knowing won't do that, so go ahead and try it, you may weed out some unsavory characters in the process.  I think the main reason is because we just don't know how to truly put ourselves in another person's place.  How to try on their thinking cap.  Because when we try to see it from their point of view, it doesn't work if we keep thinking the way we think.  To be successful in seeing their side, we have to try to think the way they might think.  Ahh...it looks different now, doesn't it? 
    Maybe the best way to look at it is like this: if someone cares enough to keep re-approaching the issue, they must care about what you think.  They want to be understood.  The answer lies in both parties really wanting to understand each other and in respecting each other enough to try to deal healthily with the gap between their thinking.  You have choices, you always do.  You can try to take the other person by surprise and push them into the gap.  Then you won't have to listen to them anymore.  You can look at the gap and see it as an empty space between you that will never be filled and can never come together.  Then you may as well give up.  Finally, you can both straddle the gap.  Sometimes you step over to their side, sometimes they come to yours.  Then you have something that can work and no one gets hurt and no one is eliminated.  You must mind the gap, but you must also keep in mind that the solid ground you both stand on is firmer than the empty space between you.  And there's no better way to close the gap than with an embrace.  Try embracing your differences and making them work for both of you. 

See Your Patients As They Are

    How do you decide what treatment is right for a patient?  You don't.  They do.  You've heard the phrase you can lead a horse to water, but you can't make them drink.  Well, you can present treatment to a patient, but you can't make them accept it.  You may be able to make them want it, but it may be more than they can afford.  Sometimes, no matter how you look at it, you can't make a removable partial budget stretch enough to afford implant supported crowns. 
    I presented just such a treatment plan today.  The patient was a 50ish woman who had just completed orthodontic treatment to correct her occlusion.  She expressed a desire for her smile to look better and to replace missing teeth.  If you judged her by her attire and appearance you would immediately start planning a removable partial.  But, that would be wrong because attire is just not important to some people.  So, my boss treatment planned an optimal series of procedures for her.  The fee was quite high.  I find patient's reactions to expensive treatment plans to be fascinating.  The patients that want the treatment and can afford it may start to try to find ways to get the fee down a little.  They're going to take the whole enchilada, they just want to see if they can save a little dinero first.  Some patients want to challenge the need for the treatment.  They fire off a rapid series of questions to see if they can find a loophole or trip me up.  That's why it's important to study the case and discuss it with the dentist before presenting it.  You must know and understand the treatment or they won't believe in it.  Then, there are patients like the lady today.  She just really can't afford it.  Her reaction was to become angry and defiant.  Now, this is a person who is generally very meek and quiet so I knew she wasn't really mad, she felt threatened.  She wanted some treatment, but not all of the treatment I was telling her about.  She may have thought it was all or nothing.  She may have worried that we wouldn't respect her.  Whatever it was, at that moment I knew I had to stop doing whatever was threatening her.  So I asked her to help me.  I explained that I can't judge patients and decide who gets an optimal treatment plan and who gets an acceptable plan.  They have to decide that themselves.  By her reaction, she was telling me that she needed to have an acceptable plan that would help her function well and allow her to smile without feeling self conscious.  We worked out a phased plan with a payment plan that would allow her to make progress at a reasonable rate.  The fee was something that she could afford and not feel resentful toward us about.  At one point, I sensed that she was ready to get up and walk out feeling discouraged and possibly ashamed.  In the end, she was able to leave with a treatment plan in her hand that suited her and she smiled and thanked me.  I didn't do anything special.  I did what anyone can do.  I looked at her and I saw her as she was.  I accepted where she is right now.  That helped me guide her to treatment that is right for her.  The person who showed me how to do that is my boss.  He sees patients as they are, where they are, and he meets them in that place.  If he can bring them further along, he does.  He never judges them or makes them feel inferior.  He needs to make money, everyone does, but he needs something else more.  He needs and wants to serve his patients.  He makes me and the rest of our staff want to follow his example.  That is one of the things that makes our practice special.  If making money is your bottom line, it will also be your downfall.  If serving your patients is your mission, it will also be your reward.

Is It Really a Man/Woman Thing?

    I'm stealing this topic directly from a discussion I'm involved in that's going on at Dentaltown right now.  It's about the man/woman thing at work.  What makes it so difficult for men and women to communicate.  This seems to affect the dentist and assistant or the dentist and manager more than any other combination.  I think the reason it affects those pairings is because they are together the most and work more dependently on each other.  They tend to develop a more substantial relationship and are more aware of each other's warts as a result. 
    I think that all people communicate in their own way regardless of whether they are male or female.  They also respond and react individually as well.  Different personality types seem to be drawn together because they appreciate some of the differences, but they are repelled by others, so that complicates things as well.  It's a perfect love/hate relationship.  The trick is to work it into a love/accept relationship.  Trying to change someone is useless.  It makes them resist.  You have to first accept that part of them that puts you off.  To do that, you have to realize that it's your problem, not their's.  It's who they are right now.  They may eventually change, but it's what you've got in front of you right now.  Can you deal with that?  If you can, that's great, find a way to accept with what you don't like.  If you can't, deal with that in a healthy, caring way.  By accepting the whole person, you may be surprised to find that the things that bothered you about them seem to fade away, either literally, or in their importance in your mind.
    There is a difference in how men and women use and interpret words, though.  Men see words as tools.  This word is used to describe this and this is how you use it.  Women see words as paint.  This word is used to paint this picture and once the paint is applied, it dries quickly and can't be erased.  The words paint a picture in their mind that they can keep turning at different angles and examining.  It's not so cut and dried for us.  So, when a man uses a word like ignorant or irrational, he means "your actions at that moment, in that event."  A woman hears, "You are irrational or ignorant."  There's no two ways about it, you've got a fight on your hands.  That guy is going to walk away satisfied that he made his point.  He may even be a little self-satisfied with his analogies, especially if he was able to think of a tool or car analogy.  Not so fast mister, you're in a big heap of trouble.  She's mad and you're going to hear about it.  A lot.  No, you can't rationalize this, don't even try, she can't hear you.  Not right now.  You've hurt her.  You've bruised her ego and offended her sensibilities.  Explaining yourself will just sound like blah, blah, blah.  So what can you do?  I don't know.  I've been there myself.  I don't know what my boss could have said at that moment to make me believe he didn't think I was irrational, but that my actions might have been.  So there, I've admitted it.
    I think that the best thing to do is to sit down at a time when every thing's great and have a strategy session.  Figure out how to handle bad times during good times, not in the heat of the moment.  I suspect that the reason that women react strongly to words like ignorant and irrational is because they are psychologically descriptive words.  Women come from a history of men looking at them as people who need to be cared for and protected.  Almost one step above children, but certainly not equal in intelligence or ability.  Women may react to those words because they feel like they are being "put in their place."  Now, this is just my theory, you could even say my guess, but I think that's how I felt about the word irrational.  To my boss, it was the perfect word to describe my actions in one instance.  To me, it was a condemnation of my character and intelligence and an example of what "he really thought of me."  Now, months later, I can see not only that my actions in that instance were irrational, but my reaction to the word was irrational as well.  On the other hand, he could have been more sensitive in his choice of words.  The real issue is to deal with behavior, not to attack the person.  If feedback hurts, at least consider it's validity, don't just bat it away.  It will just keep coming back to you.  Finally, understand that the man or woman giving you the difficult news must care about you.  One of the hardest things to do is to tell someone something that they aren't going to like.  The unpredictability of their response is not going to be risked by someone who could care less.  So men/women, put down your armor and just listen to each other.  Stay calm.  Ask questions if you need clarification.  Listen with your whole mind rather than preparing your rebuttal.  Forget the rebuttal altogether and just converse.  Maybe if we drop the right/wrong thing, we won't have so much problem with the man/woman thing.