04.10.09 Issue #370 Forward This Newsletter To A Colleague
Handling Disgruntled Patients
Hygiene Directions
Leadership Coaching

Got A Hot-tempered Patient? Chill.
by Sally McKenzie CEO
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According to the American Dental Association, 67% of patients who are unhappy with a dental practice will leave. However, only 30% will voice their dissatisfaction; the other 37% will just not return. If you’re lucky, you’ll know how to handle that precious 30% and encourage them to give the practice another try. If not, you’ll make their decision to leave all the easier.

When patients are upset they need the opportunity to unload their concerns. These are crucial moments in which the highest level of diplomacy is required. You have to sit there and let the patients tell their story and get it out—difficult as that may be. Obviously, you have no control over what a patient says, but you can take huge steps toward creating a positive outcome if you judiciously contain the urge to get nasty even when the patient deserves it. In effect, you have to build an imaginary wall that separates you emotionally from the patient. At the same time, however, you have to come across as empathetic to the patient.

Indicate to patients that you have heard and understand what they are telling you. Use phrases such as, “It sounds like what you’re telling me is…,” or, “You’re concerned about <…>. Do I have that right?” Only then will upset patients be willing to listen to anything you have to say because only then will they feel that you have heard their concerns.

Look for areas in which staff can agree with a disgruntled patient. For example, a patient complains to the front desk staff because the doctor is charging $50 to examine their child and says, “The doctor only spent two minutes in the room, and it cost $50.” The staff member might respond with, “You know, you’re right; the doctor is quick. She is able to complete the exam before the child has a chance to become fearful or get upset. Pretty amazing how effective her approach is, wouldn’t you agree?” Then tell the parent all the things the doctor is able to look for and find based on that seemingly brief examination.

Resist the urge to get defensive toward the patient who accuses the practice of trying to cheat them on the bill. Instead, say to the patient, “I’m sorry there’s a mistake on your bill. Let’s go over it together, and find out what the error is. Let’s see how quickly I can get this fixed.” While you’re at it, look for a compliment that can be offered to the irritated patient as the team member is trying to solve the problem, such as, “You’ve certainly been a good patient over the years, Mrs. Cartright.” The approach will help to calm the patient down, help her to feel appreciated, and help her to feel that you are on her side.

One of the best approaches to curbing patients’ disgruntlement is making things expressly clear to them when they are in the chair. It can be tremendously beneficial to outline to a patient specifically what’s going to happen during the visit. For example: “First we’re going to talk about why you’re here. Then I’m going to examine you. After that we’ll talk about my findings.” A study conducted by the American Medical Association of physicians who had never been sued compared them to physicians who had been sued at least twice and found that those who had never been sued spent slightly more time with patients. They allowed the patients to tell their story without interruption. They also outlined what would happen during the visit. Moreover, patients tend to be more cooperative when they know what to expect during the visit.

Keep in mind that patients don’t want you to “like” them. In other words, don’t tell a patient what you would “like” to do. It implies that the doctor is recommending what he/she prefers rather than what the patient actually needs. Instead of saying, “I’d like to put a crown on that back molar,” say, “I strongly urge you to…,” “My professional recommendation is …,” “The treatment that is the best match for your needs and priorities is…,” or “The treatment I would choose for myself or my family is….”

Patients judge dentists and dental staffs more on their talk than their treatment. Like it or not, patients reason, “I may not know dentistry, but I know people.”

Interested in speaking to Sally about your practice concerns? Email her at sallymck@mckenziemgmt.com.
Interested in having Sally speak to your dental society or study club? Click here.

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Angie Stone
Angie Stone RDH, BS
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Candy Can Save The Day

An elderly patient is seated in the dental chair waiting for Suzie the hygienist to begin treatment. As Suzie enters the operatory, she says, “Hello, Mr. Smith. It is very good to see you. Are you ready to get started?” The hygienist begins with a review of Mr. Smith’s medical history. She notes medications the patient is taking. Many of the medications cause dry mouth. During their conversation, Mr. Smith reports the arthritis in his hands continues to worsen as the days go by. It is becoming difficult for him to hang on to small objects. He even believes his jaw is becoming affected by the arthritis.

When the update is complete, Mr. Smith is tipped back so that hygiene treatment can begin. Suzie, the hygienist, is mortified by the amount of plaque clinging to the patient’s teeth. “Oh, no, not this again!” she is thinking. “I know I discussed his poor brushing habits at his visit 6 months ago. I just wish he would listen to me. I am sick of scrapping this junk off of his teeth every time I see him.” She proceeds with the prophy while struggling to refrain from scolding Mr. Smith.

At the completion of the prophy, as she is waiting for the doctor to come in for Mr. Smith’s exam, Suzie again tells Mr. Smith how important it is that he is brushing and flossing his teeth. This is the exact same discussion she has been having with him every 6 months for the last 10 years! What is the frustrated hygienist to do?

It is the responsibility of the dental hygienist to offer more options to a patient in this situation than just brushing and flossing. Though there are mechanical aids other than traditional brushes and floss, these items may not offer much more assistance than traditional items. Mr. Smith’s health issue of arthritis in his hands is a good indicator as to why he is not brushing or flossing effectively. Patients with the inability to execute adequate oral care, no matter what the reason, need to be given achievable options.

An option that fits this situation and description is xylitol. This naturally occurring sugar alcohol had been proven to reduce plaque levels in people who consume the substance on a daily basis. Xylitol is found in the fibers of many fruits and vegetables, including various berries, corn husks, oats and mushrooms; it was first derived from birch trees. The beauty of xylitol is that it is a food substance for harmful bacteria that populate the human mouth. Bacteria ingest xylitol, but they do not have the ability to digest it. Without digestion, the bacteria die off and leave room for more friendly bacteria. Plaque cannot grow in the presence of xylitol.

Xylitol is available in many products, including gum, candy, toothpaste and mouth spray. It is also available in bulk and individual packets much like other sugars. The recommended daily dose to achieve an oral health benefit is 6–10 grams, although benefits have been noted at lesser amounts. If interested in reaping the benefits of xylitol, people should assess the labels of products containing the product. Xylitol should be at least in the top three on the ingredient list, and products with xylitol listed first on the list are preferable. Some company’s market gum and candy sweetened only with xylitol. This sugar substitute does not alter blood glucose levels in diabetics. An adverse side effect of xylitol usage is GI upset, but research suggests adults typically are not adversely affected with diarrhea until xylitol consumption exceeds 100 grams daily.

Consider Mr. Smith’s appointment again. Envision Suzie educating him about the dental benefits of chewing gum or eating candy sweetened with xylitol instead of discussing brushing and flossing again. Imagine the relief Mr. Smith feels knowing there is a way he can improve his oral health other than struggling to brush and floss. Of course, Suzie tells him to still attempt to brush as well as he can, but to incorporate xylitol as well.

Imagine the next visit after that. Suzie is elated because Mr. Smith’s mouth is healthier. Mr. Smith is thankful for not hearing about brushing and flossing again. He is also thankful to Suzie for finding an achievable alternative method which has allowed him to improve his oral health. Suzie is the hero!

Suzie has not only assisted Mr. Smith, she could also increase hygiene production if you sell xylitol products in the office. In today’s economy, the incorporation of any product that assists patients and the office is a must!

Need help with implementing new systems and products in your hygiene department? Email hygiene@mckenziemgmt.com. Interested in having Angie speak to your study group or at your next seminar? Click here.

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Nancy Haller
Dr. Nancy Haller
Dentist Coach
McKenzie Management
coach@ mckenziemgmt.com
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Just Because You're Not Paranoid Doesn't Mean They Aren't Watching You

Fortunately it’s faded in the news, but you still can learn from this mistake, regardless of where you stand on the issue.

A couple of weeks ago, President Obama appeared on The Tonight Show. As is typical of Jay Leno, he focused on the serious issues first then moved onto lighter topics. During the back-and-forth conversation, he asked about bowling in the White House. The President admitted his high score is 129. Of course, this was good for a laugh. In a quick and clearly unscripted moment, he went on to make the big gaffe—he said his skills were "like Special Olympics or something." Critics seized on the incident to assail the President.

I truly believe this off-handed remark was intended to make fun of his own bowling abilities and in no way was meant to disparage the Special Olympics. However, the President did make a BIG mistake. He seemingly got caught up in the moment of having fun and forgot who he was and where he was. In this situation, the President blurred the line between leader and just one of the guys.

You may not be a guest on The Tonight Show, but your staff is eyeing you just as closely. The real issue here is that leaders can never be too careful about what they say or do. Self-effacing humor is a sign of good mental health, but at some level, everything you say and do is scrutinized by the people around you. We call it professional boundaries, and it has everything to do with leadership image.

When I talk about boundaries with people, I am referring to how much you say and do when you interact with employees, patients, family and friends. These decisions affect your leadership image. Who you are as a leader and what you’re able to accomplish are as much about how others perceive you as they are about your innate skills and ability. Your personality, behavior, body language and speaking style, together with your physical appearance, all contribute to the image others hold of who you are.

The perception that others form of you as a result of the impression you make on them has a significant correlation to their perceptions about whether you’re qualified to do your job. Your image can have a great impact on how people get to know you as a person and as a leader. Whether someone is getting to know you through a first meeting, over time or through the media, your image is being broadcast and your reputation is being formed. Furthermore, your employees take emotional cues from you. They learn how to act by watching you, especially when you're off-balance and your guard is down.

So avoid the gaffes, those comments that are seemingly innocent but misrepresent who you are. We’ve all done it at some point in our lives… made (or laughed) at a joke about a Jewish guy picking up money, an Asian driver, a Mexican worker, a woman in the kitchen, etc. We all know they are in poor taste, but the vast, vast majority of us make them anyway—and we laugh. The risk of forgetting and using this kind of humor can have serious impact on how you are seen by others.

Of course there are those times when you innocently disclose too much personal information. You’re trying to put a quiet patient with dental-anxiety at ease. While the anesthetic takes effect, you talk about the new TV sound system you just bought. Trying to be humorous, you admit there are so many bells and whistles it takes an engineering degree to connect all the wires. But the patient is hearing that you spent an enormous amount of money and he wonders if you’re overcharging him. It’s that easy to slip! Your fees may be the lowest in your community but if that one patient perceives that you spent more money than necessary he’s going to think you have too much money.

Developing your leadership image isn’t complicated but it does require self-awareness and self-management. What image do you want employees and patients to have of you? But before you make any changes, be sure to get a good, truthful picture of your image. Take time to understand how others see you and why. Seek feedback from colleagues, your employees and even your patients. Ask your friends, children and significant other. Each of these points of view will shed light on how your words and behavior are viewed by the people around you. Once you gather this information, you can develop the skills to close the gap between how you are seen and how you want to be seen. For example, if you realize you talk too fast when delivering bad news and are often viewed as nervous, you can make a conscious effort to take a breath, slow down and remain calm.

As a leader, you need your employees and your patients to view you as being capable and trustworthy. Mistakes can threaten that and impact your bottom line. Learn to build a leadership image that conveys credibility, confidence and compassion. After all, they will be watching you… whether you realize it or not.

Dr. Haller is the Leadership Coach at McKenzie Management. She can be reached at coach@mckenziemgmt.com.
Interested in having Dr. Haller speak to your dental society or study club? Click here.

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