This Post discusses:

Scripts and Rehearsals

Imagine there are two actors in a play. Both have important parts with a lot of dialogue. Actor #1 memorizes her lines before rehearsals begin. Actor #2 does not. When it comes to being able to perform more naturally, which actor has the advantage?

There have been times when I have personally felt I was wasting my time thinking through and rehearsing scripts with my office team. I also think it is more fun to  play a round of golf than hit buckets of balls at the driving range. Sadly serious golf requires serious practice. It’s no different with dentistry.

Here is how I see performance and rehearsals when it comes to dental practices. Whenever patients are in the office or on the phone, I tell the team that we are in performance mode. When we are debriefing and training, we sometimes will practice through role playing. And role playing exercises always work better and are easier to train when the team works from a developed script.

If, on the other hand, you find this material, too general or too easy, I guess my question back to you is why is this a problem? Even if the material is simple – not as complicated as reading research articles, for example – people and their variety of personalities definitely are not.

The objective is to give you a few tools to improve the quality and outcomes of conversations. People who tend to blow this off also often have interpersonal blind spots. They tend to roll past the feelings of others, not realizing they are stepping on land mines. If the monthly reports are telling you that a large number of people are declining care, or only opting for minimal care, then take this to heart and keep reading.

So far in this post I have addressed some potential concerns or objections people typically have to learning and scripting.  It is based on years of experience presenting A Tooth Has Four Parts.  In fact, a good part of the reason I present it to patients is to address anticipated common barriers people have  to proceeding with care.

Whenever we can address objections even before they come up, it builds credibility and moves treatment forward more efficiently and effectively.

Here are a few common sticking points to proceeding with periodontal therapy that we should be prepared to address in any presentation.

– It doesn’t hurt, so it can’t be that big a deal.

– Why didn’t the last dentist do more or tell me what you are telling me?

– I came in with one area of concern. Why are you spending time looking at other things? Are you just looking for work to do?

– When will I be back to normal?

– I won’t floss, so don’t go there!

– I won’t stop smoking, so don’t go there either.

– I just need to brush harder or “do a better job,” right?

How Adults Learn

The way adults learn and make decisions is different from how children operate. It is critical that we understand this before attempting to give anyone instruction on anything.

Will they listen or not? – is a big question.

Also, it is good to understand what they have likely heard and not heard during our conversation/presentation.

Are you tracking with me thus far? (That’s sort of a trick question). If you aren’t  you have the opportunity of going back and rereading until you can say you are. My point is, and as you well know, sometimes when reading or listening, we go passive. Our minds tend to drift — all the time and for lots of reasons. Attention spans for adults are likely no better than they are for children, it’s just that adults area able to pretend to listen longer than kids can. We can blink in and out during a conversation and still look intensely interested in the process. Fortunately when reading, we can wake up and go back by rereading what we missed. If we are listening to a recording, we can rewind and re-listen (assuming we are motivated enough to do so). But, when engaged in an active conversation, keeping the other person tracking through fairly lengthy and detailed information is a bit trickier, even when the information is critical and patients are doing their absolute best to follow along.

When I drift in listening, I’m faced with a problem. How do I get back on track without embarrassing myself or annoying the other person, who is taking valuable time out of their day to talk with me?

This is where the one in the teacher role plays a critical function that greatly improves the odds of successful information transfer.

When you and others on your team operate with the understanding that minds drift all the time, and that there are often no ways to tell when this is happening, you can then develop strategies to improve the odds of effectively getting through to others.

So here are three presentation recommendations.

1.      Treat adults as adults, not as children. Children, based on their level of development, are involved with brain growth and development. They initially need basic information, before they can then develop the skills to process information in more mature ways. This is why they cannot make good decisions and need parents.

Adults have mature brains. This does not mean, obviously, that they know everything, but they have experiences that help them assimilate new information, make sense of it, and then make decisions based on it.

They are not looking for general lectures. Instead they are looking for answers, but because they are adults, they are not looking to depend on someone else’s answers, not completely, at least. Instead, they want to make up their own minds. So the presentation must be crafted to be respectful and to explain in adequate detail  the issues or problems facing the patient.

2.      Speak to their immediate questions or concerns. Take advantage of  the “golden moment.”

Golden moments are times when adults are most open to information that can change their lives.

Normally, as we go through our days, we know, or pretend we know, what it is we are doing. We don’t want to be bothered by others telling us what to do. On the other hand, when we have a problem and know we don’t have the information to solve it, we actually seek and are open to information – as long as it appears to remain on point.

When people have to make decisions, they begin to ask questions. Learn to identify and speak into golden moments. Often people are not interested in health-related messages and we in healthcare, over time, can come to the conclusion that talking to patients is a waste of time. The truth of the matter is talking is important, but timing as to when to talk is critical.

Here is a good example. You have a neighbor who smokes. His wife has been nagging him to stop. One day when they are over for a visit, the wife turns to you, knowing you are a dentist or work in a dental office and says, “Tell Harry he has to stop smoking. It’s bad for him, isn’t it?”

No matter what you say, you know it will make no impact on Harry. In fact, if I were Harry, it might cause me to increase my cigarette consumption just out of spite.

Why doesn’t Harry change? Smoking isn’t good for him. Everyone agrees with this, even Harry. Is Harry stupid? No, Harry is addicted. He may want to stop but at some level, he really doesn’t.  He is conflicted, and conflicted people because their thinking is wishy-washy are powerless in overcoming powerful habits like smoking.

But here is what Harry does know. In fact, he feel this in his bones. He is an adult. He understands he has the right to make his own decisions, to live his own life with some peace. In return, he also understands it is important to respect the rights and liberties of others. It is for this reason he will resist being  nagged like a child by either his wife or his dentist. In fact, when Harry resists the nagging of others, he is displaying a healthy adult response.

Later, Harry comes to you as a patient. Following the initial interview and examination you two are now ready to have a conversation. By now you know how long he has smoked, when he last attempted to stop and how long he was successful with this attempt.

At this point it is so easy to automatically move into lecture mode. But if Harry, so far hasn’t asked any questions, learn to keep quiet. He hasn’t admitted a problem. If he has no questions or concerns and if he has never made an attempt to stop smoking, then I think the best you can say to him is that if he ever wants to know more about quitting, to let you know.

So the frontal assault on smoking may not be possible at this moment. It isn’t a golden moment in this area of Harry’s life. But now we move to Harry’s other concern. He is seeing you about other oral problems and treatment options. With this as the topic, it is legitimate and important that you discuss smoking as it relates to possible outcomes to treatment he wants you to provide.

When it comes to periodontal therapy, I tell my smokers that there are two groups of people – smokers and non-smokers. The smokers surprise me more than the non-smokers – in two ways. First, whenever a smoker stops smoking during therapy, they have a remarkably good response. I then offer them this analogy.

Have you ever driven a car with the parking break on? When you discover this and release the break, isn’t it remarkable how much better the car runs?

Smoking is like a parking break to your immune system. When someone stops smoking some of the health benefits are immediate – along with the withdrawal symptoms.

The second way smokers surprise me more than non-smokers comes when they are in Supportive Periodontal Therapy. Non-smokers are very predictable whereas smokers come in periodically with sudden infections. It is as if little bombs go off in their mouths. They can be going along appointment after appointment just fine when, all of a sudden, something surprising suddenly sends them back into active therapy.

3.      Rethink Low Tech Versus High Tech

Somehow we think that simple conversations, one-on-one, are low tech and computer presentations are high tech. The fact of the matter is that there is no higher level learning system over the one-on-one tutoring model. This is because there is nothing more sophisticated and powerful compared with connecting one human brain with another human brain through face-to-face conversation.

Every patient is completely unique and so standardized rote presentations will not work. This does not mean that scripting is a waste of time. Just the opposite. When the teacher knows where it is she needs to go in the presentation, she can better relax and concentrate on the needs of the student. In other words, if by scripting, we have an idea of the destination, the particular route to get there is not as important. Also, the more someone presents the material, the better they will become at modifying it to meet the particular needs of each individual patient.

What about teaching oral hygiene classes?

Years ago I tried teaching classes to disseminate basic oral hygiene to people who needed to see me for periodontal consultations. In the military you can try all sorts of things. What I found was that it didn’t work well. Historically in dentistry in the US back in the early 70’s hands-on oral hygiene programs for patients was a popular concept and rooms with many sinks and mirrors were built with the idea that it would be useful to give oral hygiene instructions to more than one person at a time. So there was precedent for what I was trying to do.

The reason it didn’t work was simply due to the fact that it was embarrassing. It was calling people out on the basis of them not doing something right. No matter how the class was promoted it came across as demeaning and belittling.

This is why methods of delegation from the dentist, if he is not going to directly provide the instruction, must be accomplished in very specific ways to people who are both well trained and also who posses high levels of interpersonal instincts. These people must be extremely good at making people feel important and respected.

Even if other members of the office team are able to do this presentation, if the dentist transfer of authority or task delegation is not apparent to the patient, the training will not be taken seriously and patients will not assume their critical roles of responsibility.

Next time I will show you how A Tooth Has Four Parts explains what the patient’s two important areas of responsibility are and why they are critical to the long-term success of periodontal therapy.