Too Tough to Trust?

In this guest post, Alan Stern DDS, founder of Better, Richer, Stronger, shares a personal story of serving an assertive patient, treating her with empathy, and changing that patient's perception through kindness and patience. ‍

Mrs. Assertive is a new person referred to my office by a mutual friend. She is in her upper 70s, and has type 3 periodontal disease that is being maintained by an excellent periodontist who also is a good friend and one of my go-to specialists.

Mrs. Assertive, whose first name is Overly, came in with clear expectations. She also brought some unmitigated opinions on her perception of my hygienist’s room, which featured several educational pamphlets that she called clutter. Overly’s (she likes being called by her first name and, frankly, I like being called Alan, so that’s fine with me) chief complaint was a loose tooth #7, which had lost about 90% of its alveolar bone. It was, indeed, quite mobile. She was certain that the tooth would need to come out and be replaced by an implant.

However, she would not allow me to take impressions and make study models that enable me to create a good provisional, because she knew taking an impression would remove the tooth. So began a very interesting journey.

As good as we have to be clinically, we have to be even better at showcasing empathy and humility

I realized that Overly Assertive really wanted help, and that her tough exterior was fear in disguise. As such, that’s the assumption I worked on. I called Roy, my periodontist, and we arranged for me to meet Overly at his office the following week. Armed with an implant, a few Ion prefabricated temporaries, some Jet Acrylic, and a temporary abutment, Roy and I were able to do an extraction and an immediate provisional for Overly.

She was delighted with the level of service we gave, and with the appearance of the temporary crown we were forced to do on the fly. She was also very pleasantly surprised that her tooth did not avulse when I finally took an impression for a pre-operative model at Roy’s office!

Overly returned to our office three months later for her final crown. She accepted our offer to have a scan done at Roy’s office (he has a scanner and is very generous about sharing it with his referring Docs) rather than take a conventional impression.

Here’s where the fun begins. When we screwed the crown into place, Overly noticed that the shade was spot on, but the crown was much shorter than the lateral incisor on the opposite side.

Add positive, meaningful relationships and Monday morning doesn’t have to suck

When I showed Overly that her mandibular anterior teeth were crowded, and that the tooth opposing the crown in question would not allow for us to make it any longer, she became very upset. She wanted things perfect and wouldn’t hear anything to the contrary.

I very calmly listened to her and expressed my understanding of her feelings, along with my desire to help her make a good decision on how to proceed. Per her request, I screwed the implant retained crown in by hand without torquing it and sent Overly home. She said she’d return in two weeks after the Passover holiday.

As she left, of us in the office cheerfully wished Mrs. Assertive a good holiday. Three days later, Overly appeared in my office. It turns out that she socializes with two other dentists and a retired orthodontist, all of whom told her that her new crown looks awesome and that any attempt to change it would create more problems than it would solve. You should have seen the devilish smile of vindication that I playfully displayed to our team for the rest of that day!

On a more serious note, I gained credibility in this very skeptical lady’s mind. The foundation of a solid relationship between Mrs. Assertive and our office had been set up. Let’s do a little learning from my experience by looking at what I did right and what I could have done better.

What I Did Right in Treating the Patient

Often, when a person expresses unhappiness or becomes assertive, we dentists can become aggressively defensive. This leads to nothing good. Remember, when we get into an argument, somebody is going to lose. We do not want that. We want everyone to win.

I allowed Overly to express herself. As she did, I listened generously without interrupting. I tried to relate to what she was expressing, and imagined how I’d feel if I were in her dental situation. I wanted her to know that she was being heard clearly. In other words, I practiced empathy.

When Overly’s tooth did not avulse while I took her impression at the Periodontist’s office (as she knew would happen), I did not tell her, “I told you so.” I just went along with my business of helping her. Declaring that I was right would have been tantamount to declaring that she was wrong. How do you think Overly would have felt about that — resentful, belittled, threatened, frustrated, embarrassed, and insulted.

When we get into an argument, somebody is going to lose ... we want everyone to win

After Overly got through (what she thought was) reading me the riot act, I took a mirror and very thoroughly and gently showed her why her tooth needed to be shorter. I also explained that we could try to “make it right” by first doing orthodontics to move her jumbled teeth into order.

Beyond that, I also explained that this would be very risky, given her periodontal problems — which she has been reluctant to address definitively. At no time did I use an authoritarian tone. I communicated that I was in it with her, and that I would do what we needed to do to help her.

I got very lucky when Overly asked me to place her new crown temporarily, and even luckier that she had dentist friends who confirmed what I showed her. The great motivational speaker Earl Nightingale defined luck as the phenomenon that happens when preparedness meets opportunity. I was prepared with knowledge, experience, and — most importantly — empathy. There was no confrontation on our part, which made it very easy for Overly to see herself in control and “allow” me to torque her crown in place.

What I Could Have Done Better

Dr. L.D. Pankey taught us to never work on a stranger. Mrs. Assertive needed quick, definitive care on a tooth in distress. I could have maintained her a bit longer in her provisional, and asked her to consent to a more comprehensive restorative exam before placing a final restoration. This would have allowed me to get to know her better, dentally and personally. It would have allowed her the opportunity to co-discover her oral condition with me, and to make some decisions with me as a partner in her care.

I think this will happen eventually, but it would have been better if I had the opportunity to help her see her whole mouth and all her issues before embarking on any form of definitive care. Like the rest of the world, dentistry is changing very quickly. Retail and corporate dentistry are breathing down our necks.

Good relationships enhance clinical outcomes, and add meaning and value to life

Consumerism, advertising, and home dental treatments like SmileDirectClub have shown people that they have a choice. So, as good as we have to be clinically, we have to be even better at showcasing skills like active listening, empathy, and humility. We need to give each person entering our office a reason to return each and every time they come in contact with us.

This added burden is really a blessing in disguise, as we can now use our professional skills and bully pulpit that come with the title Doctor (or hygienist, assistant, front desk, etc.) to create deep, meaningful relationships with people who trust us. Who knows … maybe we can even inspire someone to make their work more meaningful by enhancing their relationships!

My experience has also shown that good relationships enhance clinical outcomes. Relationships also add meaning and value to life. So when we add positive, meaningful relationships to our expertise, to paraphrase country music artist Mac McAnally, Monday morning doesn’t have to suck!

Learn more about how RevenueWell improves case acceptance and creates more close-knit relationships between dentists and their patients.