Listen to your patients!

Why is attentive listening to patients crucial to your clinic’s growth?

Patients are rarely dental experts, and are likely to have very little understanding of the medical condition of their own teeth. Therefore, often it seems a waste of time to listen to their opinions about their dental condition and possible treatment plan, when they have an appointment at your clinic. Especially when considering that the appointment time is limited, and that you need time for performing the actual treatment. However, allowing time to talk with your patients, and to REALLY listen to them carefully, is crucial to your business growth, for several reasons:

• Better Diagnosis: if you spend time listening to your patients, and don’t rely only on your initial observations, the patients may reveal important hints (e.g. describe some additional symptoms or changes in behavior) that may sharpen or even entirely change your diagnosis. This, in turn, will lead to better treatment and to more successful outcomes, which of course will keep your patients more satisfied and loyal.

• Better alignment with patients: Even when the diagnosis is clear and accurate, there are always treatment choices to be made, and patients’ preferences to consider: Which treatment alternative is best for THIS patient, according to HIS preferences? Can the patient afford the costs involved? What is the best timing for him to do the treatment? How urgent is the treatment for him? If you only act according to your clinical belief about best practices, and fail to align the treatment options with the patient’s preferences, you may find yourself with a very unhappy patient, and may also face billing and collection issues, which is not a recommended way to support business growth…

• Better preparation for medical procedure: In order to improve success rate, you want your patients to undergo medical procedures in optimal physical conditions. For example, the patient can disclose that he is taking certain medicines or that his lifestyle and diet may lead to some vitamin deficiencies, which in turn can impair treatment success rates (e.g. – implant surgeries). So by asking questions and carefully listening to your patients, you may reveal potential interfering factors, and ask your patient to take some measures (for example –  to prescribe him some vitamins and to ask him to do blood tests in order to prove that the vitamin deficiency no longer exists, and only after that to perform the implant surgery).

• Avoidance of malpractice claims: Doctors who encourage their patients to talk and express their opinions, and listen to them with empathy, are less likely to get sued, regardless of how good they are professionally. In fact, following some interpersonal communication training, including attentive listening exercises, doctors experienced a drop of 65% in lawsuits against them. Failing to listen to your patients can lead to heavy legal costs, as well as to severe damage to your reputation – not a good idea if you want your business to grow…

• Adding and keeping more patients as your clients: When patients feel a dentist really listens to them, they are much more likely to accept treatment from him. Remember that patients do not know how to judge your clinical professionalism, but are very quick to judge your attitude towards them. If you are highly professional in all clinical aspects, but your patients feel you do not bother to listen to them, they will desert you, and you will find it very difficult to grow your clientele.

• Receiving additional work from treated patients: When patients visit you for on-going treatment, you can use the opportunity to discuss future treatments that they may need (e.g. – teeth cleaning or straightening, or a 3rd molar extraction). In fact, patients will often be willing to discuss new problems they have with teeth that are not currently treated by you, if you only ask them if they have additional issues with their teeth, and dedicate 3 minutes to listen to their answers and inspect their mouth accordingly. In addition, you can discuss with the patient about his family, and encourage him to ask questions about potential treatments for his relatives. If, for example, a patient’s mother needs a full mouth restoration, and you do such procedures, it will be wise to learn about it from the patient and offer your services.

All in all, applying active listening with your patients may be the single most important thing you can do with your patients in order to make your clinic grow and succeed. Become the dentist patients want to have, simply by listening to their thoughts, fears, preferences and wishes.

How to prepare to an Active Listening session

Now that we have established how important listening skills are to your clinic success, what can you do about it? Can you improve at all, when your communication skills are not your forte? The good news is that anyone can become a better listener, if he only puts his mind to it. Active listening can be learned and nurtured. To improve your listening skills, and significantly increase your clinic growth, try to apply the following recommendations.

• Treat patients like you want to be treated yourself: Everybody loves some attention. No one loves being avoided, ignored, interrupted. In order to properly listen to your patients, get into their shoes. Once you put yourself in their place, and recall what makes YOU feel bad when others don’t bother to listen to you, you will know what to avoid, and what attitude to adopt towards your patients.

• Dedicate time and place: As mentioned before, allowing time for actively listening to your patients is not a waste of time, but probably the best investment you can make in order to grow your client base and succeed. So the first conscious decision you have to make is to dedicate some time to encourage your patients to speak, and to listen to them attentively. Make sure to have such “quality time” with your patient (e.g. – at least 5 minutes per visit), especially in first meetings, but also, at least to some extent, in every meeting with your patients.  During treatment sessions, patients usually will not be able to speak, so you should initiate “listening sessions” before or after the treatment sessions.It may also be wise to sit with the patient at your desk (as opposed to at the treatment chair), face to face, thus signaling that this is a time frame dedicated for communication. Many patients feel more comfortable and open, and less intimidated, when they are not sitting in the treatment chair. By allowing them to discuss things in a more friendly environment, you signal them that you really want to listen to them. Remember how you feel when somebody dedicates time to listen to you. This is exactly what you want your patients to feel. We are all very sensitive to fake gestures, so do not fake it. Make sure your patients feel you do have the time required to listen to them. Bring in the right attitude, invest your time in your patients consciously and willingly.

• Ask “open” questions: Use questions that can’t be answered by short replies, such as – “yes”, “no”, “this tooth” “since yesterday”. “Open” questions encourage the patient to share his feelings and thoughts, e.g. – regarding his dental condition and dental health goals. “What brings you here? How do you feel about dental treatments? Tell me a little about your dental health goals” can all lead to good discussions, in which the patient can feel he is being listened to. With open questions you often can also get some vital and surprising information that will never surface if you only ask “closed” questions like – “where does it hurt?” “for how long?” “do you feel pain when you chew or drink cold water?”. It’s not that such “closed” questions are not an important part of the diagnostic investigation, but by also asking “open” questions you let your patient open up his heart (which is good!) and feel your dedicated attention, as well as allow yourself to collect important insights about things that are “blind spots” to you (things that you don’t know you don’t know, and therefore can’t ask about them initially).

How to make patients feel you REALLY listen to them

• Listen intentionally: When someone really listens to you, you can FEEL it. He is not allowing any distractions to interfere, he is entirely focused on you, he is “all yours.” This is exactly what you want to be for your patients: concentrated, focused on the patient, not allowing any distraction. When you practice active listening, don’t answer phone calls, don’t stare at any screen, don’t allow your assistant to interrupt, close the door and be with your patient. Remember – don’t just listen without paying attention – be totally engaged and turn this into quality time with your patients. Turn it into a real growth opportunity. Invest. Be committed. Be “all in”.

• SHOW genuine interest: In order to portray to the patient that you are “all in”, your body language and reactions to what the patient says must reflect it: Sit face to face to with him, lean forward slightly (but not in a threatening way), keep eye contact with him, focus, nod at things he says and encourage him to continue (“huh-hah”, “Yes, I understand”, “tell me more”…), smile with understanding when appropriate, etc. In this case it is OK to “fake it till you make it” – if it does not come natural to you or if you still feel under time pressure. If you will not be able to SHOW your interest, to vividly express it via your body language, the patient will instantly feel that you are not really interested in him. Fail to show interest – and the entire “quality time” session will be pointless.

• Build rapport: A very powerful technique to induce trust and intimacy (and we are speaking here on personal, not romantic, intimacy) is called mirroring. When two people are close to each other, they tend to mirror the other side’s body language. When one person crosses his right leg over his left leg, the other person subconsciously does it as well. When one smiles, the other smiles back at him. When one leans back – the other leans back as well. Or leans forward a bit. It’s like a little mutual and well-coordinated dance, that both parties subconsciously dance together. When this happens to you with your acquaintances, it builds a rapport, an aligned-acceptance between you. You can replicate this rapport simply by imitating patients’ posture and body language. Sit like the patient, hold your hands or legs like he does – and he is prone to feel that you are entirely “with him”. In fact, mirroring is a very effective and easy to use technique, once you practice it a bit.

• Don’t interrupt: Since you already know that quality time and attentive listening to your patient is vital for YOUR business growth, be patient with your patients… Let them talk. Try not to interrupt them. At all. Make sure they fully expressed whatever they wanted to express. Keep your questions and remarks to yourself for a while, and let them finish. Remember – it is not a waste of time, since what you are aiming for is to let the patients feel that you really listen to them (as opposed to having the most effective, efficient, fast and to the point conversation). To evoke these feelings of being listened to and being noticed, the how matters much more than the what. Every time you interrupt someone, you alienate him. Do not do that.

• Allow silence: Allowing silence periods during a conversation is another technique to signal patients that you have time to listen to them. This will sometimes allow them to regain their thoughts, and add some comments. Therefore, do not be afraid of waiting a bit, to see if the patient has anything else to say. You can encourage them by adding things like “I am listening”, “anything else you want to add?”, or even “Hmmmm….”. When people are not embarrassed by some silence periods, they are actually communicating better.

• Read body language: Minding the body language of the patient is always helpful, but it is even more useful during a treatment session, when the patient’s mouth is “occupied” and he cannot talk, and generally feels very vulnerable. Be very attentive to his facial expressions, his eyebrows, his hands position, his legs posture. For example: Does the patient close his fists tightly? Or showing other signs of anxiety? Don’t ignore it! Tell him you see he is stressed, and suggest why he shouldn’t be, or offer more sedation or anything else that can help him relax. You can also agree with him before you start the treatment, that is he will feel any pain he should raise one hand to signal it, and that then you will stop the drilling. For some patients this feels good, as they feel back in control. For others, this is not a good idea, as they will anxiously wait to feel some pain throughout the drilling… The bottom line is that attentive listening (to body language) is most critical in these moments. These are the moments where the patient learns if he can trust you, or if he is abandoned and ignored on your chair. This is what provides you the opportunity to become “the best dentist ever” in the eyes of your patients, and to build their loyalty.

How to leverage the dialogue with the patient

• Search for clues: How can you constantly show interest while actively listening, when not everything that the patient says is interesting? The answer is that you can MAKE IT interesting, if you only bring the right attitude and look for interesting stuff. When you actively listen, you don’t only listen to the words. You observe the patient’s body language, and you also deliberately search for clues, hints, projections and hidden meanings of what he verbally expresses. You can also search for correlations and discrepancies between what patients say and what their body reflects. For example – they can tell you that they are afraid of the drill sound, but their body language can reflect if it is a huge anxiety or a negligible discomfort. Or – they can comment that they did not sleep well at night, which may serve as a hint for a medical condition that calls for attention.If you actively listen to the verbal communication, to the body language, to the correlation between them, and nevertheless are looking for subtle clues and hints regarding the patient’s condition, you will find that listening becomes much more interesting and challenging. This way, you will miss less clues, you will grasp more information, and – most importantly – you will SHOW real interest, since you will be more engaged in listening, and less bored and distracted. In other words, instead of thinking “I heard it a thousand times already”, “why must she elaborate so much” – search for interesting anchors  “is his body language in accord with what he says”, “what can I learn from her need to elaborate on this?”. Become a dental detective, search for clues, find interesting spots.

• Ask for clarification: Another highly effective way to signal that you are really interested in the patient, is to ask him to clarify things he talked about. This tells the patient that you pay attention, and that you want to know even more (which means that you care, and that you don’t mind dedicating more time to listening). It makes the patient feel important and meaningful to you. And, of course, it can also assist your diagnostic investigation. So, when you find clues and hints – explore them with the patient (e.g. – ask him “why did you not sleep last night?”, “why do you smile when you speak about your fear of drill sound?”).It is also important to use the quality time with your patient in order to set up expectations regarding the dental treatment, and to clarify the patient’s preferences (e.g. – “Tell me a little about your dental health goals”).  Not all patients are alike, and by listening to their preferences you can highly improve the quality of care you provide. Remember that this quality is measured by the patient according to HIS unique expectations.

• Reflect what was said: One of the most powerful techniques of effective listening is to repeat or rephrase what you just heard, and to ask the other party to confirm that you understood well. For example – “So I understand that you work as a salesperson, and therefore the aesthetics of your smile is very important to you, and you feel you want to improve it, right?” When the reflection is in accordance with what the patient meant, he feels you really listened to him, and understand him. When the reflection is not in accordance with what the patient meant, he feels that at least you bothered to check, and that you are interested in what he REALLY feels. Either way you won his trust. If he corrects you, simply reflect your new understanding, and let him confirm. At the end – he will understand that you understand. And that he can count on you.

The proper state-of-mind for active listening

• Listen with an open mind: Patients may come to you with “crazy” ideas about alternative treatments, or about dental hygiene. But do your best not to be judgmental, and to open your mind to their beliefs, preferences, and lifestyles. When you judge them, they feel attacked, embarrassed, and misunderstood. This is the opposite of building rapport. By no means encourage them to use damaging alternative treatments or to neglect their teeth hygiene. However, if you have to change their mind or behavior, do it empathetically and without sounding judgmental (e.g. – instead of saying “this alternative treatment is terrible, and only fools take it” you can say something like “Yes, I heard this alternative treatment is becoming very popular, and I can see why you are enthusiastic about it. However, it can lead to tooth loss, and I recommend a more evidence-based and a much safer treatment, to begin with”.In addition, be open minded to new possibilities, especially if you believe they can do no harm (“Yes, you can chew mint leaves twice a day, if it makes you feel better”). In fact, patients these days use ever-growing online resources to learn about healthcare issues, and are probably one of the best information resources for dentists that want to learn new things and are open minded. Patients are also very quick to recognize which doctor is narrow-minded and conservative, and which is open-minded and advanced. And you do not want to be categorized in a the former, especially not with younger or sophisticated clients… So be less firm and judgmental, and more open-minded to new possibilities.

• Be empathetic: Active listening will not help you grow significantly, if you cannot emphasize with your patients.  Patients don’t only need to be heard, they also need you to recognize and accept their emotions. This does not mean that you have to feel like the patients do, or even to know how it feels to feel like them. It means you have to accept, acknowledge, respect and empathize with THEIR (subjective, irrational, but nevertheless legitimate) feelings. For example, you do not have to be afraid of needles in order to tell a patient something like: “I understand that you are afraid of needles. It must be awful to have this fear every time you visit a dentist.” (that’s the empathy part). “Are there things that usually help you cope with this fear?” (that’s the clarification part). “Can I offer you a laughing gas to reduce this fear?” (That’s the open mind part, if you are used to offering laughing gas only to children).If you really want to empathize with their fear, think of something that you are afraid of. It can be anything: dogs, snakes, sea waves, cancer… Think what you FEEL when you encounter these things. Then think of your patient’s fear, and realize that the FEELING (of fear) can be as devastating for him as your feeling (of fear) is tough on you. Then think how YOU would like others to respond to your fears. This will help you empathize with fears that the patients have. Respect your patient’s feelings. Don’t judge them. Accept them, “feel them” like you are in his shoes, and let the patient feel that you “feel” him.

• Adjust and be flexible: Listening, and communication – can and should change from one patient to another. Some will need more time and attention to build rapport, others will trust you instantly and will need less “quality time”. Learn what works for each patient (another interesting layer of hints and clues to feed the “detective in you”), and act accordingly. Save time with some patients, spend more time with others. Provide more emotional support with some, avoid it altogether with others.It was found in a research that patients intending to undergo complicated medical procedures divide into 3 groups: Trustful, Information seekers, and Emotional Support demanders. Therefore, you should be attentive to the patients’ response to the information you provide (“Tell me more!” or “Too much details for me, I trust you, let’s just do it!”), and to emotional support you provide (“Hold my hand a bit longer, I am afraid”, or “I am fine. Just proceed”). Be flexible. Not all patients are alike. Provide THEIR (unique) needs.

How to respond to what you heard

• Get feedback and confirmation: Asking for confirmation, as mentioned above, completes the reflection technique. After you reflect on what you understood, ask patients to confirm it. More generally, before you advance with any treatment plan, suggest a recommended plan and discuss it with the patient. Make sure you have received the patient’s consent and approval. Make sure the costs and payment terms are also clear and agreed upon (this will often save you billing and collection problems).

• Don’t force a solution: do not try to force anything on the patients, or to “trick” them to accept a treatment that YOU believe in. A very important part of the patient’s opinion about you will include his feeling that his preferences were heard and taken into account. So let the patients decide. Always. And allow decisions that are not “the best practice” in YOUR opinion or according to the guidelines, as long as they are acceptable and do more good than damage. Be open minded, remember?You may also be tempted to “push” a treatment that brings you more profits. But this is a shortsighted thinking, and it may backfire in the long range. Happy and trustful patients, who recommend you to others, will bring you more profits, and a far better reputation.

• Summarize: At the end of the “quality time”, summarize the agreed treatment plan, and make sure everything is understood. The summary can, for example, include the following parts: the medical condition, the patient’s preferences, the agreed treatment plan, the timeline and the costs. After you summarize, ask if all is clear, and answer any questions patiently. Let the patient feel fully informed. Give them time to decide and commit if they need it. The less pressure you put to “seal the deal”, the more likely they are to trust you.

How to implement Active Listening at your clinic

• Practice: The more you will practice active listening, the more you will excel in it. You can practice with your team, friends and family – just listen to them and try to apply the principles. Do simulations of discussions with patients, but also practice on other topics. For example, try to REALLY listen to your kids talking about a problem they have or a topic that interests them (and even better – that bored you to death!). See if you can “expand your horizons”. Then practice with patients, and try to add and command more and more active listening techniques. Eventually, active listening can become your second nature, because, after all, it is first and foremost a matter of attitude: focus on the other side, let the patient talk, and carefully collect insights and clues, while supporting feelings and preferences.

• Kaizen: Take one step at a time, in small steps, and gradually improve. For example – anyone can decide not to interrupt the other party for 1 second. Then, in another conversation, for 2 seconds, and so on. After some time, and 120 conversations, you will manage to not interrupt the other party for two entire minutes, which is a very tough task. And by doing so, almost seamlessly, you will become one of the best listeners in the world.

• Train your staff: Patients should be heard by your entire team. If all team members are good listeners, the satisfaction rate will significantly approve. And, if, on the other hand, your secretary is impatient and insults callers, you will not even get to the first meeting with your patient, and will have no chance to show your patient that you listen to him/her. Share this article with your teammates, practice together, and turn effective listening to a growth engine for your clinic, together.

Summary

Active listening is crucial to build your client base, improve quality of care, and avoid malpractice claims. Invest in it if you want your business to grow, and especially if communication skills are not your forte. You can become a very effective listener by applying to recommendations presented in this article. First and foremost – adapt the proper attitude: dedicate time and space, clear distractions, encourage your patient to speak by using open questions, and show genuine attention while playing the dental detective game. Make sure your response is empathetic and not judgmental, reflect what the patient told you, and allow him to confirm and agree with the suggested treatment plan. Treat the patients as you want to be treated, and gradually practice active listening with your entire team, until it becomes second nature to you all. You’ll be surprised, but in many cases this becomes a life changing journey, and a very enjoyable (and profitable) one.

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