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Common “Why’s”
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Urgency
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COVID-19 and Gum Disease Link
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Back up the “nagging” with some facts and the why
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Fear Vs. Money
Michelle Strange [Ad 00:00:00 – 00:02:11]
And Andrew Johnston:
A Tale of Two Hygienists presents this week’s TIPisode: Quick and easy tips to keep you up to date and presented by the experts in the profession. Now, get ready for your unofficial TIPisode.
Teresa Duncan: Hi. Teresa Duncan with Odyssey Management here. And I’m also the host of the Nobody Told Me That! podcast and also the co-host for Chew on This podcast, both available on the Dental Podcast Network.
I wanted to talk to you today about difficult patients and some of the conversations we have to have with them.
One of the unfortunate parts of the COVID is that we’ve had to kind of shift in responsibilities, and so you may have found that you’re taking a little bit more of the conversation regarding finances on in your operatories. You may also have always had issues with patients not really wanting to follow through with treatment. I’m going to give you a couple tips and maybe some reasons why so that you can apply those in your office.
I can’t tell you exactly what the reason is for each patient. Each patient is different. But, in my experience, it could be that it is fear of the dentist. It’s also money. There’s a lot of other things such as, you know, time, convenience, and all of that. But fear and money seem to be the top issues that I have to worry about as a financial coordinator. The money part, of course, is more because of the insurance, but you all are dealing with the fear.
One thing to think about from the patient’s point of view: if you have been seeing this patient for a long time and you’ve continually told them that they need to have scaling and root planning, that their gums are in bad shape, I mean, you’ve given them the same speech over and over again, what we’re actually doing is training our patients that it is not that bad.
And you’re thinking, “But wait. I tell them how bad it is all the time.” The unfortunate part is they hear you saying it, and in their mind, the perception is “It’s really not that bad because I go home. Yeah, I bleed a little bit, but that’s always been normal. He or she keeps telling me that it’s going to start hurting at some point, and I really don’t feel that.” And we all know perio disease. Sometimes you can’t feel it. And, if they’re not flossing, they certainly don’t realize, you know, how much damage is being done silently while they have no idea. And, even if you tell them every six months or however long it is between visits, they sometimes just don’t get it.
So, when we repeat it over and over again to them every visit, it starts to feel like wah, wah, wah because they know you’re going to talk about it. They know it’s going to be the same. So what I’d like for you to do in that situation is talk about the urgency and acknowledge the fact that you keep saying this over and over again. You know, so just head-on just say, “I know we talk about this every time, but I am really worried. It looks like it’s getting worse. And I don’t know if you’ve seen the links to certain systemic issues out there, you know” — and I’ll just take a sidebar here. The California Dental Journal just published an article that shows that COVID-19 shows up most in the bacteria in the mouth for gum disease. There’s a lot of presence of COVID-19 in those people, and it actually, of course, contributes to the poor health. And that’s a comorbidity, right? Perio disease is a comorbidity. And so I’m happy to send you that link. I’ll put it in the show notes so that you can read about it.
But that’s what I want you to do. I want you to take these studies and translate them to your patient. So, when you tell them about how there’s a link between COVID-19, the severity of it, and gum disease, that is going to wake some people up because you’re telling them something new, you’re coming at it with some urgency, and hopefully they’ll realize why they need to pay attention to you.
But it is really sad that we do our job and we do it with good intentions and we repeat their diagnosis over and over again, and because they view the prophylaxis visit as a routine visit, many times they don’t really take the necessity down for it.
Think about it this way: if you go for your check up every time and they tell you you need to cut back on your sugar and you need to lose weight — so you’re going to hear that every time — already you’re thinking to yourself “Oh, he’s going to talk to me about my sugar and my weight again.” So that’s what I mean. They are already expecting “the talk” from you, and so you’re going to have to change the talk.
I would love for you to, again, put some urgency behind it. Let them know that there’s new studies coming out every day. And even — you know what? Roll back in your chair. I know that it’s not as easy now to tug your mask down, but roll back in your chair, and really meet them eye to eye, and say, “We’ve really been dealing with this a long time. I can’t tell you how many times I see this go wrong for the patient when it remains untreated. I’m really concerned about this. And I know I say it every time, but there’s so much dental — there’s so many dental studies out there that show that we really do need to be paying attention to this.”
So make that earnest plea. I’m not begging you to beg the patient to come in, but there’s got to be a point where the patient has to realize that it’s not just guidance anymore. This is truly — it has to do with the health and — and you’ve been saying that all along, but it needs to land with the patient.
So those are pretty difficult conversations to have because it requires you to be a little bit more of a mommy or daddy figure because you’re nagging, and that’s — we don’t see it as nagging, but a lot of times patients do, so you’re going to have to back it up, that “nagging” — I hate calling it that, but that’s what they feel like it is. You’re going to have to back up that “nagging” with some facts and why.
I don’t know if any of you have teenagers. Four children. I do have a 20 year old — almost 20 year old, and this is exactly what I have to do with them because, you know, they know everything. They’ve heard it. But, until it actually hits them hard reality wise, it’s not going to make a difference, and that’s the same thing for patients.
Cardiologists have to deal with this all of the time. They usually will let a patient know they are in danger of heart disease, and it’s not until the heart attack actually happens, or a scare, that the patient decides “Okay. I may need to take this — you know, maybe they do have something to it when they’re telling me I need to exercise and all the other stuff.” We’re not much different than that.
So I’d love for you to approach it from a “How do I repeat this message in a different way each time but with impact?” And, admittedly, there’s always going to be people who aren’t going to follow your recommendations. That is what it is. That’s the nature of health care. But there are going to be people who say, “Wait a second. Okay. Now I get what she’s talking about. I –” And they may even come to you and say, “Thank God. Thank God you really pushed me on this.”
We all have had stories like that. If you’re a younger hygienist, don’t worry. You will get a story like that because there are patients out there that do wake up and realize that we had a big role in healing them not even orally but in other ways.
And so I’m going to end the whole difficult patient conversation regarding fear on that note.
Michelle Strange: [Ad 00:09:12 – 00:10:23]
Teresa Duncan: If it’s money, that’s a much different conversation to have, and that’s where you’re going to need to have options, whether it’s CareCredit third-party financing, whether it’s having some payment plans open. But, when it comes to money, the big issue — and I teach courses on this. The number one thing that it boils down to is “How will I be able to afford it?” And so you have to think in monthly bits, and that’s really easy to do if you offer payment plans or if you offer third-party financing because what patients are looking for is “How much is this going to cost me monthly?”
If you think about it, our society is used to monthly recurring charges. My goodness. Netflix, Hulu, Disney, all of that. And they’re used to a mortgage payment or a rent payment being done every month, the car payment every month. So, when they’re looking at you wondering if they can afford it, what they’re really doing is taking a look — they’re doing an internal scan, and they’re running down all of the list of monthly expenses that they have so that they can see if they can fit this into their budget.
The other part of that — there’s a lot that goes on with treatment planning — I’m sorry, financial planning, but it makes sense to be able to talk to the patients on their level. So, if you are talking to someone — and this is actually with fear too. When you’re talking to somebody and you feel that, you know, you’re a happy-go-lucky person, right? The patient is sort of coming in, and he’s morose. He’s not happy. Maybe he just got really bad news from the dentist, all sorts of crowns, you’re telling him gum disease. You being perky does not help. And, from somebody who’s naturally happy, that’s hard for me to say. But, when you come at them with that attitude, which is a good attitude, patients aren’t — you know, if they’re a grumpy person, that’s not going to help.
So I’m not saying you turn into a grump, but temper the enthusiasm down a little bit. Those people who are not as up as you are do need to have that eye contact where you sympathize, you let them know you understand how they’re feeling, this is how I can help. There’s lots more I could say about this because difficult patients are always going to be difficult, but hopefully you’ve come away with some tips on how to talk to them.
But, again, fear of the dentist — fear and money are the two typical objections that you’re going to run into in your hygiene career or your clinical career, and the sooner you can get comfortable tackling that, your verbal skills will come. Just realize it, talk eye to eye with your patients, acknowledge it, and then when it comes to their clinical health, shake them up a little bit. Let them know this is different than last time. I’m trying to tell you something here. Hopefully that will help you in your operatory.
So, again, my name is Teresa Duncan. I am the host of the Nobody Told Me That! podcast. I talk about insurance, accounts receivable, management. And Chew on This is the new podcast on the Dental Podcast Network, and my friend Kevin Henry and I co-host that. We talk about current dental news and how it affects your practice. It’s a shorter one than the regular Nobody Told Me That! episodes.
So, until the next TIPisode, thank you to A Tale of Two Hygienists for hosting me. I love doing these tips for you.
Michelle Strange: We hope you enjoyed this week’s TIPisode. Be sure to reach out to our guest experts and let them know how helpful their tips were. Follow A Tale of Two Hygienists on Facebook, Instagram, and head over to ataleoftwohygienists.com and subscribe to our newsletter. You can also email us at ataleoftwohygienists@gmail.com, and keep listening for more awesome content from your unofficial dental hygiene podcast.
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