I have spent the last 48 years of my life working in the banking industry. All of us old-timers used to say, “We were born in the lobby.” Some days I feel that way! After 30 years with the biggest bank in the South, I decided to branch out and become a banking consultant. This took me all over the country, working in banks large and small, in towns as big as a million people, and towns as small as 200 people. The one thing they all had in common was that their product was money. What they did not have in common was how they processed their work, the composition of their customer base, and how they interacted with the community.
I soon learned that my job was not to change them from being bank A to bank B. My job was to learn about their cultures, find out what types of banks they were, and to help them become the best they could be. It was also to help them transition from the era of green eyeshades and armbands to the world of technology. In that process, if I heard it once, I heard it a million times: “We’ve always done it this way!” It is interesting to me to see how many of the principles that I taught in banking apply to all businesses. Over those same 40-or-so years of change in the banking industry, dentistry has also changed dramatically.
Illustration by Brian Green
DENTISTRY KEEPS CHANGING QUICKLY
Personally, I remember dreading the dental visit, with the loud drills, white noise headphones to block out the sounds/pain (which never worked for me), the constant spray of water, and all that spitting. Recently, a new cleaning method was introduced, which included a messy combination of baking soda delivered in a strong jet of water. For this new procedure, your face was covered with a blue cloth with a small hole torn in the middle to expose your mouth. In contrast, as I settle into the dental chair nowadays, I am immediately transported to Italy. On the computer screen is a lovely scene from the back streets of a small Italian town with flowers filling all the windows. I take a deep breath while imprinting the scene into my memory. Soon the dental hygienist will come in and touch the mouse that projects my 65-year-old teeth on a screen, taking away my short-lived fantasy trip. I breathe in, not sure what to expect. However, there is one thing that I do know: I will not understand a word she says.
THE CONCEPT OF RECESSION: BANKING VERSUS DENTISTRY
Years ago, I remember hearing discussions why fluoride was only necessary when the teeth were developing and how great it would be if it was naturally present in all water supplies. As patients matured, they were told that fluoride became less important. It seems as if we have come full circle here, as now I hear about how fluoride is important to all patients, regardless of age. This is especially true as people age, since we all seem to be in a constant battle against something called recession. From my years in banking, I sure know what recession is, but why does it matter to my teeth? Why can’t someone explain the difference in concepts to me before I begin to feel too dumb to ask the question?
Not all of us go to dental, dental assisting, or dental hygiene school. For me, recession is all about money and why there isn’t enough to go around. Maybe these two concepts are not so far apart after all. The hygienist wants me to spend money to prevent further recession, and I want to keep my money in case there is one! My point here is that words generate concepts based on an individual’s past experiences. I know what I know, and I am sure that my hygienist is very well-aware of her professional knowledge. We just do not have a common theme—recession to each of us means something different. How can I begin to suggest to my hygienist that we exist in parallel and separate universes? I feel like Rip Van Winkle, who woke up to a whole new world after many years of being asleep. I need good explanations to make informed choices. Not only do I have an altered concept of some of the technical terms, but some dental procedures performed routinely in the past are now changed, or in question.
ARE WE SPEAKING THE SAME LANGUAGE?
Endodontic therapy, better known to me as a root canal, is meant to save my tooth from extraction. However, now I am told that we should extract that old tooth (because the “bone is solid”) and put an implant in its place. I must have been at an isolated bank in Kansas during this treatment concept transition because I do not know what an implant even is! I love to garden, so when I hear a term that includes plant, my mind drifts to my garden and I am lost from the discussion at hand. Rather than ask for a repetition—realizing the waiting room is full—I just nod and say, “Let me think about it.” Thank goodness for the Internet! However, a full search that evening does not answer my personal treatment issues and questions. Once again, we are traveling full-speed ahead on separate and parallel planes of the universe. Am I the only patient who doesn’t get it? Is there a course I could take on understanding dentalese? I feel like a parent trying to understand a text message: “BC, CU 2moro, BBL, F2F,” and, my favorite, “POS.” (For the uninitiated among you, the one you need to watch for is “POS,” which stands for “parent over shoulder.”)
Another challenge occurs during the medical history review, which now happens at each appointment.
I try to explain what medications I take for my various ailments. Frankly, I have forgotten the actual names of most of the drugs I take, since I renew the prescriptions online by checking off the appropriate box. I also have forgotten the dosages, too. And of course my blood pressure is high; I am waiting to see what is wrong with my teeth! Explain the term dry mouth. It’s dry in the morning, when I get up to lecture, when I have to see the boss, and when I go to the dentist! I want to say, “Please define what you mean.” Ask me if my lipstick sticks to my teeth, or if I can’t swallow a cracker without a glass of wine. Why do I need artificial saliva? I can still whistle-down a taxi.
Since I am trying to ramp up the speed on my dental learning curve, could someone explain why I need a referral to a surgeon because I gnash my teeth in traffic, and sometimes my jaw is tired? They say, “You need to wear a bite guard during the day.” I don’t think so. I use my daily drive time to talk to clients, and that will make it very difficult to speak clearly. I am going to need a healthy dose of information before I venture into a surgeon’s office. For the time being, I can deal with an occasional tight facial muscle. (Don’t forget about my previous definition of recession.)
All this to me is no different than when you come into a bank and we start telling you that we are going to debit your account and credit your loan; that you need VSI and we need the LTV and LAR on your loan before we can file the MDSD. The point is, put yourself in your patients’ shoes. Shift your communication and technical language to a more basic, A-B-C level that I can understand. Please explain not only what you are doing, but also why it is important to me. Please tell me why flossing is important and why I need to brush a certain way, and ask me questions before you put a bunch of tools in my mouth. There is an old marketing adage: “Sell the sizzle, not the steak.”
EFFECTIVE COMMUNICATION BEGINS WITH LISTENING
In everything we do, communication and training are the keys to success. I do an exercise in workshops where I walk around with a small box that has a lot of stuff glued all over it and things drawn on it. I ask everyone to write down what they saw without discussing it with anyone. Then, in small groups they make a list of everything they saw. No one ever sees everything. This is because we all see things from a different perspective and a different mindset. It is important to listen to what others say in order to see the whole picture.
How many of you actually listen to what your patient says when you ask all those routine questions? More importantly, do you explain why you are asking the questions? I had a physician many years ago who asked me at every appointment if I was wearing my seat belt while driving. After several visits of answering “no,” I made a change, and was excited to reply “yes” to his question. Then I asked him why he chose that as one of his regular questions. His answer was, “I am concerned about you and want you to be safe.” Simple, yet powerful! If he had simply said that at the beginning, I might have started wearing the seat belt much earlier. Similarly, if you had explained why bleeding gums could lead to heart issues and defeat the self-management of my diabetes, I might have paid more attention.
LEARNING HOW TO DELIVER PERSONALIZED PATIENT CARE
When you have staff meetings, do you discuss how and why the answers to your questions are important? I am fairly certain that not all of your staff members are fully trained on all the possible links between dental and medical conditions. All your patients are definitely not aware of this connection. I think having my blood pressure taken is a good thing, but I am not sure why it is routine in the dental office. How about letting me in on that secret? Is it ultimately for my benefit, for your files, or perhaps to double-check to see that my blood pressure medicines are working? Please spend a few minutes in personalizing my care, because if what you say sounds routine, I probably will not pay attention.
In customer service training sessions, we focus our energies on 3 major areas: listening to the customer; training staff (teaching them how to do their jobs); and teaching staff how to think and learn. Listening to the customer is No. 1 in all industries, and you must build your ability to train your staff. Regardless of what you think, your staff watches and learns from you. Doing it right does not take more time; it is actually more efficient.
PAMPER US...AND IT WILL PAY DIVIDENDS!
I will end with a recap of the last visit to my dentist. Remember now, I had been transported to Italy and was just about to get on the gondola. The hygienist comes in and is very friendly. She first wants to know if I would like to have my hands waxed while I go through the teeth-cleaning process. This is a nice, added touch. I say, “Yes!” However, the thought of getting the wax off my rings came to mind. She says not to worry because she will use a lotion first, and the wax will come right off, not sticking to my rings at all. Then I hear her say, “Oops!” It seems it was cold during the previous night, and the wax had not heated up very much. So, I maneuver around the solid wax and dig deep to find the hot (or somewhat melted) wax in the bottom of the bin. After several dips with both hands, she places my hands into plastic baggies and warm mitts. Aah…that feels good! I settle back into the chair for the dental work. First she scrapes off everything that I missed for the last 6 months. Next the baking soda-and-water-spray routine begins. It is a bit messy, and soda-water gets sprayed all over my makeup, hair, and glasses. But that’s ok...I get whiter teeth, right? Now for the tiny picks. Nowhere in this process does she explain what she is doing. I hear numbers being rattled off: 3, 4, 4, 3... I wonder, am I supposed to be adding them up? I guess that I will have to do it in my head because my hands are in the process of being glamorized. Finally, I am ready for the doctor’s examination. He goes into my mouth with about 3 tools while immediately asking how I’ve been. I gurgle out some odd sounds, and he actually replies! Don’t you love it? I guess he has been hearing the patients’ form of dentalese for a long time now. That part never changes. Last, but not least, is the now all-important fluoride treatment. The hygienist then takes off my hand wraps and attempts to pull the wax off. It will not come off. She says, “Uh oh! I forgot to put the cream on first.” So together, we begin to peel wax. She sheepishly apologizes, and I tell her that it is not a problem. Besides, my hands are now soft and lovely.
I have to admit that my dentist has come a long way from the days of the white-noise headphones. I actually enjoy the visits, and the side trips to Italy are the icing on the cake. However, I am still left wondering what I could be missing. BBFN. CU F2F next time! (Translated: Bye-bye for now. See you face-to-face next time!)