My Way or the Highway? Understanding the Patient's Perspective

Do you tell patients, “It’s my way or the highway?” Dentists tend to do that. Physicians tend to do that. People tend to do that. We’re not always sensitive to where someone is.

In my book People Not Patients: Treating People, Not Patients, I talk about the importance of meeting patients where they are—because they don’t know where they should be. That’s our responsibility: to teach patients where they should be.

The Story of a Patient With Bigger Issues Than a Broken Tooth

Let me tell you about something that happened today in the office with one of my associates. She came to me and said, “This patient just wants tooth number 10 taken care of because they broke it. But look at the X-rays.”

I looked at the X-rays and guess what? They need a full-mouth rehabilitation. They’re missing about 10 teeth, and about eight teeth have periapical radiolucencies. They have decay. They have severe periodontal disease. The patient’s mouth is a disaster.

And he’s an architect—you wouldn’t think an architect would walk around like this. But a lot of people just don’t know the kind of situation their mouth is in.

Why Do Patients Let It Get This Bad?

I don’t know why he hasn’t come to the dentist. I don’t know why he’s let his mouth get like that. Most of the time, when people let their mouths get to that point, it’s because they either don’t know, are in a tremendous amount of fear, have had bad experiences, or maybe have a financial problem.

They may have just gone through a divorce. They may have had a severe family issue that they haven’t talked to you about. Who knows what went on with this patient?

The Chief Complaint: Just Fix Tooth #10

The patient said to my associate, “I just want tooth number 10 fixed.” He said, “I was getting my teeth cleaned, and tooth number 10 fell out.”

Well, tooth number 10 was decayed through and through. It didn’t fall out because of the cleaning—it was decayed. But the patient is blaming the hygienist, and all he wants is this one tooth fixed.

They found my practice online. If you found my practice online, you’d know we treat comprehensively. He may be saying he only wants one tooth fixed, but what he’s really saying is, “I don’t trust you. I’m not ready to trust you.”

Earning Trust Starts With Listening

So what do you do when someone doesn’t trust you? How do you earn their trust?

You earn trust by listening. That’s the first thing. You listen to the patient. You listen to where they’re at. You listen to why they’re in the situation they are, and you try to bring them along.

It’s a neuro-linguistic programming technique—it’s called a hook, or bait and switch. You hook the patient by listening. You take them along, you tell them you understand. Once they understand that you understand, then you can move them in a direction that helps them.

Now you have a relationship where you can actually move the patient into a position where you're doing more help than harm.

Treating the Immediate Need—Without Harming the Patient

I would never take out the tooth. I would never do an implant on a patient that has severe periodontal disease. I would never mistreat them.

However, I might do something for that patient that takes care of their immediate need without hurting them.

So what would that be?

The patient broke tooth number 10 down to the gingival margin. The previous dentist said, “You’ve got to take the tooth out.” The tooth doesn’t hurt, but it has an abscess—and the patient has ten other abscesses.

The patient only wants a flipper because they can’t leave the house without that tooth. So what am I going to do?

The Flipper: A Bridge to Trust

My associate asked, “What should we do? I don’t know what to do with this patient.”

I said, “Make him a flipper.”

“But don’t touch him. Just take a digital scan, give him a flipper, and tell him that they have a significant problem that requires a comprehensive examination. Maybe after you give them the flipper, they’ll let you do that exam—and you’ll be able to do what they need. Or maybe they’ll just leave and you’ll never see them again.”

Either way, the patient gets to do what they want once you educate them.

So what did she do? She took a digital scan and sent it out to have an Essex appliance made.

I said, “Don’t do any treatment. Once you do treatment, you own the problem. Then that patient owns you, and now you’re part of the problem—not part of the solution—because you’re working in a way that’s not the most appropriate for that patient.”

The Result: A Shift in Mindset

After she finished the digital scan, the patient said, “You know something? I’m ready for a comprehensive examination.”

So, as I’m doing this video right now, she’s downstairs doing a comprehensive exam on a patient who very likely will go through a full-mouth rehabilitation.

If she hadn’t made the flipper—if she hadn’t said she’d make the Essex appliance—that relationship would never have had a chance to take off and germinate. And that’s important.

Meet the Patient Where They Are

What’s the reason I’m talking about this? I’m not saying to mistreat people. I’m not saying to commit malpractice.

I’m saying: meet the patient where they are, and hopefully you can lead them to where they should be.

Because oftentimes, if I did everything that a patient wanted me to do, I’d be hurting them. Sometimes I say to a patient, “I’d love to do that—but my responsibility is to protect you from hurting yourself.”

That’s often our role in healthcare. We have to protect the patients from hurting themselves. They’ll go online, they’ll hear something from a friend, from the barber, the butcher, the florist—“My friend had it done this way.”

Well, their friend might have had an immediate implant and it went great. Or their friend might have had all their teeth taken out and has been in pain ever since.

Bring Patients Into the Circle of Trust

You want to do it the right way. You want to do it your way—which hopefully is the right way.

And when you can bring patients into that arena where everything is done ideally, even if it’s a rocky road to get there, once they’re in that circle of trust, as Robert De Niro says in one of his movies, then you can do great things for them—and for yourself and everyone around you.

That’s just my way of being the gift.

Have a great day, everybody. I hope this video was helpful—actually, I hope it was very helpful. Not “somewhat.” What am I talking about?

Have a great day—and remember, be it a gift.