Communications & The Future of Dentistry
The May 30, 2011 issue of the New York Times included an article which may indicate the future of dental practice. Gardner Harris of the Times says, “Doctors were once overwhelmingly male and usually owned their own practices. They generally favored lower taxes and regularly fought lawyers to restrict patient lawsuits.—-But doctors are changing. They are abandoning their own practices and taking salaried jobs in hospitals. Half of all younger doctors are women, and that share is likely to grow.”
Gardner’s article tells how doctors becoming employed results in a shift from right to left, politically. The final sentence is, “People who are conservative by nature are not going to into the profession, because medicine is not about running your own shop anymore.”
Implications for Dentistry
Let’s look at dentists and dentistry to see if we can see in the crystal ball what might lie ahead.
By training and attitude a dentist can graduate and under certain circumstances perform treatment by her/himself. Given a set of dental instruments and a patient, s/he can be an entity unto himself, and historically that’s what happened. But even working alone, the dentist must be a manager and communicator dealing with labs, supply house, scheduler, appointment secretary, telephone/IT operator, make ready/put away, etc.
Times have changed and so has practice. It will continue to change, possibly more radically than dentists anticipate. The common denominator is unchanged: the people part.
Scientific discoveries, population explosion, government intervention, prepaid insurance, standards set by public agencies, technological advances and other outside forces will continue to drastically influence the organization of dental practice and the doctor-patient relationship.
More specialization, greater delegation to auxiliaries, group practice, corporate practice has further altered the practice landscape.
Many dental graduates are saddled with massive student loans making them unlikely to obtain practice financing forcing them to seek employment by corporate-owned group practices or government entities. Woefully inadequate training in management, human-relations and business leaves young dentists vulnerable to risks of running an organization.
(Note: The Baylor College of Dentistry under the direction of Dr. Bill Wathen, is addressing this critical issue with the introduction of a new approach to practice management designed for dentists. This is an important development that should be replicated in other dental schools. If you are interested in learning more, please contact me. WB)
In my view, all of these external pressures will force dentists to reorganize dental practices and become part of a larger health team. These stresses will move practices in unforeseen directions.
There are major forces advocating fully adequate dental care for all citizens. If the dental profession is unable or unwilling to adjust and accept their responsibility in solving the problems of universal access to care, the government could take over. It could become a utility where government agencies tell dentists where they can practice, how much they can charge, who they treat and what treatment will be rendered. All you need to do is look at what has happened in medicine in a very short time.
The drastic changes afoot in traditional dental practice will bring into sharp relief the importance of management, selection, training, appraisal, and development of auxiliary personnel.
Reorienting yourself to this new reality is a process, not an event.
What To Do?
Here are some ideas for consideration:
- The dentist needs to be a whole person, able to accept the whole responsibility of a professional.
- Perception of current bio-technical, social and political issues and how they relate to the dental profession.
- Self-understanding as the basis for decision making, goal setting, and hiring stable, compatible co-workers.
- Personal and professional growth.
- Participative management.
Dealing With Change
The more things change, the more dealing with it stays the same.
I became acquainted with dentists in London and Paris who had been salmon, swimming upstream against the tide of socialized medicine. They not only survived, they thrived in an environment that American dentists would have a hard time imagining. Both England and France had state takeover of medical and dental delivery. A few brave souls, like those I met, were able to communicate that they were different. The communication was both verbal and non-verbal that they were providing care that was superior to that offered by the government. There is a segment of every society who appreciates and will afford quality.
These dentists did what was necessary to establish themselves in the manner that their patients could understand and appreciate.
Ideas For Consideration
- Self- understanding as the foundation for understanding others.
- Development of a philosophy of practice that is easily understandable and repeatable by co-workers and clients.
- Clearly defined (and agreed upon) goals and objectives.
- Participative management which establishes a sense of community. (Co-workers feel a sense of proprietorship in the organization and closeness with the people.)
- Patient satisfaction (Patients appreciate and understand the quality of service performed.)
- Continual improvement of knowledge and skills. (Provide an environment which promotes this in doctor, patients and staff.)
- Development of a self-renewing organization, i.e., one that is flexible, open to change and self-correcting.
- Philosophy and goals of practice are dictated by technical competence. Therefore, continual striving to learn the latest accepted methods and modes of treatment with the best outcomes.
- The most important service offered is diagnosis. Diagnosis is based upon comprehensive oral examination (Including medical & dental history, complete oral inspection of all changes from normal, patient education, and preventive services.)
These ideas are good to consider, but they don’t just happen. Their successful implementation requires hard, grinding work, and most importantly, communication.
Communication
The first thing to realize: Communications are COMPLEX.
Potential Relationships
3 people=6 potential relationships
4 people=24 potential relationships
5 people=120 potential relationships
7 people=5040 potential relationships
Think of the implications when you add one or two auxiliaries or an associate dentist without considering the possibilities for miscommunications.
Dental practices are highly complex. There are new roles not envisaged in dental training. Being a manager was not in the concept most of us had in dental school.
The dentist can feel trapped in playing roles with no training, experience or inclination for. Personnel policies and related managerial functions which require communications skills.
“Communications is a matter of interchange, of challenge and response in human spirit.” Nathan Kohn, Jr.
The ability to communicate is at the very heart of human dynamics. Its importance cannot be exaggerated.
The basic criteria of any dental practice is the capacity to communicate. An organization or group depends for its very existence on effective communication.
Verbal & Non-Verbal
Verbal communications are what we think of first in communications, but many experts believe that 80 – 90% of all communications are non-verbal.
How you dress.
How you drive and what you drive.
The decor and cleanliness of your office.
The pictures on your walls.
The expressions on your faces.
All these and more are non-verbal communications. And, very powerful ones.
My consultant, Dr. Nathan Kohn, believed that to have a truly outstanding practice, I could not accept mediocre co-workers. Dr. Kohn gave me explicit guidance in my communications with dental assistants:
- 1. The role of the auxiliary must be defined as supporting, helping, relating, but not dominating, changing the subject or getting into anything on a personal basis. I feel this something that probably we should write as a part of the training when we have the group here. I feel this is something which is frequently neglected.
- 2. After describing and helping her to understand the nature of the dental-patient relationship, the role of the auxiliary, the place of the auxiliary in supporting the dentist, I think we next have to go into the philosophy, goals, techniques and purposes by which this individual dentist wants to be supported and how this can best be accomplished. I believe this is important.
After this I think we could develop some Do’s and Don’ts for an auxiliary.
Do greet the patient.
Do listen to what they say.
Do look them in the eye when you ask them to come in and be seated.
Do ask if there is something else they want.
Do observe and note the nature of their reaction and whether or not they are nervous, etc.
Don’t talk about something personal.
Don’t pry into their past experience.
Don’t talk to others on the staff in front of them about a subject about which they do not know and, even more, about them.”
These suggestions became important elements in our training and you can readily understand how effectively they communicated the behavior we expected from our dental assistants.
I asked Dr. Kohn how I could learn to verbalize my thoughts in a more concise and understandable manner. His answer:
“This involves first thinking before you speak; second, organizing and dealing with the things that have most importance; third, a great deal of practice. I suggested to you that you might read any short things. See how concisely and relevantly you can report them. Talk to somebody else. Then both re-read the article, out loud if you choose, and see, first, did you control the deepest most profound meaning; second, did you control the entire article in terms of thinking; third, could you have stated it more graphically, better, more concisely. Doing this once a day over a period of months and years does develop the habits of conciseness and expression. However, before doing this at all you have to be sure you have established a relationship with the patient. The most brilliant presentation, concise, etc., of a dentist’s desire to set up a control program for a patient is useless if you do not have empathy and rapport with the person. The first stage of verbalization is relationship.”
I think this says it all.
(Attribution: 1.Selection, Hiring, and Training of Dental Auxiliaries , Green & Kohn, Saunders Company
2. Nathan Kohn, Jr., Personal Communication)
(This is a “stand-alone” article. The Fifth Pillar of COHC will appear in the next post.)
Thanks for your positive comment.WB