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Episode #414: Mastering Case Acceptance, with Jenni Poulos

the best practices show podcast May 01, 2022

Mastering Case Acceptance: The Question is the Answer

Episode #414 with Kirk Behrendt & Jenni Poulos

Your practice is built on one thing: your patients’ trust. So, how do you get your patients to open up, listen, and engage with what you are saying? To help you master this area of case acceptance, Kirk Behrendt brings back Jenni Poulos, one of ACT’s lead coaches, with expert advice for building trust, rapport, and understanding so that your patients say yes to treatment. Removing fear is the first step! For easy-to-implement tips to increase your patients’ comfort and connection, listen to Episode 414 of The Best Practices Show!

Main Takeaways:

Make patients feel safe, heard, and understood.

Understand patients’ brain function during stress or fear.

Be aware of patients’ verbal and body language cues.

Recognize when you have rapport with your patients.

Ask good, open-ended questions to engage your patients.


“When patients sit in your chair, they're nervous, oftentimes. It doesn't matter if it’s the first time the patient has come in to see you or if they’ve been there five, 10, 15 times. If they're experiencing an issue, if they're experiencing pain, or if you're sharing with them something that's new, if they don't trust you, if they don't feel comfortable with you, they're going to have a hard time hearing what you're saying, understanding what you're saying, and engaging in their treatment, being an active partner in their treatment.” (3:03—3:36)

“How well you communicate determines how far you go in dentistry.” (4:47—4:51)

“The success of the practice really relies upon your ability to have patients say yes to treatment. So, we want to know how we can get them to say yes, build trusting relationships, and really beyond that, we want to create long-term, committed patients that will refer to the practice.” (5:40—6:00)

“Rapport is about building relationships that get us to some level of mutual understanding that makes communication easier. We don't want to run right into our ops, sit down next to our patient, and spend no time establishing relationships, building connection. Because if we do, we are not in rapport with our patients. We are not creating an environment in which they are open to communication, open to hearing and engaging. So, I really want you to always be asking yourself, before you begin telling a patient anything about the treatment that they need that you're proposing, I want you to think about, ‘Am I in rapport with this patient?’” (8:42—9:34)

“You want to be good at paying attention to and reading patients’ body language. Body language does not lie. Nonverbal cues are 55% of communication. By language is 38%. Only 7% is what we say. So, we want to pay attention to, ‘What does the patient’s body language tell me? What is their eye contact telling me?’ And we want to be attentive to the tone and pace of our patients’ language and how our tone and pace is in alignment with that of our patients. This is going to help us build relationships. It’s going to help us get in rapport if we can pay attention to some of these things.” (10:32—11:23)

“If you don't read cues and body language, you can inadvertently scare and confuse patients. If someone comes in and they're very closed off and nervous, and your energy levels are too high and you're too excited, you're going to set them off a little bit. They're not going to feel comfortable. They're not going to feel like you see them. So, these are things that we need to be attentive to when we walk into a room.” (11:24—11:52)

“When we’re looking at body language, really, what we’re asking is, ‘Is a patient open to me, or are they closed? Are they open to hearing what's going on, or are they closed off?’ There are some really easy cues that you can look for with your patient, even just identifying a few of them. If a patient’s arms are really crossed, they're sunken down, if they're hiding their thumbs in their hands, maybe they're rubbing their face, these are indicators that the patient is not open. They are closed off to really hearing and engaging. So, we need to take some actions to get these patients to open up.” (12:45—13:32)

“There are some easy things that we can do. We can shake a hand and get people to actually physically open. If you have models or pamphlets, some kind of patient education, you can hand something to a patient. Just by actually physically opening them up, we mentally release some of that stress and we open them up to hearing what we’re saying.” (13:33—13:59)

“What we’re looking for is arms uncrossed, resting at the sides. Maybe raised eyebrows, relaxed jaw and mouth . . . the Duchenne smile. So, if someone is smiling with their eyes, we get that really authentic smile, that's someone that's open to hearing us and engaging.” (14:00—14:26)

“We feel safe when we can see a little bit of ourselves in someone. When we recognize something of ourselves, be it the way that we’re speaking, the speed, the tone, or maybe even just body language that we’re exhibiting, when we see that, we feel safe. So, tone and pace, mirroring and matching, a couple things I want you to do, I want you to match or exceed a patient’s energy.” (16:33—17:01)

“Use similar language and repeat key words. I say this all the time: if you didn't know the word before dental school, don't use it now. So, distal, buccal, lingual, occlusal — get rid of all those words. If somebody says brown, crooked, front tooth, use the words brown, crooked, front tooth. Because it implies two things: you totally understand what I'm talking about, and number two, you were listening to what I had to say.” (19:10—19:37)

“The patient is telling you with the words that they use how they want you to communicate with them. They're literally giving you a roadmap to the type of language to use, so listen and use it.” (19:38—19:53)

“Let's look at it another way. The brain is asking, ‘Are you with me, or are you against me? Are you in my corner, or are you not?’ If, at an unconscious level, the brain doesn't think you're with me, all decisions become black-and-white. We don't have reasoning. And if I assume you are against me, how likely am I to engage in and trust what you are recommending?” (22:38—23:05)

“When we’re in this self-preservation, scanning, not knowing, the amygdala hijacks our brain. It takes control of our responses. Patients become nervous, uneasy. The stress hormone, cortisol, is going to flood their system and they have an inability to reason, think, and remember, which is a big one. We need them to remember what we’re telling them so they can understand and become partners. So, we need to get patients out of that fight-or-flight into the prefrontal cortex, the section that's responsible for reasoning, thinking, planning, decision-making. This is where we want our patients to be.” (24:01—24:46)

“The neuroscience tells us it would be wise to ask insightful questions instead of telling [patients] what they need. Why? We want to engage the brain in thought. When we ask questions, we get to hijack the brain. We get the brain out of the amygdala hijack, and we hijack it in a good way. We take control of the situation.” (25:49—26:13)

“When we ask good questions, open-ended questions that force patients to think and engage, we force them to the frontal lobe. It forces the brain to think. And when we think, it releases serotonin. This gets us out of that fight-or-flight. It gets us into safety. When there's a release of serotonin, it improves our mood. It reduces fears. It reduces anxiety. It increases mental focus. It increases our learning ability, and it increases our clarity of thought. So, we’re not just masking something. We’re actually inducing a chemical response that's changing the brain function.” (27:42—28:26)

“The majority of people are remembering less than half of what you said. So, you have to take time to get them to slow down, listen, and understand. Get out of fear and into curiosity to engage, or you have no chance of them remembering.” (29:53—30:15)

“What's the number-one predictor of likeability? It’s being a good listener.” (32:53—33:01)

“We want our patients to listen and learn. People don't learn when you tell them something. They learn, they create these new neuropathways that we’re talking about, this higher brain functioning, when they recall, and reflect, and engage in what happened. So, for higher levels of case acceptance, patients need a higher level of understanding. This only happens when you ask questions, which force the patient to answer, to recall, to reflect, and you don't just dictate to them.” (33:33—34:04)

“If you only take one question away from this webinar today, I want you to take, ‘And, what else?’ So, people talk, and the reality is the first answer that someone gives is never the complete answer. It’s rarely the whole answer. So, following up an open-ended question with another question, ‘And, what else?’ It forces you to listen and it makes you resist the urge to tell.” (37:27—37:59)


0:00 Introduction.

2:58 The importance of trust in case acceptance.

3:54 The question is the answer.

5:01 Three objectives to master case acceptance.

7:06 Why you need to read The Coaching Habit.

8:21 Defining rapport.

9:42 Cues to be attentive to.

12:44 Getting patients to the “open” state.

15:58 Mirroring and matching patients.

19:05 Use similar language and repeat key words.

20:18 “Am I safe?”

23:31 Brain function during stress.

24:50 Ask insightful questions.

27:33 Benefits of serotonin.

29:09 The importance of knowing what the doctor is talking about.

31:23 Create curiosity.

32:52 The number-one predictor of likeability.

33:31 Get patients to listen and learn.

34:14 Examples of questions to ask.

39:19 Embrace the awkward silence.

41:18 Last thoughts.

Reach Out to Jenni:

Jenni’s email: [email protected] 

Jenni’s Facebook: https://www.facebook.com/jenni.poulos

Jenni’s social media: @actdental


The Coaching Habit by Michael Bungay Stanier: https://www.porchlightbooks.com/product/coaching-habit-say-less-ask-more--change-the-way-you-lead-forever--michael-bungay-stanier?variationCode=9780978440749

Atomic Habits by James Clear: https://jamesclear.com/atomic-habits

The Importance of Knowing What the Doctor is Talking About by Jane E. Brody: https://www.nytimes.com/2007/01/30/health/30brody.html

ACT Dental To The Top study club: https://www.actdental.com/ttt

Jenni Poulos Bio:

Jenni brings to dental teams a literal lifetime of experience in dentistry. As the daughter and sister of periodontists and a dental hygienist, she has been working in many facets of the dental world since she first held a summer job turning rooms and pouring models at the age of 12. Now, with over 10 years of experience in managing and leading a large periodontal practice, she has a firm grasp on what it takes to run a thriving business. Her passion for organizational health and culture has been a driving force behind her coaching career. She has witnessed firsthand how creating an aligned and engaged team will take a practice to levels of success that they never believed possible! 


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