Listening is the most important skill, in and out of your practice. How you listen and communicate will drive your success as a dentist and as a human being. To help you provide the best care for your patients, Kirk Behrendt brings back Dr. Steve Carstensen, co-founder of Premier Sleep Associates, with advice for improving your listening and communication skills while in the chair. To start getting more engagement from your patients, listen to Episode 593 of The Best Practices Show!
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Links Mentioned in This Episode:
Read The Clinician’s Handbook for Dental Sleep Medicine by Dr. Ken Berley and Dr. Carstensen
Read articles in Dental Sleep Practice
Read Books by Alan Alda
Read Fascinate by Sally Hogshead
Learn more about Mary Osborne’s listening exercise
Register for the ADA Children’s Airway Event (July 27-29, 2023)
Know your patients, yourself, your work, and how to apply your knowledge.
Don’t tell patients what they need. Start with a benefit statement.
Understand the benefits that patients are looking for.
Get good at questions, not answers.
Listen more, talk less.
“Communication touches everything we do. If we have a great idea, fantastic. But if it doesn’t get out of our head into somebody else’s head, well, then it’s not communication. And if we sit there and we need to hear from somebody what their story is, what’s important to them, what it is that we can do to make their life better, we have to listen carefully. And so, we have to communicate that way too.” (7:18—7:41)
“Ultimately, the only thing that matters is, does somebody smile better? Does somebody chew better? Does somebody feel better? Does somebody breathe better? The ultimate rubber hitting the road is when our community health gets better.” (8:04—8:18)
“The masters, Aristotle and others, through the years have given us a better way to communicate where we get to four important points, which is knowing your patient, knowing yourself, knowing your work, and then applying your knowledge. Now, the knowing your patient part is where we get into real interpersonal communications. And that means little things like, ‘What can I do for you today?’ but also, ‘How did you get to where you are today? What’s your health history like, and details? What is it that you’ve had as an experience before? How has it been for you going to the dentist’s office? How has it been struggling with solving a snoring or sleepiness problem, given solutions that don’t really work for you, and dismissive attitudes by some of the medical colleagues that we work with, and really helpful attitudes by others? How is it you’ve gotten to this chair, in this place, with this set of attitudes, with this expectation? And by the way, patient, what are those expectations?’ If you draw those out of your patient really well as a dentist, now you can start to match up better what it is that you can offer to meet those. And if you learn that somebody has unrealistic expectations, wouldn’t you like to know that before you start your treatment?” (10:37—12:01)
“Knowing your work, knowing what you’re comfortable with, and really getting to know your patient, that gives you all the tools you need, all the crayons you need to make the right picture for applying your knowledge. Because applying your knowledge is not simply taking a new skill of fixing a composite a certain way or being able to use that CEREC machine. It’s really about how you can put it all together to make sure your patients are healthier on the other side. That’s the key. Because there are a lot of easy ways to be a great dentist. But if your patient isn’t ready for it, or it’s not the right time for them, or if you’re not the right person to do that particular treatment, then it may not be as successful as you want. Or they have expectations that you think, ‘My margin is great, the color is fantastic, and the bite is perfect,’ but their expectation was different than that. Now, we have a failure there.” (13:01—13:55)
“[It’s] all communications. It’s all really talking to yourself, talking to your team, talking to the patient, and then putting it all together. So, a treatment plan is way more than just putting the tooth list together and what you’re going to do.” (14:02—14:13)
“Another thing that you need to be able to do is to use the data that you gain from getting to know the patient to help them make decisions. Now, you have to be really careful there because we can gain skills to manipulate people pretty easily. That’s not the endpoint because that violates expectations. And so, you can manipulate somebody into saying yes. It’s not hard to do that. But if, at the other end, they feel that manipulation — and they will — that’s buyer’s remorse. And then, they’ll come back, and they won’t be your champion anymore. Like Dr. Pankey says, I want people to pay with appreciation.” (16:12—16:52)
“Scientists have told us that if you’re saying something to somebody, you have a microsecond to keep their brain engaged with what you’re talking about. If you don’t start with something that engages their brain, they’re thinking of something else by the time you’re in your third or fourth word in the sentence. Well, if our job is to communicate, then we have to keep them engaged. And the way to do that is to come up with a benefit statement. So, you start your sentence with what’s good for them, or their name. Their name works too. A classic example, somebody walks into your office, and they have a broken off cusp on number 30. You look at that and you might think, ‘I’m going to do a crown on that tooth.’ Define crown any way you want these days, but, ‘I’m going to do a crown on that tooth.’ And so, you look at that and go, ‘Well, patient, we need to do a crown on that tooth to put it all back together. It’s going to be gorgeous. It’s going to look pretty on your teeth. It’ll be great.’ Well, what did you start with? You started with what the dentist needed, and you ended up saying what the dentist could do.” (17:47—18:51)
“[Instead of telling the patient what they need], if you sit down and go, ‘Huh. I see that cusp is broken. Tell me more about that,’ and they tell you the history of that one, and how long the filling has been there, and whether another tooth has had a broken cusp. ‘Okay. Now, what is it you’d like to make sure we do for you about that broken off cusp?’ And they may say, ‘Well, I’m worried that another piece will break. I’m worried that I can’t chew my food.’ Whatever it is that they say right there, you listen carefully to. And say they are worried about another tooth breaking. ‘Well, patient, in order to make sure that your other teeth are strong, I’m going to do a thorough exam. In order to make sure this tooth won’t break down some more, there’s a procedure we can make called a bonded porcelain restoration.’ Whatever it is, the thing you have to do for that tooth, start with the thing that they told you is the benefit that they’re looking for.” (18:52—19:45)
“We like to talk about features. We like to talk about color match. We like to talk about shape, flossing ability, close margins, and all these fun things about crowns. But we don’t lead with that because patients don’t care. Right? They care a little bit, but that’s not their primary. They didn’t walk in saying, ‘I really want some better margins here.’ They walk in and say, ‘I have a broken tooth, and I’m worried about it.’ ‘Okay. Tell me what you’re worried about.’ And they tell you. Then, you follow up with a benefit statement first. So, it’s like talking with their first name. ‘John, in order for your tooth to be strong,’ bang. Now, they’re listening. Their brain is engaged. And so, you can carry on that way. So, there’s another way of approaching your communications, is to think, what is their benefit, and how do we support what they want with what we can do?” (20:23—21:15)
“[Patients] have a picture of what they want. And they also might have a picture of what they don’t want. Say, for example, you have this broken off cusp on number 30. Easy for a dentist to treatment plan. Then, you look across the mouth and number 19 has a crown on it. And number 19’s crown has a hole in the top of it with a filling. So, we all know what the history there was. They had a crown, and the tooth kept hurting, kept hurting. So, now they had a root canal. Maybe that’s their only experience before. And if you lead with “crown”, well, guess what their brain is remembering? So, get to know your patient. Get their history. Notice that other tooth and say, ‘Tell me more about that other tooth and your experience over there,’ so you get a little bit of their history.” (22:17—23:03)
“Think about our dental practices. If somebody sits in your chair and says, ‘Well, I have this concern,’ and your first response is, ‘Well, no. That’s not really a thing. We can do this other thing.’ Well, you’ve stopped communication right there. But if they say, ‘I have this concern,’ and you say, ‘Oh, I hear that. Yeah, I’m concerned about that too. Let me help you understand that a little bit more,’ now, you’ve engaged your patient with that. And so, the first rule is to listen. The second rule is, ‘Yes, and,’ which means you always have to add to the information. And the third rule is that you have to give more information.” (32:29—33:05)
“The last rule of improvisation is, when it’s over, it’s over. When the story is run out, when the patient shared with you the right things, when you feel it’s time that they’ve said yes, they understand what it is that they’re making a decision about, shut up. It’s time to finish the story. Stop talking because we can overdo it, and that doesn’t apply our knowledge very well. It doesn’t provide a benefit. It doesn’t stay in their question. It starts to add yours, and you won’t be as successful in getting your patient comfortable with making the decision to move forward on the health issues that you’ve talked about.” (33:28—34:03)
“Part of applying your knowledge is to be able to know when the patient is ready to make a decision. Because on a simple example, a broken off cusp, and you really do think a crown is right for that person, and you overcome the history of number 19, so they say, ‘Yeah, I guess I need to do that,’ that’s it. Done. Let’s get it scheduled. Let’s do it right now, whatever it is that works for you at that point. Stop talking because they don’t need any more information about the margins, the color, the bonding system, or whatever it is you’re going to do.” (34:38—35:15)
“When you are sure that the patient is giving you all the signs that they’re comfortable, stop talking. Ask for the close, if you want to be salesy about it. The close is, ‘Well, shall we get started? Are you ready to make an appointment? Would you like to talk to our financial coordinator?’ Whatever it is that gets them to say yes. Because if they don’t say yes to whatever it is that you have in your wheelhouse, they’re not going to get healthier. And we have to not manipulate people into saying yes — that doesn’t work. But if we apply all that teaching, and if we provide a benefit so they stay with us and we stay with them, and then we listen carefully and add to the question, don’t shut down communications, they’re going to get to the point where they’re going to make a decision that’s in their favor or their best interest. They’re going to say yes to something. And that’s when we get out of the way and do whatever it is they told us to do.” (36:07—37:04)
2:15 Dr. Carstensen’s background.
5:26 Why communication is important.
8:18 Treatment planning starts with communication.
14:13 Start by knowing yourself.
17:24 The benefit statement, explained.
22:02 Mary Osborne’s listening exercise, explained.
26:37 Build trust through questions.
29:40 The improv approach.
34:04 Know when to stop talking.
37:22 Last thoughts.
40:04 More about Dr. Carstensen’s work and how to get in touch.
Dr. Steve Carstensen Bio:
After Dr. Stephen Carstensen graduated from Baylor College of Dentistry in 1983, he and his wife, Midge, a dental hygienist, started a private practice of general dentistry in Texas before moving to native Seattle in 1990.
In 1996, he achieved a Fellowship in the Academy of General Dentists in recognition of over 3,000 hours of advanced education in dentistry, with an increasing amount of time in both practice and classwork devoted to sleep medicine. A lifelong educator himself, Dr. Carstensen is currently the Sleep Education Director for both The Pankey Institute and Spear Education, recognized as among the finest places for dentists to further their education. As a volunteer leader for the American Dental Association, he was a Program Chairman and General Chairman for the Annual Session, the biggest educational event the Association sponsors.
He is a Consultant to the American Dental Association for sleep-related breathing disorders and co-author of a textbook for dentists treating the disease.
For the American Academy of Dental Sleep Medicine, he’s been a Board Member, Secretary-Treasurer, and President-Elect. In 2006, he achieved Certification by the American Board of Dental Sleep Medicine.