The Behavioral Dimension

Build your relationships first….then your dentistry. ~ Bob Barkley

The Behavioral Dimension

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By Paul A. Henny, DDS & Dana C. Ackley, PhD 

           The first three articles of this series described proven ways to attract to your practice those individuals most likely to be interested in your best and finest services. But, when that person steps through your door, your work has only begun. If they leave after their first contact confused, anxious, shamed, or unheard, they may never come back. Or, they may come back skeptical or closed to hearing what you have to share with them. As dentists, we never set out to make someone feel this way, yet it can easily happen. Why? Because many of us are not trained in the behavioral dimension of practice, which is the dimension that determines how our patients feel.

The behavioral dimension has a huge influence on patient decision-making, perhaps more than any other factor. The good news is that you can learn how to make the behavioral dimension work to better advance the purpose of your practice.

New patients need a good reason to stay in your practice. They must quickly and consistently feel that they are in the right place, at the right time, with the right people, and for the right reasons. You have a good reason to want them to stay. Studies tell us that the profitability of a comprehensive restorative practice is inextricably linked to its ability to consistently establish long-term helping relationships with patients.

Noted psychologist Carl Rogers stated that helping relationships are present when “one of the parties has the intent of promoting growth, development, and the improved health and functioning of the other.” Isn’t this your goal?

While you can learn to build true helping relationships, we have to be candid. There is no magic formula to memorize or cookbook to follow. Instead, you must adapt to each person’s different needs, beliefs, expectations, and emotional state. You can’t expect them to adapt to yours. This “adapting” on your part is the key to reaching the goal of becoming optimally effective on an interpersonal level.

This may sound hard but you’ll get the hang of it. Think of it this way. Personalizing treatment is familiar territory to you. Helping patients feel they are in the right place emotionally is similar and best managed by personalizing the way you interact with them. You can master this kind of personalization by becoming familiar with the concepts and skills of Emotional Intelligence (EQ).

EQ has been a growing area of research and practice over the past twenty years. It is based on the sometimes surprising fact that emotions can make us function more intelligently – if we know how to use them.

How does this apply to dentistry? Emotion drives decision-making. Hence, each patient decides which treatment plan to accept and even whether or not to continue in your care largely on their emotional response to you and the environment that you have created for them. This law of human behavior may contradict your belief that patients make reasoned choices only after carefully weighing the facts. Yes, logic has a part in the process, but it is how people feel about their decision at the moment the decision is being made that really matters in the end.

Recall some of the most important decisions in your life. Did you marry based entirely on cold logic? We hope not. Did you become a dentist only after carefully analyzing all of your career options, or was there a passion for dentistry that made you forgo other ways to make a living? We hope the latter.

As discussed in a previous article in this series, your patients make decisions based on how they feel in your presence. Do they feel safe, comfortable, fully informed, and trusting? Does your new patient process cause them to feel intelligent and competent, or is it reminiscent of a dental experience that left them anxious, ashamed, injured, or intimidated?

How can you lead patients to put trust in your knowledge and leadership rather than feel fear or uncertainty? First, you must recognize that most patients are not competent to judge the true value behind your credentials. Consequently, asking them to rely on your doctorate and training as a sufficient demonstration of your judgment and expertise (and therefore reason enough for others to follow your every directive) rarely carries the day.

Patients base decisions on things with which they are most familiar – namely, their experiences (memories) and gut (emotional response to the situation). Your job is to help their gut feel like you are a highly trust-worthy professional. How can you do that?

Trust is the natural outcome of authentic, empathetic, caring, and hidden-agenda-free communication. Stephen Covey said “The more authentic you become, the more genuine your expression, particularly regarding personal experiences and even self-doubts; the more people can relate to your expression, and the safer it makes them feel to express themselves.” When someone feels safe with you, they are more likely to allow you to help them resolve a problem.

We are talking about skills you likely did not have time to learn in dental school but it is not too late. Enhancing your EQ skills helps you demystify and better utilize emotions to the benefit of everyone. By better helping others emotionally, as well as helping them clinically, you naturally fall into the process of creating the practice of your dreams.

The application of EQ to dentistry is not just a pie-in-the-sky altruism or philosophical rambling. Our fifty plus years of combined experience working with people just like you and the patients you serve has led us to conclusions that have been confirmed by an empirical study completed with the assistance of The Pankey Institute.

The Pankey Institute teaches comprehensive restorative skills, but it also teaches a philosophy of care that can help its students best leverage them. Within their philosophy is a deep commitment to developing genuine helping relationships. To better understand why not every dentist who attends the Institute successfully transitions to the model it promotes, Dana Ackley, Ph.D. along with Drs. Irwin M. Becker and Richard A. Green, completed a study to find out:

1.      If dentists with stronger EQ skills were more likely to succeed at making the practice transition, and

2.      If so, which EQ skills seemed to matter most.

After surveying 144 Pankey-trained dentists, it was found that there was a high correlation between the overall score on the Emotional Quotient Inventory (the only statistically confirmed measurement tool of EQ) and their ability to fully transition to the promoted practice model.

The findings also are relevant to dentists who have not trained at the Institute. You likely know an exceptional clinical dentist whose practice flounders financially. Contrary to common belief that their financial shortcomings are due to their being “poor business people,” our experience (now confirmed with research) tells us that it is more likely that they do not have the critical emotional skill set necessary to prosper financially.

Without the emotional skills needed to create deep, helping relationships, these dentists seem unable to set up and run appropriate patient management systems. Patients in these practices say “no” too frequently to the type of dentistry for which these dentists are best skilled and which ultimately enhances profitability. In other words, the dentists’ lack of financial security is often an outcome of a correctable emotional skill set deficit – and not business skill incompetence.

While the study showed that stronger EQ skills in general clearly contribute to success, four emotional skills were found to be most critical to a successful transition. (See for a more complete discussion of the study).

Emotional Self-Awareness (ESA): As the name implies, ESA is the skill of recognizing and accurately naming whatever emotion one may feel at the time. Dentists with high ESA are better at creating trustworthy, helping relationships. And as stated earlier, trust is a natural outcome of truly authentic emotional communication. Most patients (particularly discerning individuals likely to be interested in comprehensive restorative dentistry) know when others are functioning behind an emotional façade. They can sense, on an intuitive level, when the voice tone, body movements, and type of eye contact are incongruent with what is being said. Thus, they know when communication is being used to advance an agenda potentially outside of their own best interest.

We refer to people with these superficial learned behavior patterns as “impostors.” And when an entire office functions on this level, Dr. Charley Varipapa, calls it a “Happydale Practice.” By this, he describes a group of people strategically acting happy, chatty, and interested. But in reality, it is only a “behavioral veneer;” their actions are simply a learned way of behaving devoid of any authentic feeling.

To illustrate, you may have experienced an emotionally inauthentic experience at a restaurant. Commonly, a well-trained server gets on his or her knee, looks you in the eye, and tactfully pushes a sales agenda – perhaps a special entree′ independent of your preferences. Savvy restaurateurs train people to strategically act in this fashion, as it leads to higher food sales – particularly for high-profit items.

This superficial strategy works for some fast-paced family practices where patient needs are relatively simple and mostly covered by insurance. However, when a patient has a complex problem that cannot be easily deciphered on-the-fly with quick, witty comments, and treatment is well beyond the coverage of their insurance plan, the wheels start to come off of the relationship. People with complex problems aren’t looking for quick answers from witty smooth-talkers. They seek real answers to tough problems from someone who knows what they are talking about and genuinely cares, taking time to thoroughly diagnose, treatment plan and explain the situation.

Restorative dentistry commonly involves what the sales profession refers to as a “complex sale.” Complex sales require significantly greater commitments from both seller and buyer. Avrom King called these commitments “The three coins of Time, Energy, and Money.”

Large, complex treatment plans require time for the patient to decide what is in their best interest, as well as how they intend to find and distribute the energy and money required. Dentists and team members who are masterful at authentic communication and facilitating appropriate patient decision-making are the champions of this different kind of money game. And not so coincidentally, it turns out that these folks are the same individuals with high levels of Emotional Self-Awareness. A skill you can learn as well.

Assertiveness: Those dentists who can present treatment plans confidently and without coercion sell more dentistry. And those who don’t – don’t. It’s about that simple. But before you cringe, be sure that you know what true assertiveness is. Assertiveness is not a politically correct word for being aggressive.

Dentists who are emotionally aggressive send the unspoken message “Our needs come first!” (Not exactly a trust-building strategy). Aggressiveness can be seen in shame inducing, leading, or diminishing statements like “Don’t you want to keep your teeth?” (Meaning: Don’t you want to show me you are not going to act foolishly?) , “Don’t you want me to fix this right now?” (Meaning: If you don’t do what I want right now, I may not be able to help you later), or “Do you want to do anything about the way your teeth look? (Meaning: We both know they look bad, why don’t you do something about it?).

Alternatively, when dentists speak assertively, they send a message backed by respectful, principle-centered leadership, not impatient pushiness. It says “Let’s try to figure out the best way to help you with this problem. But first, can you help me better understand your concerns, goals and expectations?”

Dentists who present treatment plans in an assertive manner are masterful at helping patients understand the full value behind their various options. They express confidence without arrogance, and they allow patients the freedom and time to make the best decisions for themselves. Patients then feel safe to ask questions, challenge ideas, propose alternatives, and ultimately sell themselves on a solution that best fits their long and short term needs.  

Do you think during moments of frustration you may be a bit too aggressive with some patients? A much more effective strategy is to learn how to be assertive. Conversely, there may be times when you concede to a less than ideal solution demanded by the patient in an attempt to not be perceived as aggressive. Such passivity avoids conflict in the short- term but fails to serve you or your patient’s best interests in the long-term as it lacks openness and honesty.

Reality Testing: Whenever we interact with others, we automatically develop a theory about what their behavior means to us. Suppose you present a complex treatment plan to a patient. Upon hearing it, she shakes her head. Based on previous experiences with other patients, you theorize that she is shaking her head due to the high cost of the treatment. Because you have recently learned the EQ skill of testing your theory against reality, you ask, “I notice that you are shaking your head, would you be comfortable telling me why?”

She might answer, “It’s just too much money,” thereby confirming the story in your head. If she were to respond with “When we began, I did not fully realize how long this was going to take, and doing this is going to interfere with my plans for the summer,” your theory would not be validated but you would know the correct issue to explore – how to fit the necessary treatment into a busy summer schedule. Had you acted on your initial interpretation of her headshake, she would have felt unheard and unsafe because you failed to recognize the issues that really mattered in her life.

Our study found that dentists who know how to test their theories about patients’ behavior are much more successful at relationship-building. Reality testing is what helps build enduring bonds of trust as patients feel heard and understood. Critically, patients who feel understood are much more likely to eventually say “yes” to a more comprehensive approach to addressing their needs.

Self-Actualization: Perhaps you are familiar with this term from the work of Abraham Maslow. It is an EQ skill that helps us to develop to our fullest potential. It represents our drive to learn, grow, and mature over time. High self-actualization skills were found to be key to practice transition, as they help sustain the high level of focus and effort necessary to succeed.

You are familiar with dentists who have very strong self-actualization skills as they are considered to be today’s masters. Peter Dawson, Frank Spear, Bob Winter, Carl Misch, John Kois, and Henry Gremillion are a few who quickly come to mind. You may not aspire to a career like Drs. Dawson or Spear, nor do you have to. However, to consistently practice fine comprehensive restorative dentistry, you will need to know enough about self-actualization to sustain your energy through the steep part of the learning curve.

In summary, research supports what many in dentistry have concluded from their experiences over the past forty years; behavioral skills play an essential role when a dentist aspires to provide more sophisticated forms of treatment. We know more concretely than ever that, at the mastery level of comprehensive restorative dentistry, the strength of one’s EQ skills plays an essential role in both practice success and profitability.



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