Factors Contributing to Attaining Success in the Clinical Practice of Dentistry
A rewarding practice starts with developing relationships
The ultimate goal of practicing clinicians is to be personally and professionally successful. To achieve this goal, a variety of issues need to be considered. While it is true that success means different things to different people, it is reasonable to presume that a clinician who is content has attained a satisfying level of fulfillment based on doing desired procedures, teaching, undertaking research, helping people, or receiving financial remuneration. In private practice, this contentment must be realized while coping with the pressures of treating patients and managing a business. No commentary can cover every issue that concerns all clinicians. Nevertheless, caring for patients over decades has provided the author opportunities to accumulate practical suggestions for achieving a gratifying practice. The following commentary addresses ideas to be considered and thoughts to build on that are pertinent to being happy and attaining success in a clinical dental practice.
Critically Important Issues
The Two Most Important Keys to Success
The two most important keys to success in the private practice of dentistry are to like and be liked by your patients. If you are genuinely concerned about your patients, they will be fond of you in return. Furthermore, if you really care for the patients, you will do what is right for them and they will recognize it. Patients who truly appreciate their dentist’s kindness and attention to detail are more likely to refer their friends and relatives to the practice for treatment.
An important aspect of this mutual affection is to enjoy patients as individuals no matter what their personality or how well informed they are. It is hard for a patient to dislike a doctor who is truly interested in them. From a personal perspective, it is important to take the time to get to know and enjoy your patients each day for the dual rewards of doing good work and having positive interpersonal relations.
Level of Service You Want to Provide
The level of service provided by a clinician is a critical determinant with respect to the degree of success that will be achieved in clinical practice. Good effort achieves a mediocre level of accomplishment. Excellent service attains a greater sense of success. But, that is not good enough. You want to provide outstanding work, and the rewards—personally and professionally—will be remarkable. There are several techniques that can be used to enhance the patient’s perception that you are providing an outstanding service. First, you have to recognize that patients presume that clinicians do all procedures well; therefore, you need to do things beyond fulfilling their expectation of competence. The following measures are helpful:
1. Call patients at night after large procedures to find out how they are doing.
2. After therapy, tell them they are great patients.
3. Call them by their name often, and greet them every time you see them with a big smile.
4. Do something extra as a courtesy, for instance, recontouring a front tooth that’s extruded. In short, if you want to be outstanding in the patient’s mind, you need to do more than perfunctorily carry out tasks.
Certainty During Case Presentations
There are three main challenges that a patient faces when presented with a complex treatment plan: uncertainly, fear of pain, and cost. The hardest challenge for a patient is dealing with uncertainty. Therefore, think through various treatment plans, and present with confidence what you think is the best plan and explain the advantages and limitations of each recommendation. Letting patients know you can fix their problem (if you can) provides great relief, especially when they think their issues are beyond repair. With respect to pain, you can assure them they will feel minimal discomfort from injections, and that concern can be minimized using approaches such as topical anesthetic, nitrous oxide administered at time of injections, and prior premedication. The patient’s third concern is cost. Surprisingly, this is often not the main challenge. Payment arrangements, therapy spread out over time, and alternate treatment plans are measures that allow a patient to proceed.
Keeping Up to Date
Staying abreast of changing academic concepts and technology is time consuming. Nevertheless, both are important to ensure you are providing a high level of care. Continuing education courses, journals, and dental meetings all provide opportunities to enhance your knowledge. Pertinently, it is important to convey to patients that you are providing therapy based on current data. The perception that an outstanding level of care is being provided is a powerful incentive for patients to return and to refer other patients to the office.
Staff is Part of Your Success
Staff is an integral part of your success. You need to express appreciation to your employees. Say something positive to them every day. Do not start the day off with negative comments when staff members arrive. Let them get settled before any issues are addressed. If you treat your staff with respect, it inspires their self-confidence. On the other hand, if an individual is not fulfilling your needs after counseling, steps should be taken to discharge this person. On a daily basis, staff should not be aggravating you, but it is okay for you to prompt them to fulfill your professional goals.
It also is important not to disagree with staff in front of a patient. Employees find it demeaning and the patient senses things are out of sync in the office. These discussions should occur in another room where the patient can’t hear the conversation.
Relating to the Patient
Introducing Yourself
It is important to introduce yourself to the patient with the same type of salutation that you expect to be greeted with by them. In other words, if you introduce yourself as Dr. Jones, you should greet the patient as Mr. or Mrs. or Miss. If you greet patients using their first name, then you should introduce yourself using your first and last name and leave out the doctor, although most patients will call you doctor.
First Impressions
Patients will make their initial judgment about you upon first contact, so make it count. There is no second first impression when you meet someone. Establish eye contact, shake hands, and say hello. Watch your facial expressions, smile, monitor your gestures and body movement, and watch the tone of your voice. You also need to look at yourself in the mirror before meeting patients with respect to your hair, nails, and attire, because you are part of the message. Patients want to be treated by someone who sounds and looks professional.
Presenting Clinical Findings
Presentation of clinical findings after an examination is a defining moment in establishing a relationship with a patient. When discussing results of an oral evaluation, emphasize the positive clinical findings first. Then discuss what can be done for detected issues. If the required treatment to correct a problem is complex, tell the patient that you can help, but it will take time and money. Patients appreciate honesty and a candid discussion about alternate treatment plans. Finish the conversation by expressing that you will take good care of him/her.
Be a Compassionate Dentist
Listen to the emotional content of the message that the patient is delivering. There are methods for the clinician to demonstrate concern. Stay at eye level with the patient but also maintain a social physical distance. Avoid careless posture, and most importantly, avoid staff conversations in front of patients when they are in the chair. The patient should always be the center of attention. There should be no cross chatter between assistants or the doctor regarding subjects other than professional conversations concerning the patient.
Dealing with Patient Issues
Converting an Unhappy Patient
The best way to get rid of an enemy is to turn them into a friend. Ask a patient, how is everything? If they respond fine, but if you see from their face or tone of their voice that it isn’t, you should ask what the problem is. If the patient has a complaint, don’t get defensive; allow patients to express themselves. Ask them how you can make them satisfied. Then if it is possible, accommodate them. Happy patients make referrals to the office; unhappy individuals do not return.
Managing a Patient’s Fear of Dentistry
Respect the concerns of patients who express fear of dental procedures. Tell them they are courageous, because they presented for help even though they have anxiety. If someone is not scared, it doesn’t take courage to come to the dental office. To assuage patient fears, a soft tone and assurance help. A gentle step-by-step approach also may be warranted. Patient should be given the option of taking a tranquilizer to help them cope with procedures that cause them anxiety. You can make patients laugh by saying, “It’s okay if you are nervous. The only time you should worry is when the doctor is nervous.”
What Is Important to a Patient?
Patients want to achieve health, which is why they seek professional care. They anticipate everything will be done correctly. However, patients do not assess the office solely on treatment. They often judge the surroundings as well. Seemingly small things are important, such as having high-quality paper products. Patients expect the office and the bathroom to be clean. They expect courtesy at the front desk. In that regard, if the doctor is running late, the patient should be informed and told why. This simple courtesy avoids patients’ annoyance. Similarly, written payment plans and explanation of insurance benefits prior to initiating therapy circumvent misunderstandings.
Enhancing Relations with Colleagues
Demonstrating Respect
If you are a dental specialist and receive referrals from a general practitioner, there are several steps that should be taken to ensure a good relationship, in addition to doing good work. The sine qua non is that you must always show respect for a referring doctor in front of their patients. Remember, patients usually go to their dentist because they like him/her.
It is important to always have a good word to say about the referring doctor, even those for whom your regard is not the highest. Watch your facial gestures and body posture when presenting results of an examination. Patients are watching and interpreting your movements positively or negatively concerning your assessment of their dentist’s ideas. It is appropriate to send a written report to the referring doctor and he/she should be called and provided a verbal evaluation with respect to their patient. The referring dentist is important and should be included in the final decision-making process. Ultimately, it must be emphasized that the referring doctor’s success is part of your success. From another perspective, if a referred patient asks to be sent to another general practitioner, politely decline to do this. Because, if you do, and this gets back to the referring dentist, you can lose his/her confidence and that of their dental friends in the area. This statement is not contradictory to liking your patients and doing the right thing for them. Do the best you can for the patient and counsel the referring dentist when you disagree with his/her assessments. Otherwise, you can lose a referring dentist, and it will be costly. Yes, there are exceptions to this concept, but be prepared for the consequences of your actions.
Problematic Issues
Problems can arise with respect to prescription referrals to any specialty office, for example, a periodontist. Sometimes when patients are referred for a specific procedure, such as crown lengthening, the examination reveals other concerns (eg, periodontitis). Upon referral, it becomes the periodontist’s responsibility to examine the patient’s periodontal status. Now comes the difficult part. The referring doctor must be informed of all clinical findings. In addition, the periodontist needs to indicate to the patient that although a specific procedure was requested by their dentist, other issues were detected and consultation with their dentist is needed before any additional procedures are contemplated. However, an inquisitive patient may pursue the subject, asking questions, such as about how long the problem has been present or whether the referral for evaluation should have been made sooner. It can get more complicated, if the patient asks about the extent of the problem. A prescription referral in a situation described above is problematic. The periodontist can’t ignore detected problems, and at the same time, does not want to undermine the referring doctor. It is a dilemma for which there is no easy answer. The best way to avoid this type of situation is to ask referring doctors when they make a prescription referral to mention that the periodontist will conduct a more thorough overall periodontal evaluation.
Professional Involvement
Become professionally active at the local, state, or national level. Join committees where you will meet the nicest people and engage in professional camaraderie. Surprisingly, you will find that a prepared person on a committee who has passion and knowledge can make a difference. Dentistry is a great and noble career. Enjoy it.
Acknowledgments
This essay is based on personal experiences, lectures heard over many years, and opinions of colleagues.
About the Author
Gary Greenstein is a clinical professor in the department of periodontology at the College of Dental Medicine at Columbia University in New York, New York. He also maintains a private practice specializing in surgical implantology and periodontics in Freehold, New Jersey.
