Best Responses to 10 Common Questions Asked by Your Patients

You're listening to the Phil Klein Dental Podcast Thanks for joining us. I'm Dr. Phil Klein. Today, we'll be learning how to deal with difficult questions posed to us by our patients right there in our operatory. Being prepared to answer these questions in the most effective way can empower you to improve your rapport with your patient, get things started off on the right foot, and ultimately lead to improved case acceptance. Our guest is Dr. Mark Hyman, who was in private practice for 32 years and currently serves as an adjunct full professor and special assistant to the office of the dean at the UNC Adams School of Dentistry in Chapel Hill, North Carolina. Since 2001, Dentistry Today magazine has recognized Dr. Hyman as one of the top speakers in dentistry. Dr. Hyman's two-part series webinar titled Questions You Hate, Answers You'll Love, a guide for dealing with difficult patients, part one and two, are now available as on-demand webinars on vivalearning.com. Simply type in the search field Hyman, H-Y-M-A-N, and you'll see both webinars. They're both excellent webinars for the entire dental team. Before we get started, I'd like to thank our sponsor, Philips Oral Healthcare. This is a phenomenal company that helps you empower patients with innovative, evidence -based solutions that meet your patient's unique oral care needs. Philips Oral Healthcare's advanced product line features Sonicare power flossers, electric toothbrushes, and Zoom whitening. To learn more, visit their dental professional website at philipsoralhealthcare.com. Dr. Hyman, it's a pleasure to have you on the show. Hey, Dr. Phil, great to be back with you again, sir. So this is very interesting because we've never quite done a podcast like this. But what we're going to be doing throughout this podcast is kind of simulating the kind of questions that are posed to the dentist chair side that many dentists are unprepared to answer. So today we're going to be talking to you. who's an expert in patient communication and case acceptance and many other things for that matter. We're honored to have you back on the show, Dr. Hyman. And we really are interested and excited to hear the best way to respond to some of these questions. So let me start off with the first question. We're going to go through 10 of them, depending on how much time we have. The first question that is often asked by a patient to a dentist, and you're in the operatory with this patient, and they say, why didn't my last dentist tell me about this? And your response? I love it. So, Phil, one thing I want is our audiences, our teammates and doctors to be prepared. And if you don't role play, if you're caught off guard, you can get defensive and then you are at a deficit with the patient. It's win, win or no deal. And I want people to be in a win-win situation. So if a patient asks you something inane, catches you off guard or asks you, why did my last dentist tell me about this? If you're not sure what to say, a quick response is, you know. That's a good question. It's not, but that's the great stall answer while you get yourself together and think about the response. So my reply to that would be, well, Dr. Phil, you know, that's a good question. I wasn't there when you saw your last dentist. I don't know what you all discussed. May I ask you a question, sir? If I see changes going on in your mouth, do I have your permission to tell you? And when the patient says yes, then you've kind of turned it around where instead of being on the defensive, well, why did my last dentist tell me about this? The answer is, I don't know. I wasn't there. I don't know what you all discussed. However, it's your body, it's your health. If I see changes going on, sir, do I have your permission to tell you? And I'm a huge intro camera believer. We've talked about that. I had eight operatories. I had eight DigiDocs. We took a picture on every patient for every procedure before, during, and after. Dr. Phil, that is the liberating point of dentistry. We are a visual society. So again, I'm not looking for the dentist and the team to get above the patient. I'm looking for us to get on a level playing field and have a common way to communicate. And it is all about the picture. So if I can teach our audiences one thing, Dr. Phil, it's a picture on every patient before, during, and after people do that, it will transform their career. That certainly makes sense. You want to tell the patient that you weren't there. So you obviously don't know why they missed it. And you want to support everything you propose to the patient with imaging, as you mentioned before, during, and after. So what happens when you do present? your treatment plan to the patient, and then they say, well, can I think about it? What is your response? Can I think about it? The temptation is to say, well, what do you want to think about? And that's not a benefit. So my answer to that would be, Dr. Phil, you can do anything you want. It's your body. It's your health. Can I ask you a question? When you came in today, you said you wanted to keep your teeth the rest of your life. You didn't want to have excessive expenses. And now I'm hearing you say, I don't want X, Y, and Z. So help me understand. In your own words, guide me. Help me understand. Were you accurate that you said you wanted to keep your teeth the rest of your life? Are you anxious about the shot? Are you concerned about the taste? Are you concerned about the time? Almost always, it's a financial issue. Again, my coach hero and mentor, Dr. Kathy Jameson, said eight magic words to me years ago and changed my life. She looked at me one day and said, Mark, how do you create the sense of urgency? And so that's what I want for our audiences, which will really help defeat that. Can I think about it? Let me think about it. You can do anything you want. Bill, you mentioned telling the patient what they need in my practice. Need was a punitive four letter word. We never, ever told someone you need a crown. You need to floss. You need to brush better. The better four letter word is what do you want? Do you want fresher breath? Do you want to save time? Do you want to save money? Do you want to save the number of visits? You tell me. So it's a really liberating way to take yourself again out of the confrontation. But also we have to keep in mind if a patient says, can I think about it? It doesn't mean they don't want the treatment. Maybe they're thinking about two different choices or two different directions to go in. Does that make sense? Absolutely. And so I love to answer a question with a question, which is, again, sort of the misdirect. Is it the concern about the time? Is it concerned about the shot? Is it concerned about you're going to gag with the impression? Well, we have digital dentistry. We're going to scan you and not take the impressions. Who's the decision maker here? And my family, my wife's a nurse. All family health care decisions go through my wife. So I hate it when we present a treatment plan in dentistry and the patient says, I have to ask my wife, my cousin's milkman's rabbi's neighbor's priest. We have excusitis in dentistry. I don't care what it is, but I want to know right up front, is there anyone else that's going to have something to say about this treatment? Do you want them to come with you for the visit? Let's move on to the next popular question or frequently asked question in the operatory. When the patient is presented with a treatment plan, why is dentistry so expensive? What do you say to that? I love that one. And my answer to that is, you know, comprehensive dentistry is not expensive. Neglect is. Now that may be a little assertive, aggressive for some people, and I'm okay with that too. But why is dentistry expensive? What is not a winner to me say? Do you know how much money I spent going to dental school? Do you know how expensive this CAD-CAM machine, this digital printer, this CVCT is? That's not a benefit to a patient. You've got some teeth that are in fantastic shape and some that have dramatic changes going on. And so to achieve your goals of keeping your teeth and not having a root canal and not having dentistry that comes in and out of your mouth, here's your investment. Phil, I love to break it up in dollars a day. When I left private practice to teach at the UNC Adams School of Dentistry in Chapel Hill, a crown buildup in Greensboro, North Carolina was like $1,500 some bucks. And people say, man, that's expensive. And so what I'd rather say, it's $3 a day for a year, particularly when a patient's holding a cup of Starbucks for about half that cup of Starbucks a day for a year. I'm not being critical. I want to see where we are and let's move forward. Another approach, tell me if I'm in the right direction here, Dr. Hyman, is that, you know, they ask, why is it so expensive? And the answer is, if you want to keep your teeth, it's going to be a lot more expensive if we don't do it. Because in order to keep your teeth for the rest of your life, by not doing it now is going to cost you three times as much money to get your mouth in good condition two years from now. So this is the most, this is the least expensive time to do this if you want to keep your teeth. Okay, next question. Can you just do a cleaning instead of scaling root planing? Your response. Help me understand what you're asking me. We looked at these pictures, Phil, and you saw when I touched your gums that the blood poured out and pus poured out and your gums have pulled down almost halfway from where they initially were. Whoever was cleaning your teeth historically, I respect their decisions, but that didn't get you healthy. So now you're infected. So just a cleaning. like has been done historically, is not going to help you achieve your goals for getting this infection out of your body. Based on the kind of questions that are being asked by the patient, that should give you a pretty good clue of what you're working with as far as a patient goes, as far as their overall knowledge of dental health, overall knowledge of dental care. Do you look at these questions and kind of change your approach on the fly, kind of like, run some audibles on the field decisions and say, I need to approach this a little bit differently. And I think sometimes, Phil, the way that we have been trained, the way you and I were trained in dental school, professor asks us a question, we give them the five possible answers, and we get the A. And it's overwhelming for patients when we tell them everything we know about stress strain curves and reedy pegs and basal laminas, and it's just like they didn't ask. I've heard dentists describe the different types of monolithic zirconium. I'm like, if you're not speaking to a materials engineer, you're killing them. So a whole bunch of that is really truly getting to know your patient and being able to improvise, to be able to audible and be able to guide the patient so that they're asking for optimal care. Here's another common question that will come up many times in the operatory. Do you think I have soft teeth? Your response? You know, everybody has different genetics and different response to infection in their mouth. And you have 28 teeth, sir, and 28 teeth have cavities. So let me ask you a question. Did you grow up on well water? Did you drink a lot of sugar sodas? Were you guided on how to brush when you were young? Was that reinforced in your family? So soft teeth is kind of a concept that I'm respectful of it, but basically people don't have soft teeth. teeth that have cavities because of genetics, disease, neglect, whatever, however we describe it. Right. Now, that patient that's asking that question probably heard that in their family discussions at home all their life. They've heard their grandparents talk about it and say, well, our family's always had soft teeth. So that's one of the big issues we have in this family. So you have to be careful and kind of tiptoe around that because you don't want to... Absolutely. Calling them on a family. Right. You don't want to bust that myth too strongly. Accurate. Many factors go into this, the sugar, the fluoride, your genetics. And here's what I'm seeing today. And if they are soft, we're going to do everything that we can to reinforce them so they'll last a lifetime. So another common question is, why didn't my insurance pay for this? Or it could be something like, why doesn't my insurance cover this? And your response to that. Why didn't your insurance pay for this? I'd say, Dr. Phil, that's a good question. Was it your expectation that your limited dental yearly reimbursement was going to help you achieve your goals for keeping your teeth the rest of your life? Was that your understanding? Did somebody lead you to believe that the limited yearly reimbursement of your dental coupon was going to help you get eight veneers? Help me understand. So I put it back to them. For us to go into a soliloquy. Dental insurance is a contract between you and your employer, and I wasn't part of that negotiation. It gets onerous, and I think it's a lose. But I just want to put it back to the patient. Help me understand. What was your expectation? Now, what do you say to a patient that says, I would love to have my dental treatment, but if my insurance doesn't cover it, I can't afford it? I say I'm respectful of that. I love having you here in this practice, Phil. And what I would love for us to do is maintain what you have. with thorough, comprehensive cleaning, floor cleanings, and home care. And the cheapest money you'll ever spend is on a Sonicare to get the junk off your teeth, to use the Philips Sonicare Power Flosser, to use regular floss, to use fluoride, to use all these different things we have in dentistry. We can even use some day white, night white to lighten your teeth so they're prettier until you're ready to get some comprehensive care done. So I don't want to criticize the temptation for me. Well, I'm not going to do it if the insurance doesn't pay for it. I almost want to say, really? You're willing to lose teeth based on the arbitrary limits of your insurance? But that can be aggressive as well. Phil, if you think about the continuum of a passive, assertive, aggressive, where do we want to be? And it's a fragile thing and it's a continuum. I tend to be on the assertive plus. I hope it's not aggressive, but I'm confident. that I can figure out a way to help patients achieve their goals for their health teeth and smile. We're so open in dentistry to solve the problem, and sometimes it's going to take several years to get there, and that's okay. So in a sense, you are a proponent of doing some interim dentistry to keep the patient stable during the time where they're looking to get their finances in order so that they can pay for the definitive treatment. No, I don't love it, but absolutely doing caries control, doing quad scales. In a slower timeframe, you know, and there's also times, Phil, because our practice was successful, we would do just because dentistry, as I know that you did too. On average, my practice wrote off about $10,000 of dentistry a month. If someone said please to me, I was going to work with them. When someone said, give me, it's a little harder to be benevolent. To me, Jewish Family Service is called, Lutheran Family Service is called, all different organizations in town because. Dentistry was so good to me, I wanted to give back to my community. And so, again, if someone came to us and they honestly couldn't afford it, we would really work with them. They couldn't afford it because they were going to the Bahamas. They just bought a bass boat. They're going to Vegas. That's harder to say. It's not going to afford it. You don't choose to value it. No one comes to the dental office for a lecture. So I want to be respectful that you don't know everybody's story. You think you might, but you don't. So another question that a dentist might face, which many dentists that have practiced for years have faced many times in the past, is the patient is on a Saturday morning, they call your office, you're closed. They claim to be uncomfortable or in pain. Maybe they had some procedures done on a Thursday or Friday and they're calling you on the weekend. And they ask your front desk, why can't you just call in a prescription? Or that same person. did not come into your office. They are, however, a patient of record, but they have not had any treatment recently, but they're having some pain or discomfort and they don't want to come in to get an exam. They just want you as their dentist to call in a prescription. What do you do there? You know, that's a touchy one. If someone is a patient of record and they've been a good patient and this hasn't happened before, I often give people the benefit of the doubt if they just were trying to avoid paying for it. it's harder to feel benevolent about that. A comment that we could make, Phil, for that is to say, you know what, that's practicing dentistry without a true diagnosis. I can't do that over the phone. Now with teledentistry, it can kind of tiptoe into an area that is beyond the scope of what we're going to talk about today. And people have to decide how they want to deal with that. Phil, this is also a red flag raising opportunity when somebody says, well, how'd you find out about our office? Well, Dr. Phil sent me to you and he said, you're the best. But I'm allergic to everything, but that perka, perka, perka, which we call the triple perka, that's raising the red flag that I'm a drug abuser. So as soon as someone does the triple perka, I say, thank you very much. I'm not calling in anything. Have a good day. I had to teach my students this. Your patient's always right. They just don't have to be your patient. It's okay to listen, look at them and say, what you need is not what I do. So another question, why do we have to do x-rays? You're asked that question. patient sitting in the operatory, you're doing an exam, your staff is ready to line them up to get a set of x-rays, and they say, why do I have to do x-rays? I've had a chest x-ray last week. I love that one. I had a chest x-ray last week. I would say, may I ask you a question? Did the chest x-ray take pictures of your teeth? Well, no. Well, the fact is you're asking me to make a diagnosis of your total dental health with only half of the information. That's not fair to either of us. But in all fairness, in some cases, the patient just had a chest x-ray, so they're concerned. Some of these patients, you know, they're very concerned about the radiation. Now they've gone to you twice a year, and they had x-rays, let's say, 12 months ago, and you didn't find anything wrong, and you're examining their mouth, you don't see any obvious decay, and they go, you know, can we just do without the x-rays? I just had a chest x -ray, so I've been radiated recently. Can we just... off on doing x-rays today. That is the art of what we do in dentistry. And so that's where our judgment comes in to say, you know what, I'm willing to defer this for six months, but at the next visit, I think for your health, it's critical that I can see what's really going on under the gum, in the bone, between the teeth, in your sinuses, around your jaw joints, you know, to start doing an explanation about Rankin's and... you know, we have an apron or do we still use those or not? And the beam is collimated and it's not going to hit the same area. This doesn't benefit the patient. So I would always defer to seek first to understand. Help me understand why you're objecting and what's the risk and benefit. If I miss something, I'm going to feel bad and you're going to feel worse. I care about you all. So guide me. You want to defer six months? We can do that. But please come in six months. And we're going to take a couple moments for some conservative x-rays. And you and I will study them together. And we'll celebrate if they look great. And if something's growing in there, then we'll deal with it. No fuss, no guilt, okay? So another question that might come up, which as a dentist, we should be prepared to answer. Do you know a cosmetic dentist that does smile makeovers? Ooh, baby. Particularly there have been a longtime patient of record in your office. And that's where I think that we may have failed in our marketing. And I would tell people listening to this, don't beat yourself up. Just say, man, is that a great question? That happens to be me. I bet you didn't know dance training we've done in this office. I bet you don't know about the dozens of makeovers we've done that really changed people's lives. May I show you, this is a great time to do some imaging. There's a lot of wonderful systems, whether it's Photoshop, Envision a Smile. preview a hygienist invented that, P-R-E capital V-U, or having some documented cases that just with your SLR camera, your DigiDoc that you've taken over the years and say, Dr. Phil, do I have your permission to show you? Do you have two minutes? Let me just show you what we can do in this office. Here's a set of five before and afters. So you can get furious and say, don't you know I do this? Don't you know I have my fellowship and master's at the Academy of General Dentistry? Don't you know I studied at Dawson, Panky, Spear, Coise? Yeah, really? That's not benefiting them. I'd say, yes, I know the best cosmetic dentist and he's looking right at you right now. Tell me how soon you want to be finished with your new smile. Number 10. This is the last question we're going to be discussing in this podcast. It's been quite entertaining, interesting and entertaining. It's always entertaining with you, Dr. Hyman. You've been my dentist for 20 years. Why are you just seeing this now? Ooh, I had that happen to me. And the answer is, well, thanks. Thank you for asking that question. Dentistry changes so much over the years and we have better diagnostic tools. What I was using 10 years ago wasn't as diagnostic and precise as what I can offer today, particularly if we're using some AI like Pearl. If you were using film x-ray and now using digital radiography, if you're using an old Panorex and now you have a CBCT. So I would try to turn it right to the benefits statement. Isn't it great that we got better diagnostics today than we had 5, 10, 20 years ago? Isn't it great that we caught this today, sir, instead of down the road when it would have been twice as expensive and more unpleasant? Very well positioned answer to that. Very, very good response. I mean, you're bringing out all the positive and the, The fact that he's in your office now, he should be very happy that he has the opportunity to take advantage of all the new diagnostic devices that you've incorporated into your practice. You've changed the landscaping with that response. The genesis of that is I had one of my best friends from elementary school. We took a panorex in 1986 and a full series in 89. And then bite wings year after year after year. And we just freaking missed. And he had an ameloblastoma growing on the angle of his mandible under my supervision that I missed. And it was devastating. And we're dear friends. I see him. We hug and kiss and life is cool. But that's the genesis of that. You've been a patient all these years and you missed it. And sometimes you'd say, yes, I did. We flat out didn't order the right x-ray at the right time. And it's on me. That was a real world situation. Thank you, Dr. Hyman, for your time on this podcast. We'll have you on future programs. And from now, until we see you again, wish you the best. It'll be my privilege. Take care, sir. If you're enjoying our podcast, please leave a review or follow us on your favorite podcast platform. It's a great way to support our program and spread the word to others. Thanks so much for listening. See you in the next episode.