Victory with Verbal Skills: Hygienist to Patient

You're listening to the Phil Klein Dental Podcast Thanks for joining us. I'm Dr. Phil Klein. Today, we'll be talking about setting the stage and mastering verbal skills during the dental hygiene visit. Our guest today is Kim Miller. Kim is an RDH, international speaker, writer, trainer, and coach with Inspired Hygiene. Kim's passion is to help clinicians incorporate the oral systemic link, treating periodontal disease with the whole body and mind, resulting in healthier patients and happier, more fulfilled clinicians. Kim, thanks for joining us on our show today. Thank you, Phil. I'm happy to be back. Yeah, you gave a great podcast previously on The Connection. between periodontal disease or bleeding gums and the whole systemic health issue. And it was an excellent, excellent podcast. If our listeners have not tapped into that, please feel free to. It's titled, What's All the Fuss? Learn the Latest on the Oral Systemic Link. Really good information there. So on this one, yeah, on this one, we're going to be talking about the dental hygiene visit. And verbal skills, obviously, are important not only in the dental practice, but... business you're involved with. So let's start with the first question. Setting the stage for the hygiene visit is critical. What is the best way to get the ball rolling with a patient in a positive, non -confrontive way? Oh, I'm so glad you asked me this. I really, this for me, this particular issue is a real big sticking point. I think all hygienists will tell you that We oftentimes get patients who, as soon as they sit down in the chair, they fold their arms across their chest and they say to us something along the lines of, okay, look, before we get started, I just want to let you know, I haven't been flossing like I'm supposed to. I haven't been using that little pit between my teeth like you told me to do. And they feel like they have to confess their shortcomings. And I do a lot of observation when I'm coaching with my clients. I see this very thing happen a lot. And when the patient doesn't hit that head on with us, the other thing that happens is the hygienist gets the patient in the chair and starts immediately firing them with a series of questions. It might sound something like this. So, Phil, have you been brushing? And Phil, feel free to answer. Let's do a little role playing. It's kind of fun. Have you been brushing? Yes, I have. How often do you brush? I try to brush twice a day. What kind of toothbrush do you use? No, I actually use a hand toothbrush most of the time. I do have a power toothbrush, but I don't use it as much as I should. But I have a hand toothbrush, and the bristles are not very rigid, so they're soft bristles. Soft bristles. Okay, that's great. How about flossing? Do you floss? You're asking someone who actually flosses religiously, so I may not be a good person to interview on this one. The whole point I'm trying to make here, I'm sorry for interrupting you, is that the hygienist fires a series of questions at the patient almost immediately upon the beginning of the appointment. And when we're talking about getting the ball rolling with the hygiene visit in a positive, non-confrontive way. That is not positive and it's not non-confrontative. And you, like you just pointed out, are actually a religious flosser. And most of our patients are not. Most hygienists will tell you about 10%, maybe less, of our patients really devote any time to flossing. So here's my suggestion is to ask what I like to call the home care question. So it goes like this. So before we get started with your visit today, tell me what you do on a daily basis to take care of your teeth and gums. And I'm looking for your normal routine. And so now the patient can tell me what they do rather than me firing a bunch of questions at them. Now here's the trick. The trick is once I've asked that question to let the patient answer and not start asking them a bunch of questions. And then no matter what the patient says, My responsibility is to say, good job. I'm glad you're making that effort. So no matter what it is, if the patient says to me, I brush once a day and I floss on Sundays after roast beef dinner, my response is good job. Right. I want to praise the patient for the effort that they are making rather than making them feel bad about not doing what they think I expect. And then there's another part. Part two to the question is, tell me, do you ever spit out pink in the sink? Do you ever see blood when you rinse and spit? And if the patient says no, and most of the time they do, they say, oh, no, my guns will ever bleed at home. Here's the follow up. You know what that means, Phil? It means you're doing a great job cleaning the areas that you can easily and effectively reach. Today, while you're here in my chair, I'm going to check the areas that you cannot easily reach and make sure that they're healthy as well. So what happens is once I pick up my periodontal probe and I start doing a periodontal assessment for the patient and there are bleeding gums, undoubtedly the patient always says, Well, my gums never bleed at home. I only bleed when I come here and you poke me with your tool. So then what's the implication that their bleeding gums are my fault? That's an amazing approach because when you were asking me those questions, when you were throwing one question after another, even though I brush and floss regularly, I'm a dentist, so I'm obviously aware of it. I also heard your other podcast about how dangerous bleeding gums are, but I've been doing it before then. But I felt I was on the defensive. the whole time. Even though I'm actually brushing fairly frequently and flossing more than most people, I still felt that you might not be pleased with my response. And I felt that I was on the defensive the whole time. So this approach that you're mentioning is completely the other way around. And I'm glad you got there because I was worried you were going to be pushing the first approach the way you were asking those questions. Exactly. And most patients are used to the hygienist asking those series of questions. So if we turn the table and we start the appointment on a different foot, a more positive foot, a more positive approach, which this is hard for hygienists, for me to not even have looked in your mouth and say to you that if you're not spitting out blood in the sink, you're doing a good job cleaning your teeth at home. Most hygienists are like, I'm not going to tell the patient that. Why not? Tell the patient. That means if you're not bleeding, that means you're doing a good job cleaning the areas that you can reach. I'm going to check the areas you can't reach. So now, 20 minutes later into the appointment, when there is bleeding upon probing and the patient blames that on me, right? I never bleed at home. I only bleed when I come here. Well, remember. I'm checking the areas you can't reach. This bleeding is coming from areas that are difficult for you to reach, Phil. That's my job, and it's okay. I can help you with this. So it takes out the guilt, and it takes out the blame and the shame, and now it allows me to really coach and guide the patient what's really truly in their best interest here. Here's another question. Here's another scenario. When you're not the patient's regular hygienist, is there something special you tell that patient? when you first see them. So in other words, how do you respond to a new patient when they say, well, actually, this is part two of the question. How do you respond to a new patient when they say, my last dentist or hygienist, Susan, from the other office, never told me I had gum disease or that a crown needs to be replaced? So how do you approach those two scenarios? Yes, I love this question. I love it when a patient says to me, well, I've been seeing my last dentist in California for 30 years, and he never said I had any of these problems. Okay, I hear two things happen. I often hear the dentist or the hygienist throw the other professional under the bus. Well, some people diagnose differently. Not everybody thinks that bleeding gums are a problem, so they're making the previous practitioner wrong. which that doesn't gain me any ground with the patient in the chair. So really the very best way to respond is this. You know, Phil, if your previous dentist or your previous hygienist were seeing what you have going on in your mouth today, they would be just as concerned as I am. Let's talk about this crack tooth or let's talk about your bleeding gums. So rather than throwing that other professional under the bus, I simply acknowledge that if they were seeing what I was seeing, that they would be responding in the same way. They would be equally as concerned. Yeah, and these kinds of responses that you're discussing now are so critical in the minds of that patient in the chair. If I heard someone say that first response where they threw my previous healthcare provider under the bus, I would immediately have doubt about that. the provider that I'm sitting in the chair now. Absolutely. With the second response, first of all, I respect the person for being so diplomatic about their answer, even if I don't, I may or may not completely believe them, you know, because I may not even like my previous hygienist and thinking that they weren't doing their job. Possibly. But even that, I would respect you for presenting that type of answer. just in the face of professionalism and diplomacy in that way. But most patients, I think, would think that was the best possible response a provider can give. Here's another question I have for you. Regarding the medical systemic connection, which you talked about on a previous podcast, what can a hygienist tell patients about this? And given that, we don't want to scare the patient, but they do need to know the truth because it's such a serious issue. So how do you handle that? Right. Right. Well, I have thought long and hard over this. And one of the things that I think that I am that I'm good at is patient communication. And so I would say something along the following lines. So when bleeding gums are present, like you have in your mouth, research shows that these dangerous bacteria can enter your bloodstream. Now, there's mounting evidence that these bacteria are going to travel all the way throughout your body. putting you at risk for a number of conditions such as cardiovascular disease, stroke, rheumatoid arthritis, dementia, diabetes, adverse pregnancy outcomes, if it's appropriate, right, if the patient is a female, and even some cancers. You can be at risk for cancers from these bacteria that can enter your body through bleeding gums. So in our office, what we recommend is something called periodontal therapy. And this is a treatment that's aimed at controlling these bacteria and reducing your risk. However, Phil, I have to tell you that this treatment is only successful if you keep your scheduled visits and you participate by stepping up your oral care at home. So are you interested in treating this infection that you see in your mouth? So I pretty much laid it out in just... I figure you've got the patient's attention for about 60 seconds, really, when you start talking about this stuff. And after each question, I have just a very short amount of time to answer that question and respond to that patient and keep their attention before their mind starts wandering off or their cell phone buzzes or beeps, right? That's exactly what happens, yes. So I want the patient to understand that these bacteria, when they enter the bloodstream, put them at risk. Now, I'm not telling this patient that I can prevent them from having a heart attack or I can prevent them from having a stroke or I can prevent a preterm low birth weight or a stillbirth. I can't say that. I would discourage any dental professional from giving the patient the impression that I can prevent those things from happening. But I do know. from the research that I have read and the courses that I've studied, that these bacteria are putting our patients at risk. And we need to tell the patient about that and then let the patient make the choice whether they want to pursue treating the bleeding gums or not. Yeah. Now, would you also hand out that document that you mentioned in your previous podcast at that visit? Yes, I would. In fact, every patient that sits in the chair that receives a periodontal evaluation or assessment should be given that copy of that landmark study so that the patient understands why I'm doing this. Just in case the listeners didn't catch the first one, could you just briefly go over that? Because that is so important to hand that out, I think. Yeah, it's called the landmark study, and it's a patient-friendly version of this. article that was published in the British Medical Journal, which is a systematic review. Let me give you the exact title here. It's called causative arterial burden, high risk periodontal pathogens contribute to the pathogenesis of arteriosclerosis or arteriosclerotic vascular disease. And it's a very well written paper, but it's, you know, it's a research paper, you have to have a medical dictionary when you're reading it. And so it's been translated into what's called the landmark study, landmark valedonein study. And it's very patient friendly. And any patient that gets a periodontal assessment should get a copy of that. I believe very strongly in third party validation. I always want to give the patient something from a third party that says, this substantiates what I was just telling you. And I don't expect patients to take my word for it. I will even tell a patient that. You know what? Don't take my word for it. Do your diligence. Go home, get on your computer, start doing some searching. And when you search, you are going to find that what I'm telling you is the absolute truth and bleeding gums are dangerous. In fact, I'm sorry, go ahead. Yeah, I mean, do you motivate your patients to be more compliant with home care using the medical systemic connection to the oral pathology? would say that the patients are more motivated when they recognize that what's happening in their mouth can affect the rest of their body most people unfortunately are still in the mindset that whatever happens in my mouth stays in my mouth that you know it's just my teeth you know it's like when you when a patient comes to the dentist and you ask them if they've had any changes in their health and they say oh no nothing that affects my mouth and then 10 minutes later, when the doctor comes in to do the exam, the patient says, hey, doc, you want to see my scar from my open heart surgery? And you could knock me over with a feather because I asked, but the patient doesn't have a relationship understanding that their mouth and their body are affecting one another, that the mouth is the gateway to a healthy body. I think it becomes a motivating factor, yes, to answer your question. Okay, so just... little bit off this particular topic. It is a verbal response type thing that we need to know how to handle when the patient says, will my insurance pay for this? What's the best response? Don't you love that question? That's a good one. You know what? Nobody really knows what insurance is going to pay because even if you do a predetermination, there's a little clause at the bottom that says that the insurance has no obligation to do what they said that they're going to do. Typically, what I say to the patient when they ask about their insurance is the following. You know, Phil, most good insurance companies will give you some benefit toward the treatment that you need. But here's what I need to know. Before Dr. Jones comes in today to do your exam, do you want to treat this infection that you have in your mouth? and get this under control. And here's what I can promise you is that our business team at the front desk, they are experts in helping our patients maximize their insurance benefits and fit their needed dentistry into their budget and their schedule. So we can help you with those things, but doctor's gonna wanna know when he comes in or when she comes in, if you're interested in treating the infection. We can help you with the money part. and we can help you with the insurance. Do you want to take care of the problem that you see in your mouth? And so if it were a cracked tooth or missing teeth, or it was Invisalign that we were talking about, or all on four, whatever, it doesn't matter. It doesn't have to be perio. It could be any condition. Everybody is interested to know that their insurance is going to give them some benefit. And I get that. They pay for it, and they want to know that they can use it. My job at the chair, when I'm at the chair with the patient on the clinical side, is to reassure them that our business team are experts, that they know how to maximize the benefits, and that we can help them fit their necessary treatment into their schedule and we can, I mean, into their budget, and that we can help get them into our schedule, get them an appointment that will work with their life. Yeah, no, that's very good information. Very inspiring. It goes along with the name of your program, Inspired Hygiene. So that is all we're going to have for today's podcast. But I do want to let our listeners know what your email is in the event they want to reach out to you. And that is kim@inspiredhygiene.com. Is that correct? That's me. Yes, that's me. I welcome emails. Thanks again, Kim, for joining us. And we look forward to having you on future podcasts. Thank you, Phil. My pleasure.