My second opinion on patient compliance: Winning over the patients who withhold their trust in you

By Tanya Stein Gold, RDH, BS, BA

I bet all of you are familiar with the concept of a "second opinion." If not, it means patients leave one dental office and go in search of treatment confirmation at another. They want another dentist to either say "yes," they agree with the previous dentist's findings, or "no," the treatment diagnosed by the first dentist is not needed.

I find the concept of the second opinion very interesting because of its direct tie to patient compliance. By looking past the surface meaning, we can understand what patients are really saying when they seek a second opinion. Essentially, they're saying one of three things. They do not trust the dentist's ability to diagnose appropriately; they need an outside party to validate; or they don't feel the office's fees are fair. This is a problem any way we look at it because the patient leaves and may not return. So, what are we doing in our offices that makes patients feel like they need a second opinion? What will it take for a better connection and patient compliance? Why don't they trust us?

According to Merriam-Webster dictionary, trust is defined as "Assured reliance on the character, ability, strength or truth of someone or something." It is the core of all good relationships. Patients need to believe we are acting truthfully on their behalf so they feel safe when abiding by our recommendations. They also need to like us on some level. How can we as hygienists create better relationships with our patients and build trust in an effort to eliminate the second opinion? How can we build better relationships that lead to increased patient compliance?

Patient compliance is key for the success of the patient and practice. It is mutually beneficial in the sense that patients adhere to good oral health-care practices, and dental clinicians have the opportunity to implement prevention-based dentistry. Finding dental disease and treating it when it occurs keeps the office doors open. So the question is, how do we create this relationship that keeps the business running and patients returning?

If you've been seeing the same patients for years, you already have a relationship, which makes it easy for them to follow your advice. They've learned to trust you. These tend to be the compliant patients. But we also have returning patients who think they know better and don't follow our recommendations. Some patients are fearful of dental work or have a hard time putting a value on dentistry. It is these patients, as well as new patients, with whom we need to work harder and approach differently.

For some clinicians, communication skills-connecting with others and employing the art of persuasion-come naturally. For others, not so much. As an industry, we face a huge challenge with every new patient who walks through the door. In a very limited amount of time we must build rapport and gain trust to move forward with dental recommendations. Even with x-rays and photos to illustrate our case, in order to be compliant, some patients still need to like us, trust us, and believe we're acting in their best interest.

As a communication specialist and practicing hygienist, I have identified key nonverbal and verbal tactics you can use to encourage trust and rapport. By implementing some of my recommendations, you will be able to establish patient trust and even friendships, thereby increasing patient compliance and retention and making the second opinion obsolete.

Nonverbal communication

Nonverbal communication tactics include the use of body position, facial expressions, and gestures to get a message across without any spoken language.

• Eye contact-We can influence how our patients perceive us and our trustworthiness by how we direct our gaze. Looking someone in the eye is critically important for building trust and rapport. If we look at our patients' eyes when engaged in conversation, the message is one of interest and caring. If we avoid looking at their eyes, that avoidance can be misinterpreted as secrecy or deceit.

This goes for reading our patients' body language as well. If a patient avoids looking at us when we make a recommendation, the message we receive is typically one of disinterest. Scott Stewart, CEO of Clifford and Associates Consulting, has been working with dental offices for over 20 years. He swears by this and says, "You can diagnose all the treatment you want, but if you don't have the eyes, you don't have the trust."

• Body language-What are our bodies saying while we communicate? We want our patients to feel they can be open and honest without judgment. To communicate this, our body language needs to show our patients they are in a safe space. This means eliminating off-putting or negative facial expressions, keeping our bodies in an open position, and never turning our backs to patients.

Your face should have a receptive look. Avoid scowling, frowning, or looking disturbed unless you're empathizing with a patient. It doesn't matter if someone just told you they never floss or their last dentist did 15 crowns in one sitting. People read facial expressions and nuances without thought, and a negative expression will convey disapproval even if your words are neutral. Although you might have problems with what a patient tells you, you want them to be honest and know that you'll address their issues in a positive manner. People like positivity and solutions.

Your body needs to be open, with unfolded arms. Crossed arms give the impression of being closed off or of premeditating responses while the patient is talking. As clinicians, we hear the same problems and concerns all day long. We probably already know what someone's issue is before they've finished describing it. However, to the patient, their problem is unique and personal. It is up to us to respond genuinely so they feel their inquiry is valid and accepted. Be open so they feel open to sharing.

Showing your back to someone who is talking is an unmistakable sign of disrespect. We all need to multitask in the office, but there are some times when we must wait. One of those times is when a patient is sharing. Take time for each patient with face-to-face communication. This is an opportunity to show interest and make a genuine connection to earn their trust. Even if you have a patient that loves to talk and the clock is ticking, be kind. After you've listened to the relevant information, it's easy to say you would love to talk more but staying on schedule is important.

• Take a position-Whether you sit or stand, you want to be roughly at eye level with your patients. Hovering or standing over a patient conveys control and dominance. If you need to take charge of a situation or act authoritatively, this is a good way to do it. Conversely, if you want to give your patients control of a situation and allow them to feel they're in charge, give them the higher ground. While it may feel awkward being talked down to, this empowering tactic of role reversal may allow your patients to feel they have more control, even if they don't.

In general, though, I suggest being on the same level. If the patient is sitting, you sit. If the patient is standing, you stand. Mirroring a patient's behavior allows for equal say and equal commitment.

• Grooming-Everyone is judged on appearance. As dental clinicians, we are held to a higher standard of grooming, not only because we invade our patients' personal space, but because clean-looking people are perceived as adhering to safety guidelines in a health-care environment. In addition, nicely groomed individuals are seen as free from germs and as taking pride in themselves and their jobs. These are all important nonverbal messages that can bolster trust in your practice. You want your patients to trust they are literally in good, clean hands.

Verbal communication

Verbal tactics include the use of spoken language to get a message across.

• Encourage and care-Never lecture. Unless I'm taking a class, I don't want to be lectured to, and patients don't either. When we lecture patients, it deters them from wanting to engage in future conversations, whether that means concealing the truth or just not returning. Remember, we want to create a happy space for trust, a space that encourages patients to come back and comply with treatment.

Support and praise your patients' efforts. Even if someone is brushing only once a day, it's still better than nothing. We can always find something positive to say, even with the most difficult patients. As we repeat positive reinforcement, our patients develop a sense of obligation to not let us down. With our feedback and support, they learn to trust what we're saying because they can see results.

Likewise, beware of speaking poorly about someone else. It's unprofessional to badmouth the work of another dentist. It is confusing and upsetting to patients. We don't want them second guessing every dental decision they need to make going forward. We are trying to eliminate the second opinion, not perpetuate them. If it becomes necessary, be honest and advise the patient to return to the other office for clarification. Obviously there are extreme cases where a dentist should probably step in to prevent harm, but otherwise never say anything disparaging about another dental professional.

• Use language everyone understands-Have you ever been around people who speak a different language, say, at a party? It can be unnerving if you don't understand, either because you feel excluded or you feel they're talking about you. Now imagine how patients feel when we speak a language they don't understand-professional dental jargon. We exclude our patients from being in the know if we speak in our terminology. If that's your intention, fine, but most people want to know what's going on with their mouths. Explaining dental conditions in plain language builds trust by allowing patients to know what's being recommended.
• Know your audience-Just as it's important to avoid speaking in dental jargon, it's equally important to pay attention when you're speaking with someone. To build trust and rapport, you must be relatable and understandable. Use terms that are age-appropriate or even profession-appropriate. The goal is to get patients to see you as a professional to ensure that you're both on the same page regarding their treatment.
• Ownership-Part of being an effective communicator is being able to transfer ownership of dental problems. Some patients need this before they comply with their treatment needs. There is a huge difference between saying, "I need to do a filling to fix this cavity," and "You have a cavity that needs to be fixed." The former removes responsibility and control from patients, while the latter dispassionately lays out the solution and leaves the course of action to them.

When we transfer ownership of problems to patients, we're allowing them to make up their own minds. This is very important when it comes to treatment compliance. Our willingness to give power to the patients puts the ball in their court. We no longer seem money-hungry or drill-happy if we aren't pushing for control, which helps patients see that we simply want to provide exemplary dental care.

• Reaffirm-Repeating information helps patients understand their needs. Hygienists have many jobs, but one critical responsibility is to make sure patients understand what the doctor is recommending. By repeating this important information, I offer an opportunity for clarity, and I also encourage patient compliance. It's almost as if the patient gets a second opinion or second pair of eyes and ears in their very own dental office. If both the hygienist and doctor agree on an issue, the patient knows it's important.
• Don't talk too much-This is not an opportunity for you to unload personal information unrelated to your job onto patients. When this happens, it allows patients to see you as something other than a dental professional. It's harder for patients to comply with dental recommendations from a hygienist who just returned from another weekend bender. You need to keep the relationship professional in order to support any claims you have about their dental health.

When you do engage in friendly conversation, it's important to keep it light, positive, and in the patient's control. Let them determine how much talking is comfortable for them. Otherwise they could perceive you as annoying, which is counterproductive for repeat business. It's great to be friendly and comfortable, but please be respectful of your patient's time and interests. We want them to enjoy their time with us and look forward to the next appointment.

Building relationships both professionally and personally use very similar tactics, if not the same. The more people we make feel good and teach to trust us, the more successful relationships we have. Follow my suggestions and see the results for yourself. The easiest way to apply them is to use common sense or put yourself in the patient's position. How would you like to be treated, what would make you comfortable, and what would make you want to stick around? Use those answers as your guide to increase patient retention. The second opinions will decrease as patient compliance increases, resulting in happy offices and happy patients. RDH

Tanya Stein Gold, RDH, BS, BA, has worked with hundreds of offices in her 20-plus years in dentistry, technology, and marketing. After earning her first degree in interpersonal communication, she worked in the private sector as a marketing manager and publicist. She then received her degree in dental hygiene from the University of Southern California and practiced hygiene throughout the greater Los Angeles area. Today she represents such companies as Dental Anywhere Mobile Apps and The Dental Insider through her company, Dental Hand for Hire, which specializes in public relations, practice enhancement, and communication strategies.