By Larry Wintersteen, BA, MA, CMT
Published: Dental Economics
Although technological advances, growth, and specialization in health care delivery have led to great improvements in the treatment of disease and disability, they also have resulted in the impersonalization of health services.
– National Commission on Allied Health Education
Dentistry is a part of health care in the United States; therefore, we can conclude that dentistry participates in the indictment or impersonalization reference. The National Commission on Allied Health Education has simply confirmed what patients and communication consultants have been telling us for years.
Dental professionals must realize that dentistry is, first, a behavioral art first and, second, a clinical science. The behavioral aspects of human communication are often taken for granted. It is unwise to generalize that if someone speaks – a message is sent; and if another listens – the message is received.
Many people act as though that sending & receiving messages is all there is to human communication. Some of these attitudes are apparent in the statements:
- “I know how to talk with this patient; I treated him last year.”
- “How could she have misunderstood me? I told her everything.”
- “Obviously she wasn’t listening when I went over the Treatment Information.”
- “I explained the fees and the treatment, and she still complained to the receptionist.”
These statements reflect a failure to appreciate the complexity and sensitivity of human communication, resulting in hurt feelings, misunderstandings, and eventually complete breakdowns in communication. Dental personnel who continually fine-tune their communication skills will serve the dental team and the patients well.
Dental professionals, like those in other fields, spend a lot of time communicating. In a classic study1, adults in a variety of occupations kept a record of the time they spent in the four types of verbal communication: talking, writing, reading, and listening.
Participants concluded that at least 70 percent of their day involved one or more of these communications. The study broke down the percentages of activity further:
Listening — 42 percent
Talking — 32 percent
Reading — 15 percent
Writing — 11 percent
Since the early 1950s, studies 2-6 have supported the importance of listening. Listening makes up a large part of the communications process and is a primary means of acquiring information, feelings, attitudes, and understanding. We’re not born with an ability to listen effectively nor does it develop naturally. Rather, effective listening is a learned skill that requires considerable energy, on-going effort and attention.7 Yet, most people don’t listen. Done properly, listening combines what we hear, our attention, understanding, and what we remember.
Larry Barker, a recognized authority on listening, theorizes that four stages occur sequentially, generally with little awareness but with rapid succession.
Hearing – the physiological first stage of the listening process, is the audible part of communication that doesn’t involve conscious perception. Unless you’re deaf, you hear. (sound perception)
On the other hand, listening occurs when you attach meaning or understanding to the hearing process. A dental patient may acknowledge sound but without meaning. Listening comes with exposure, education, and repetition. For comprehensive listening, you must advance beyond the hearing, the noise, and the sound. Heard in the proper context, visual association or personality identification, a moan, grunt or groan as you greet a patient has meaning. But to hear and properly process these sounds, you must have a healthy auditory system and not be too tired.
Attention – As multiple sounds bombard our eardrums, we may acknowledge some sounds and ignore others. When we listen to a patient we may block out distracting sounds around us. Yet, we can train ourselves to hear sounds that may improve understanding—the buzz on the office’s light/communication system, for example.
Sound has meaning. It’s also selective. A loud or unusual sound may disrupt our conversation regardless of our control, our conditioning and training. Even when we focus on a particular sound, the listening process isn’t complete.
Attention requires the dental team’s concentration, choice and conscious discipline. Staff members must want to greet patients when they enter the office, and clinicians must enter the operatory intending to focus on the patient. In short, paying attention requires your mind, your mouth, and your eyes working in sync.
Understanding – requires the listener attach meaning to sound. Because people are affected by different perceptions, experiences, language associations and context, works or sounds may have personal interpretations or common meanings.
Understanding occurs with time, exposure, clarification, and repetition. For example, dental terminology, second nature to you, may sound threatening to the patient. An MOD – is general terminology to you, but a patient may think it stands for the March of Dimes.
A strong part of listening ensures that the message sender and the message receiver share the same meaning. A more comprehensive health history or a more thorough verbal interview may better help you understand patient needs.
Listening takes effort, planning, time and foresight. Remember, unless you’re listening to yourself (a different and distracting yet legitimate topic called intrapersonal communication), more than one person is involved in the process.
If a patient understands the financial commitment and policy before treatment begins, for example, then the patient will be comfortable during the check-out process. It’s wise to ask patients how comprehensive your explanations should be. At chairside, some patients aren’t interested; they just want you to complete the work and get out of the office.
Remembering – the final stage in the listening process, isn’t addressed by all writers and researchers, but recall or information stored in your memory bank improves your listening capability. Even partial remembering or recall enhances improved listening or patient and staff relations.
Remembering important events and dates about each patient (and noting them in the patient file) helps you personalize your approach and credibility, build rapport, and establish a comfortable communication environment.
Researcher Ralph G. Nichols7,9,10 has studied extensively the behaviors of a poor listener, many of which are considered dangers or barriers by other authors and researchers. Nichols has identified behaviors10 or bad listening habits, but his research applied mostly to public speaking forums. Listening, of course, is different for different people, even if they’re in the same situation. A good listener knows how to interpret and adjust to various situations and audiences. You’ll be smart to constantly monitor your level of listening and your attitude.
You can control barriers if you recognize them. For example:
Reacting to a speaker’s physical appearance and speech patterns rather than listening to what is said—we live in an image-conscious society, in which patients don’t always look or speak according to another person’s comfort level, bias or prejudice. A patient’s condition or attitude toward dental professionals may affect appearance, body language or vocal tones. A patient’s walk, body posture, voice patterns, accent, attire, size, or color may prevent you from listening.
Age, nationality, appearance, or language need not be barriers. After all, every patient entering your office is a guest.
Faking Attention – Most of us don’t want to appear rude or bored and may pretend to listen. Unfortunately in the operatory, we miss opportunities to learn valuable information and behavioral insights. If you fake attention or remove yourself from the patient, you shut down the four stages of listening. If you find yourself shaking your head in agreement when your mind is a million miles away, discipline yourself to get back on track.
The faker probably assumes that appearing to listen satisfies patients, but in most instances, the only person deceived is the faker.
Allowing Certain Words or Phrases to Interfere With Listening – Words, spoken or written, conjure pictures and associations that result from direct or vicarious experiences. The word “hygienist,” for instance, might be associated with the words cleaner, nurse, educated, arrogant, rough, preacher. To go beyond possible negative meanings, you should do some perception checking with the patient. Consider asking:
“Have you received treatment from a hygienist before? How was it?”
“Before we get started, do you have any questions of me or what we’ll be doing?”
“In your last office, were you comfortable working with a hygienist?”
Too many words distract patients. Recently, we surveyed 1,125 patients, asking the question, “What words or subjects would you rather not hear in the dental office?” The top ten prioritized responses included: shot; root canal; needle; We’re running late; be right with you; oops; root planning; the girls; drill; gross scaling.
You simply have to become desensitized to some words, and ignore distracting words and listen for the overall message. Also, words mean different things in different part of the country. The word girl, for instance, can be perceived as OK, or it may ignite hostility and defensiveness. Unfortunately, an emotion-laden word can end listening rather quickly.
Failing to Eliminate or Compensate for Noise – Two kinds of noise exist: physical and psychological. Usually, most of us think of the physical kind – a phone, a crying patient, hall noise, loud talkers. Psychological noise – anxiety, negative stereotypes, sleeplessness, previous memory, preoccupation—is internal, while physical noise is external interference.
Physical and psychological noise inhibit the listening process. Messages may be misunderstood or completely lost. The physical sound of a handpiece may distract a patient most. Or the psychological sound of mental fear can upset the patient.
There are more than these three barriers. Take a minute to develop your own list. Most human beings know when they’ve shut down or have stopped listening, because they turn inward. Try to improve your listening skills with your family. Sometimes, though, it’s easier listening to strangers.
Many studies discuss listening improvement techniques; however, my own research during the past 32 years has allowed me to meet and interview many dental personnel. Using questionnaires, personal observations, and interviews, I’ve drawn some conclusions why listening or communication shuts down in an office.
Effective listening begins with a serious interest in what other people think, but what you think and practice is of great importance as well. With this in mind, consider the following ways to improve your listening techniques: (These are good for your personal and professional communication experiences.)
- Stop talking and listen.
- Force yourself to listen to difficult topics.
- Create an interest in dentistry.
- Determine why you’re communicating with patients.
- Determine your role in the listening process.
- Adjust to your patient.
- Fight or control distractions.
- Set your “self” aside. Be inconvenienced.
- Be tolerant.
- Hold your fire and keep emotions in check.
- Balance your speaking rate and your thinking rate.
- Be kind. Don’t dominate the interaction.
- Suspend judgments.
- Be patient. Avoid interruptions and tuning out.
- Learn to read verbal and non-verbal cues.
- Remember that posture affects listening.
- Develop empathy and concern for others.
- Periodically state what you’ve heard.
- Treasure the moment – it’s gone tomorrow.
- Want to be a listener.
- Care about yourself and people.
If you improve your listening skills, you’ll be better prepared to handle the steadily increasing avalanche of communication. Because you serve a variety of patients, you must adapt your listening skills. The poor listener working in a dental office is severely handicapped. Without adequate skills to become an effective receiver and send, all parties involved may be overcome by internal and external messages.
With so many activities and distractions around us, it’s becoming more difficult to focus and pay attention, and that places a greater need and burden on the listener. A good listener opens doors to new and beneficial experiences. As a dental professional—and a good listener—you play a prime role in touching other peoples lives, educating them and motivating them. Learn to listen with your ears, you eyes, your senses, you mind, and your heart.
DON’T MAKE LISTENING A LOST ART – IN YOUR LIFE!