Just a few months ago, I had the pleasure of returning to work with a very prestigious study club in southern California for the second consecutive year. It is always wonderful to work with a stellar group, but the opportunity
to create a learning continuum is rare, and I am always appreciative. The first program focused on communication basics - attitudes and skills people often overlook or presume they have without complete foundation. This year, we did what chef Emeril does - we cranked it up a notch!

The group and I worked for two days on some highly sophisticated aspects of communication and they went home with a year’s worth of communications experiments and assignments. I cannot wait until next year when I hope to return and challenge them further.

Last week, one of the members askd me to help him and his team learn more about patient outcomes and how to learn about them more effectively. In response, I’ve decided to return to this very important topic and share

While many dentists focus their attention primarily on identifying disease and breakdown and proposing treat-ments that will eliminate that disease or restore original function or form, beha-viorally sophisticated relationship- based practices understand that patients cannot easily relate to those issues on which dentists focus in the way dentists do. These practices make a distinction between clinical conditions or findings and patientidentified problems. This distinction is enormous and must be understood for a practice to thrive.

I tend to talk about it as software (patient experienced and identified problems) versus hardward (clinical conditions or findings). Outcomes are the software of dentistry - the quality of life issues the patient wants dentistry to impact in a positive way. No one comes to your practice for procedures. Rather, they come because they are experiencing

“I don’t like the way that looks. That front tooth is too big and the one behind it is a different color.”

“The tooth in the back is really sensitive when I eat something cold.”

“I can’t chew on my left side because of that open space.”

“I’m worried that something is wrong; things feel different than they did before. Do you think I have gum disease?”

When you really listen to what patients are telling you, it quickly becomes clear that their everyday experiences are what matter most and what will get their attention. This makes perfect sense. Patients aren’t academicians or intellectuals about dentistry; they are people whose mouths are either working well or not working well. Practicality is a key factor for almost everyone and your paying attention to what is practical for your patients will help you understand and serve them better.

Thus, asking about and listening to their stories and tales is an essential component of learning about their dental priorities. When you study what patients relate, you will often hear a pattern to

appearance, or how things look
comfort, or how things feel
function, or how things work
peace of mind issues or health,
stability, etc.

Every issue, concern, complaint, want or need you hear from a patient will fall into one of those catagories. While some patients will focus on a single issue, many will often be experiencing several problems which might span two or more of these catagories.

“There are two things that are bugging me. First, the ugly tooth on the left side and the sharp corner on the one that is broken on the upper right.”

Thus, you must be prepared to listen for the full range of problems and not stop the conversation too quickly. In most cases, you will hear symptoms which will lead you to discover the underlying conditions, but to the patient, the symptoms are everything.

Patients often need time to believe you are really interested in learning about problems as they are experiencing them because they are so accustomed to dentists jumping in and telling them everything that is wrong and how they intend to fix it. You can make an enormous difference in how patients see dentistry

Once you have learned what your patient is experiencing, you can begin to learn what you need to know as a clinician:

• What condition or finding does the patientexperienced symptom reflect?
• What other conditions or findings exist that the patient is not yet experiencing?
• What are the causes of these conditions or findings?
• What are the possible treatments for these conditions or findings?

Notice that I have used the words conditions and findings to refer to the focus of the clinician and the words symptoms and problems to describe the patients’ focus. This is a good way to make the distinction in your own mind and keep you clear about the patient’s concern and focus versus your clinical concern and focus. Patients come in to have symptoms supressed and problems resolved. You do provide them this service by focusing on the conditions that are causing the symptoms and problems they are experiencing and your treatment recommendations or solutions must relate directly to what the patient is experiencing. This is the linkage or relevance that must be established for your treatment

The way you convey what you are are finding upon examination and the causes of those conditions as well as the treatment you are proposing will determine whether your patient can relate what you are saying to what they are experiencing.

Dentists are charged with the following obligations:

• examination
• diagnosis
• prognosis
• treatment recommendations
• delivery of care

When your examination is linked and relevant to what your patient is experiencing...When your diagnosis is linked and relevant to what your patient is experiencing.... When your prognosis is linked and relevant to what your patient is experiencing....When your treatment recommendations are linked and relevant to what your patient is experiencing.... your patients are more likely to ask you to deliver care than if your process is neither linked nor relevant.

I have often said that your first job as a clinician is to learn. Learn about and from your patient what you do not yet know about what they think, how they feel and what they want.