The Art of Listening
We all think we are good listeners……. But are we?
By Lori Lawrence, RDH and Bev Woods, RRDH
In our profession as dental hygienists, we are given a unique opportunity to help people in many ways. We interact with clients every day, trying to assess their medical and dental needs. In such an intimate environment, it is vital that we develop a trusting relationship.
We have all heard it before; but do we really pay attention, or are we just going through the motions? It is so important to really listen to your clients and what they are saying in order to figure out what motivates them!
Are you asking the right questions?
Are you asking lots of questions to find out what the clients need
It takes time and effort to ask “good” questions
A good rule to follow is the 80/20 rule….we talk only 20% of the time !
The key lies in getting the clients to talk about themselves …that will change the way we deliver our messaging. Try to answer the clients question with a question, and make sure you make the time to repeat their answers back to them. This creates a ‘trusting’ relationship. Relationships with our clients are vital….clients will ‘trust’ you if you have a great rapport.
There are reasons for Questions…..we should never assume anything.
We need to have a complete understanding of what the clients’ want….not need!
Try to co-diagnose with your clients, ask the client questions rather than saying something like “you have an old filling that is cracked and you need a new one”. Instead ask the client “how old is that filling?”, then take the time to present an analogy to them by saying something like: have you ever had a crack in your windshield? Listen to their answer, if they say yes then you can respond with “what happens even if it starts out small?” The key here is to allow the client to process on his/her own, the logical consequences of leaving a filling broken over time.
Look around at all the advances in technology and though they are not all bad they have robbed our time to think, time to contemplate and time to plan. They do not give one the time to listen.
Scenario: a client walks into your office an tells you “I have a problem”….you should respond with “Yes you do”….don’t tell them “you don’t have a problem”, instead agree with them when they say they have a problem. This will make them feel like they are being “heard”
What makes someone a good or not so good listener? Those who are good at listening are often good at managing relationships, both professional and personal.
Some suggestions to improve your ability to listen well are:
- Make sure you are giving the person you wish to communicate with your undivided attention through body language and eye contact.
- Ensure you are sending a clear message both verbal and nonverbal. (Making sure that the tone and volume you use agrees with the content of your message, if you are pleased, look and sound happy. If you are angry, look and sound annoyed but never yell!)
- Be direct and honest
- Ask for feedback to ensure that your message was sent accurately
- Always wait for the person to complete a thought without interrupting before expressing your own ideas
- If you are not sure you understand the message, seek clarification by asking questions
- Paraphrase what you heard so the sender can be sure you got it right
When you have someone on the phone, upset because their dental hygiene visit was not paid for by their insurance company, are you listening to every word they say? Or did you hear the first few words and then start to formulate your reply. When a new client comes into your clinic and shares all their past experiences are you truly listening? Or are you thinking to yourself, “I have heard this all before” and wait for them to finish before proceeding with your own opinion.
Remember make sure to identify the ‘specific’ concern of the client, not a concern that you may be thinking is the clients concern.
Here is a very common scenario that happens in dental offices. A woman phones the office for the first time and speaks with the office administrator, asking her “Do you see children at your office?”…well before the words were out of her mouth the administrator says quite quickly and cheerfully…”oh yes we see lots of children in this office, we love children”! The administrator thought she was doing a great thing by encouraging this new client to come because they loved children. Instead what happened was quite the opposite. The potential new client on the phone thanked her for her time and advised that she would NOT be booking her appointment because she was looking for an office that does not see children, because she doesn’t like children! Whoops!
When you stop to listen instead of trying to think of how to answer the question posed to you, you will hear so much more.
Try to remember to stop and open your ears, eyes and heart to all those around you. You will see more than you ever say before.
“Thank-you for listening”
Lori Lawrence RDH, Bev Woods, RRDH
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Is it possible for your Dental Hygiene practice to survive a recession?
By Cindy Isaak-Ploegman RDH
When I first graduated in 1989 it was easy to find employment as a dental hygiene clinician. At all three dental offices I had an interview; the only question I was asked was, "When are you able to start?" Three years later I was laid off due to a reduction in the client base. Due to the economic recession at the time, dental insurance companies were reducing their coverage of regular dental hygiene appointments from every six months to every nine months. Now it seems we face similar fiscal concerns again.
Do you every wonder if you are going to survive this recession? There is a constant pull between loyalty to professional values and economic pressures. As repugnant as daily production goals are, if a certain amount of revenue is not generated, renumeration for dental hygiene staff and practice sustainability is not possible. But how much revenue is enough exactly? Do we need to have an upper cap at all? How are we able to serve someone who we are trying to squeeze more income from based on our interests and not their own?
The idea of treating clients as sources of consumer dollars, who we need to compete for with the dental office down the hall, definitely suggests a business model of client care and not a professional or client based model (Ozar, 1985). If we find that our focus on production places clients' values or our professional or personal values in jeopardy, our upcoming webinar May 16, 2012 with presenter Laura Kessler on "Finding your voice in Dental Hygiene practice" will cover tips on how to succeed in your professional practice and remain in alignment with your personal integrity.
Sometimes a recession is a good thing as it causes us to re-examine why we do what we do, for whom we do it, and how we approach our role as professionals.
Client education has been highlighted as the key ingredient to ensure our clients are aware of the importance of what dental hygienists role is in maintaining their oral health and the link to their overall health (Christensen, 2011). There are huge opportunities to promote wellness in our dental hygiene practice given the recent research on systemic conditions and oral health as well as the importance for preschool age children to maintain good oral hygiene.
However, this does not imply that we should threaten clients by telling them that they will have a heart attack if they refuse to attend their regular periodontal maintenance appointment, or we then risk being accused of breeching veracity (Wentworth, 2011). The truth is that not every client is diabetic or at risk of a stroke, endocarditis, or having a low weight pre-term baby.
If clients know the value of a health service, they will not hesitate to seek treatment regardless of financial limitations (Christensen, 2011). This is true of treatment deemed unavoidable, but possibly expensive, such as the removal of suspicious lesions.
The challenge is managing our client load with care. Some practical suggestions include replacing diminutive terms such as 'cleanings' with periodontal maintenance appointments, preventive care appointments, or oral cancer examinations when referring to dental hygiene appointments (Elster, 2009; Levin, 2009). Also included are suggestions for replacing the term 'confirming appointments' with reminding clients of upcoming appointments (Levin, 2009).
As a research assistant for a dental implant study, I was faced with a challenge of having research participants attend sample collection appointments over the span of a year at preset times, with only a ten-day window for change and my own limited availability. I realized I had to connect with each of these clients in a personal way or they would not be motivated to be compliant with the series of appointments, especially after their crowns were placed.
I also found that discovering their preferred mode of communication was necessary. Turns out that some don't use email, some don't have answering machines, and some never answer or return my phone calls, but they have all attended their appointments. Scheduling the follow up appointment at the last appointment is key and following up that arrangement soon after it is made is a good idea.
Educating clients, connecting with our clients personally, and not denigrating our value to the dental health care team are all consistent with client-centered professionalism.
I would love to hear your comments about this timely concern and of your strategies or challenges.
**Please note our webinars are also available in the archived version so if Wednesday evening does not suit your schedule you are able to access Laura's webinar presentation and question and answer period at your convenience by logging into our website.
References:
Christensen, G. J. (2011). Helping patients understand and accept the best treatment plans. Journal of the American Dental Association, 142(8), 197-200.
Elster, M. (2009). Recession proof your practice through patient retention in hygiene. Hawaii Dental Journal, 40(6), 15.
Levin, R. P. (2009). Making the most of hygiene appointments. Journal of the American Dental Association, 140, 1305-1306.
Ozar, D. T. (1985). Three models of professionalism and professional obligation in dentistry. Journal of the American Dental Association, 110(2), 173-177.
Wentworth, R. B. (2011). What are the ethical issues I need to consider when developing marketing strategies for my practice? Journal of the American Dental Association, 142(8), 966-967.
Oral Care for seniors
By Swati Vazir RDH
It’s a well-known fact, that Canada is experiencing a dramatic growth in the number of older citizens in its population. As a result, the need for health and dental care has also increased. Health care providers must be prepared to cope with this increased need.
Dental hygienists, as educators, cannot only provide traditional preventive strategies, but they can also provide and promote a positive and healthy lifestyle for older clients. A dental hygienist can encourage seniors to get involved in physical activities, have a nutritious diet, practice proper oral hygiene, and manage stress effectively.
In order to provide effective oral care for seniors, there are certain points that need to be stressed, such as their health, age, dental and medical history, accessibility, costs, and cultural values.
At the first appointment, ask them to bring a list of the medications they are on and discuss all the dental concerns and current o
ral care habits. It’s also good idea to have a approval letter from their physician. Also, discuss the medical and dental history in coordination with the dentist because this will help you immensely while making their personalized treatment plan later on.
You should make an individualized assessment, without any prior assumptions. Getting friendly with them and asking about their interests and activities will make them feel more comfortable. Show great enthusiasm when talking to them to make them feel relaxed. Educate the person and family members by explaining the importance of oral care. Ask questions about their lifestyle, food habits, exercise, education, employment and use of alcohol and tobacco to understand the factors that influence them.
Accessibility is another extremely important factor for the disabled and people with limited mobility. It is important to note any physical repercussions that may prevent the person from receiving proper dental treatment. A perfect example of this is appropriate dental chair positioning. Many other factors also influence their appointments such as a lack of a ride or poor weather conditions. Be courteous and offer your help! Take initiative to help the elderly by helping them with directions or even offering them a ride! It is important to make sure senior citizens have access to proper dental care. There are some community programs that provide oral care at the senior homes themselves.
Not having insurance or a limited source of income may be another concern to seniors. Some times it is challenging for them to get regular dental care with limited coverage or a limited budget. At one of the events at the Peel Women Health and Social Services Community Centre (PWHSS), I had an opportunity to discuss oral hygiene with 12 ladies, from ages 50 to 70, and most of them were primarily concerned about the cost involved in dental cleanings, as some of them were retired and some had limited source of income. Although the basic requirements for oral care include a complete oral exam, x-rays and regular dental cleanings, the ladies asked me, if they can get only cleaning done (without any exams or x-rays), since they can only afford dental cleaning. Now, how can we provide complete oral care, while keeping their budget in mind?
What we can do as providers is to educate them and make them more aware about the importance of oral care, show them pictures and videos of oral care, give them all the options, show them the techniques of brushing and flossing, and give information on denture care. For more information on this, check out the following link:
http://www.cda-adc.ca/en/oral_health/cfyt/dental_care_seniors/flossing_brushing.asp
After educating them, we should give them the best option, which suits their requirements, while making sure that the treatment plan fits their budget.
Another important aspect that can affect seniors is abuse. Senior abuse is a real issue and can have devastating effects on seniors and their health. Talk to the person directly if you suspect any sign of abuse and offer them help. There is an informative article in the Milestones WINTER 2011, in News from the field section; the topic is “Elderly abuse” What every registrant should know.
http://cdho.org/Milestones.asp
Its time to give back to the community, spare some time, and help our seniors! They have done a lot for us, and now it is our turn to take care of them!
Any personal experiences related to this topic that you want to share? Please feel free to comment! Any feedback is appreciated!
Do you know what your client’s Blood pressure is?
By Leah Ugulini
Is Blood Pressure a regular part of your clients care?
From my experience and casual water cooler conversation the most common response as to why Blood pressure is not done as part of the Dental Hygiene Assessment is “there is no time”. We can all appreciate the “beat the clock” regime every day in a busy practice. Our total “appointment time” with our clients seems to be shrinking but their needs are taking “longer”. You may or may not have control of you appointment time schedule which likely influences your own blood pressure. With technology things are changing in our practices. We have computer terminals in the operatory, we schedule our clients appointments, provide intra oral camera assessments, oral cancer screenings using tissue fluorescence (velscope) all in 45 minutes to an hour! Wow! And yes we clean their teeth too in the time left!
According to the Canadian Heart and Stroke Association, statistics show that every 7 minutes someone has a heart attack, 16,000 Canadians die from them. Heart Disease and Stroke is the 1 killer in Women. There new campaign” Make Death Wait” aims to reduce deaths due to heart disease and stroke by 25% by 2020. There is an online risk assessment that I recommend for yourself and as a resource for your clients. What can we do as Health care Providers? Make the time to take your clients blood pressure.
Dental Hygienists take pride in how thorough we are in assessing our client’s oral health by providing extensive Intra Oral – Extra Oral Examinations, Head and Neck Cancer Screenings, Smoking Cessation, Periodontal Assessments and Dietary Assessments. We know the links between Periodontal Disease and Heart and Stroke but the missing link here is Blood Pressure. This is yet another benefit to seeing your Dental Hygienist on a regular basis, they see us more often than their physicians. They trust our judgment and often tell us when they are stressed, not eating well, have gained weight, drinking and smoking more all risk factors.
Now that you are excited about implementing this into your practice I have a few links to refresh your memory about Blood Pressure. This is a great goal for 2012 for your professional portfolio.
How to measure blood pressure using an automatic monitor
How to measure blood pressure using a manual monitor
I would love to hear from our members who currently take Blood pressure regularly within their practice setting and how they integrated this routine into their daily schedule.
Leave the Pack Behind
By Jennifer O'Brien
Thirty-three percent of Ontario college students smoke and many have their first cigarette when they start their post-secondary education. This habit impacts a student’s health beyond their years at college and can have life threatening effects. Luckily Leave the Pack Behind (LTPB) can help!
LTPB has been extremely successful in its efforts to make 'not smoking' the norm on university and college campuses. Also, in recognition of this success, LTPB has acquired official standing as a provincial best practice for tobacco control in the young adult population. Since the program’s initial start in 2000 it has expanded from 6 to 51 geographically-diverse universities and colleges including large urban campuses, small town universities, commuter schools, residential schools, high profile institutions and smaller colleges.
Niagara College has LTPB teams at both the Welland and Niagara-on-the-Lake Campuses. The program seamlessly integrates cessation, protection, prevention and industry denormalization activities to:
- Promote smoking cessation among occasional and regular smokers
- Protect non-smokers from second-hand smoke
- Expose tobacco industry tactics that keep people hooked on its deadly products
LTPB’s team members at Niagara College provide students with self-help smoking cessation interventions in combination with other resources to students on campus.
At a weekly booth display, the teams are prepared with information about tobacco and smoking cessation that cater to the needs and interests of the student population. Various campaigns are run throughout the year to keep all students interested and actively involved with the program. The team uses a carbon monoxide (CO) monitor to assist in educating on the effects of first and second hand smoke inhalation. Throughout walkabouts the team visits various designated and non-designated smoking areas across the campus to speak to individual smokers and non-smokers about the current policy on campus and provide resources for those that may be ready to quit.
Each year LTPB implements their annual “would u rather… contest.” This year the contest runs from January 23rd until March 5th, 2012. All registered students in a publically funded post-secondary institution in Ontario are eligible for the contest and can register in one of four categories. Quit for good is for regular smokers who plan to quit for the entire duration of the contest, keep the count allows students to cut back on their smoking by 50%, party without the smoke attempts to break the association between tobacco and alcohol having students cut out smoking when drinking, and don’t start and win is for non-smokers or ex-smokers challenging them to stay smoke free. Students can register at ltpb.org/contest.php.
Visit leavethepackbehind.org to see what other information LTPB has for you!
Inter-disciplinary Care at “Quest” Community Health Centre
By Leah Ugulini RDH
One of the exciting commitments a dental hygienist can do is to volunteer in their community. In St. Catharine’s, hygienists are part of a committee that has been instrumental in putting two dental units in their Community Health Centre called “Quest.” They all had a common goal to be advocates for the oral health of the homeless and to help those in need.
Not only is this rewarding on a personal basis but to be able to give back to our community is priceless. Quest received a grant from 
our local public health unit for the equipment needed. The new dental area at “Quest” will open in 2012. Dentists, hygienists and dental assistants will be able to provide dental care.
Presently, clients can access care and assistance from doctors, nurse practitioners and social workers. As dental hygienists, we can be part of the collaborative team that will work together to provide care of their clients. Dental Hygienists can provide “primary, interceptive, therapeutic, preventive, and ongoing care procedures that” will enable this population.
How can you get involved? Volunteers are needed. As a fellow blogger at DHPro, I will be interviewing the hygienists for an upcoming edition and will keep all of you posted on the “Grand Opening”!
Aren’t We All Working For The Same Thing?
By: Marcia Dillabough RDH
Before I continue my blogs about my own experiences in independent dental hygiene practice, we should discuss something that’s really bothering me! How in the world have all of us (dental hygienists) lost sight of the big picture? I’m serious. All of a sudden I’m hearing all of these horror stories. Dental hygienists not supporting each other’s decisions, stealing each other’s clients, and ‘tattling’ on each other! We are making ourselves look like kindergartener’s!
Let’s think back to our days in college. If you graduated from a dental hygiene program of any kind there was a lesson to be learned in professionalism. Think about the history behind dental hygiene. Think of how our profession has grown. It’s amazing to think of all of the progress. But progress is only an accomplishment if we celebrate it!
So let’s take a minute to celebrate the things that we do. All dental hygienists are proud to say that they help people. Let’s talk about how we all do that. If we can see how much we have in common, maybe it will be easier to discuss our differences. Maybe we can even agree to respect each other, and each other‘s decisions, even if our view points differ.
Dental hygienists provide preventive oral health services to each individual client that we see. If you are actively practicing dental hygiene, everyday you step into your place of practice you are providing a healthcare service to multiple clients. Whether you look at the physical removal of calculus and plaque, or the educational aspect of our ‘job’, we are always working to prevent disease! Even those dental hygienists who are not actively practicing can usually find their link to disease prevention. Educators contribute to the dental hygiene knowledge base; researchers provide us with the information we need to do our jobs to the best of our abilities using research-based knowledge, and information to help educate our clients; and those actively working for groups, associations, etc. are helping the profession move forward, allowing us to better serve our skills and knowledge base on prevention to others. We are all working for the same goal.
In the same token, those of us who are practicing dental hygiene are helping to heal or stop oral conditions and problems. Some clients are past prevention, and when we see that, we know it’s time for active therapy. So, we assess, dental hygiene diagnose, treatment plan, implement and evaluate what we have done, to help get our clients back to health. Again, those who are not practicing dental hygiene are contributing to these practices in their own way.
Every dental hygienist working in practice has collaborated with another professional in one way or another. Whether it be collaboration with another dental hygienist, dentist, denturist, naturopathic doctor, family physician, etc. At some point or another collaboration has taken place. Collaboration is great! It means that we are treating our client the way that we should be, and ensuring that they receive all of the care they need for any issue that comes up during their appointment. That is what a professional does! It doesn’t matter what type of practice you are working in, by collaborating with others, you are ensuring quality care for your client. For those who are not practicing dental hygiene, you are likely collaborating too. Possibly with another dental hygienist to get ’real world’ results or information. Or maybe you are ensuring that the information that you are passing on to others is in-fact up-to-date and accurate. We all collaborate.
So, I know this is pretty basic, and we are all very aware of what we do, but I think with all of the growth in our profession over the years, it’s easy to lose sight of our similarities. Although our places of practice and practice styles are very different, we are all working toward the same goals, preventative oral health care for everyone! Let’s celebrate our professional progress and be proud of who we are as a community!