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How to Deliver Bad News

October 19, 2015

Filed under: Case Presentation,Communication — Tags: , , — Barry @ 2:34 PM



As a practicing dentist for over forty years, if there is something I do regularly it’s deliver bad news.  As the GEICO ad tells us…“if you’re a doctor you deliver bad news…it’s what you do.”

Not a day goes by when I don’t have to tell someone that they have a cavity, periodontal disease or worse yet, how much it will cost them.  And it’s not just the dentistry: how about when a case comes back from the lab and the shade is off or worse, we need to take another impression.  In a dental practice the situations are endless.

It’s a rare moment when we get to say “Mrs. Jones…it’s a boy.”

This is not the fun part of a dentist’s job…and many dentists paradoxically try to avoid it.

Think about that for a second.

A longtime patient comes in for a routine cleaning and you discover early decay under a old long-span bridge.  It’s a bridge you made for her fifteen years ago.  She comes in regularly and she has not needed work in years.  You know she’s under the impression that as long as she flosses daily and comes in on a regular basis that she is immune to major problems.  Worse yet, she is recently divorced and approaching retirement.

Tense times…for everyone, unless of course you lack empathy.  That’s another problem, but if you truly want to master the art of delivering bad news better – then this may interest you.

Leadership and communication lie at the center of your success in dentistry.  Present your case in a positive manner and you will get more acceptance, less complaints and most importantly better health for everyone.  In the past I have written blog posts about the charismatic dentist and empathy…delivering bad news better can go a long way to improving your charisma scores.

In a new book, Broadcasting Happiness, The Science of Igniting and Sustaining Positive Change, author Michelle Gielan offers her Four Cs on how to deliver bad news.

If you practice the Four Cs I am sure your dental practice will become more positive in every way and you will never complain about “people” again.

Let’s take a look at the Four Cs in dental practice:

  1. Create Social Capital.  A buzzword being used these days in business and sports, is culture.  But what exactly does that mean?  Dental practices need to build cultures of trust.  Covey, years ago referred to an emotional bank account.  Social capital refers to the resources that we have available to us based on trust and the willingness of practice to support our actions.  For patients of record this trust is built up over the years.  For new patients it is built through the examination process, and how the practice welcomes patients in.  Other resources include our ability to communicate, educate and motivate through listening and clear expression of thoughts and ideas.
  2. Give Context.  How you frame your conversation means everything.  If we frame our treatment in negativity…pain, cost and inconvenience, our acceptance will go down.  Just this morning I entered my hygiene room and my patient sensed my presence and said, “Uh Oh!”  She was joking, but let’s be honest most patients frame their dental visits negatively.  One way to provide context is to use what I call a “reason why philosophy.”  It takes a bit longer but I usually give a thorough explanation about why I need to do dentistry.  Not only what needs to be done but why it needs to be done.  This takes a bit of skill. but it can be learned.  Many dental practices use what author Gielan calls a Band-Aid mentality in delivering bad news- they just rip it off fast so it won’t hurt as much.  I hate when that happens to me…the reason why philosophy builds trust.  This comes up more often than we might think.  Even in the case of a patient who repeatedly refuses x-rays…just saying “because I said so,”  doesn’t inspire trust.  Taking the time to give a well thought explanation goes a long way.
  3. Express Compassion.  One of the strangest things for me to understand is noticing how so many of my dentist friends feel when they are on the receiving side of bad news.  And I mean any bad news.  They especially love to complain about the cost of things these days, yet they have no problem dispensing the bad news.  It’s human nature to not take bad news well.  Just knowing that means we have to step back and show empathy…it’s appreciated.  Dentistry is expensive these days.  If you’re reading this and getting angry because your fees are justified, I get it.  You know who doesn’t get it?  Most patients, so show compassion.  Talk about it.  And it gets worse when it’s your work that fails.  According to Michelle Gielan, compassion not only makes moral sense, it makes business sense. 
  4. Stay Committed.  Earlier I said that delivering bad news was an aspect of leadership and communication.  The leader’s commitment is to the patient and their well being.  Leaders deliver long term value and in order to do that we must remain committed.  In the end delivering bad news starts with being human.  If we remind our patients of what John Lennon once said, “Everything will be okay in the end.  If it’s not okay, it’s not the end.”

So take heart, if delivering bad news gets you down, use these 4 Cs to change the way you look at things—because “if you change the way you look at things the things you look at change.”









To Prep or Not to Prep

July 16, 2013



The second a dentist sees teeth he wants to fix them.  I guess it just comes with the territory.  Or is it just good old American pragmatism.  I used to be that way until I took the time to really understand people.

That thought process lead to the writing two books, The Art of Examination and the forthcoming Art of Case Presentation.

The photo on the right was recently posted on Dentaltown. The post was titled, “She Wants No-Prep Veneers–What Would You Do?”  It spurred a slew of comments that caught my attention.

Now…I know the title asked a direct question…but my first thoughts centered around how she knew what “no-prep veneers were.”

The comments answered that question…it was Lumineers she wanted.

I recalled a quote from Theodore Levitt, the ex-editor of the Harvard Business Review who said:

 “People don’t want to buy a quarter-inch drill, they want a quarter-inch hole.”

And so it follows that patients don’t want no-prep veneers…they want…

That’s for the dentist to find out from the patient.  Even the guy at Home Depot asks what I am going to use the quarter-inch drill for.

The comments in the post are fairly enlightening.  Most of the commenting dentists wanted to do bleaching or orthodontics.  Many voted against any veneers at all.

Reading through the comments lead me to some perceptions about the state of dentistry.

One thing I see is that most dentists truly want to stay with conservative treatments…bleaching and orthodontics.  I feel the same.  However the public’s perception is that dentists tend to want to destroy teeth.  I guess that’s why the media portrays dentists as “drilling for dollars.”  The comments confirmed what I have always felt about the dental community…that they are caring concerned professionals who want to help their patients.

Another thought I had was how obsessed we are with whitening teeth.  Have we been lead to believe that whiter teeth equals cosmetic dentistry.  I am sure that if a dentists had a serious conversation with the patient she would come up with a few more things than just whitening.

Stop looking…this isn’t about fixing her…it’s about understanding her.

Who is she?  Dentists should REALLY get to know their patients...it’s part of the examination and diagnosis.  Only then, once we have articulated the problem…can we present the case.

In order to do that we must approach our patients without an agenda…like the guy in Home Depot.

Another thought, which was also expressed by the author of the post, is that the patient came in with a knowledge of Lumineers or no-prep veneers.  Okay, I know the various methods to treat prostate cancer but I will always defer to the professionals to help make my decision.

The state of advertising in health care these days is a blessing and a curse.

Doctors must work through it…by becoming better leaders and staying true to their diagnostic abilities...above all to keep the human component in dental care.

I have faith.







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Dental Design the Steve Jobs Way

October 9, 2011

Filed under: Business of Dentistry,Marketing — Tags: , , , — Barry @ 10:08 PM

An Elite GroupThroughout the past week the Internet has been filled with blog posts concerning the death of Steve Jobs.  Like  everyone in America, I too am a big fan of what he created.  For years I have been calling him our modern day Thomas Edison.

Everything that needs to be said has already been said as noted by my friend’s blog post at Spear Education.  Most of the references to Jobs have centered around the world of business…what a great leader, and what a great marketer he was.  And yes, that is all true, but just as Edison was primarily a great inventor, Jobs was primarily a great designer who truly understood what humans wanted and needed at a practical level.

And he delivered.

That is his greatest lesson for dentists.

Steve Jobs understood what “design” means.  He understood “form follows function,” where others just give it lip service.

I will never forget his keynote speech introducing the iPad2.  The entire presentation was designed (yes doctors, his presentations were designed as well), around function; how the new iPad worked.  He subtly mocked his competitors because he knew what his audience wanted and he delivered it—so many improvements over the original iPad and yet all he kept saying was “It just works.”

Clear and concise: “It just works.”

Form follows function.

Read what Steve Jobs said about design in a New York Times article written in 2003 titled, The Guts of a New Machine:

“Most people make the mistake of thinking design is what it looks like. People think it’s this veneer – that the designers are handed this box and told, ‘Make it look good!’ That’s not what we think design is. It’s not just what it looks like and feels like. Design is how it works.”

Design is how it works…makes us wonder about the cosmetic dentistry revolution, and about what Peter Dawson has been preaching for the last thirty years.  People really want dentistry that works, that lasts…quality dentistry.

First you have to design it…then you have to sell it ( the idea, I mean).

And Jobs was good at that too.  He was a master presenter, an impressive storyteller who painted crystal clear images with extraordinary graphic design.

So what can dentists learn from Steve Jobs?

Hopefully I have given you two things…become a great dental designer by deeply understanding examination and treatment planning skills and second, take your presentations very seriously.

I have created another blog called Casepresenter.com which explores all the nuances of effective dental case presentation.  Please visit and contribute your thoughts and ideas.

One more thing.  I am a frequent visitor to Amazon.com.  Some months ago I noticed that Walter Isaacson, the author of Ben Franklin’s  and Einstein’s bio’s, was writing the first authorized biography of Steve Jobs.  The publication date was March 2012.  Over time I noticed the date was moving forward.  That combined with his departure from Apple in August should have tipped me off to his imminent death.

I can’t wait to read Isaacson’s book, due out at the end of October 2011…that will surely tell dentists what we could learn from Steve Jobs.

Use Your Power Tool – VOA

February 27, 2010

Filed under: ARTICLES,Uncategorized — Tags: , , , — Barry @ 12:04 PM

It's easier than you think.During tough times I see dentists reaching for “new” ways to create business.  New ideas, products and technologies to help fill their schedules.  In keeping with my standard philosophy, I like to use good old powers of influence and persuasion.  I could write forever on persuasion and influence and if you follow TAO-Book you will certainly get your share of (more…)