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Basic Rule 7: Who Are You Dealing With?

Posted By Stephanie Wilhelm, Thursday, February 21, 2019
Updated: Thursday, February 21, 2019

A number of years ago I attended a presentation by Suzanne Boswell and I experienced an epiphany.1 Her presentation was on personality styles.2-4 The presentation not only overviewed the four basic personality styles or types, but also involved the audience doing an exercise which ultimately gave us an insight into our own basic personality type. Then the epiphany part. She related our personality type to a preference for either receiving or giving out information and suggested that a dental teams approach with their patients would be enhanced by respecting patient personality type and thereby preference for communication. In no way did she infer that dental teams were to be insincere. Quite the opposite was in fact emphasized. Suzanne Boswell was firm on the concept that every patient receives the same information except that presentation was to be tailored to the personality type. In this way the patient is more likely to hear what was being said and be more responsive. We do not want to insult our patients.

Figure 1 shows the four basic personality types (analytical, driver, expressive, amiable) and they are arranged with the thinkers/controllers (analytical, driver) on top while the feel/responsives (expressive, amiable) are on the bottom.1-4 Also note that the tellers (driver, expressive) are to the right while the askers (analytical, amiable) are to the left. We all have these four basic personality traits (analytical, driver, expressive, amiable) but we will be predominant in one of the corners. I, for example, check out as mainly an expressive. I love to talk, I am futuristic, the whole world is my friend, and the glass is always half full.

What is important about this simplistic layout is that we interact easiest with the patients that are closest to our traits and style. In my case, expressives are a piece of cake while I can easily adapt to the amiables (need reassurance, thoughtful, detailed explanations) and the drivers (quick decisions, want the information fast and concise). It is the personality type diagonally across from your personality type that will give you the most grief. With me it is the analyticals (thinkers, want time and all the facts for decision making) that I use to have all the problems with. Since analyticals want the facts so that they can leave and call our office on their terms, I would be so busy talking my head off about the facts and peripheral topics that I would annoy the dickens out of my poor patient. Needless to say, my case acceptance rate with these individuals was abysmal.  I did not appreciate or respect who I was dealing with. Today I, along with dental team members, now guesstimate a profile on all our patients so that we can best educate and service their needs in a non-manipulative manner that is consistent with our practice model, team ethics, and our individual personality types.

Another important tool that I employ with team members to help assess who we are dealing with is the commitment/ activity table that I learned from Sandy Roth (Figure 2).5

This table identifies patient desirability. We all want committed, active patients, don’t we? On this particular table those are the 2’s with 2a being a more frequent client (possibly a periodontal/prosthetic maintenance patient) whereas a 2c is still a fabulous patient but seen in the practice a little less frequently (possibly an out of town patient). On the other hand we all have 0’s, don’t we! These are the patients that rarely attend and if and when they do it is usually for long overdue recare appointments or emergency care. Somewhere in-between these two extremes lies the grey area of the semi-committed patient. You know the type. These individuals have one foot in the practice and one foot out. This is a potentially scary relationship and situation to initiate any oral care with, especially that which is comprehensive in nature.

Where the table in Figure 2 has helped my dental team and I out is we spend the most time with the individuals that want to spend the most time with us and we clarify our relationships with those individuals that are uncertain or unclear of our services. This does not mean that we treat our patients differently. Au contre. We just adjust the amount of time and the comprehensiveness level of treatment to suit the patient’s commitment/activity level. Most importantly, we would never begin comprehensive oral rehabilitative care, for example, with anyone who is not on the same page as us. Comprehensive care requires a committed, loyal patient who enjoys coming to your office and who is on your side.

Who are you dealing with? A committed active patient who you respect, understand, and want to help achieve the dentistry that they understand to be the best for them with today’s technology and protocols. And they feel the same way too about your team.

Further Suggested Reading and References:

  1. Boswell S. The mystery patient’s guide to gaining and retaining patients. Tulsa: Pennwell Pub; 1997.
  2. Racich MJ. The basic rules of oral rehabilitation. Markham: Palmeri Publishing; 2010.
  3. Racich MJ. The basic rules of facially generated treatment planning. Markham: Palmeri Publishing; 2013.
  4. Racich MJ. The basic rules of being a dental patient. Markham: Palmeri Publishing; 2016.
  5. Roth SR.


Tags:  Basic Rules  Consultation  Racich  Treatment 

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Basic Rule 6: Consult, Consult, Consult

Posted By Stephanie Wilhelm, Wednesday, November 21, 2018

 Basic Rule 6: Consult, Consult, Consult

 When we first started examining patients in dental school one of the first items to be filled out on the examination form was the section titled “chief complaint”. It seemed like a silly item at the time especially since we were going to do all the treatment anyway, were we not? Well, needless to say as time has passed I have, just as you have no doubt, come to learn that this is probably the most important item to explore and answer when we first meet our new client. Actually, we now refer to this not as the chief complaint but as the chief concern. This, along with knowing why the new patient left their previous oral care provider, must be identified before we proceed.

A patient’s chief concern will become the chief complaint if we do not address it first.

Another important point to be made before I discuss Basic Rule 6 is the 5 stages of convalescence. The 5 stages are as follows:

1. why me?
2. anger
3. depression
4. bargaining
5. acceptance

We all go through these different stages at different rates when we are faced with a difficult challenge.1 For example, if we are advised that we have a terminal illness some of us will go straight to stage 5 and apply professional advise accordingly, whereas some might go to stage 4 and seek alternative, non proven remedies.2 On the other hand, some of us might get stuck in stage 2 and find blame for our condition. Most of us go through these stages in our routine daily lives as well. A good example of this is a leaky roof. How many of us call the roofing company when that first drop of water on the kitchen floor is noted and order a new roof on the spot. Not many I would guess. Over the years I have had my share of roofing problems and I can assure you that I did a whole lot of bargaining (patching). This brings me to my point. We all have a practice full of patients that are usually mulling in one of the stages, usually bargaining. Such questions as “do I really need this?” or statements such as “I’ll wait until it breaks” concerning obvious necessary major restorative treatment are down right frustrating for the conscientious practitioner. Nevertheless, patience is a virtue and must be employed when dealing with patients especially when it comes to consideration of complete oral rehabilitation.3 We must help our patients go through the 5 stages at their own pace and offer appropriate support so that they can make the best choice for themselves. Patients that choose the treatment plan that is right for them are more likely to be satisfied with the final result. In a paper by Fitzpatrick it was concluded that completely edentulous patients were satisfied with their prosthetic outcome with or without implant support if they choose the prosthesis design.4 Getting to know our patients is thus of critical importance and working as a team with them to help them to decide what path they will take on their dental journey is prudent to say the least.5 This brings us to Basic Rule 6: Consult, Consult, Consult.

I don’t know about you but I find that the more time I spend consulting with a new or existing patient the less problems I have.6,7 This is because the patients are making the decisions, not us.8 Provided that the decided course of treatment does not compromise our core values then all we become in caring out the treatment is the operators. If there are any snags long the way the patient is working with us to move forward once again as quickly as possible. The pressure is off and dentistry remains fun. We just have to make sure that we do the job right by following all the Basic Rules.

I consult as often as the patient wants. I keep the consultation visits to under an hour. Usually all that is required is just one consult appointment. It’s probably because I have set in my mind that I am not in any hurry that it only takes one consultation. Having stated this, occasionally I might see the patient three or four times. It doesn’t matter since once the treatment has been decided upon and commenced we will more than make up our production costs. I also try to listen as actively and intently as possible. When Dr. Bill Dorfman was asked the following question in an interview (, August 2005): “When a dentist … performs a bad makeover, where do you find they go wrong most often?” he responded: “I think that most often the dentists don’t listen to what their patients want …”. I agree. Please do not forget that with each consultation we also thoroughly document what transpired.  

Finding out the patient’s major concern, facilitating the decision making process, and being patient as our client moves toward acceptance of their oral rehabilitation needs and plan harmonizes and optimizes the treatment journey. This is done by consulting. Consult, Consult, Consult. It will be the best time ever spent in our offices, guaranteed!

Further Suggested Reading and References:

1. Jensen BO, Petersson K. The illness experiences of patients after a first time myocardial infarction. Patient Educ Couns. 2003;51:123-31.

2. Stoller EP, Gilbert GH, Pyle MA, Duncan RP. Coping with tooth pain: a qualitative study of lay management strategies and professional consultation. Spec Care Dentist 2001;21:208-15.

3. White BA, Maupome G. Making clinical decisions for dental care: concepts to consider. Spec Care Dentist. 2003;23:168-72.

4. Fitzpatrick B. Standard of care for the edentulous mandible: a systematic review. J Prosthet Dent 2006;95:71-8.

5. Holman AR, Brumer S, Ware WH, Pasta DJ. The impact of interpersonal support on patient satisfaction with orthognathic surgery. Oral Maxillofac Surg 1995;53:1289-97.

6. Schouten BC, Eijkman MA, Hoogstraten J. Dentists' and patients' communicative behaviour and their satisfaction with the dental encounter. Community Dent Health 2003;20:11-5.

7. Schouten BC, Hoogstraten J, Eijkman MA. Patient participation during dental consultations: the influence of patients' characteristics and dentists' behavior. Community Dent Oral Epidemiol 2003;31:368-77.

8. Bailey LJ, Haltiwanger LH, Blakey GH, Proffit WR. Who seeks surgical-orthodontic treatment: a current review. Int J Adult Orthodon Orthognath Surg. 2001;16:280-92.



Tags:  Basic Rules  Consultation  Racich 

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