What am I Missing Here?

I had just gotten off a plane in the Minneapolis airport and spotted a sign with the stick figure of a woman indicating a rest room The entrance had a wide area where you could go right or left around a wall. As I confidently headed to the right of the wall, I was passed by a man coming in the opposite direction. “Funny,” I thought, “a man in the Woman’s Room.” As I rounded the wall, I saw another man with his back to me. “Two men in the Woman’s Room,” I thought with a puzzled smile.

By this time, my feet were ahead of my brain and I had turned around to head out of what was obviously the Men’s Room. Of course, this was only a matter of seconds, but isn’t it interesting how convinced I was that I was right, all evidence to the contrary? Once I chose my direction, my brain would only acknowledge evidence that I had chosen correctly.

Isn’t it funny that I never once asked the question, “What am I missing here?”

As humans we have a tendency to look for confirmation that we are right once we have taken a position. We tend to miss opportunities to explore other possibilities. It occurs to me that this was not the first time I had engaged in this way of thinking.

In working with patients in dentistry who chose not to go forward with treatment my default thinking for many years was to speculate about what was wrong with them. Was it their lack of value for dental health? Their dependence on dental insurance? Their fears? I continually went back to my resources of information trying to find ways to counteract what I guessed were their barriers.

I told them that dental insurance was not designed to cover all their needs; that it was just a contract between their employer and the insurance company. I gave them information about the effect of dental health on their overall health and on their appearance. I told them about the advances in dentistry that offered more profound anesthesia and less painful treatment.

Isn’t it funny that I never asked the question, “What am I missing here?”

Once I determined what I believed to be in their best interest, I focused only on how to convince them that I was right. What new research, data, or high tech visual aid would get them to change their minds? Occasionally I gave up on them. I decided they just did not care about their health, or they were not committed enough to do the work required for health. I sometimes came to believe that they just could not afford good dentistry, or that they preferred to spend their money on more frivolous things.

I was in complete denial about my own part in the process; about the assumptions I was making, the attitude I might be bringing to the conversation. I did not wonder about how well prepared I was, how confident I was about the diagnosis made, or if the treatment we were recommending was really the best for this unique individual.   I was unable to access my curiosity about what was important to them. What did I not yet know about this person that would help me to help him or her better?

We must provide our patients with information; that is our responsibility as clinicians. Information is frequently the key to helping our patients own their existing conditions and begin to look for solutions to problems. We know a lot about dentistry and dental health, and we are often most comfortable and confident when we are giving information. However, information is only one part of the equation. It is one tool in our education toolbox. We can be more effective when we bring a variety of skills to our conversations.

Case Workup:

In preparing for a treatment conversation with a new or existing patient, take the time to work up the case thoroughly. The purpose of this process is to immerse yourself in the complexity of the clinical riddle to be solved. To make an accurate diagnosis before you plan for treatment. To fully absorb the risks and benefits of various courses of action, including the choice to do nothing. Your patient will probably need very little of this information. This is for you and it is a highly productive use of your time. This preparation builds your confidence in your own ability to provide treatment. Well-founded confidence allows you to be more open to possibility. When you have worked through the clinical case you will be more comfortable to explore whatever questions your patient raises, without a need to justify and defend.

Chart Review:

Reading over the patient record in advance of an appointment offers an overview of where you have been in your relationship to date. It not only provides information about what you have done for the patient, but it should also refresh your memory about what the patient has said to you over time. A thorough review of the record allows you to see patterns in the choices they have made and the reasons for those choices. More important, a review of previous conversations can raise questions for you that you did not think to ask in the moment. It allows you to weave the thread of history, curiosity, acknowledgment, and intuition into your current conversation.

Morning Huddle:

When each person on the team has done the work of preparation, the morning huddle can be a dynamic exploration of what is in the best interest of every patient you plan to see throughout your day. Instead of a mind numbing reading of the procedures you plan to do and discussion of who needs help and where, it becomes an opportunity to challenge your thinking. It offers a team perspective on “What am I missing here?” Invite everyone on the team to raise questions about any assumptions we might begin to make about patients. Everyone can contribute to greater curiosity by asking, “Is that something we know because the patient said it, or something we think we know based on our intuition or guesses?”

Inquire, Inform, Confirm:

The more our conversations with patients have a good balance of asking questions, confirming what we are hearing, and giving information the better. Too much of any one of the three raises the likelihood that we will miss something important. Take the time to explore, to understand who this patient is today. Your questions can help them clarify what is important them and how dental health fits into their ever evolving picture of health.

You have all the time you need. You have the lifetime of your relationship with your patients to help them discover what they want from dentistry and how you can help them best. Work on expanding your capacity to walk away from any given interaction asking yourself with a smile, “What am I missing here?”