Consensus on “Verbal Skills” that Help Build a Dental Sleep Medicine Practice

(Tony Soileau, Kent Smith, Rob Suter, Todd Morgan, Steve Carstensen, Steve Lamberg, John Viviano)

The LinkedIn Discussion Group, “SleepDisordersDentistry” has just completed an open discussion on “Verbal Skills” that help build a dental sleep medicine practice. Here is a consensus for all to ponder.

What was asked,

“Building a Dental Sleep Medicine Practice has proven to be both exceedingly rewarding and exceedingly difficult. Obstacles abound; physician resistance, re-imbursement resistance, misinformation about oral appliances, fear of side effects such as bite changes, the learning curve involved, etc. 

Let’s share our personal experiences, tips, suggestions, and in particular, “Verbal Skills” that effectively deal with these barriers…"

What was said,

Tony Soileau was first to jump in by posting the videos he has created to communicate sleep issues with patients. He pointed out that they are directed at the layperson, and as such he has tried to keep the message simple. Thanks Tony for sharing your work. Kent Smith shared that he viewed these videos repeatedly to glean phrases that may come in handy in his practice. Remember, it’s not about agreeing with everything you hear, it’s about listening for phrases that may work for you...

https://vimeo.com/potenzavideo/review/174372888/9f121dc835 

https://vimeo.com/potenzavideo/review/172471804/6b72eb6c76 

https://vimeo.com/potenzavideo/review/172966053/c800b27cdc 

https://vimeo.com/potenzavideo/review/172924144/533e5b9cc0 

https://vimeo.com/potenzavideo/review/174248662/f9073af36f 

Rob Suter feels that inadequate “Verbal Skills” is one of the primary reasons more patients don't get diagnosed and treated, on both the medical and dental sides...

“We all know 80-90% of OSA patients aren't diagnosed. University of Chicago hospital used the Stop-Bang on 1,000 patients walking into the hospital during a set amount of time. Of those who screened positive for OSA guess what percent actually made it from their specialist, to the sleep lab, to Cpap, Bilevel, OAT or Surgery. Only 8%! So 92% with high risk for OSA fell out of the sleep channel at one of our top Academic Hospitals.”

Rob insightfully suggested that if this is the success rate experienced in a Health Centre that enjoys an established reputation and position of Medical Authority, as dentists, we have to work that much harder with our “Verbal Skills” and “Knowledge Base” regarding the risks and rewards associated with ignoring or managing a sleep issue. OSA University teaches their clients to use the word “Airway Health” in place of “Sleep Apnea”…

“Patients don't want to hear or be screened for sleep apnea. Imagine if you walked into an Oncologists office and they said today we are screening for cancer and the treatment is $2900 if you test positive and want treatment.”

Rob also discussed the importance of having a “Balanced Conversation” with the patient…

“Instead of saying you could die of an MI or have a stroke, focus on things people really care about: Weight, Energy, Cognition, Skin Quality, etc. Those are the things people spend tons of money on and are motivated by. I think too many MDs and DDS verbalize the glass half empty to potential patients and they shut down and avoid diagnosis and treatment.”

Rob shared an important point he learned from Steve Carstensen, the importance of having a properly trained team…

“Many DDS teams can't handle sleep phone calls if they aren't trained or experienced to collect key pain points and verbalize what OAT or PAP can do to relieve that pain point.”

Steve Carstensen joined in and provided an overview of "The Influencing Cycle", something he learned at the Pride Institute many years ago, he summed it up as follows and it’s said too well to be re-written…

“The first point is to “Active Listen” to learn what the "Hot Buttons" are, in our case, the Chief Complaint. Nobody wants a “MAD”, they want to “Stop Snoring”, for example. This communication is not unique to medicine, it's universal human connectivity. We must address others where their concerns lie. For patients, it is the symptoms. For our colleagues, it is a mixture of their commitment to improving their patients' health and their business. When we take time to learn what other's hot buttons are, we can shape our responses to keep them involved in the conversation. If a patient calls and says "I want to stop snoring' and we talk about ‘AHI’, we're not meeting them where they are. Doesn't mean our clinical wisdom isn't important, it just means we are not giving the encounter enough chance to be successful (I really like this angle Steve!). We can help anyone we talk with realize what they see as most critical links to what we see as critical and that creates a “Shared Objective” - we both make decisions to solve the problems we perceive, and the more we see the problems alike, the more likely a positive outcome.

If our collaborating physicians perceive that we do care about them, their patient outcomes, and their desire to remain in the treatment loop (no matter what their motivation for that is) then we have a better provider team. Better communication comes with focusing on the other person, and that is easiest to accomplish with excellent verbal skills of the Influencing Cycle. ‘Active Listening’ and ‘Benefit Statements’ are key.”

Steve provided a link to an article about the first phone call that illustrates some skills that can be used for dental sleep medicine:

 https://prideinstitute.wpengine.com/wpcontent/uploads/2015/10/The_Ultimate_First_Call.pdf

Todd Morgan stressed the importance of a well-trained team and the “Hand Off” approach he uses in his office. Todd’s assistant acts much like a PA in the sense that they work-up the patient's Chief Complaint (CC) and History before he see’s them. This way assistant time is spent up front vs. doctor time. Usually, the assistant will “Hand-Off” the patient to Todd while reciting the CC, prior issues and History. Todd finds that this system saves time and the patients feel like they have been heard! The only job left then is to review images and qualify the patient for OAT.

Steve Carstensen shared a useful exercise to do with your team that helps prepare them to do what Todd’s team does. Something he learned from Mary Osborne; The Listening Game…

“In pairs, the question posed by the first listener is:

'In order for us to work well together, what would you like me to know about you?’

Timer is set for five minutes. The first listener is allowed to ask questions of the first speaker, but the question has to directly relate to what was just said.

For example, if the speaker says,

'My kids make fun of me for snoring'

The next question has to be about the kids, the snoring, or how she feels about being made fun of.

After five minutes, the roles reverse, same question to start.

You can't use the word "I". It has to be all about the one you are listening to.

The group discussion that follows is about how it felt to really pay attention when someone else is speaking and not be thinking about what you want to say. This is a really fun game that we do a few times a year in my office.”

Kent Smith also spoke of Mary Osbourne and the art of "Staying in the Question", which is really about listening.

Kent and his team listen for the "M&M", or “What Matters Most" to the patient. For example, this could be weight loss, memory, grandkids making fun of their snoring, etc. Kent places the patient’s M&M in the chart note to refer to when following up as the patient’s progress through therapy. The M&M is also passed on to the physician and the financial coordinator (if needed), so the patient is kept aware of why they actually made the appointment in the first place and how far they have come as therapy progresses.

Steve Lamberg shared what he learned at “Prime Speak”, a seminar hosted by Dawson Academy…

1) Explain damaging results of existing conditions, which explains choice 1 or doing no treatment

2) Explain suboptimal treatment

3) Explain optimal treatment

When reviewing advantages and disadvantages it's best to explain advantages first then the disadvantages for 1 and 2. Then for optimal treatment reverse and finish with advantages. In other words, when explaining Optimum or preferred treatment, always end on a positive note.

Steve pointed out that these verbal skills are especially important when doing initial screenings, as patients being referred by physicians are already well primed. Nevertheless, it seems to me that learning these skills can help us in all aspects of our lives. It really does not matter how proficient of a clinician you are, if you never get the opportunity to treat a patient!

While writing this consensus article I was reminded of three quotes I have heard over the years, which I believe, help to round out the information discussed about the importance of listening when connecting with patients, after all, eventually you do have to speak…

“You have to be believed to be heard”…

…take the time to establish patient rapport before explaining their needs.

“Patients don’t care how much you know until they know how much you care”…

… concern, empathy and compassion go a long way here.

“You learn when you listen. You earn when you listen—not just money, but respect”…

… earn respect and your message is much more likely to get through.

Once again, I would like to thank all those clinicians that took the time to participate in this discussion, this consensus article is intended to provide guidance for those that are new to this area of practice and also to provide valuable insights for those of us that have been at this a while. I look forward to your participation in future SleepDisordersDentistry LinkedIn discussions.

John Viviano DDS D ABDSM

SleepDisordersDentistry.com

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