An Invitation to Influence

Mary Osborne, RDH, discusses listening to patients and then informing them of your recommendations to motivate them to improve their health.

Listening to patientsby Mary Osborne, RDH

You come back from a sleep course armed with new information, research, and experiences. The first patient you see in your practice exhibits signs of airway issues you simply cannot not see! Enthusiastically, you show her what you see, explain the implication, and encourage her to have a sleep study.

“Umm. I’m okay.”

“Not right now.”

“No thank you.”

Wait, what? Weren’t we taught that if you give people good information, they will make the right choices? What went wrong here?

The truth is it is probably not the first time you gave a patient good information that they chose not to act on. Perio disease. Replacing a missing tooth. Home care recommendations. We have seen this before. All of our study, our thoroughness, our clarity of communication does not always result in acceptance.

What’s missing? Some indication from the patient that they want your advice. An invitation to become a trusted advisor regarding their overall health.

Have you ever been given advice you did not ask for? You may be able to hear it, but it is not the same as when you have asked for advice. We have a responsibility to inform our patients, but they may not be ready to hear all of what we know.

How can we help our patients open up to hearing our recommendations? It’s a process. The late Dr Bob Barkley said your dental degree gives you the right to practice dentistry, but “you have to earn the right to influence your patients.” The key to earning that right is trust.

Start by asking questions and listening more intentionally.


Patients must trust our competence, but our clinical training can lead us to believe that information alone builds trust. Information is important, but it is equally important that patients trust our motives. They must feel confident that our recommendations are in their best interest. We must know them well enough to make recommendations for them.

Another aspect of trust that is too often neglected is our patients’ ability to trust themselves, a confidence in their own knowledge and ability to make decisions about their health. Without that confidence, they may choose not to make a choice. They often choose to do nothing.

How can we learn enough about our patients to help them find the motivation to improve their health? Start by asking questions and listening more intentionally to information they are already providing. You may be missing opportunities in systems you already have in place in your practice.


Medical history: If we want to be seen as partners in health the first form a patient fills out should give them an opportunity to focus on health, not just disease. Reviewing a patient’s health history form is standard practice, but it can be more than just a review of health problems. It can be an opportunity to ask them about what they do to maintain health. We can ask them about how they came to include exercise or supplements or healthy diet patterns. If we listen carefully, we can hear patterns about how they make decisions about their health. We can look for opportunities to acknowledge and support their choices.

A few well-placed questions can also help us understand something about a patient’s ability to incorporate significant change into their lives. They may report they have quit smoking, or lost weight, or incorporated regular exercise into their lives. Showing an interest in how they accomplished the change reinforces their success. “What prompted you to lose all that weight?” is a question that helps us understand what motivates them. Asking “How did you quit smoking?” offers insights into strategies that have been successful for them in the past. Questions like these can provide useful insights about how you can help your patients through the process of integrating sleep appliances into their lives.

Clinical Exam: A thorough clinical exam demonstrates our attention to detail and our knowledge. When we ask the patient questions during an exam, we also invite the patient’s expertise into the relationship and engage them in the process. “What do you remember about how you came to lose that tooth?” (or have that root canal, or that crown.) That conversation during an exam also allows us to support decisions made to restore a tooth, or replace it.

Show patients conditions you notice andask them questions about what you find before giving treatment information. “Have you noticed this scalloped pattern on the sides of your tongue?” You might ask how long they have been aware of that pattern on their tongue. When patients provide us with information, they are more likely to be interested in findings we point out to them and information we offer.

Review of Findings: Going over conditions we observe provides an opportunity to ask the patients thoughts about what we have discovered together. Patients can share their confusion, concern, or pre-conceived ideas. “I know we’ve given you a lot of information today, Mr. Jones. I’m wondering, what thoughts do you have about what we have found?” They may be surprised, confused, disappointed, skeptical. Listen carefully, attentively, to understand more deeply who they are and what is important to them. Avoid the temptation to suggest treatment too quickly, to offer a solution to a problem they do not yet own.

Allow time for them to digest the new learning. You might give more information or ask further questions. “Do you tend to wake up in the morning with a dry mouth?” “Has anyone ever told you that you snore?” When these questions emerge through a dialogue about what they are thinking or feeling, they will be more meaningful to the patient. If they have little or no awareness of conditions you identify you can encourage them to pay attention between now and the next time you see them. See if they notice mouth breathing, or dry mouth, or disturbances in their sleep.

Mutual Trust

Nobel prize recipient Dr. Albert Schweitzer said, “Patients carry their own doctor inside. They come to us not knowing that truth. We are at our best when we give the physician who resides within each patient a chance to go to work.” When we invite the “physician who resides within each patient” to come forward in our conversations we encourage patients to trust themselves. When we listen generously to the doctor inside, we encourage patients to trust us.

We can “earn the right to influence.”

Listening to patients and your team can keep everyone focused on health. To find out how to communicate with your team more effectively, read “The #1 Struggle in a Dental Sleep Practice Isn’t What You Think” by Michael Cowen here:

Listening to patientsMary Osborne, RDH, has worked in dentistry for over forty years. She brings to her work the experience of day to day, hands on clinical dentistry as well as a wide range of knowledge gained in working with dental practices around the world. Mary’s education and experience as a dental hygienist and patient facilitator help her to understand both the rewards and challenges of practicing dentistry. Her love of learning, and deep belief in personal and professional growth through authentic communication have made her a respected and admired advisor to dentists and their teams for many years. Mary is known internationally as a writer and speaker on patient care and communication. Her writing has been acclaimed in respected print and online publications. She is widely known at dental meetings in the U.S., Canada, and Europe as a knowledgeable and dynamic speaker. Her passion for dentistry inspires individuals and groups to bring the best of themselves to their work, and to fully embrace the difference they make in the lives of those they serve.


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