AME: Still Pushing the Button

[00:00:00] Okay, let's talk about one of the most underrated tools in your practice, the dental mirror. It's in your hand all day, every day. But have you ever thought about how much it actually impacts your work? If your mirrors aren't giving you a crystal clear view, you're working harder than you need to. That's where Zerk comes in with their Crystal HD Dental Mirrors. I love these mirrors. I keep two in every single setup just in case I drop one. These aren't your average mirrors. They're so much brighter than the standard ones. That means better visibility, reduced eye strain, and more confidence during every procedure.

[00:00:28] And they're durable and lightweight, designed to reduce hand fatigue and improve ergonomics, so you can work comfortably even during those long, demanding days. Plus, your patients will love them too. Available in a variety of vibrant colors, these mirrors are made with durable resin to prevent galvanic shock and eliminate the unpleasant clanking against teeth, ensuring a more comfortable experience for everyone. Upgrade one of the most important tools in your kit with Crystal HD Dental Mirrors from Zerk. The moment you bring one into the oral cavity, you'll be amazed at the clarity and brightness.

[00:00:56] It's like seeing your procedures in a whole new light. Maintaining optimal ergonomics is essential for a long and healthy dental career. That's where BQE comes in. BQE stands for Back Quality Ergonomics. I swear by a BQE model called the Ergodynamic, but they have a variety of styles that can fit you and your whole team. Keep listening to Very Dental to hear a conversation I recently had with Stephen Hoxma of BQE about their commitment to creating the best seating for dental teams.

[00:01:22] If you're looking to improve your workspace and well-being, check them out at bqe-usa.com. This is a production of the Very Dental Podcast Network. Alan Mead is a dentist with too much time on his hands and too much recording equipment in his basement.

[00:01:45] Armed with an obsession to bring entertaining and informative content to the dental world in a way that's never been done before, I give you the Alan Mead Experience. Well, hello and welcome to another episode of the Alan Mead Experience. I'm your host, Dr. Alan Mead. I'm a dentist, a podcaster, and a very nostalgic person. I say that in so many different ways. I really am nostalgic about stuff.

[00:02:15] I'm the guy who, whenever stressed out, I fall back to the three albums I listened to on repeat when I was in high school, that sort of thing. Nostalgia is the thing with me. Anyhow, I had a couple experiences this week that made me think of, long story short, like, I can be a little bit manipulative to my patients.

[00:02:40] And I was thinking to myself how I was going to explain this to you in an Alan Mead Experience episode. And in the back of my mind, I'm like, man, I think I've recorded something about this. I don't want to necessarily repeat myself if I've already talked about this. But, so I looked. I went to Google and looked. Turns out, I wrote something for the Dental Hacks website back in 2018 or so.

[00:03:05] We were kind of putting out a bunch of written content as well as, like, a whole team of us were putting out a bunch of written content. And that's where I got started, too. I started writing a blog in 2008. That's where, like, this whole content creation thing started for me. Which is so funny because, right now, how old-fashioned and old-timey does it seem that someone would, like, write a blog? Even podcasting at this point seems a little bit old-timey compared to, like, Instagram influencers. But, anyhow, I'm a 53-year-old man. I'm not doing makeup tutorials. No one's sitting for that.

[00:03:35] So, let's be honest. I think I found my spot. Anyhow, I went back and I happened to see a blog post that I wrote about this. So, I don't think I've recorded anything, like, on a podcast. But I wrote something about how – I called it Push the Button. And, essentially, it's the same concept that I was thinking about last week.

[00:04:00] And, basically, it's a way of dealing with patients that – I don't know. Maybe patients that are a little hostile or patients that are – the patient that you see on your schedule that makes your stomach kind of, like, go, ugh, one of those things. And I actually – I refer back to a story in dental school and how I kind of learned this technique. And, I don't know. There's probably actual name for it. But I just call it Pushing the Button. Anyhow, I'm going to just start – I actually read the article in its entirety.

[00:04:29] I will send you a link or I'll put a link in the show notes to the actual Dental Hacks article from 2018. But this is the article. This is the blog post that I wrote. And then, on the other end of it, I'll talk a little bit more about it. This is Push the Button from the Dental Hacks website. His name was Bruce. He came to my office with a mouthful of problems. Eight implants had already been placed with no input from me, ready to be restored.

[00:04:58] His bite was collapsed and he was overclosed. He was medically compromised. He was a complicated case that I hadn't had any input on. I was in so far over my head, yet I was young and dumb enough not to know it. Even worse, he was wealthy and used to getting his way. He was a snowbird spending his winters in Florida or Arizona. But every year around mid-April, occasionally in February because he would fly north with the tooth problem – awesome – I'd see his name on the schedule.

[00:05:28] For two hours. With a passive-aggressive description of his problem like, Crown that was just done is broken. He was good at making me feel like everything I was doing was wrong. Some of that feeling came from the fact that I really didn't have a good plan. But the other part was his withering stare. Every time I would see Bruce on the schedule, my stomach would tighten. If he was on the schedule, I was guaranteed to lose sleep the night before. Be honest. You have a Bruce in your practice.

[00:05:55] In fact, if you're like most dentists, you have a bunch of Bruces. The denture patient that's never satisfied. That woman you've been seeing for 15 years in hygiene who hates having any work done and won't look at you when you walk into your hygienist's operatory. Maybe it's the patient that you're on decent terms with, but every single time you treat them, things go completely off the rails. We all have our Bruces. Sure, you can fire these patients from your practice, and for some, you probably should.

[00:06:21] But honestly, if I fired every patient that's caused me to wince when I look at the schedule, I'd be decimating my practice. What if I told you that I figured out a pretty reliable solution for these patients? It might not make the dentistry any easier, but you'll probably sleep better most nights no matter who's on the schedule the next day. The solution is pretty simple. Everyone has a button. You just have to figure out what it is and be willing to push it. It started in dental school for me.

[00:06:48] Once we started in clinic, the social interactions we had on a regular basis became more complicated. Not only did we have to figure out the patients, but we had to work with an instructor as well. In most cases, the patients were the easy part. Patients willing to come to the dental school for treatment were already pulling for the dental students to do well. They wouldn't put up with the extra time and hassle if they didn't kind of love their dental students. The instructors were a whole different deal, though. You couldn't really predict who you'd be working with on any given day,

[00:07:15] so you were never quite sure what you were in for. Some instructors were laid back and helpful. Others were grumpy and mean. Kind of like Bruce. For instance, there was Dr. Stone. He was a prosthodontist who worked mostly with the grad pros program, but during my senior year, ended up on the clinic floor quite often. He was tough. He made snap judgments about you before your patient was ever seated. If you didn't know what you were doing, and let's be honest, who did?

[00:07:43] He would eviscerate you with words in front of your patient. He was a guy you avoided at all costs. I knew I would eventually end up on his corridor of cubicles, so I took a proactive stance. Whenever I could, I would go over and talk with him. I would seek him out. What would I talk with him about? Perhaps balance occlusion indentures? Tissue retraction for the ideal polysulfide impression? Hell no. I talked with him about the thing he liked to do most, fly fishing.

[00:08:09] You see, it turns out that I overheard him talking about fly fishing with another instructor. You could tell that he was passionate about it, and it was something he did whenever he got a chance. I didn't know much about fly fishing, but I spent a lot of time at Barnes & Noble. This was some years before Google was really a thing. So knowing that Dr. Stone was a fly fishing fanatic, and knowing that I would eventually have to work with him, I did some research. I used the extensive selection of fly fishing books at the Barnes & Noble to become somewhat familiar.

[00:08:38] Although I didn't become a fisherman, I could carry a conversation. From there, I would approach Dr. Stone whenever I could and ask him if he'd been fishing lately. And more often than not, he had been. And if he hadn't been, he was planning a trip. What I found was that people like to talk about themselves, their families, and their interests. Furthermore, they don't need a lot of prodding to do it. Dr. Stone was always up to talk about fishing. To the point where when he would see me in the clinic, he would seek me out to have enjoyable conversations about fishing adventures.

[00:09:08] It wasn't all that important to him that I didn't fish. It was more important that I showed interest in him, and we enjoyed talking to each other. Dr. Stone turned out to be an instructor that I could work with even when others dreaded him. This experience taught me that almost everyone has a button. And if you learn what their button is and are willing to push it, you have a chance to change your relationship with that person in a positive way. Dr. Stone's button was fly fishing. I did a little research, pushed the button, and changed the way that he and I interacted in a way that benefited both of us.

[00:09:37] Isn't that kind of manipulative? Yes, it really is. But not in a dishonest way. By doing a little legwork, I was able to change the relationship I had with this person. That made it more likely that we would have good interpersonal interactions going forward. So back to Bruce. He's a difficult patient. When I see him on the schedule, my stomach tenses up. Does Bruce have a button I can push? Probably. Most people do. How do I find out?

[00:10:04] Well, you have to be willing to engage with a person on a completely non-teeth level. It starts with talking to the patient. And not the kind of talk that starts with, are you having any discomfort? More the kind that starts with, how was your weekend? Or if you could be somewhere else doing something else, what would it be? These conversations should happen with no mask on, no gloves on, and no loops on. Ideally, you're sitting facing each other in the way that human beings do when they're having a conversation. The difficulty is almost always your schedule.

[00:10:32] You've got patience to see and you don't want to get behind. I understand. My suggestion is to always leave a little more time than you think you'll need for these people. You probably won't win them over right away, but the extra TLC you're willing to give them with a conversation is worth it in the long run. Each time I see Bruce, I have to spend some time catching up. Bruce is a snowbird and a road warrior. He's an RV guy, and he's probably been on some kind of cross-country adventure since I saw him last.

[00:10:59] Whether it's Arizona or Florida, he's been living it up in his ridiculously fancy and expensive RV, and he's got some stories to tell. Travel, RVs, and horses are Bruce's button. And because we know he can be pretty unpleasant and bossy, I'm always ready to push one of these buttons, or maybe even multiple buttons. Over the years, we've created another problem with Bruce. He talks too much. I'm not even kidding. My assistant struggles, not with his mood or behavior, but just shutting him up long enough to get work done and to get me on to the next patient.

[00:11:28] Pushing the buttons that we discovered with Bruce has changed his relationship to me and my office in a profound way. I prefer this new problem over the one I started with, though. Before I became completely conscious of my push-the-button technique, a challenge like Bruce could wreck my day. I must admit that sometimes it doesn't work. Sometimes people aren't interested in making a connection like this, and you can't make them. But more often than not, if you're willing to be selfless and do some listening, most every situation can be de-escalated.

[00:11:57] In fact, some of these patients can be turned into raging fans of you in your practice, all while sparing you that tense stomach feeling when you look at your schedule. So that was the blog post I wrote back in 2018. And what made me kind of think of it again was an interaction I had with a patient. I think it was last week. It might have been two weeks ago, something like that.

[00:12:21] But long story short, I'm finding that this technique is not always just for patients you don't like seeing. On some level, I got to say that it makes me – okay, so my natural default position is to not be around people and to be alone. It's funny. I'm an introvert. If you've ever been around me, you wouldn't think that. But I'm an introvert.

[00:12:49] And so being extroverted takes a lot out of me. But on the other hand, I've found that some of the more healthy and better parts of my life lately have been where I've had human interaction. I can't even believe I'm saying this. I sound like such a freak when I say this. But when I was in high school and college, I was good at being sociable. I didn't have a hard time talking with people. I do now.

[00:13:15] As a 53-year-old man, I don't have any good – like I don't have any friends that I do stuff with locally. And I know I've said this on – but I think I'm somewhat common. It's just like because I don't have any close friends that live by me, so I don't like go out and do stuff. Plus, I mean, I have two boys that keep me very busy. My family life is very busy, which is fine and all that.

[00:13:37] But like on some level, being on a regular adult terms with other adults, I'm sort of limited to my office interactions in a lot of ways. And of course, that's great. And I will say that most dentists are quite good at putting on the show. Maybe they aren't. I mean, I only work with me, so I don't know. Maybe dentists are super antisocial and snotty. But I just can't do that to patients. You know, I can't be super short and not – and I'm the guy who fills in –

[00:14:06] you know, if there's empty space in the room where it's quiet, I tend to fill it in with chatter or whatever. But what's funny is that is exhausting to me. But part of it is that it's sort of a superficial thing too. It's not like I'm actually interacting with these people on a personal level. So what I found lately, I feel better working on patients that I like and like me. And that doesn't mean I can automatically like everyone.

[00:14:35] But this sort of – having these personal interactions and sort of finding a little bit more out about your patient in whatever way that you do makes the day go by faster, makes awkward conversations less awkward. And this is one of these things where I – so I'm not using this push-the-button technique just for patients that hate me or patients that I'm anxious about.

[00:14:59] Like I'm just kind of – I basically find that my day goes better when I go out of my way to kind of find out a little bit more about – I've been in this office for 27 years. And there are some patients that I'm just getting to know now after 27 years, which is – it's a little embarrassing. But I'm like, oh, life's too short at this point. So I tend to try and do this technique more often than not. And at very least, if you take a little effort on this, it's much more fun to work on these patients.

[00:15:28] I'm always light and kind of as much jokey as I can be and making light of stuff in my day-to-day. But I mean getting to know these people – let me give you an example. I'm talking around this thing. Let me give you an example. So I had a patient. He came in. We prepped a tooth. We prepped a crown on 18. And it was a pretty busted up tooth.

[00:15:48] And it's one of these things where I probably didn't give him the best informed consent that I've ever given someone because I thought he was asymptomatic when it broke. He seemed to be fine. We prepped the crown. And a couple weeks later, when we were ready to see it, it was hurting him. He was actually – when in the temporary, it was hurting him. And this is not one of those where, oh, it might just be a little sensitivity. This is a busted-ass tooth. And this is a tooth that I should have said, this could need a root canal. And it didn't need a root canal.

[00:16:15] It tested – I mean it was partially vital by the time we opened it up. But anyhow, a lot of times when I know we've got a partially vital tooth or a tooth that's on the way out, I find that giving like a Medrol dose pack or some kind of a steroid really helps with pain. But, you know, the main contraindication, you know what it is. It's diabetes. You don't want to throw their blood sugar off with a steroid. So I was talking to this patient.

[00:16:40] And he was not mad at me, not thrilled that this tooth had been hurting so much after we prepared the crown. And, you know, and I'm like – and I'm like, I can't give you a – I can't give you a steroid, can I? I can't – because we talked a little bit about the – and he took his phone out and he was like, yeah, I mean I'm diabetic. I'm pretty well-controlled. Okay, so I'm type 2 diabetic. And it turns out he uses the same glucose monitor that I do. So this poor guy, I mean we're getting him feeling a little bit better.

[00:17:10] But he and I literally talked for 10 or 15 minutes about the games we play with our glucose monitor. And maybe your diabetic patients have the same thing that I do. But like literally I will go between – when one glucose – they last for 14 days. So you get two weeks' worth. And I always take a break where I go crazy. Like I gamify it because I want to stay in that green zone. I want to do better than everyone else.

[00:17:36] I want to get – so I'm really good when I have the glucose monitor on, right? Like my diet is fantastic. And exercising helps a lot with this too. And, of course, the weather has been crap. So I haven't exercised as much as I normally do. But you can really – if you're sticking close to a diet and you're really high on protein and avoiding carbs and drinking lots of water and taking care of yourself, you can stay in this green zone, which is between like 80 and 100 and whatever. And then – but if you go – there's like a yellow zone, which is the caution zone.

[00:18:06] And the caution zone is – and then you get in the red zone, which is technically high glucose. I don't know exactly the numbers. But bottom line, I do really well with it for the most part. But I know when that glucose monitor is off, I let everything go to hell for a day or two because I'm not monitoring. What a stupid game I play. It's like literally – because I don't know, like eating a bowl of ice cream would clearly put me into the high zone. And so I do this game. And what was so great was we – he and I talked about it.

[00:18:34] And I know he does the same thing. And I'm like, oh, my God. I'm so glad to know that someone else is as stupid about this as I am. Mind you, both of us are taking decent care of our diabetes. You know, we're both mid-50s. You know, I think both of us have lost some weight and stuff. But we kind of grew up fat and weren't looking at this stuff and all that. And, I mean, honestly, so I'm going to tell you that we bonded over this glucose monitor thing. And it was hilarious.

[00:19:00] Like we didn't – the other thing, the classic thing is like every once in a while the glucose monitor, like you get up in the morning, you haven't eaten anything at all. You just had a glass of water. And you look up and you're already in the yellow zone. And it makes no sense whatsoever. Apparently there's – oh, when you wake up, apparently there's a hormone dump in a lot of cases. And you get – well, he was saying, this is not even fair. I mean, if I'm going to go into that zone, the least I could do is have a fucking candy bar. You know, it's really funny. It was – and we bonded over this, right? This is a button I can push with this patient.

[00:19:29] We sort of laughed over this and we really have – we have common ground. I got another patient. This one is a patient that my team hates when I schedule. I didn't – I had known him for a while. But before I started riding bikes seriously, he was just a nice guy that came in. But this guy rides his bike. He doesn't ever drive. He rides his bike everywhere in Saginaw. Now, I don't ride my bike in Saginaw. I ride my bike at home.

[00:19:58] But he and I can talk for hours literally about bikes, like cycling bikes, different trails we've gone on, different – I mean, it is ridiculous. And my team hates it because I get behind. But, like, this is a guy who I should be friends with on the outside because he and I just hit it off like crazy. I mean, I saw his daughter last week. I hadn't seen him for a little while. And I was just saying, so is your dad? And, of course, he's injured.

[00:20:24] Cyclists are always basically going in cycles of really riding hard and then falling and injuring ourselves and not being able to ride. And he's – apparently he's injured. So I need to probably send him a card or something like that. But, like, I'm finding that I have patients that are more likely to follow through with treatment because of the personal relationship I have with them. I don't have to prove to them that I'm a good dentist because, you know what it is?

[00:20:51] Because I'm working on patients that like me and that have a connection with me and vice versa. I have a connection with them. And it's better because of that. And I don't know how other dental offices handle this. But I do know that I've had patients that tell me that the dentist was not personable, wasn't nice to them. They felt like they were just a number and next. And I'm not trying to brag.

[00:21:15] I'm just saying it doesn't feel right to me to do that in this – having this personal connection, whether it's, you know, learning something about the person so you know that you've got a button to push in the future or because you like having patients that like you and, you know, trust your judgment and have stuck around long enough to get to know that you are a good dentist and you'll do the right thing for them. It's a huge thing. So I guess what I'm saying is just take to heart.

[00:21:42] And if you have to, write in there, chart what the button is or put a sticky note or put whatever, put a flag so you know – so you don't have to remember all the time. Although what I've found is most of the time when I really have a connection with the patient, I kind of remember. I remember and we kind of pick up where we left off, which is a really nice – it's a really nice position to be in. It sounds cheesy, I know. But it isn't – so it isn't just a way to manipulate your cranky patients. It's a way to have a better experience on a day-to-day basis. I mean you could do this with team too, I suppose.

[00:22:12] But you know your team better than you know your patients. But your patients, if you have, you know, something personal that you can talk with your patients about that's non-dental, you become a part of their life in a little bit different way than just the doctor, just the guy. They go back to that office and hear all the bad news and say, okay, whatever, doc. I honestly believe that. And in some cases, knowing that I've had, you know, patients' families forever so we can – you know, we have things to talk about. They're kids and they're all – it's great.

[00:22:41] Personal relationships are not – I'm not great at it. I'm an introvert. A lot of times I kind of want to be alone. But honestly, it's been a really good thing for me to explore this again, to think about this and make an effort. I think if you'll take the time, you won't regret it. So this was a little cheesy, but it was to fall back on an article I wrote a while ago and the trick is still working for me. So I just – if you have any questions or comments or if you think I'm crazy or like, oh my gosh, this is exactly right. I have a patient just like this.

[00:23:11] Let's talk about the Very Dental Facebook group. If you're not a member yet, go to Facebook, look up Very Dental, and then you have to request an invite. And you have to give me one of five passwords. The passwords are Timmerman, Hornbrook, Papa Randy, McQuethy, or Lipscomb. Any of those five will get you in. I don't really let people in the Facebook group unless I know they're a Facebook – a podcast listener. That's kind of how I've kept – it's a small Facebook group. It hasn't gotten big like some of the other nightmarish Facebook groups.

[00:23:40] But the conversation is very calm and it's very supportive and it's not a thing you're going to feel bad about. So go check it out. We can talk about this. I'd love to hear other people's tricks and how to find out what buttons to push. I appreciate you guys listening. I hope this was helpful for you. It was kind of fun for me to do, kind of fun for me to look through some of the old Dental Hacks website stuff. And I will catch you again next episode.