Raabe Family Dentistry - NEWS

May 5, 2014

The Importance of Giving Your Dentist Feedback


Dr. Shelley Kappel, a retired clinical dentist, works as a health care dialogue facilitator and leadership coach. She helps dental teams optimize their clinical, relational, and business outcomes by practicing collaborative, inclusive models of engagement, ones where doctors, team members, professional colleagues, and of course, patients thrive together.

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This morning I was hiking with a good friend whom Iʼll call Nancy. Months ago I had referred her to a long time colleague of mine for dental care for herself and her family. Apologetically, she shared a recent experience she had of a sudden and unexpected panic attack that occurred half way through her last appointment to replace two simple fillings on her upper right molars.

Normally a self-described easy going dental patient, Nancy recounted how the rubber dam felt increasingly tight throughout the procedure as if it were cutting off her ability to breathe. Never before had she experienced discomfort or even any awareness of the rubber dam. She felt she could “hang in there” a bit longer until she heard the dentist say to his assistant that it was now time to begin the second tooth. “Iʼm only half way done!!!”, she realized with horror. At that moment she sat up, unable to continue, and explained her plight. The dentist was appropriately responsive, and used the moment as an opportunity to excuse himself to check on another patient. Nancy was given the time to compose herself.

The procedure was completed with the dentistʼs consent to continue on without the use of the rubber dam, but Nancy left the appointment quite affected.

It was apparent now a week later, how shaken she still was; so much so that she expressed a desire to cancel her next appointment scheduled for a crown on a lower molar next week.

She asked me, “What should I do?”

I replied,”What do you want to do?”

She replied, “Not go back. I am so traumatized by the experience and memory of feeling completely and utterly out of control that I cannot put myself in such a vulnerable position again. The dentist also told me that I would have to use the rubber dam as it was essential to protect my tongue during next weekʼs procedure. I need to cancel theappointment.”

Sadly, what Nancy shared with me is a typical reaction to traumatic dental experiences. As a species we are wired to protect ourselves with the “fight or flight” response when our bodies register something as life threatening. Certainly a sense of being unable to breathe is such a condition.

Many patients with suboptimal dental experiences literally perceive the situation as one where there are only these two options, 1. Speak to the dentist, which is commonly seen as confrontational,“ a fight” for what is needed to comfortably receive care or 2. Flee from the setting entirely, thus avoiding necessary care, sometimes for decades.

When “ flight” is chosen, the patient leaves the practice, often with the dentist left wondering why, and never having an opportunity to learn from the experience and make positive adjustments for the patient whom s/he is dedicated to serve. Everyone loses. As an active advocate for healthy doctor/patient relationships, I consistently employ and support a third option. However, this third option is commonly avoided as frequently as the dreaded treatment itself.

That option is Feedback.

When I asked Nancy if she considered exercising this powerful and highly effective option, she shared that she had, but didnʼt want to hurt his feelings, seem like a “problem patient”, or jeopardize my professional relationship with my colleague (since I highly recommended him). She also revealed that, although respectful and responsive, the dentist didnʼt seem to really understand just how terrified she was. “He seemed to lack genuine compassion and understanding for what I was going through”. She also didnʼt trust that heʼd care enough to actually do anything about the situation, or that anything could be done since he said the rubber dam must be used. In short, she felt offering feedback would be futile.

Nancy expressed many of the common reasons most patients choose fleeing and avoidance instead of speaking directly to the dentist when experiences miss the mark. In almost 4 decades of working with patients (and being one myself) I have found the single most effective tool in achieving optimal outcomes, preserving respectful relationships, and empowering the patient nd the dentist in bringing the best of themselves to the situation is feedback.

When seen for what it is, feedback is nothing more than an individual “feeding back” information to the other about the experience in the moment as it relates to an understood intended outcome. In the case of Nancyʼs rubber dam experience, the intended outcome was that the two fillings be replaced efficiently, effectively, safely, and comfortably. If it is understood at the onset that this is the shared intended outcome, then it is crucial that each party “feed back” information to the other in a mutual effort to stay on track to that destination.

The dentist and Nancy want the same outcome. Feedback is easy when the outcome is clearly understood and prioritized between the parties.

Instead, we as a society, have been trained to focus our attention on other things, like social convention, titles, roles, gender differences, age, experience, superiority, inferiority, assumptions, how others may view us, saving face, not wanting to appear a certain way, wanting to be liked, negative past experiences, tightly held beliefs, opinions and stories about the other, blame and victimhood, needing to be right, etc. The list goes on.

Rather than keeping our focus on the intended purpose( in this case, the fillings), we frequently get derailed by such distractions; and soon we find ourselves way off course to our intended destination, frequently disappointed with the journey, outcome, ourselves, and the other in the process.

When Nancy first experienced the discomfort of the rubber dam being too tight, it would have been not only OK, but essential to raise her hand and simply state what was going on for her in that moment.

“Excuse me. This rubber dam is really pulling and is already uncomfortable. I canʼt imagine being able to tolerate this for an hour as it is fitting right now. Can it be repositioned so that you can do your work and I can be comfortable for the duration of the procedure?”

Since one of the understood outcomes was the patientʼs comfort, the dentist, also committed to that outcome, could have responded immediately, and that distraction would have been mitigated.

Feedback must be ongoing and timely for ideal results to be achieved.When we actually pay attention, we notice that feedback is constant in the natural world. What is unnatural and highly undesirable, is to wait until the end of an event when it is too late to respond to the damage done.

Nancy and I discussed reframing feedback as a simple tool to keep things on track for everyoneʼs benefit. When seen from this vantage, she said, “Wow, I owe it to myself and the dentist to share my experience, not only for us but also for the assistant and all the other patients who may struggle with similar situations.

Nancy ultimately decided to call the dentist to set up an appointment to give feedback prior to her next visit. She was inspired and eager to have the conversation. By doing this, she is empowering herself and the dentist to take full responsibility for their decisions and actions, going forward, and setting the stage for more optimal experiences.

I invite you to engage feedback in this way as well. Youʼll be amazed at whatʼs possible!

Raabe Family Dentistry, 155 Cook St. Suite 351, Denver, CO 80206 (303) 320-0160 Smiles@DenDDS.com