The Jameson Files 109 – Mastering Patient Communication with Dr. Shannon Maddox

Carrie Webber [00:00:10] Hi everyone and welcome back to the Jameson files. I’m Carrie Webber and I’m your host And I’m so excited for another episode of our podcast where I get the opportunity to interview an amazing doctor from Oklahoma City, Oklahoma. A dear friend of mine and my own personal dentist, Dr. Shannon Maddox. Dr. Maddox thank you so much for joining us today. 

Carrie Webber [00:00:31] I am really excited to have this time and this conversation with you because I say this frequently to people and I really believe it to be true. Sitting in your office being a patient but also observing you with your team and with your patient family. I consider you one of the best communicators as a dentist in that I’ve ever seen and been able to see in action. And I believe that not only from a point of case presentation communication skills but really in your relationship building with your patients and how you educate your patients the time that you prioritize to do that so effectively and how well and how eloquently you do that is really quite extraordinary in my opinion and I know we’re friends and I know you could easily say that I’m biased but I’m not. 

Dr. Shannon Maddox [00:01:32] You might be a little biased but I do appreciate it. 

Carrie Webber [00:01:36] So I want to talk a little bit about communication skills from the doctor-patient relationship. It’s obvious to me that you have made that a priority for you professionally. How have you managed to develop that. I know some of that is is a gift that you have. But I’ve come to your office and tucked away in your consultation with room with you before just to pick your brain because I wanted to know you know how you have honed that for yourself. And because I believe a lot of doctors and and hygeinists, team members, treatment coordinators could really benefit from any any tools or any exercises or anything that you’ve done over time to be the best you can be when it comes to patient communication and education. So tell me a little bit about where does that fall in terms of prioritization for you in the relationship and how do you make the time for that and how have you learned to refine that skill over time. That was a lot of questions all in one question! 

Dr. Shannon Maddox [00:02:45] I’ll try and remember them all, but remind me if I forget. 

Dr. Shannon Maddox [00:02:47] Yeah absolutely. It’s I would say probably my most important priority when I think about the way that I practice or the way that I want my team to function because without sounding cliche people can not make educated decisions without knowledge. So if you want to have confidence in the treatment that you’re providing people or the treatment that patients have agreed to, you have to know that they know all of the facts before they get in. So I don’t feel confident if a patient doesn’t know what’s happening. I can’t feel confident in the care that I’m providing if they’re just blindly trusting me. And it gets kind of awkward at times because there are patients that want to blindly trust me. There are patients that, hey, I don’t want to know anything. You’re the doctor. I don’t want to see a picture. I don’t want to talk about it. You just tell me how much it’s going to cost and we’ll do it. And I have to kind of say, no, that’s not how I do things. I need you to know what’s going on and I need you to tell me what your goals are, and what you want. I don’t want you to end up with a smile that I want you to have. I want you to end up with a smile that you want to have. 

Carrie Webber [00:04:06] That’s right. And you know, I think that’s description of the level of trust you have built in your patient family. It’s such a testament to you that your patients would step in and say, “Just tell me what I need to do and let’s do it.” My father is the same way. Patients that would step in and do that. But I love that – you know in the in the previous episode you said it’s easy to settle for good enough, and you don’t ever want to settle for that – I think now you’re saying, “No, we’re gonna talk about this so we’re crystal clear.”

Dr. Shannon Maddox [00:04:46] Well and so much goes into when we when we sit down with a new patient. Specifically, I can’t tell you how many times there’s been a situation that they’ve told me about in their dental past that would have just been completely different had somebody explained what was happening – the disease process that was going in their mouth, how to treat that disease, what’s the best way, or what are the options for treating that disease, what are the financial aspects of treating that. So if you don’t cross off all of those boxes, then patients are left with question marks. 

Dr. Shannon Maddox [00:05:28] If they don’t have checkmarks they have question marks. 

Dr. Shannon Maddox [00:05:30] And if they leave your practice and those question marks never get filled, it’s always a little bit of I don’t know why he did that or I don’t know why she told me that and I don’t want to be back. I never want to. If they leave my practice because we’re not a good fit, okay. But if you leave my practice because you don’t know what’s going on, that’s all on me. And so it’s important to prioritize that time. You have to invest the time to be able to say this is everything that’s going on in your mouth. This isn’t the part that I’m going to tell you today and the part that I’m going to tell you in six months and the part that I’m going to tell you five years from now when you believe me. This is everything that’s going on in your mouth, and we’re gonna talk about it all today. 

Carrie Webber [00:06:16] So, if I were to look at your schedule, are you prioritizing time within your schedule to have those conversations, or is it such a natural part of how you communicate that it just really blends in with a minimal timeframe. 

Dr. Shannon Maddox [00:06:32] No it’s prioritizing time in the schedule.I I have to make sure that I have time and there are instances within my professional career where the system has broken down and I don’t have adequate time. I’m rushing through it. And it’s always a regret. I always regret that conversation. 

Dr. Shannon Maddox [00:06:51] So we try and follow a pretty specific system for our new patients. And I’ve noticed throughout the years that when we get off of that track, if we’re trying to fit somebody in for an emergency and we’re just trying to take care of somebody – and your intention is good – I’m trying to take care of you because you have this need today, I’m trying to fit you in. But you’re fitting them in, and other people on the schedule need you too. And I can’t be everywhere at once. So I’m having to have this conversation really fast, and and it never works. They don’t believe you. They don’t trust you or they leave with question marks. And that’s really regrettable to me. 

Dr. Shannon Maddox [00:07:32] So I’m pretty specific with and the team is pretty specific about what we need in an in a new patient setting or in an existing patient that has a need setting about conversation. And so when I schedule a new patient, I schedule enough time to have that conversation. If I don’t have enough time to have that conversation, I schedule a consultation outside of that normal. I don’t go down the road of having the conversation with somebody if I don’t have enough time, because I’ve done it, and it doesn’t work. 

Dr. Shannon Maddox [00:08:00] Dr. Mark Hyman who was a client of ours for 15 years, but he’s also an extraordinary speaker in his own right across the country, calls it sacred time. That you have this sacred time to communicate, and that makes made all the difference for him and his practice building in his career. And you know, what would you say to anyone that says, yeah, that sounds all fine and good, but I really don’t have time in my schedule. I mean, what would you encourage people to do to make a shift in the prioritization of time in their schedule here today, if they haven’t been doing that historically?

Dr. Shannon Maddox [00:08:40] So you have to do it. I would say you have to do it with your new patient, your patient that has never met you, has never met your team, doesn’t have any level of trust other than potentially the referral that they got to your practice. You you have to prioritize that time with them then because that’s the solidification of the patient experience. 

Dr. Shannon Maddox [00:09:06] If you can solidify trust in that first visit, then you can outsource the trust the rest of the time. You can teach your team how to communicate with people. You can teach your team how to talk about disease. You can you can have team members that are extensions of your personality and the way that you do things. They can take care of it for you because – I’ve got a prep to do and I’ve got to do whatever – you know, I do dentistry, I don’t just talk to people all day. 

Dr. Shannon Maddox [00:09:33] So you you just have to do it once. If you can do it once then the rest of the team can take care of it the rest of the time. So I would say make sure that you’re prioritizing with your new patient visit. Make sure that time is sacred in that new patient visit and then the rest of the time, empower, teach your team, model that for your team, so that they can hear the words that you’re saying and hear how you want something to be explained. You know, my my hygienist can talk about the clues of disease. Coming out of dental school I could barely talk about this disease. So if my hygieneist, you know, my team, my entire team can talk about the clues of disease. So if you can invest the time with your team outside of the schedule to teach them how to talk about things, and you invest the time in your schedule for the new patient, I think you’re gonna be ahead of the curve. 

Carrie Webber [00:10:32] So what does that look like. If I’m a new patient coming in your practice what are what are some of the ways that you begin to break down maybe those barriers. Do you have some ways that you that you start those conversations? It seems to me, but this could just be my skewed perception when I’m with you, people seem to gravitate to having these conversations with you fairly easily. But is that truly the case, or are there some kind of some door openers or some ways that you communicate to help them and maybe some of your body language or whatever the case may be that help them really get into conversation with you so that you can have those clarifying conversations that are so important. 

Dr. Shannon Maddox [00:11:18] Well I mean I think it just starts out as a conversation. People want to tell you their story. Very rarely do people not want to tell you what’s going on with them. They come to the dentist because they want to be there. There’s not they don’t seek care because they don’t want to be there. 

Dr. Shannon Maddox [00:11:35] So you have to ask questions. Why are you here? What are your expectations? What are your goals? And and those lead to more questions. People will give you a list of three or four goals that include 10 to 15 follow-up questions. And so you just have to be willing to take the time to ask the question and take the time to listen to the answer. Because if you’re not listening, then they won’t feel heard, and being heard is probably the biggest hurdle to trust. So because they’ve been to other dentists that haven’t heard them. 

Carrie Webber [00:12:13] Right. Then how do they respond? What’s the response to this experience from your patients? 

Dr. Shannon Maddox [00:12:20] So initially you may there’s the occasional I don’t have any goals I don’t know what you’re talking about right. But you can lead them through that and try and kind of peel the onion layers back and eventually most patients – and I would say the majority of patients – thank you for asking. They say, “No one’s ever asked me that before.”. 

Dr. Shannon Maddox [00:12:42] We do a consultation before we bring them into the dental chair just because dental chairs are a little scary. And so we bring them back into my office. We discuss things back there. And they say, “Thank you for taking the time to talk to me before you started popping x-rays in my mouth and taking pictures.” So we take that time and they appreciate that. They recognize that it’s different. And people like different, for the most part. And if they don’t, I might not be the best fit. And so that’s OK. That’s OK if they want wham-bam-done-thank-you-see-you-later. But that’s not the kind of dentistry that my office provides. So it’s OK if that’s not a good fit, but for the most part, my patients that stay with me for the long haul are the ones that like it. And I can sleep at night because I’m providing them the type of care that they want. I know that they know what they’re getting themselves into. I don’t get into any situations where I’m like, I shouldn’t have done it that way. They agreed with every aspect of what I’m doing. And so I feel better because I’m reaching their goals. 

Carrie Webber [00:13:59] And when you know their goals even if when you go in to do their evaluation you discover maybe disease that was not expected by them by knowing their goals you can typically tie it back to what’s important to them and you’re pretty masterful at that too. I mean bringing him back to to what brought them to you in the first place. Do you find yourself having those conversations with them? What’s that look like? Cause you sit me up and talk to me in the most extraordinary way. And you remember the things that are scary to me that are important to me. And you remind me that those are important to you too. Is that common for you? 

Dr. Shannon Maddox [00:14:45] It takes work. I wouldn’t pretend like I’ve always done that well. And it’s taken a long time. I’m pretty self-critical and so pretty much after any conversation I have, dental or non-dental related, I’m running back through that conversation as to what I said, what I shouldn’t have said, what worked, what didn’t work. And while that might drive me nuts most of the time, it helps me in my professional career, because I’m able to kind of hone in on, oh that didn’t work right. That didn’t resonate. That wasn’t a good way to explain. That wasn’t a good analogy. Whatever that might be why didn’t that work. Is it that person. Or is it not a good way to explain what’s going on. And so it takes work to to remember and to hone in on people’s goals and to remember that each person is a person. 

Dr. Shannon Maddox [00:15:40] But I mean I write down their goals. I don’t have this masterful memory. I write down their goals there in their chart. 

Carrie Webber [00:15:46] But that is great. You’re documenting those conversations. 

Dr. Shannon Maddox [00:15:50] And they’re on a piece of paper sitting in front of me. So when I’m talking about your treatment plan I’m also I’m I’m always talking about it in terms of what it matters to you because it it doesn’t really matter if it matters to me. I don’t I don’t have to spend 24 hours a day with your teeth. So if you if it’s your mouth and your smile, it needs to matter to you. So if if it doesn’t then you know I can communicate more effectively to try and explain disease. And I’ve got to spend more time in the disease process and what that means for you if that’s not resonating with you. But if it’s something that you already want, then tie it to a goal. 

Carrie Webber [00:16:32] And you know, you had talked about, in the previous episode, your early years of your career the first year year and a half of your dental career was in a corporate setting and that you learned a lot about the different mindsets of the different patients that you were taking care of. And those that had that insurance mindset. How do you find yourself working through that in your practice to help patients meet their goals, even if it means they have to look outside of the minimum that their particular plan provides. 

Dr. Shannon Maddox [00:17:15] So I learned a lot in the corporate setting about that patient. Not about managing that expectation and not about getting around that hurdle, but about that patient. What’s motivating to them. Why is that a motivating factor. And it all boils down to either preconceived notions about insurance and what insurance is and what insurance isn’t. You know a lot of people don’t think that they can go out of their network. A lot of people believe that I would prefer to see somebody that has insurance than a cash paid patient. So you know, it’s the “they didn’t see me because I didn’t have insurance” mindset for people. 

Dr. Shannon Maddox [00:17:59] So I do a lot of talking. We talk a lot about insurance, and quite frankly can be exhausting at times, because it’s just like this record player that’s constantly going on, and I think my team kind of would rather not talk about insurance too because it’s just we’re tired as practitioners. That’s the last thing we want to talk about. Patients need to know right what it is and what it isn’t. And I’ve done a lot of research and a lot of thinking about it and a lot of talking about it with peers of mine that you know insurance in today’s day and age is not what insurance was 50 years ago when it was created and it’s a maintenance plan. And you’ve got to talk to patients as if it’s a maintenance plan, and they need to know that it’s a maintenance plan, because if they see it as health insurance or home insurance… You know if your house gets taken up by a tornado, they’re going to pay for what the damage was that was caused. If your mouth is taken up by periodontal disease, they’re going to pay for 50 percent, 80 percent. That’s a problem. And patients need to know that’s a detriment and a hurdle to their overall health. If they’re only listening to what their insurance is going to cover and they’re forgetting to listen to the people that are spending time in their mouth. So we have to talk about. 

Carrie Webber [00:19:25] Well and that goes back to how you do prioritize prioritize that communication time with your team and with your patients. That building of trust and value is the sense of need for more comprehensive care. It seems like you’ve come a long way from from starting in that practice when you took it over to where you are now in terms of the patient’s willingness and readiness to hear what you have to say. But I love what you had said about the team and how your team communicates equally as effectively as you do. And it’s true. But you talked about that you prioritize time outside of the work of the day to day. So hone in on that and refine those skills. What’s it look like for you and the team? How do you all work on that to the point that they are more comfortable with those conversations?

Dr. Shannon Maddox [00:20:27] So first of all, during scheduled time, they hear me talk. The most effective way of learning – I mean, as a parent we all know this – you have to model it for your kids. So you have to model it for your team as well. You have to walk the walk and talk the talk and believe what you’re saying. And they’re going to hear it. And if they hear it enough, they know how to talk about it. And we talk about it at the meetings. What does this look like. How could we better, with hygiene meetings, how can we better talk about periodontal disease. What are the things that we need to talk about. What are the bullet points that we could hit and really hone in on. Did this work. What didn’t work. Why did this patient not agree. Why is this patient still on the fence. We talk about that in huddle. Why is this patient still on the fence. What’s the holdup. What do you think the holdup is. What can we do about it as a team. Can you hit it and then I hit it and then we go back to it later, you know. So we talk about it all behind closed doors. Together we will play. (Yeah. No one loves it. Let me least of all.) But we have practice, and it’s better to practice with each other and laugh at it with each other than to not practice. 

Dr. Shannon Maddox [00:21:45] So we will play it out, and we take time to figure out what the barrier is. I think that’s the hardest part is that patient has said no to me five times. I don’t want to talk about it again. And you have to talk. You have to talk about it every time they’re in. And it’s OK. It might take him 10 years to say yes. And they may never say yes. You have to be the leader, and you are a practitioner, and you have to tell them that it’s still there. It’s not going away. It’s not getting better. You know we have to do something and I’m going to keep telling you about it. And I’m not getting in the rut of like, the patient is telling me no, and so I’m never gonna talk about it again. 

Carrie Webber [00:22:31] And I think that’s a mindset that is understanding and embracing our roles in a dental practice. No matter your role, when you are face to face with that patient, you are the primary advocate for their overall health and well-being. And it’s a responsibility. And when team members can own that sense of responsibility with their doctors, I think it it builds up more of that trust and understanding but also a sense of pride and respect that you keep saying no but I’m going to keep showing you the risks that you’re choosing to roll the dice on by continuing to say no to this treatment. But it doesn’t mean that we can’t we don’t continue bringing it up and I feel like your team does. 

Carrie Webber [00:23:25] There is there is a sense of pride when you when you go through a new patient experience such as the one that your team does from the team members as well. To be a part of a process that is such a value building process for a practice in relation and when it’s so patient focused it’s really marrying a partnership between that patient and you and your team. 

Dr. Shannon Maddox [00:23:46] Right. Well it has to be unacceptable to not explain things. And it has to be unacceptable to not talk about it. You have to create a culture where it’s unacceptable for you to not talk about fluoride at a hygiene visit. It’s unacceptable for us to not talk about where we see the patients’ teeth. Because it’s easy to not. It’s easier to not push the barrier. The patients happy, so just tell them everything’s good. And that’s easy. And we have to create a culture as the leaders of the practice that we have to create a culture where that’s not how we do it here. 

Carrie Webber [00:24:22] We have to believe in it first. If a patient’s ever going to believe in the value in the need for that kind of proactive care in their dental health, we as the providers have to believe in it. 

Dr. Shannon Maddox [00:24:35] Yeah. I absolutely agree. 

Carrie Webber [00:24:42] So I don’t know if this is a tough question or not, but of all the different places and spaces in which you communicate and educate and connect with your patients, if you had one starting point – I know you’d said the new patient experienced prioritizing that time – but from a communications standpoint for those who recognize they could be better at this. Do you have a starting point that you might recommend that they they hone in on that they assess for themselves and how they do it in their practice. Or maybe some questions or something for them to start with. 

Dr. Shannon Maddox [00:25:20] So, you said one, but I’m going to give you two. I would say what I said before about goals. Asking your patients. Just ask them and listen to their answers and write them down and revisit them because they’ll lead you down the path that they want to be on and then you can pick up on that path. And they’ll feel hurt., don’t assume that they’ve never felt hurt. They’re still looking for a new dentist. And if they’re still looking for a new dentist, they haven’t ever been heard the way that they want to be heard. So you just have to keep asking, and you have and revisit it. It’s not just a one time thing. What your goal is in 2019 might not be your goal in 2025. So you’ve got to revisit it. 

Dr. Shannon Maddox [00:26:11] And then the second thing I would say is making sure that you’re utilizing different avenues of education. So once you kind of hone in on that patient, what their needs are, what their wants are, what their desires are. You’ve got to be able to show the disease process that’s going on in their mouth. So you’ve got to get a camera. You’ve got to get it. You’ve got to get a monitor out and show them what’s going on. And maybe they’ve either never seen it or they’d never been told that’s the problem. And so you have to be able to utilize different avenues. We don’t all learn the same. I’m an auditory learner. I hear a lot and I can I can learn it that way. But the majority of people are visual learners. And so you’ve got to be able to show them, even if you’re an auditory person. And I talk while I’m shoing them all these pictures, because I don’t learn visually. But then they are hearing it at least two ways. They’re hearing it through what they see and they’re hearing it through your words. So it’s important to hone in on your different avenues. Get to know your patient get to know what their expectations are and then show them what they need. 

Carrie Webber [00:27:23] I love that. I love how you just drove it home. We all learn different in different ways. We all learn differently. We all take different amounts of time to make decisions that are best for us. And you have created an environment that not only is presenting education and communication in as many ways as possible for the different variations of ways people learn and retain information but also that you that it’s not a one time a one and done conversation that you are consistently having these kinds of conversations over the lifetime of a relationship with the patient. And that communication is not a “one time and they get it” because we as human beings take multiple touches a lot of the time to resonate and work to make decisions and to take action. And so we have to embrace that that’s a part of our professional lives that communication is key. 

Carrie Webber [00:28:26] A lot of times I say when you read bad reviews when you see that a patient’s left, when they’ve gone from another dentist to you, a lot of the times that’s happened because there was a misunderstanding in expectations. There was a disconnect. And if we can prioritize the communication, like you do so well, that can make all the difference in making sure that message sent is message received. And just as you beautifully stated that patients can make the decisions that are best for them and you can sleep at night because you’re clear they’re clear and you have a happy healthy patient family. So thank you so much for being with us. It’s been a pleasure again.

Carrie Webber [00:29:12] Thank you for joining us on this episode of the Jameson Files. Visit us online at JMSN dot com. You can subscribe to this podcast on iTunes, Google Play Music, or Spotify. Do you have questions or topics you’d like for us to answer or cover on the next podcast? Email us at podcast at JMSN.com.