July 17, 2010
Thank you very much, Dean Nadershahi. That title has such a nice ring to it! Good luck, Nader. We're all counting on you!
Seriously, though, it is a distinct honor to speak at this very special event.
First of all, a warm welcome to parents, partners, alumni and other supporters, colleagues, and friends of the dental school. I'd like to begin by asking parents of dental and hygiene students to please stand and remain standing for a moment. Next I'd like to ask spouses, significant others, partners, other family members, and support teams to stand. We want to thank you for all that you do. Now I'd like to ask all faculty members who teach first year students to stand and be recognized.
Second, I want to mention, with sadness, the recent passing of a long-time colleague, Professor Armand Lugassy, who taught with us for 44 years in the Restorative Department. You may remember him roaming the hallways with ski poles and a huge smile. Armand had a PhD in philosophy as well as a DDS, and it seems to me that the following passage from his obituary should pretty much guarantee his entry into heaven: "Dr. Lugassy completed the Bay to Breakers many times dressed as a gum stimulator at the end of a toothbrush float carried by students at the Pacific Dugoni School of Dentistry." That's an example of the kind of committed faculty members that we have here,....or perhaps the kind who should be committed.
Members of the DDS and IDS classes of 2012, and the Hygiene class of 2011, welcome to your white coat ceremony. You have good reason to feel proud and afraid, both at the same time. You all have worked so very hard to get here, and done so well! I know most of you a little bit, and some of you quite well, and I can assure our audience today that you are a particularly special group of young professionals.
There's a lot to feel good about, and there's also plenty to worry about, as well. This is indeed a great moment, for it marks the spot where dental students and hygiene students make the big leap from rubber faces and plastic teeth to real people, human tissue, and dentin. We like to mark this moment as powerfully as we can, because you students sitting here in front of us are about to begin a long career that must be built on a foundation of solid rapport and trust.
The topic of my talk today is Listening. While this will be something of a review for most of you, it must be said that people tend to think that they are already good listeners, that they have the requisite skills, and that there's really no need to waste time on such a basic topic. I mean, most everyone has ears, right? To that Stravinsky was once quoted as saying, "To listen is an effort, and just to hear is no merit. A duck hears also."
So, everyone thinks they know how to listen. What's the big deal? Well, it is a big deal, a very big deal. It turns out that the vast majority of people are inadequate or even poor listeners and they don't even know it. Listening is a difficult and rare skill. I'll confess that I personally continue to be challenged to really listen in an effective way, even though I've been attending to this core competency of a psychologist for many years now.
You've heard all the clichés. Abraham Lincoln is credited with saying that if you want to learn to listen it helps to stop talking. There's apparently an old Greek or Chinese proverb observing that since you have two ears and only one mouth you should use those organs proportionately. Baruch is credited with saying, "Most of the successful people I've known are the ones who do more listening than talking." That said, it turns out that listening is more complicated than you might imagine, and few have mastered this skill. Of all the skills of a doctor, listening is probably the most underrated.
To align with the zeitgeist I'll present a list of ten tips in reverse order. I began with twenty, but won't burden you here today with all of those. Besides, we went over many of them last year in your coursework.
So, here are my top ten.
Number 10. Remember that, as a beginner it's tempting to try to present yourself as really smart and knowledgeable. This is likely to be a compensation for your deeply held fear that you really don't know much--or worse, that you are a pretender or even a fraud. Please don't try too hard to compensate by making yourself look smart. This strategy tends to backfire. Telling people how smart you are rarely convinces them. Listening well is a much better way to go. Good listeners are often perceived to be smart and wise.
Number 9. Stop talking, and don't interrupt. This can be more difficult than it sounds, partly because every one of you is very smart and you have great ideas. Avoid inadvertently telling people to "shut up." There are certain phrases which, when uttered at the wrong moment can have this unintended impact. For example, if a patient tells you something important to them, perhaps something they are worried about, and you respond dismissively by saying "I understand" or worse: "Don't worry," the speaker can get the impression that you don't really want to hear any more about their concerns and that they should be quiet.
Number 8. Watch out for distractions. Don't use the time when the other person is talking to rehearse the next point you are about to make. Keep the focus on the speaker, and avoid competing in conversation. Track your daydreaming and pull yourself back to the task at hand. Notice distractions and put them out of your mind or manage them. If you must, ask the speaker to "Hold on just a moment. I need to take care of something so that I can give you my undivided attention and really understand what you are saying." Of course, you must subsequently follow-through on your promise.
Number 7. Hearing is something that happens with your ears and it involves the processing of physical sounds. Listening, on the other hand is something that you do with your mind, body, and feelings. This is called "listening to the whole message." It's not enough to just hear words. Listen for meaning, listen for feelings, listen for hidden questions, listen to understand. Figure out the speaker's point of view and remember it. Learn physical listening, which includes two components. Present yourself and your body in a way that sends the message that you are tuned in, that you are interested. Second, pay attention to the nonverbal and physical messages that the speaker sends and notice any incongruence. Do they say that they are comfortable, but actually appear physically tense?
Remember: it's not enough to hear someone. I know that you can watch a football game or a TV movie and listen at the same time, but the speaker does not get that impression. Not only do you have to listen, but you also have to seem like you are listening.
Number 6. Ask open-ended questions, that is, questions that cannot be answered with a simple "yes" or "no." The question "Are you brushing and flossing regularly" is essentially worthless. You probably know the answer before you even bother to ask, plus it doesn't give you very much information. A better approach might go something like this: "Tell me about how you take care of your teeth and gums." Then give the speaker time and space to respond. Follow up with "How do you feel about this?" That kind of questioning assumes, of course, that you actually care about the information.
Number 5. In order to listen well you must take a serious interest in the speaker and their point of view. This is difficult if you are preoccupied with your own needs, such as the need to graduate. It is also difficult if you perceive the speaker to be boring. But people are not intrinsically boring. They are boring or interesting to you as a function of how you choose to think about them. There are always ways to make someone else interesting, and not all of them involve alcohol. It's your duty to think of your patients in a way that makes them intriguing to you. The ability to find other people interesting is an important life skill.
Number 4. Use restatement. I taught you this skill last year, and you made fun of it. Well, I made fun of it, too, when my teachers presented it to me in 1973, but it wasn't so funny when I finally realized --years later--how powerful the technique really is. It just takes some practice to get comfortable with restatement and to appreciate how it works. If you are interested, get in touch and we can set up a workshop.
Number 3. Remember that listening varies a bit from culture to culture. Rules for eye contact, use of voice, vocabulary, how long to speak, and physical touch vary. These rules can be quite complex, but you can figure them out or wade through them effectively if you put in the time and effort. Plus, when people perceive that you care about them and are really interested in what they have to say, they will forgive your social faux pas.
Number 2. Remind yourself to improve your listening. Write it down in your calendar, wear a colored wrist band, peck a note on your phone, or recruit friends to evaluate and remind you. The learning process must be active and deliberate. You are unlikely to get better naturally. Poor listening habits are more natural for most of us, myself included.
And finally, Number 1. Your job as a dentist is not to sell treatment plans to patients. It is not to achieve high rates of "treatment plan acceptance." It is to figure out what your patient wants and needs and to reach an agreement with them about how you can help them get as much of that as possible. This necessarily involves a lot of listening and probing, and is especially challenging when your patient doesn't know what they want or seems indifferent to dental treatment. A careful, sincere inquiry is the only thing that can get this job done.
Here's one last bit of advice, while I'm at it: Celebrate. You can start this in just a few minutes. Take time to appreciate what you have accomplished, and do this continuously throughout your career. You've gotten through the first year of dental school at the University of the Pacific, a world-class accomplishment. You've made it into the clinic and you've put yourself into a very good spot in life.