Avoiding Difficult Conversations?

Not long after entering practice, you realize the one skill you did not acquire in dental school: the ability to have difficult conversations, or what I sometimes call courageous conversations.

For the scope of this article, I am referring to the leadership hat you wear, or leave in the closet in your daily practice.  These conversations often involve issues or behaviors related to staff, patients, associates or partners.  I find the majority of dentists and physicians avoid these difficult moments by focusing on what they were trained for and enjoy.  We wishfully hope “perhaps the issue will go away if I ignore it long enough”.  Unfortunately, left unaddressed, issues often only get worse and impact both the morale and performance of the office. 

Rather than leaving the office with a sense of satisfaction each night, you go home ruminating and often grinding your teeth over an issue you once again avoided.  At this point, if you can not relate to which I am writing, consider yourself fortunate and you can put this article into the recycling bin.  For those of you who exclaim “that’s me!” continue reading.

The following are some examples where courageous conversations are often required:

1. The employee or office manager is using intimidation or bullying co-workers to gain a desired outcome.
2. The low performing employee, who is ignored, brings the performance standards to a level that makes co-workers (or you) want to scream!  And worse yet, nobody will address it in an effective manner.
3. The associate whose relationship skills are demeaning to staff or driving patients out the backdoor.
4. The patient who started out with your practice from day one has now progressed into a “schedule killer” and everyone dreads the moment  they enter the door.
5. You have a new employee who isn’t being accepted or allowed to develop and be part of the team – “the click syndrome.”

Have you avoided conversations for so long that you now call it normal?  Often, the doctor’s tool box for coping is anger, frustration, or manipulation – or BETTER YET he/she passes it off to the office manager.

As leaders of the practice, a different skill set is required to address these issues.  We are accustomed to completing procedures such as a crown, endodontics or surgery.  With leadership and the development of people, it is an ongoing process that requires our continuing influence.  We all recognize that patients refer patients and return to our office primarily because of the experience they encounter with our team.  

The following are steps to get unstuck and short circuit the toxic producing situation. 

1. Acknowledge and commit to addressing the issue. Have a conversation with a trusted colleague or your spouse.  Hopefully if you have raised this issue 10 or 15 times; they will ask when are you going to take action?!
2. In a calm reflective moment, write out the specific issue, how long it has been occurring, the consequences of this performance or behavior and the people involved.
3. List the different choices you have and the anticipated consequences of each choice.  Dismissal, train and develop, coach? Perhaps you need legal advice or coaching before starting the process.
4. Commit to a date that you will address the issue and do not let yourself rationalize I will do it later.
5. Identify what will look different in the employee behavior or performance to demonstrate that they have clarity of your expectations. Be specific and try to eliminate ambiguity.
6. Offer coaching, counseling or skill training depending on the situation. Sometimes the person may need development and your investment in them will turn them around into an outstanding employee.

Take the time to develop a process that brings you to a place that puts light on the situation in an objective manner; a process that brings about action and results in growth. Recognize your own strengths and weaknesses in your leadership style.  Commit to growth in this area not unlike a continuing education course in cosmetics or surgery.  Allow your brain to think objectively and analyze the various components – much like we approach a complex dental case. View moving forward and looking at your steps as win- win.  We are doing no one any favors by ignoring these issues…everyone suffers.


Understanding and developing our leadership skills is one of the most underdeveloped skills in our tool box. It impacts every facet of our office from profitability to the enjoyment of our profession.

Below is a reading list to enhance your lifelong learning.

• The Truth About Leadership, by James M. Kouzes and Barry Z. Posner
• Developing the Leader Within You , by John C. Maxwell
• Good to Great:  Why Some Companies Make the Leap…and Others’ Don’t, by Jim Collins
• Lead Change, by John P. Kotter
• The Motivating Team Leader, by Lewis E. Losoncy
• Jack: Straight from the Gut, by Jack Welch and John A. Byrne
• On Becoming a Leader:  The Leadership Classic, by Warren G. Bennis

© 2017 Leadership by Design, LLC |  Would you like to use this article on your blog or website? You can, as long as you include the following complete verbiage: “Dr. Jim Schroeder is the President and founder of Leadership by Design, Inc., a consulting firm that works with and teaches organizations and individuals how to bring personal and business strategies to life by focusing on people and relationships. 
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