George Carlin challenges us in a funny way about the meaning behind words. What’s not so funny is the difficulty dental professionals experience with words like compliance, commit, and passion.
I have been fascinated by words and their meaning for a long time. I enjoy comedian George Carlin because his comedy routines and books talk about words and the often ridiculous meanings and emphasis we give them. George loves words because they represent thoughts. Thoughts are ever flowing and random in nature. Words are what we assign to thoughts for communication. This can be a screwed-up process. Words can represent positive emotion or can be an assault. Some words can hurt and some can heal. There are no inherently bad words (even though our mothers taught us otherwise). There are bad thoughts and bad intentions, but not bad words. There are also words for empowerment and words that disempower.
Compliance and commitment
If there’s one frustration dental hygiene professionals share, it is the lack of patient compliance in preventive treatment regimes. For example, despite firm, yet gentle words encouraging patients to floss regularly, our home/self-care instructions often go unheeded. A constant feeling of frustration can lead to stereotyping or apathy. Yet, we don’t want to give up. We want to know what to do to change the outcomes. Perhaps our instruction goes unheeded because we are seeking compliance rather than commitment.
Despite being disempowering, compliance has become dogma for some hygienists - the sole measure of hygiene and home/self-care success. So what are our thoughts behind the word compliance? To fully examine this question, we need to examine another word: commitment.
With the table of definitions included with this article, read and evaluate the definition, synonyms, and related words for each.
As clinicians, we know that wellness and health require proactive commitment, both on our part and on the part of the clients. Are we really seeking compliance? Is that what we really want? Perhaps it is. Perhaps we really do want patients to act according to our standards, and to bend them to our will.
If that is the case, then patient compliance is what we seek. People who are compliant accept and do what someone else wants in order to get something they want. For example, on the job, it may be to make our employer happy. We comply to keep our job or get a promotion. In the dental office, patients may comply because they want to please us. Do you ever have people report to you how often they floss? People confess to us. They are not very concerned about how flossing may help them become healthier. It seems more important that the hygienist is pleased with them.
How well, over the long run, does our desire for compliance work? Often, we find that when our coercive force is no longer present or patients just get tired of trying to please us, they choose their own way.
Peter Senge, in his book The Fifth Discipline, said that real commitment is rare. Ninety percent of the time, what passes for commitment is compliance. By using all of our gifts and talents at presentation, patients might understand our vision for their dental health. We may think they understand because they shake their heads in the affirmative. Yet, we really don’t know how much they understand because we do 80 to 95 percent of the talking. Patients can even genuinely want our plan to occur, yet it is still our vision, not theirs. Patients may take action needed, but not spend much time on the next step because they don’t own it; we do.
Senge said that feeling committed means feeling fully responsible for making something happen. For example, people often support causes because they have a genuine desire to see particular inequities righted. Once a year, they make a donation to help a fundraising campaign. Yet, when they’re committed to a cause, the cause can count on them year-round. The vision is pulling them into action; no outside forces are making them comply.
Few people are committed. Most people are compliant. Compliant followers “go along.” They support an idea to some degree but are not truly committed. Compliance is often confused with commitment. In part, this is because compliance has prevailed for so long that people don’t know how to recognize real commitment.
So, what is the difference between compliance and commitment? The difference is deceptively simple. Committed people truly want something and are ready to work for it. Commitment is a natural process that springs from a recognition and genuine enthusiasm for an idea or vision. Commitment can’t be forced. With compliance, behavior change lasts only as long as people feel the coercive force or desire to please. There is no sustained change in behavior.
Do you have a shared vision of each person’s dental health? Or do you have a one-size-fits-all abstract or ideological model for everyone? Have you asked clients for their vision of their dental health and fitness? You can learn the client’s vision by asking and facilitating discussion. Listening is more difficult than talking, especially for strong-willed individuals with definite ideas. It takes openness and willingness to entertain many ideas. Our patients have been conditioned by how we have dictated the goal. More people are questioning our dictatorial behavior and desire self-directed healthcare. They won’t go passively along; they want compelling reasons to change behavior, such as can be provided with a microscope, intraoral camera, and other diagnostic modalities.
Another argument against compliance as a dental hygiene goal is that it’s fundamentally bad psychology. The best-selling book I’m OK. You’re OK studied the concept of transactional analysis. Communication can be viewed as a series of transactions. We trade phrases. If both traders feel they are getting a fair deal, everyone wins. But often, transactions are not equal. I’m OK. You’re not OK. This is an example of parent-child communication, and compliance is a parent-child relationship, much like a guard/inmate relationship. In both cases, the “child” resents being told what to do and often rebels.
Hygienists should not become parents to our patient “children.” Eighty percent of human experience is visual, but most hygienists “lecture” their patients. Words are less meaningful and only reinforce the parent-child relationship. Images are far more powerful.
Some professionals use these terms patients and clients interchangeably. Yet, these are not truly interchangeable terms. Traditionally, people receiving treatment have been referred to as patients. In today’s world and in the future, the more ideal relationship is based on and involves getting people connected and committed to their own success: a client relationship. It requires getting to know what is important to each person.
A client relationship allows the time necessary to treat each person in a personal, caring manner, and scheduling is done to respect everyone’s time. Treatment plans are developed with the individual, not for them. Patients typically have been people whom professionals did things “to,” rather than whom they work “with.” Clients, on the other hand, work with their practitioners to achieve a common, mutually agreed-upon objective. The process and outcomes are totally different. Many people want to be clients, to not merely be included in the processes, but rather be the focus of the process.
Look again at the table of definitions. Many modern-day people, including hygienists, seem to be passionless. We don’t work with passion, we don’t play with passion, and we don’t express ourselves with passion. We have stopped celebrating life. How can we differentiate between people who are passionately involved and those who are not? People who are passionate about their work:
• Like to take personal responsibility
• Do not pass the buck
• Have all their senses involved in the job at hand
• Persist in the face of adversity
• Are innovative
• Demonstrate interpersonal competence and enjoy long-term relationships
• Look forward to unique accomplishments and are oriented toward the future
• Are never completely content
• Live in-process
• Know when to take time out and are different from workaholics
When people become passionate, they unleash an unparalleled level of commitment. This is so much beyond patient compliance! Passion can viralize change in our profession.
You may think this is just another exercise in being PC (politically correct), but this is more than that. George Carlin believes there are no bad words. Words are just words; the powerful part is the ideas and thoughts they represent to each of us. Each person communicates values and beliefs by his or her words and actions. What do your words say about you? Are your actions congruent? Are you ready to live more passionately?
Patti DiGangi, RDH, BS, is a speaker, author, and practicing dental hygiene clinician. She has continually performed preventive dental hygiene care and periodontal therapy since graduating from William Rainey Harper Dental Hygiene in 1973. She received her bachelor’s degree in health care leadership from National Louis University in 1996. As a lifelong learner, her education continues with her pursuit of an MBA with a Certificate in Educational Management at DeVry’s Keller Graduate School of Management. Patti received a special Presidential award from the Illinois Dental Hygienists’ Association as the 2000 Illinois Dental Hygienist of the Year. Patti is also a Fellow in the American Academy of Dental Hygiene.