Th 209801

Lateral Thinking: When home care fails

May 1, 2006
You told your patient about the problem. You’ve given instructions for home care.
Click here to enlarge image

You told your patient about the problem. You’ve given instructions for home care. But the pockets are getting deeper. There is more bleeding. Why are patients so dumb? Well, they’re really not. Try a little lateral thinking and you’ll find that your patients become more compliant.

Has this ever happened to you? A patient comes in for a six-month appointment. According to the chart, this patient was told that he or she had some deep pockets and bleeding and was given oral hygiene instructions. Now the pockets are getting deeper, the tissue still bleeds, and there’s a lot of calculus. You’ve told the patient time and again what the problem is and what he or she should be doing at home. Why isn’t it being done? Is it laziness? How can patients be so dumb?

Well, they’re not dumb. There’s a reason why they do (or don’t do) things. Their behavior may not make sense to you, but you can be sure it makes perfect sense to them … or they wouldn’t be doing it! If you could put yourself in their shoes, you’d realize that there is a method to their madness, however weird or irrational it might seem to others.

It’s not a hygiene thing, but a human thing. You can’t change the behavior and habits of people unless you understand what motivates them. It’s not just a matter of spending more time with patients. It’s all about learning how to think outside the box, what psychologists call Lateral Thinking. Unfortunately, most dental and dental hygiene schools train their students not to think laterally. Dogmatic thinking predominates - there’s only one correct way to do things.

Lateral thinking is just the opposite. Problems can have more than one solution. To think laterally, you don’t have to be smarter; you just have to realize that your particular experience and knowledge boxes you into your point of view. Your patients, who lack your experience and training, will not be motivated by your priorities. Their experiences box them into entirely different points of view. To change their behavior, you must understand that your experiences are preventing you from seeing the problem from your patient’s perspective.

When patients aren’t compliant, it’s either because they don’t share your values or you don’t appreciate theirs. Believe it or not, some things are more important to laymen than dentistry. Constant, repetitive lectures won’t be effective, particularly if patients don’t understand or place value on the basic precepts you take for granted. If you want better compliance with home care, think laterally. Take an objective look at what you say and do. Don’t make any assumptions about what patients know. Find out what is important to them and show them how daily oral hygiene affects it. It’s a much more effective approach.

So how do you learn to think laterally, to see hygiene from the patient’s perspective? It’s really not that hard. You just need to be constantly aware that your patients will be motivated to do daily hygiene only if you provide a rationale that motivates them, not you. Home care is a daily concern for clinicians because their world revolves around teeth. Patients, however, spend most of their lives not thinking about dentistry. A dental visit is just an occasional necessity. What’s important to your patients when they aren’t at the dentist? Find out. What are they passionate about? Reducing pocket depths? Not likely, but there are some things they probably care about, such as:

Children Do they adore their kids and grandkids? Do they know that periodontal disease is communicable? That they could be infecting their children? Do they know that periodontal disease starts early and that about 30 percent of children already have periodontal disease?

Food Do they love cooking and eating out? Do they know that periodontal disease causes more tooth loss than cavities? Have they imagined what eating would be like with dentures?

Social Do they like to party and go out with friends? Are they concerned about bad breath? Do they know that periodontal disease contributes to bad breath?

Sex Do they think bad breath is a turn-off? Do they know that oral hygiene can prevent malodor?

Health Are they aware that periodontal disease increases the risk of many serious medical diseases that could kill them?

Another aspect of lateral thinking is learning to see yourself from a different perspective. You know what you’re saying and what you mean, but how do you know the patient is hearing you? What you say gets filtered through patients’ personal experiences. Thinking laterally means asking yourself, “Sure, it makes sense to me, but what if I didn’t know what I know? How can I get outside my personal box to hear what I’m saying from the patient’s perspective?”

Here’s how. Your office probably has written OHI. This is good, but what you say is far more important than written instructions. Record one of your typical verbal OHI sessions. Then make a written copy of your verbal remarks. Read the transcript without any prior assumptions. Pretend you didn’t go to dental or dental hygiene school, and that this is your first visit to a dentist. Better yet, give it to a layman to read. Is the written transcript clear and unambiguous? Could it be misinterpreted? Does it require prior knowledge? Would the instructions make sense to someone who didn’t graduate from high school? This is what lateral thinking is all about, seeing things from a new perspective without making prior assumptions.

Some examples of lateral vs. dogmatic thinking are:

Jargon Are you using hygiene jargon that might as well be Latin to the average patient?

Aptitude Don’t assume anything. Let the patient show you what he or she does at home while still in the chair.

Floss Do you actually believe that most people floss daily? If brushing and flossing are your only options, you’re in for a rude surprise when you get outside that box!

Desire Patients are only compliant if they want to be or if they fear the consequences. Ask yourself: Is the patient enthusiastic or guilty about home care? If the patient seems guilty and makes excuses, he or she doesn’t want to practice good hygiene. Saying the same thing over and over won’t work. You’re trying to hammer a square peg into a round hole. Think laterally. Use a different approach. Change the shape of the peg.

Since they aren’t dentists or hygienists, patients simply can’t visualize periodontal disease like clinicians. Think laterally. How can you help patients see things the way you do? Get out the old mouth mirror? That’s still thinking inside the box. What about a magnified mouth mirror or, even better, a magnifying intraoral camera? Do you have a scrapbook of close-up photographs of advanced periodontal disease? Do patients really understand what you mean when you talk about oral infections? Most patients have no idea what the millions of microbes in plaque really look like. What if you used a video microscope to show them their own microbes magnified a thousand times?

When you think laterally about why home care fails, you’ll find that patients really aren’t dumb. They just don’t have your training and experience to place the same value on home care. They may nod and agree with you while they’re in your chair, but that’s just a social behavior to cover a lack of comprehension. The proof of comprehension is compliance. If the patient had your perspective, they would be compliant. If the patient isn’t compliant, you need to find a way to link home care to something they care about.