When case acceptance is pleasurable: Guide dental patients to best choice for treatment

Susan Clark, RDH, offers suggestions for guiding dental patients to case acceptance for the best choice for dental treatment.

Apr 15th, 2016
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Guide dental patients to best choice for treatment

By Susan Clark, RDH, BS, OM

Who would like to spend a day at a health spa? Who would like a manicure and pedicure? What about getting a facial or a full-body massage? Many of us would willingly raise our hands and accept any of these relaxing treatments. What if I asked you if you would like to get a shot in your mouth and have a quadrant of root planing or a root canal? What about getting all four wisdom teeth extracted during one office visit, or have the dentist drill into your jawbone in preparation for an implant?

Do you think there would be many raised hands? This is not a trick question. While reaching a decision, though, your patients might privately consider these questions when we are presenting our clinical findings, asking them to commit to necessary dental treatment.

Why do patients choose the pleasurable outcome over the not-so-pleasant scenario? Simply put, an emotional reaction influenced the decision to choose the more favorable outcome over the not-so-pleasant scenario. It is the emphasis they place on what they want versus what they know they need. When it's logic versus emotion, our brains are hard-wired toward giving emotions the upper hand.

So, when asked if they want to spend the day at a health spa or have a root canal, as long as the targeted tooth doesn't bother the patient, they might choose going to the health spa. People don't always do what they know they need to do. More often than not, they will do what they want to do. Patients might explain that they can't afford a crown, even though you notice that each time they walk into the dental office a Starbucks cup is in their hands. Their fingernails may be nicely manicured, and they may be sporting a new hairstyle. They might even share with you about a trip they took, or upcoming plans to take one.

The consumer services described above all cost money, right? What about you? Have you ever slipped into Costco for a few necessary items and walked out of the store with items not on your shopping list? You didn't plan on spending more money. You saw something, though, that you liked and just had to have it. Did you want it, or did you need it? Were you thinking emotionally or logically? Ten percent of all buying decisions are based on logical reasoning, while 90% are based on emotional drive.

Buying Motives

The number one emotional impulse that will have your patients accepting or denying treatment stems from their dominant buying motive (DBM). A dominant buying motive is an emotional fulfillment caused by the attainment of the wants and needs of an individual. People buy for their reasons, not yours. Patients might not readily admit what their buying motive is because it would make them feel too exposed or embarrassed. They feel vulnerable admitting to an outsider what they care about, desire, or fear the most. Understanding the motivation that drives a person to accept or deny treatment is of paramount importance if you want to increase your case acceptance rates.

Engaging patients in a conversation and asking open-ended, probing questions will elicit DBMs, allowing us to gain a better understanding of what those motives might be. Uncovering and tapping into emotions such as having more self-confidence, looking better, feeling better, being socially accepted, and saving money contribute to recognizing how to appeal to a patient's desire for change and case acceptance.

Utilize the SWOT analysis-strengths, weaknesses, opportunities, threats-as a means to determine an individual's likes, dislikes, concerns, and needs, and any barriers for not proceeding with dental needs.

  • Strengths: The internal positive thoughts a patient may have that will support a successful outcome for case acceptance.
  • Weaknesses: The internal negative thoughts a patient may have that work against a successful outcome, and have your patient denying dental recommendations.
  • Opportunities: External factors that can be utilized to create a positive outcome.
  • Threats: Objections or external factors, such as lack of money, time, fear of pain, or no sense of urgency that could jeopardize a positive outcome.

Review health histories to understand why the patient came to see you, searching for a motivation for behavioral change. The health history form can provide you with information regarding the patient's past dental, medical, and personal history. It can also provide information that may be necessary for making a diagnosis, aiding in making decisions concerning the treatment plan for the patient.

Patients may know what they need to do, but the emotional desire to do the dentistry is compromised by obstacles. Obstacles are reasons why patients justify why they can't or won't move forward with treatment, or change negative behavioral habits. These obstacles are not the defining factor, however. It's just ambivalence to what they know they should do, but prefer not to do. Ambivalence is an internal process of mixed feelings about something creating uncertainty and indecisiveness. It is a tug of war between emotions versus logic.

This may lead to a patient deciding to forgo necessary treatment for fear of pain or not wanting to spend money. When people are ambivalent about any area of their lives, they tend to build a sense of pressure and anxiety about the decision they have to make. As the pressure builds, people become less and less able to work through and resolve their ambivalence. So they find reasons for not moving forward with a decision to justify their indecisiveness.

It is best to avoid taking an advisory approach, but instead to use a patient-centered collaborative approach to help remove that pressure. Allow patients to tap into their own ability to make good decisions for themselves from their perspective, not the clinician's point of view. This is where understanding the philosophy of motivational interviewing can be effective.

Motivational Interviewing

Although motivational interviewing has been around since the early 1970s, it is still a fairly new concept in dentistry. It is a method of facilitating and engaging intrinsic motivation from the patient. The core principle is negotiation. It is a patient-centered, collaborative form of communication, a means to elicit and explore the patient's own reason for wanting change. It is a way to help break down the "no" barrier with your patients and to help them overcome any obstacles to case acceptance.

The motivational interviewing philosophy develops a relationship with the patient where you are not the expert trying to solve their problem by coming up with a solution. Instead, the clinician imparts information and guides patients toward exploring their own motivation for change. Patients describe in their own words the reasons, weighing the pros and cons of why they should or should not move forward with our dental recommendations, or change negative behavioral habits. The clinician actively listens and guides the patient toward case acceptance from this perspective.

Skillful communication requires the clinician to listen more and talk less. A reflective listening approach acknowledges what patients want, not what you know they need, by recapping what you heard them say. If you want to be understood, you first have to be understanding of your patient. Being nonjudgmental, empathetic, and caring will encourage patients to speak openly and honestly.

Then they will go through a series of "change talk" statements, revealing consideration of, motivation for, or commitment to change. When you and your patients focus on what is bothering them, you offer them autonomy, the ability to self-reflect, and an opportunity to go through the five stages for change.

Each stage is defined by specific tasks a patient needs to work through before proceeding to the next stage. Some patients move through all the stages quickly, while others may get fixated at one stage or another.

During the precontemplation stage, the patient does not see a need to change a habit or see the urgency to begin treatment. As health-care providers, it is up to us to bring awareness of the issue to our patients and encourage them to share information about their concerns.

Contemplation is when the patient becomes aware of the problem and is weighing the pros and cons for the need to change. People don't buy solutions to problems they don't perceive they have. More frequently, they believe the problems they have discovered than what someone may tell them. Using an intraoral camera during your clinical evaluation is invaluable. Fewer words need to be spoken because patients can now see what you are telling them. Keep patients thinking about the benefits and value of the dentistry you are recommending and provide them with any information, resources, or other assistance they may require. Allow them to address their ambivalence and foster self-efficacy and autonomy.

During the preparation or decision-making stage, they have received all the pertinent information regarding the need for treatment and can arrive at their own decisions to accept or deny treatment. Once patients know they have a voice in their decision-making process and feel supported by you, they are then able to realize what it is that they need to do, resolve their ambivalence, and come to a concise, well-educated decision.

Guide patients toward the action stage by helping them develop realistic goals, mutually creating a plan of action for getting the treatment completed, and encouraging the patient to schedule the necessary treatment. The action stage is when the patient actually says yes to treatment, schedules their appointment, shows up for treatment, and pays for treatment.

Finally, the maintenance or relapse stage is when your patient has now returned to the office for a recare visit. Either permanent behavioral change has occurred (the patient is now flossing daily), or a regression has occurred. If the patient has created a positive change in behavioral habits, offer praise, encouraging the patient to continue. If, however, you notice your patient has relapsed, acknowledge that relapse happens. Encourage a discussion to find out what led to the relapse, and then develop a new strategy that might be more suited to your patient's lifestyle. Perhaps the use of an oral irrigator or interdental picks might be an acceptable alternative.

Patients accept treatment when they can see what's in it for them. If you are a skillful communicator and help them see the benefit and value of the dentistry you are offering, you will increase case acceptance. Be interested in the patient as a person, not just a dental consumer, and you will create a long-term, cooperative dental patient. RDH


SUSAN CLARK, RDH, BS, OM, is a registered dental hygienist, orofacial myologist, key opinion leader, public speaker, and self-published author of "Exploring Dental Hygiene, Finding the Hidden Rewards." She served two terms as president of the San Diego County Dental Hygienists' Society, and is now VP of professional development. She is a 2013 Sunstar/RDH Award of Distinction recipient. Susan is the sole proprietor of a free dental clinic for 63 orphans at the Colina de Luz Christian Home for Children in La Gloria, Mexico. She also is an independent contractor on behalf of Waterpik, conducting lunch-and-learn presentations in the San Diego area. She can be reached @ sgc31@verizon.net.


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