Did curiosity kill the cat? Are we educating or engaging pediatric patients?

Jan. 12, 2016
It struck me that so often in clinical practice we adopt a "curiosity killed the cat" mentality. We adopt a tell style of educating our pediatric patients instead of an engaging style, one that is often triggered through curiosity!

By Dorothy Garlough

Today, I discovered a lifeless "critter" on the walkway in front of our home. Its small size, coloring, and thin bushy tail initially led me to believe it was a squirrel. Yet it was different. Its body was long and narrow with disproportionately short legs, and its mouselike head, delicate ears, and snow-white underbelly had me curious. What was this little animal and how did it end up there?

It didn't take long to make the association of how it got there. Our cat, Mo, is an instinctual master hunter and his romping often results in the delivery of his spoils to our deck. But was this prize a Pandora's Box in disguise? For, you see, where there are babies, there are mothers. If this mammal was a baby fisher, a vicious carnivore, Mo could be on the mother's menu tonight! Now, my curiosity and concern were ignited!

Based on what my investigation uncovers, Mo's life could be altered. If he continues his evening expeditions, he could be dead; if he loses his outdoor privileges, his life may be extended but the quality adversely affected. The risks need to be weighed to achieve the desired outcome . . . Mo living. What will my curiosity uncover?

Wikipedia defines curiosity as a quality related to inquisitive thinking such as exploration, investigation, and learning, evident by observation in human and animal species. "Curiosity killed the cat," on the other hand, is a proverb used to warn of the dangers of unnecessary investigation or experimentation. This seems to hint that unpleasant outcomes can arise from trying new ideas.

It struck me that so often in clinical practice we adopt a "curiosity killed the cat" mentality. We choose not to look beyond the obvious to uncover what really may be going on. We rely on old patterns of communication to get our messages across. We adopt a tell style of educating our patients instead of an engaging style, one that is often triggered through curiosity!

A collaboration of a Harvard Negotiation Project says there is only one way to understand the other person's story-and that's by being curious. Instead of asking yourself, "How can they think that?" ask yourself, "How might they see the world such that their view makes sense?" Curiosity keeps the conversation open, so that we might learn and get creative to influence our patients.1

What happens when a preadolescent boy presents himself with beet-red, swollen gingivae and a thick layer of seasoned green plaque that needs to be scaled from his teeth? Do you harp at him, telling him that he has to floss daily and brush three times a day? Do you see that he has tuned you out the moment you went down this predictable path? You and his parents are relying on his listening to you, the expert, but you clearly are not reaching him.

Having had a 10-year-old son, who for a short while I affectionately referred to as "Pig Pen," I understand the parents' frustration. For many boys and some girls, grooming on any level (teeth, hair or bath) is not on the radar. Yet, if you are creative, you may discover techniques to spark their curiosity leading to critical thinking.

As professionals we need to identify the problem, which in this case is poor oral hygiene. We then need to reframe the problem. Instead of beating the patient with a toothbrush, ignite his curiosity on what the potential outcomes of neglect could be. We could reframe the problem as a story . . . maybe about the boy's cat, who, like Mo, brought home a gift that could change his life.

Stories are powerful and memorable.2 Humans are wired for stories; information has been passed through the ages in story form. Stories ignite curiosity and stimulate exploratory behavior, specifically observing, consulting, and thinking.3 The resulting self-directed learning is more effective than rote learning.

Perhaps you can ask the preadolescent patient what he would do if the scenario above were presented? Does he do nothing and leave the situation the same and take the risk of injury, disease, or death for his cat? Or would he weigh the possible solutions to bring the cat in at night or trap the predator? What does he think the risks are? What would he recommend? What are the pros and cons of each action? Would the boy play roulette with his cat's life or would he be proactive to keep him healthy? A young boy will likely become enlisted in making recommendations and then taking action to protect his pet.

The challenge for the clinician is to help the child understand that by ignoring the issue of his mouth, he is playing roulette with his teeth. Through neglect he too is in danger of illness, injury, or death of his teeth unless preventive action is taken. Can we enable him to find his own solutions and recommendations for the long-term health of his mouth? Does he know what advanced periodontal disease looks like and what might be the effect of a diseased mouth on himself and others? He won't want to imagine his mouth looking diseased any more than he wants to imagine his pet after an attack. Our job as hygienists is to motivate him to make the association that the outcome for his mouth is directly related to his decision to implement oral hygiene methods.

Lasting good habits are hard to create and you will need to enlist the help of the parents. Their son will need coaching on a daily basis for many weeks until new patterns are created. The goal is to create a pattern where he no longer will tolerate the feel of slimy teeth.

Further reinforcement can be established by having the child return for another prophylaxis appointment in six weeks. Whatever pushback you get from the parents from a financial standpoint can be offset. By creating positive habits for their son, they are preserving his health and actually reducing long-term costs.

All of our clients are different, and each individual has their own blueprint of what their priorities are. As health professionals, we need to remain curious in order to communicate in a meaningful way. We need to become good listeners and tailor our directives through stories that spark our patients' curiosity. Challenging ourselves to educate through stories that promote self-directed learning will provide a greater learning experience for our clients.

As for Mo, it has been determined that the animal on the walkway is a short-tailed weasel. Fortunately, weasels are not threatening to cats, although clearly Mo is a threat to weasels. For the time being, his lifestyle remains unchanged, and for tonight I needn't fear that curiosity killed the cat! RDH

Steps to spark curiosity, leading to engagement

1. Identify challenge: What problem are you addressing
2. Reframe the challenge: Spark curiosity by reframing the challenge in a creative way that relates to your client's personal interests.
3. Weigh possible solutions: Through questioning, lead your client to arrive at possible solutions.
4. Enable association: Help your client to make a leap of thought to their personal needs.
5. Create an action plan: Co-create an action plan with your client and encourage them to take action.
6. Reinforce action: Make follow-up appointments as required to establish healthy habits.


1. Stone D, Patton B, Heen S. Difficult Conversations. London, England: The Penguin Group; 1999.
2. Szurmak J, Thuna M. Tell Me a Story: The Use of Narrative as a Tool for Instruction. In: Proceedings of the ACRL 2013 Conference. April 10-13, 2013; Indianapolis, IN. 546-552. http://www.ala.org/acrl/sites/ala.org.acrl/files/content/conferences/confsandpreconfs/2013/papers/SzurmakThuna_TellMe.pdf.
3. Reio TG. Prior Knowledge, Self-Directed Learning Readiness, and Curiosity: Antecedents to Classroom Learning Performance. Int J Self-Directed Learn. 2004;1:18-24. http://sdlglobal.com/IJSDL/IJSDL1.1-2004.pdf#page=22

Dorothy Garlough, RDH, MPA, is an innovation architect, facilitating strategy sessions and forums to orchestrate change in both the dental and corporate worlds. As an international speaker and writer, Dorothy trains others to broaden their skill-set to include creativity, collaborative innovation and forward thinking. She recognizes that engagement is the outcome when the mechanisms are put in place to drive new innovations. Connect with her at [email protected].