Th 220100

Patient Compliance

Aug. 1, 2006
How Can We Improve Our Batting Average?
How Can We Improve Our Batting Average?
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Dental teams in today’s health-care environment offer patients a multitude of positive results. As “major league players” we are not only in the ballpark with our ability to assist almost every human in retaining their teeth for all of their lives, we can score consistently in providing the benefits of comfort, function, health, and esthetics. Our patients no longer have to fear or experience pain, disfigurement, or tooth loss. We offer a lineup of appropriate measures to successfully prevent and manage the two major causes of dental failures - caries and periodontal disease.

Yet, even with the capability to prevent virtually all the ravages of dental disease, why do we see so many patients who have a mouth full of problems? We know we have extended the effort; we have thrown them our best “pitch” with all the latest information and all the supporting data to motivate them to sign up for the treatment we recommend. The question is: why have we “struck out” so consistently? Could it be we need to go back to “spring training” and fine tune our communication skills?

In the 1980s, we started the transition from pushing our patients with a classroom lecturing-type mode into a gentler, more individualized and compassionate approach. We became aware of the experts referring to our patient education as “lecturing” instead of “listening” to better understand our patients’ needs. We were advised to identify what the patients want, then try to meet their needs. As with any change, this became very difficult for many of us, primarily because we lacked the know-how to accomplish this transition. Time constraints, ingrained habits, lack of staff commitment and/or appropriate training typically led to the continuation of ineffective patient education.

How many times have we paused at the end of a workday and queried at the unresponsiveness of some of our patients? After exhaustive efforts in gathering diagnostic data, preparing a treatment plan, and designing a schedule to accomplish all of the work the patient needs, they, in turn, reject, ignore, or totally dismiss our recommendations.

What’s wrong with these patients? How can they be so irresponsible and shortsighted? After all, we have told them, shown them, begged them and, yes, even threatened them with the reality of this destructive pathway. We know we have the right answers. We know we can help them.

As we reflect on our failures we cannot logically explain why we are able to turn some people around to our way of thinking, yet fail so miserably with others. We find this devastating, demoralizing, and downright defeating for the entire dental team, and, most importantly, the patient.

The answer becomes evident: We have fallen short when it comes to giving our patients the right information, in the right environment, at the right time, and with the right priority or, simply stated, we have “missed the strike zone” by failing to communicate effectively.

In every aspect of our lives we must be able to sell ourselves, sell our ideas, and sell our services if we want to make a positive impact and expect to make a change. Just because we are right does NOT predicate that people accept our ideas and/or act in accordance with our wishes.

They have to be persuaded or “coached.” If you are a parent, you know it is your responsibility to teach or coach your children to do what’s right. Correspondingly, it is our responsibility to coach our patients to make the right choices. Unfortunately, the dental professional often perceives persuasive techniques in a negative sense. We may identify persuasion as a high-pressure, manipulative pressure. We may be reluctant to use persuasive tactics. That perception could only be chalked up as an “error on our playing field” when actually, the art of persuasion - essentially coaching - is an effective link between having good ideas and having others put our good ideas into action. It defines the fine line between being a caring professional and having our patients embrace our values!

To persuade gently, we must eliminate any thoughts of personal gain or actions trying to impose our will. It cannot be all about your need to produce “x” amount of revenue out of your chairs on any given day. Instead, we must adopt the concept that persuasion is merely effective communication that puts us all on a “winning team.”

Imagine the personal power and gratification in being able to master the skills to persuade your patients to do what you want them to do and believe what you want them to believe about you, simply by communicating effectively. Now imagine ... all of the patients who were in your office today accepted your treatment recommendations, scheduled all their appointments, showed up for those appointments, cheerfully paid you for your services, and thanked you profusely as they left the office!

Okay, snap out of it ... but don’t leave the “ball park,” because you can make this happen.

Volumes of published articles “coach” us on the mastery of persuasive skills. Even though we all agree that communication is key to our success, many of us have never been able to get to “first base” in conquering a method or mode that is reasonably simple, yet surprisingly effective. How many seminars or journal articles have we waded through trying to find the answer, yet when we return to the office environment, we revert right back to our old routine? Why? Because it is easier in the short term to fall back into the way we have “always done it,” or, in some cases, the way we were taught!

Because of the availability of hundreds of concepts and theories as to the best persuasive presentation styles, we have so many options thrust upon us that we generally find it all too overwhelming. We often leave a seminar all pumped up with the greatest of intentions, only to find it nearly impossible to transpose those volumes of notes and handouts and incorporate the principles into our practice procedures. So we revert back to our old comfortable habits. Of all the things we experience in our lives, change is one of the most difficult things to master and accept. So, in the interest of raising our “batting average,” let’s narrow our sights to concentrate on mastering one specific, critical skill.

Sound simple? Actually, it is. Step up to the plate and prepare to focus on the differences between gentle and forced persuasion and then compare the process and outcomes of the use of each.

For many of us who were in school during the “early years” of dental hygiene, and have practiced our profession for several decades, we were taught to center our patient education on the hard-sell technique. We went at it with a prideful vengeance.

Unfortunately, we often destroyed favorable relationships with patients in our unyielding efforts to “convince” them that we knew what was best for their dental health. In those efforts, the cost of getting our way was not worth the prize. Looking back, we can realize we were using forced persuasion. We were causing a negative reaction that opposed our persuasive efforts.

The concept of forced persuasion can be compared to Isaac Newton’s Third Law of Motion: “For every action there is an equal and opposite reaction.”

This law applies to physical forces acting on physical objects, but the idea applies to psychological forces acting on people as well. It explains why people resist being convinced, even when they are being persuaded to do something that is clearly in their best interest. When you push them, their natural reaction is to resist and push back! The harder you push, the harder they resist. Have you ever tried to convince a three-year-old to eat broccoli, just because it is good for them? Do you recall any confrontations with patients over their home-care habits? How successful have you been by insisting that all your patients floss every day? What messages have you found successful in getting your teenage patients to brush thoroughly around those orthodontic wires, use a water-irrigation device, rinse with chlorhexidine, or use any interdental cleaning device regularly? Is it in their best interest? Would they benefit? Do they know they would be better off? Were we successful? Upon reflection, we discover our general methods of “motivation” were actually forced persuasion.

We have often relied on:
• Authoritative power - “You must floss every night before bedtime.”
• Punishment - “Until you do a better job with your home-care, we cannot help you.”
• Reward - “Come every three months; your appointment will be much more comfortable.”
• Negotiation - “If you floss your teeth regularly, you are less likely to lose them.”

Hard-sell threats and warnings often have been our mode of patient education. However, looking at our success rate, it becomes obvious we need a new “set of signals” coming from down the third base line.

Gene Bedell, author of 3 Steps to Yes: The Gentle Art of Getting Your Way, presents an interesting persuasion concept that we believe could be one of the most innovative tools in “coaching” our patients to “want what we want them to want.”

Bedell defines “gentle persuasion” as: “the art of communicating so effectively and compellingly that the people you’re persuading voluntarily act in ways you intend.”

With gentle persuasion, we do not set up a force that patients naturally resist or reject. All we are doing is “communicating.” There is a big difference between gentle and forced persuasion. If we are good at our communication skills, the patient will make the decision we want them to make.

An example of forced persuasion is, “You need a crown on that tooth, and the sooner the better. We could do it tomorrow immediately after lunch or Wednesday at 8 a.m. Which would be best for you?”

Unfortunately, using this approach often lacks effective persuasion. The patient’s instinct would be to resist your manipulation and leave the office without committing to an appointment. Or, he or she will committing under pressure, long enough to escape and then call and cancel, or simply become the next “no-show.”

Now consider the approach of gentle persuasion.

“John, I want you to look at these X-ray films with me. (Explain the problem.) Here’s how we can help you save this tooth and stay out of pain. Without treatment, the infection is going to spread and cause considerable pain and tooth loss.

“We believe we can do an excellent job for you and one which will make you proud to smile. We take pride in the fact that all the members of our dental team have completed many professional courses on this particular type of care. Notice the many degrees, awards, and certificates throughout our office. This is your first experience requiring this kind of treatment and we’d like to fully explain what is involved in this procedure.

“We want to make sure you don’t have to worry about experiencing any pain or concerned about meeting your financial obligations. Our office manager will be happy to discuss the fee schedule and provide you with various payment options that best meet your needs. We would welcome any questions you might have. You can be assured that we will do everything possible to provide for your complete comfort during and following your treatment.

“You will be amazed at the ease with which we can accomplish restoring this diseased area back to a healthy status. Then we can assist you in a preventive schedule to avoid a continual destructive pathway. We have treated hundreds of patients with similar concerns and have been very successful in completing painless, time-efficient results.”

This is gentle, persuasive communication. We do not need to provide a persuasive force, no hard sell, and no “my way or you’ll regret it for the rest of your life” routine.

Patients will not feel sold, pressured, manipulated, or forced to resist. The patient will be gently persuaded and voluntarily consent to the services we recommend. The key is that gentle persuasion happens not because of our authority, selling, or negotiation forces, but because the patients accept our recommendations as valuable and valid, and they choose to act on them.

If patients face a threat to their freedom of choice or economic security, their personal needs will prevail as a negative persuasive force. You will have struck out.

When your ideas and proposals have merit and you persuade or “coach” your patients by means of effective communication, you’ll not only achieve your goals, you will strengthen these relationships. Life on the dental team can be exceedingly successful and rewarding.

You can set up your schedule to result in win-win situations. You can make this happen. You can be the most valuable player, sell the peanuts and popcorn, sing the national anthem, and receive an enthusiastic ovation from the “crowd.” You can have it all! Let’s play ball!


Selling yourself - communicating so effectively that people will accept that you are what you want them to believe you are.

Selling your ideas - communicating so effectively that people accept your ideas as valid and valuable, and act on them.

Selling your services - communicating so effectively that people use services you personally provide.

Source: 3 Steps to Yes, by Gene Bedell, Crown Business Publisher, New York, 2000