Part One of this post was posted by Mary Osborne on Dec. 17.
We can assume if they are in a dental office that they have some value for health. Deeper questions flow from that assumption: What important aspects of this person’s life will be affected in a positive way by having good oral health? What aspirations do they have that would be negatively impacted if they avoid doing dentistry? Exploring those issues can help them clarify what our dentistry will help them achieve that is personally relevant to them.I don’t think of understanding patients’ values as some obscure, esoteric concept. I think of practical issues, such as what they like to eat, and how they like to spend their time. Questions that come up for me are: What has motivated them to choose healthy foods, or exercise, or make any significant change in their lives? Who influences their choices and why? What are their hopes and their fears? What is valuable enough to them to cause them to move beyond financial concerns, discomfort, inconvenience, or other perceived barriers? What must we include in our conversation to allow them to trust that we have their best interest at heart?
Our values tend to drive us toward some things, and away from others. When you are clear about what is important to your patients you can offer them information about two key elements of choice as described by Dr. Bob Barkley. The first is their Probable Future. It is important for patients to understand what is most likely to happen, given their current conditions, if they do nothing. Our responsibility is to let them know — as clearly, honestly, and specifically as we can — what we believe will happen in the future if nothing is done to intervene. Only when patients fully grasp their Probable Future can we help them visualize their Possible Future. This process goes far beyond a treatment plan. It is outcome based, not procedure based. It helps the patient see possibility where they may have seen inevitability. It is a long term plan for health; specific in its goals, and compelling in its vision. It is not our plan. It is their plan, for their future, based on their preferred outcomes.
Their values create the context for our recommendations. Ideally every recommendation we make for a patient — from bitewings to implants — would be placed in the context of what we are learning about their values: “Based on what I am hearing from you I suggest . . .” “Based on your goals as I understand them my recommendation is that we . . .” Without that context we can make a logical argument for why one should have treatment. Within that context we can have a conversation about why that unique individual would have treatment.
Lee, I thoroughly discuss this in my book, Art of Case Presentation. I totally agree with your premise…and who would ever argue with the great Bob Barkley. The problem as I see it is in the “how.” Motivating people (see Dan Pink’s book, To Sell is Human), will be the most sought after trait in education and medicine in the future. It truly is what we bring to the table and makes us effective. The problem…motivating people is a skill and an art, not to be taken lightly as it is in our dental education.
Dentists spend an overwhelming amount of time these days learning technology…or ways to do their tasks better in order to earn more money, while neglecting the true science of dentistry…what caused the problems to begin with. If we, as health care providers are to make a dent in this universe then we have to be more effective in helping patients change their habits. Tough job…but very doable…need help from dental education systems.
Very good point (and question). It begs the question to me: with advances like for instance MI paste or Cari Free, two products that I find are very appealing to patients who really won’t floss and brush properly, we now have a little more direct control, less dependent on perfect patient homecare. Motivating people, indeed, is an art that requires a willingness to really get to know the patients frame of reference and be willing to operate in that frame until they gain renewed or new interest in a possible future they hadn’t thought possible before. I also, find that due to simple things like fluoride toothpaste, our challenge today is to help patients see subtle downhill challenges, vs the obvious ones that existed in Barkley’s day.
I have learned that people must perceive a problem exists before they have interest in potential solutions. Thus I believe strongly we must START the process where they are, and frame our discussion in terms of their current state of mind/awareness etc (as Lee says “placing our recommendations in the context of what we are learning about their values”)
As I have been exposed to this way of thinking over the years, I have discovered that we have to be careful not to force a long drawn out process on patients, but learn the art of what different people want once they perceive a problem. In other words, there reaches a time that once they are feeling we truly have their best interests at heart, we have a duty in my mind to give them our professional opinion (based on what we have discovered). The art to me is to present those recommendations when the patient “asks” for a solution. This doesn’t necessarily take a lot of time for every patient either.
Regards,
Fmm
Great article and discussion. I have really tried to embrace the concept Mary teaches that the doctor-patient relationship must have an element of advocacy on the doctor’s part of it, whereby the practitioner doesn’t always just accept the patient’s current viewpoint regarding their oral health, but sometimes challenges the patient to question their feelings regarding any barriers they may have. Certainly for a practitioner’s advocacy to be followed, trust must be established. And one thing that can really help establish that trust is consistency in the way the entire office communicates with the patients. And not just what they say, but the entirety of the professionalism and seriousness with which we conduct ourselves. I’ve just found that when my staff delivers a clear consistent message to the patients about what they see and how it is significant, it becomes much easier for me to communicate with them myself.
Thanks to all for the great feedback on this piece. I’m glad it stimulated your thinking.
Barry’s comments about motivation are right on as are Franks thoughts about the importance of owning a problem before people seek a solution. Without ownership of a problem there is no motivation for change. I believe that ownership comes from awareness. The highest level of awareness is pain, but our goal is to help people avoid pain. The “how” in that is in our ability to help patients become aware of signs before they have symptoms; like paying attention to wear on a tire before they have a blow out. Awareness does not come from information alone. I think of it as a physical experience that makes it hard to ignore subtle signs.
As Michelle points out from a patient’s perspective it is not east for patients to have some of these conversations with dentists. The good news is that we have an opportunity to work with people over time and discover what is important to them, how they like to learn, and what kind of information is helpful to them. I love Kurt’s comments about the importance of building trust, not just with the doctor but wit the team as well. Inviting everyone in the practice to build relationships with patients that encourage health is a gift to both patients and team members. And often team members can communicate in a way that is, as Michelle says, simpler and more relaxed.