Then, the patient thoughtfully replied, "Doc, I am going to need to think about
it." Nine simple words that are uttered in every language, in every country, in every
dental practice around the world. Nine simple words that crush us, frustrate us and in
the end lead to the patient never scheduling treatment. We wonder what they "need to
think about." Did we not give them enough information? Perhaps we should have
included more pamphlets on periodontal disease and comprehensive care, or the tooth
drawing with the nerve and dentin drawn out in red and blue pencil. What was it that
we were missing? What a waste of time.
The patient walks out of our office, overwhelmed and frustrated. "What was that
doctor thinking? Didn't he know what I came to see him for? What was all of that
garbage that he wanted me to do? What a waste of time."
As doctors, we want to help our patients. In some way, shape or form it is why we
chose the profession that we did. First, Hippocrates implored us to first do no harm.
Following that, it was the natural progression that we committed ourselves to our
patients' well-being. Patients seek us out to help them achieve their health goals. They
seek, we provide. It seems like the perfect arrangement, yet we still encounter the "Nos,"
"maybes" and the "I will think about its." Where and how does this disconnect occur?
When we consider the opening scenario between the patient and the doctor, there
is a tangible frustration that stems from unmet expectations. The doctor expected for
the patient to understand, appreciate and accept the treatment recommendations. The
patient had an expectation that the doctor would provide treatment options to choose
from that would address his concerns and goals. Each had invested time, money and
effort into the process, yet no one was happy with the end result.
Expectations can be better understood and achieved by breaking down the process
of offering dental care options.
The first step in meeting expectations is awareness. We as practitioners must seek
to understand the patients' level of awareness regarding their dental health conditions.
Assumptions of their level of awareness can lead to offering "solutions" that have little
or no level of value or relevance for a patient. Steven Covey wrote, "First seek to understand,
then seek to be understood." This commitment is a foundation for meeting
expectations but also for a successful and continued patient-doctor relationship. Once
we have put forth that effort, we can share our additional observations and do our best
to raise patients' level of awareness.
Awareness should also be considered when it comes to patient goals. Without
awareness of their conditions, they might not have the same goals that we do.
Considering their level of awareness, are we ready to present appropriate treatment
options? Mind you, awareness of conditions does not mean that the patient has any
desire or urgency to address the condition.
Consequence is the "information" that might or might not motivate a patient to
treatment. Once we have established a co-awareness of the conditions between the
patient and the doctor, we can begin the educational process of discussing benefits of
treatment as well as the consequences of inaction or delayed treatment. If the benefit
or consequence is great enough for the patient, and appropriate as a motivator, he
or she will seek treatment. However, if the benefit is not of interest or the consequence
is not a concern, then he or she might just "think about it."
As a simple example, we all frequently see cracked yet intact and asymptomatic
premolars or molars. The patient likely might have been unaware of the condition
until we pointed it out. Even then, they might seem completely unmotivated to do
any treatment. Why should they? There is no consequence.
By referring to a third party – like your other patient who had his tooth crack and
it was too late to salvage – you might be able to get the message across. In the absence
of our own awareness of the patient's concerns, we were able to communicate
through third-person analogy, the classic consequences of inaction to the patient.
These consequences are common motivators that inspire patients to seek and accept
Some patients come to us in pain, looking for relief. Others might come to us hoping
to avoid the onset of pain. Patients might even decline treatment due to the perceived
pain involved with the procedure. They might balance tolerating their existing pain to
avoid what they feel will be a greater pain.
Like pain, money can be a motivator or barrier. Patients can be inspired to seek treatment
before treatment fees escalate. They can also feel a financial barrier to treatment if
payment options or phasing is not available. Money can be a barrier to patients when they
consider prognosis, longevity and re-treatment costs. I recall a patient reacting quite
strongly to the financial aspect of root canal therapy, but following up by asking for an
extraction and implant restoration. Her concern, while financial, was not with spending
the money. Her concern was with the longevity of initial treatment, future treatments
and ending up with an implant restoration anyway. The better we understand patients'
financial concerns, the better we are equipped to discuss them.
Aesthetics and Social Embarrassment
As I imagine we have all experienced how aesthetics can be the chief motivator for
some. Trying to communicate the benefits of treatment from an aesthetic standpoint to
a patient who doesn't have concerns about aesthetics is not only ineffective but could
also be perceived as insulting. If a patient seeks a beautiful new smile but is only focused
on her two front teeth, she might need to be counseled on how her desired treatment
might not actually help her achieve her goals. In fact, we could communicate how
limited treatment could have the consequence of making her smile worse.
What do the patients want from treatment? Do they want their dentures to stay in
their mouth while they eat? Or is their goal to be able to eat corn on the cob and steak
when they are 70? Are the patients' treatment decisions consistent with their goals? Do
we communicate the consequences associated with their choices?
Once we are able to better understand a patient's awareness of his or her conditions,
we can better communicate the consequences of denying treatment
and offering appropriate and affordable treatment options. All of our technical
know-how and continuing education is of little value to us or our
patients if we are unable to apply it and step beyond Hippocrates'
charge. When we can look the patient in the eye at the treatment
consultation appointment or at the exam and say with confidence
"Based on your goals, as I understand them, what I would recommend
is…" we can feel that we have taken that step. It is then
that we can move beyond diagnosing conditions and toward
diagnosing "yes" and treatment success.