Dr. Abraham Maslow has described a hierarchy of needs (Figure 3-1) that aids in understanding how a person’s needs motivate his or her behavior. Maslow identified the following five basic levels of needs ranging from basic biological needs to complex social or psychological drives:

Relating this hierarchy to dentistry means getting to know the patients and the individuals with whom one is associated. Before a dentist can motivate a patient to accept a certain type of dental treatment, it must be understood where the patient is on the hierarchy of needs.

To help realize the application of these needs to dentistry, consider this situation. One of the practice’s patients is a bank president who is respected for his civic activities and has a warm, loving family and a fine home. The patient develops severe pain in the maxillary anterior area. The pain is sudden, sharp, and excruciating. It is difficult for him to eat, and there is a great deal of swelling in his upper lip. This person has dropped from perhaps a self-esteem level to the physiological, and the dentist must satisfy this physiological need immediately before attempting to suggest any further treatment.

Setting up payment plans for a patient often exposes a conflict of needs. A patient must ensure that basic needs of food, housing, and clothing are met, yet there may be a desire to meet social needs by improving appearance with some form of dental treatment. A conflict arises in the decision-making process when the patient is confronted with conflict on how to satisfy all of these needs with a specified income. The dentist and staff must make an effort to determine the patient’s needs, realize the patient’s potential conflict, and consider presenting an alternative treatment plan so the patient has some options.

This theory need not only apply to relationships with patients. It also can be applied to interactions among staff members. The dentist, assistant, and hygienist all have the same needs, and each is concerned, like the patient, about security today and in the future. Often conflict arises when a person becomes fixed at one level. There may appear to be no change in motivation, and the person remains unchanged in his or her perspective. This is evidenced often when a person has an interest in making money or increasing social status without regard for other people’s levels of motivation.

Perhaps one of the best lessons to be learned from Maslow’s theory is that an individual has a choice in determining his or her behavior. Although basic physiological and environmental needs have a strong influence, an individual makes choices voluntarily.

Another barrier occurs when one hears but does not listen. A dental professional should never be too busy to listen with understanding to a patient. Don’t just listen to the words. Listen to the meaning of the words and the feeling behind the meaning. Before presenting a personal point of view, be able to restate what has been said to the patient’s satisfaction. This may sound easy, but is not. Often people are too eager to present their own point of view and fail to understand the real meaning of what the patient is attempting to say. What is the patient really saying when he or she says, “I think I’ll wait to have that treatment done”? If the dental professional responds, “Oh, that’s okay, Mrs. Gates, I understand,” he or she won’t find out what the patient is really saying, and may cut off communication. The patient may really be saying, “I’m scared,” “I can’t afford it,” or “I don’t like the way you treat me.” The best way to arrive at the real meaning is to continue the dialogue until the patient’s true feelings are discerned. The following example demonstrates this idea:

Notice in this dialogue the assistant offered a solution to the problem so that it could be discussed further.

However, the dialogue may have continued along different lines, such as the following example:

In this case, the assistant rephrased what the patient said to arrive at the real meaning.

A third barrier is preoccupation. During daily routines many demands are placed on one’s time, and it is easy to begin to suddenly think about other activities while trying to communicate with a patient. Everyone has been in that position at one time or another. A patient is trying to explain why an appointment time is not convenient, and suddenly the dental professional realizes that she or he hasn’t heard a word that was said because of concentration on another problem. This often happens in an office that is understaffed. Each staff member has so much work to accomplish that listening to a patient sometimes just becomes an additional burden. Unfortunately patients are quick to recognize such preoccupation and may suddenly stop talking or eventually may even stop coming into the dental office. This type of situation re-emphasizes the service model illustrated in Chapter 1. As mentioned, the patient is the most important person in the office and should be given complete attention.

Unawareness of importance, impatience, and even hearing loss are barriers to communication. How important the problem is to a patient may not be realized, and the patient’s concern may simply be ignored as a whim. Likewise, one may inadvertently become impatient with a chatty young child or an older person who is slow. Furthermore, it is possible not to hear everything a person says because of an unrealized hearing loss.

It is not beneficial just to know about these barriers. The dental professional must be willing to evaluate him or herself. Before each contact with a patient, decide to ignore extraneous activities, and be willing to listen and understand a patient’s problem before offering a solution.