5 – “Is It Worth It?”

5

“Is It Worth It?”

Motivating Patients to Accept Treatment

“If you want to persuade people, show the immediate value and relevance of what you’re saying in terms of meeting their needs and desires.”

—Herb Cohen


“I detest life insurance agents. They always try to convince me that someday I will die, which is not so.”

—Carl Sandburg

“Why do I need treatment if nothing hurts?” “What will happen if I do nothing?” “Why will it take so many visits?” “I just want this tooth filled; don’t try to talk me into anything else.” “What if I just have all my teeth pulled like my parents did?” “I don’t have time for treatment right now.”

Although you wish patients would just say “Yes, Doctor,” when you make a case presentation, some patients don’t accept treatment. If your case acceptance rate is above 70 percent, you are ahead of the game. On the average, four of ten patients fail to do what their doctors recommend.1

Why do some patients say “no” to treatment? Is it because they don’t understand the dental information? Do they miss the seriousness of their conditions? Is it because they don’t feel capable of following treatment plans? Are they busy, lazy, forgetful? Is it all of the above? This chapter takes a close look at the barriers to treatment acceptance and offers practical solutions for bringing patients to “yes” in case presentations.

A Persuasive Plan: Five Steps to Patients Saying “Yes”

When patients hear your treatment recommendations, they carefully evaluate your messages to decide whether to do what you suggest. Here are five issues in patient acceptance of treatment.

Step 5: Action

Believing isn’t doing. For example, you value your children’s education, but somehow you’ve missed the last three PTA meetings. You believe in protecting the environment, but your to-be-recycled newspapers are still stacked in the garage. Similarly, some patients recognize the seriousness of their dental conditions, agree with the benefits of prompt treatment, perceive themselves as responsible dental patients, but still don’t take action. How do you get those patients in the chair? How do you keep them motivated in home care? Specific techniques in persuasion will help increase patient compliance with necessary treatment.

Five Steps to Persuasion

Issues Definitions Examples
Understanding Patient finds dental information inadequate, confusing, or hard to believe “I don’t understand why you fill baby teeth when they fall out anyway.”
Need Patient isn’t sure of the existence, severity, or immediacy of a dental problem “How long can I put this off?” “Since it doesn’t hurt, why do I need anything done?”
Identity Patient doesn’t consider herself the type of person who invests in care “I just don’t know if this treatment is for me. I figured I’d lose my teeth like my dad did.”
Value Patient isn’t sure the treatment is worth the time or inconvenience “I don’t have time for this right now.” “Why does it take so many visits?”
Action Patient doesn’t comply with treatment or home-care instructions “I forgot about my appointment.” “I don’t have time to floss.”

Understanding: How to Be Clear When It’s Confusing

Explaining dental care to patients is not easy. The information is unfamiliar, the language difficult, the concepts hard to picture. Complicating your task is the low level of functional literacy for many Americans. According to the Educational Testing Services in Princeton, one-quarter of U.S. adults cannot read a job application, determine the difference in price between two items, find a designated intersection on a street map, or enter background information on a simple form.3

Many patients in our health-care system are dangerously confused. In fact, 50 percent of patients leave their doctors’ offices not knowing what they are supposed to do to take care of themselves.2 More than 30 percent of patients who receive prescriptions use their medication in ways that could pose serious threats to their health.4

How Much Do Your Patients Know about Dental Treatment?

According to a 1995 consumer research project from the Massachusetts Dental Society,5 77 percent of patients think their dentist keeps them informed about new techniques. However:

  • 21 % are unfamiliar with caps, crowns, and root canals
  • 33% are unfamiliar with gum treatments and bridges
  • 42% are unfamiliar with such cosmetic procedures as bonding and veneers
  • 50% are unfamiliar with bleaching, whitening, or dental implants
  • 33% did not know that children get fewer cavities today than their parents did

As shown by the table above, dental patients consider themselves “well informed.” Yet many are unfamiliar with treatment procedures central to quality dentistry. This is not just an educational challenge, it is a marketing opportunity. For example, four in ten patients are unfamiliar with bonding and veneers. The enterprising dental communicator who informs them about cosmetic dentistry could promote patient knowledge as well as practice growth. Here are communication techniques to help create a clearer understanding of dental care.

Make the message complete

Researchers have found that in a typical 20-minute medical visit, physicians spend less than one minute giving patient information.6 Most patients want more information than they get. They especially want to hear about the treatment, the use of equipment, and how patients are expected to act. Further, patients are nearly unanimous in their dislike of dentists who start treatment without explanation.7

Don’t do all the talking

People remember 20 percent of what they hear and 90 percent of what they themselves say, according to a study by the U.S. Department of Health and Human Services. So, if you let patients explain, they will remember more.

Statements to Involve Patients in Treatment Explanations

How would you describe the dental problem?
What (if any) experience have you had with this in the past?
What do you think is causing the problem?
What do you think will help clear up this condition?

Just to make sure I didn’t leave anything out, would you mind telling me how you are going to take this medication?

To make sure I’ve been clear, give me a quick summary of your home-care plans.

Word type Description Examples
Relative words Because these words get their meaning through comparisons, they may mean something different to patients than to you Smaller, more, longer, frequently, sooner, in a while
Secret antagonizers These words may be perceived as condescending Using “he” to refer to both men and women; calling a Cynthia “Cindy” or a Richard “Dick”; calling a patient “son” when you are not his parent
Scary words Words that can create anxiety for patients Cut, drill, needle, extraction
Jargon Words that hold meaning only within a particular area of expertise Amalgam restoration instead of silver filling; fermentable carbohydrate instead of starchy food

Understanding: How to Be Convincing When It’s Hard to Believe

Some dental messages are difficult to understand not because they include unfamiliar words or complex concepts, but because they run counter to intuition.9 Certain dental ideas conflict with patients’ deeply held theories about how health care or the world works. This conflict can lead patients to reject or misunderstand fundamental aspects of preventive dentistry.

Following are examples of dental messages that are hard to believe because they conflict with common-sense notions:


Dental message: In spite of a lack of symptoms, you have a potentially serious periodontal problem.

Common-sense notion: I can’t have a serious dental problem because I’m not in any pain.


Dental message: A little bleeding when you floss is normal; please floss every day.

Common-sense notion: If my gums bleed when I floss, I must be damaging my mouth. I’d better stop doing it.


Dental message: That cavity in your son’s baby tooth should be taken care of.

Common-sense notion: Why fix baby teeth when they fall out anyway?


Dental message: Choose a soft-bristled toothbrush.

Common-sense notion: Stiff bristles should clean better than soft ones.

When a patient holds an erroneous (but plausible) belief about dentistry, should you jump in with expert information proving him wrong? No. This approach communicates an underlying message of “Anything that I think of off the top of my head is better than what you have thought of, even if you have been thinking about it a long time.” The patient may respond by ignoring, denying, or disbelieving your message. Instead, you must validate the patient’s point of view, then create an explanation that makes sense in the patient’s world.

Suppose you tell a patient he has a serious problem in his mouth due to periodontal disease. He finds your message hard to believe because he has no symptoms. Purdue professor Katherine Rowan recommends the following approach9:

Explaining a Message That’s Hard to Believe

Technique Application
Restate the patient’s erroneous but plausible notion and acknowledge its plausibility “It’s hard for any of us to understand that a physical problem exists when we don’t have any symptoms. After all, when you sprain an ankle or have a cold, you are uncomfortable.”
Demonstrate the inadequacy of the patient’s belief by comparing it with other ideas familiar to the patient “Periodontal disease is similar to medical conditions like high blood pressure or anemia that can be present without the person’s knowledge and can become serious without any outward symptoms.”
Demonstrate the greater adequacy of your dental concept “Would you like to see how gum infections can progress to an advanced stage even though the mouth looks normal? Let’s take a look at this chart…”

Need: How to Overcome the “It Ain’t Broke, Don’t Fix It” Attitude

You and the patient must agree on the nature of the dental problem before you can agree on a treatment plan. For example, if a parent thinks a cavity a year is normal for children, she won’t be motivated to make changes in her child’s diet and home-care habits. If a patient is not convinced of the need for treatment during a discussion of her dental condition, she cannot be convinced to take action.

Insight on how to convince patients of the need for dental treatment comes from communication professor Kim Witte.10,11 Summarizing decades of research on persuasion, she argues that when individuals are informed of a threat to their health (like a dental problem) they appraise the seriousness and likelihood of the danger. If the danger is perceived as irrelevant or insignificant, there is no motivation to process the message further. The potential for patient action stops.

If patients believe themselves to be threatened by serious harm, they are motivated to begin a second appraisal, which is an evaluation of the effectiveness of the recommended action to deal with the threat. If patients believe they can successfully avert the threat to their health, they are motivated toward danger control. They seek strategies to protect themselves and are likely to adopt a treatment plan.

If, however, patients believe they cannot prevent the threat, they are motivated toward fear control. They seek ways to deal with the fear, not with the danger. They may deny the threat, ignore the message, or lash out at you as the bearer of the news.

How Patients Deal with Health Threats

Step One: Appraising the Problem
If patients believe the threat is minimal or irrelevant: Patients stop listening to the message
If patients believe the threat is serious and likely: Patients continue to listen and move to Step Two
Step Two: Appraising the Solution
If patients believe they are capable of taking effective action to avert the danger: Patients will adopt the recommended action, such as accepting a treatment plan
If patients believe they are incapable of taking action or believe the action will be ineffective: Patients will engage in fear control processes such as denial, avoidance, or hostility

As an example, suppose you have a patient who is at risk of o ral cancer because of his use of smokeless tobacco. If he perceives his situation as low threat, he would say to himself, “It’s not like I’m smoking. A chew once in a while isn’t going to hurt me.”

If he perceives his situation as high threat/high effectiveness, he would say to himself, “I’m at risk of oral cancer from chewing tobacco. I don’t really want to quit, but I can and will.”

If he perceives his situation as high threat/low effectiveness, he would say to himself, “I’m at risk of oral cancer, but there’s nothing I can do. I can’t quit. I’m too old to change. That dentist should keep his nose out of my personal business.”

To follow Witte’s advice in convincing patients of the need for treatment, your first step is to convince patients of the seriousness of their dental condition. The following points explain how to do that. Your second step is to outline specific steps to cure the dental condition, emphasize the effectiveness of the recommended treat- ment, and convince patients they are capable of taking action. The next section (Identity) will assist you with this second step.

Prove the existence of the dental condition

Patients will accept your recommendations only if they believe they actually have the dental problem. Consider this example: Citizens in Thompson Canyon, Colorado, were warned of a flood due to heavy rains in the mountains. Because the skies were clear over town, many did not evacuate. The warning message conflicted with their own evaluation of the weather. Other residents were told incorrectly that a dam break precipitated the flood. These citizens believed the warning at once. The message did not conflict with their own reading of the signs.12

When you give a patient an “emergency warning” about treatment need, your message should match the patient’s reading of dental health signs. Make treatment need observable to the patient. Provide multiple signs of the dental condition if possible. Take the patient on a tour of her mouth and say, “See here? . . . and see here?… You can see for yourself that . . . .” Explain the relevance of any symptoms the patient may have experienced by saying, “You may have noticed (bleeding gums, sensitivity, eating difficulty, etc.) as symptoms of this condition.” X-rays, models, and multimedia computer technology are />

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Jan 5, 2015 | Posted by in General Dentistry | Comments Off on 5 – “Is It Worth It?”
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