“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.”
“I detest life insurance agents. They always try to convince me that someday I will die, which is not so.”
“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.
Case Acceptance Brings Patient Benefits Plus Practice Success
Without a doubt, treatment acceptance is good for patients. When patients follow through on your recommendations, they can eat better, talk better, smile better. Treatment even saves lives. Simultaneously, case acceptance is good for your practice. When patients assent to treatment, a practice is productive and profitable. Quality dentistry exists only when patients agree to it.
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 1: Understanding
Research shows that patients fully understand what their doctors tell them only 15 percent of the time. Further, although 90 percent of patients value having as much information as possible from their doctors, the information they desire often is not provided.2 The first step in persuasion is closing the gap between what the patient knows and what the patient wants or needs to know.
Step 2: Need
Patients listen to your explanations of dental conditions and ask themselves: “Is my dental health really threatened?” “How bad is it?” “Must I take care of it right away or can it wait?” It’s a rare patient who accepts a treatment plan simply to defer to a doctor’s orders. Instead, patients decide for themselves about the severity of their dental conditions. If they judge their dental problems to be serious and immediate, they are more likely to listen to your treatment recommendations.
Step 3: Value
Patients next consider if treatment is worth their time, inconvenience, and money. In deciding whether to do what you suggest (or do something else or do nothing) patients will select the action with the greatest benefits and the smallest disadvantages. To gain patient agreement, you must maximize the benefits and minimize the disadvantages of treatment from the patient’s point of view.
Step 4: Identity
Some patients don’t accept treatment because they don’t believe they are capable of doing it. For example, a patient may see himself as too busy (or disorganized) to schedule the necessary appointments. Other patients don’t see themselves as the kind of people who deserve excellent dental care. A patient may say to herself, “A crown probably is ideal for a lot of people, just not for me.” A most effective but seldom used approach to persuasion is assisting patients in identifying themselves as the type of people who are capable of following through on 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.
|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.
Know the patient
The better you know your patients, the more accurately you can match your message to their backgrounds, knowledge, and interests.
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
Focus on your main message
On the other hand, patients do not want a word-for-word rendition of the last clinical seminar you attended. If you know your communication goal, you will be more likely to stick to your topic and tell just the important facts rather than wandering off on a related-but-irrelevant point. By focusing on specific messages, you can save time—and keep the patient’s attention.
People tend to remember the first and last things you say and to forget the middle of your message. Put your most important statements first and last for long-term impact.
Give the big picture
A preview statement will help patients create an outline or mental model of your explanation. For example, “There are four phases to your treatment plan,” or “First let’s discuss your dental condition, then talk about the treatment itself.”
Use short sentences
Brief statements containing one idea are easier to understand than long, complex statements containing several ideas.
Use familiar words
Your goal is to have patients understand your message so well that they can repeat it later when family members ask, “So what did the doctor say?” Simple, familiar words will make your message memorable as well as understandable. Many patients will not ask for an explanation of a clinical term. They will create a distorted lay translation of your message rather than risk the embarrassment of appearing uninformed.
Highlight key points
Use your delivery style to make important messages stand out. (You want key points to be in boldface.) Pause before and after crucial messages. State them slowly and forcefully, then resume a more relaxed style for background information.
Examples make your explanation specific, interesting, and memorable. If you tell a story, you can demonstrate the effect of your information on the life and health of the patient.
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.
|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:
|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.
|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 />