Pain as a Motivator
Understanding the frame of reference for a patient’s motivation is important to the success of a treatment plan, since the term “success” means different things to different people. Too often practitioners assume that the patient’s motivation and
definition of success are identical to their own and proceed accordingly, only to find that their perspectives differed. This miscommunication can cause disastrous results, particularly in aesthetic, prosthetic, or pain management dentistry.
In order to successfully initiate a beneficial relationship, the clinician must first establish proper communication with the patient. The initial step is to listen carefully and intently. It is not unusual for this to be a fatal stumbling block in the doctor-patient relationship. Too often the clinician attempts to dictate treatment to the patient. If the value systems of the patient and doctor do not coincide immediately, the patient responds negatively and abandons the clinician following the initial visit. An effective communicator always begins the relationship by constructive, empathetic listening. Lifelong relationships are established at this crucial phase.
A verbal “cushion” is a neutral acknowledgment of the patient’s desires. It is not judgmental in nature but rather an affirmation of the patient’s rights to feel a certain way — even if it is different from the clinician’s viewpoint. An empathetic response such as “ I understand how you feel,” will help establish rapport, prevent feelings of insecurity, and make the patients more receptive to the advice of the dental professional.
A conversation is controlled by the person asking the questions. The clinician who waits for a question so he or she can respond accomplishes little more than functioning as a well educated encyclopedia. Carefully crafted questions allow the clinician to determine the true motivating factor of the patient. Walter Hailey of Planned Marketing Associates states that “the question is the answer.” By questioning the patient in this manner the clinician may be able to address concerns that were not actually voiced. For instance, if a patient telephones to inquire “Do you recommend treatment with veneers?” how should you interpret the question? That they want veneer restorations? What if the caller’s brother had veneers that failed, and veneers were precisely what the patient wanted to avoid? Would it not be more productive to first ask a question to determine the patient’s rationale? By using probing questions, the clinician can often ascertain the motivation driving the patient to seek or reject care.
Once the patient’s concerns have been identified, the clinician can share the benefit of his or her education. Most importantly, the patient is ready to listen. Patients are often frightened and confused when they first enter the office. Often their frame of reference is derived from a friend or a relative who may have had a bad experience and loves to share it in graphic detail. The patient may not even know what treatment to select. The clinician must be confident that the answer he or she gives addresses the question the patient asks both mentally and verbally.
This is a step frequently omitted by even the most well-meaning clinician. A statement of support, such as “you have made the right decision,” will affirm in the patient’s mind that it is the most promising choice for him or her. In addition, this simple step helps to alleviate the frequency of canceled appointments. A definitive verbal confirmation instills the patient with the confidence to begin the treatment and follow it through to completion. Most clinicians think of pain management only as pills, injections, or physical modalities. Often the best form of pain management is assurance and confirmation that treatment is proceeding as planned. Following the formula of listen-cushion-question-confirm provides the best kind of pain management — and that is prevention.