Joseph P. Graskemper, DDS, JD
Motivating patients to obtain needed dental care is a challenge every dentist has experienced. It is more than just “closing the sale” for a treatment plan, “selling dentistry” better, or even instilling fear of dire consequences of nontreatment in the patient. I have heard about all of these approaches in regard to case acceptance over the years. These approaches do not change the way patients view dental health. These approaches turn dentistry into a product, rather than a service. They merely focus on how much treatment dentists can get patients to accept. So, what does it take to motivate patients to change their attitudes toward dentistry? Motivation, whether of a patient or even yourself, is dependent on many factors.
It all begins with proper listening. You cannot lead your patients to the correct choices in their dental care if you do not listen to them. Your full attention must be given to each patient, so you are not just hearing what he or she says but truly listening to any wants, needs, desires, fears, concerns, questions, and misunderstandings.1 Listening is more than just hearing patients explain issues and understandings. The way you listen matters too. In 1971 Albert Mehrabian researched nonverbal communication. He found that 55% of communication occurs via body language, 38% via the tone of voice, and only 7% occurs through the actual words spoken.1 Hearing is passive; listening is active. Actively listening and observing a patient’s body language and tone of voice can give you an idea of the patient’s attitude toward dentistry.
There are many barriers to effective listening: time, effort, message overload, rapid thought, psychological noise, physical noise, hearing problems, faulty assumptions, emphasis on talk, and cultural differences.1,2 Each of these barriers can interfere with your ability to listen fully to patients. These barriers must be acknowledged and dealt with. Once you have mastered control over these, you can listen and observe patients to understand their attitudes toward dentistry. Each patient’s attitude will guide you toward the proper motivational techniques necessary to lead the patient to making proper treatment plan decisions.
Patient motivation is one of the most important factors in building a successful practice. If you are just “selling dentistry,” patients see you as providing a product. Once they have purchased the product, their loyalty wanes. Loyal patients will look to you to lead them to make the right decisions concerning their dental health and will refer to your practice. Before you can motivate a patient to accept the needed dental care, there is usually an obstacle to overcome.
I have found that there are basically three major obstacles that prevent patients from following through on proposed treatment: fear, finances, and time. Fear of the dentist has always been a deterrent to dental care. Patients have many fears, such as fear of the needle, fear of pain, and fear of swallowing something. Many patient fears can be dismantled. When a patient exhibits fear, take the time to discuss it, showing a caring attitude and empathy. You can then proceed while reassuring the patient what he or she feared is not as big of an obstacle as it might have seemed.
Finances are also an obstacle. With third-party financing options available, many of which offer 0% interest for a predetermined amount of time, most patients are able to afford basic dental care. Private in-office dental plans are another option. For many people, dental treatment is a discretionary expense, except when there is a painful or infectious situation. Hence, a vacation sounds better than needed dental care. Almost any purchase sounds better than dental care. This is because these patients have not placed value on dental care. For these patients, it most likely boils down to two questions: Do I need or value this care? Can I fit this care into my budget and schedule?1
Value is the perception that you received more than what you bargained for, and it is not just about the money spent. Patients can find value in a better smile, better chewing, a more comfortable visit than expected, or your practice accepting their insurance.
Value has been described as3:
functional benefits + psychic benefits
monetary costs + time costs
value perceived ≥ price paid
Once patients place value on your services, the first base of motivation, you can further engage and motivate them. Motivation is built upon a base of value and three pillars: an appropriate goal, knowledge, and a positive attitude. The goal must be an attainable goal. If the goal is unattainable for a patient, then the patient will not become motivated. The patient will become unhappy if his or her expectations are not met, and the dentist will become frustrated in attempting to work toward a dentist-driven treatment plan that is unattainable for the patient.
The proper attainable goal for a patient depends on his or her “dental IQ.” The higher the dental IQ, the easier it will be for you to motivate the patient because he or she already has placed value on dental services. However, most patients do not have such perspective. Raising a patient’s dental IQ can raise the value of treatment for the patient, turning his or her needs into wants.4 Through proper listening and communication skills, you can elevate the patient’s dental IQ. You will have educated the patient regarding dental health and made a previously unattainable goal a true possibility, and the patient will place value in this.
Giving patients knowledge of dental health can allow you to lead them to good decision-making. With full-screen images, patient education videos, and educational models, you can educate patients about their needs easily. It is the entire office staff’s responsibility to engage patients in the effort to raise their dental IQs so they will place value on your services. With a little change in your patients’ attitudes toward dental care, they will become more motivated.
Patients’ attitudes may be deeply rooted in poor information, negative past experiences, cultural perceptions of dentistry, and many other things.1 You can build a lot of trust in your doctor-patient relationships, which will help your patients feel connected to the office.
Attitude is the most delicate because it can change quickly when expectations, outcomes, or value diminish as the dental care proceeds. Patients should be informed that some unexpected, unforeseeable situations may occur that will need attention and care for proper treatment outcomes. To help patients understand the order of a complex treatment plan and the potential unexpected, unforeseeable situations, they should be told that the order of treatment will be based on four areas in the following order: pain, infection, function, esthetics.
As the treatment plan progresses, if there is an unexpected setback involving pain, then pain becomes the top priority. This gives patients the sense of some control over the course of treatment. Infection includes caries, periodontal, and endodontic issues. Function is next, since you have to make sure you are not “building a house on quicksand.” Esthetics obviously crosses over all areas when necessary. Constant reassurances throughout the course of treatment can help patients maintain a good attitude.
Therefore, in summary, to motivate a patient, you must have proper focus on the way you communicate with the patient. To do so, you must:
• be the foundation of trusting doctor-patient relationships;
• not be condescending, controlling, or overbearing with patients;
• not take a one-sided approach (i.e., “the doctor’s way or no way”);
• provide an avenue for feedback, which may be shaded with individual patients’ cultural dental beliefs;
• be aware of your patients’ perspectives of dentistry;
• be flexible and understanding of patients;
• engage patients to help them feel included in treatment plan decisions;
• be truthful, honest, and sincere;
• be ethical and knowledgeable;
• be clear; and
• have your entire staff embrace the communication effort.1
Motivation is multifacted and different for each patient. There is no single method for motivating patients because each patient has different values and motivators. To motivate a patient, you must take the time and understand the patient’s obstacles, values, and motivators.
1. Graskemper JP. Leadership and Communication in Dentistry. Hoboken, NJ: John Wiley and Son; 2019:61-76.
2. Young LB, O’Toole C, Wolf B. Communication Skills for Dental Health Care Providers. Hanover Park, IL: Quintessence Publishing; 2015:73.
3. Tybout A. Kellogg on Marketing. 2nd ed. Hoboken, NJ: John Wiley and Sons; 2010:188.
4. Graskemper JP. Professional Responsibility in Dentistry: A Practical Guide to Dental Law and Ethics. Ames, IA: Wiley-Blackwell; 2011:101.
JOSEPH P. GRASKEMPER, DDS, JD, DABMM, DABLM, FAGD, FAES, FICOI, FASO, FACD, FACLM, is an associate clinical professor at Stony Brook School of Dental Medicine, where he teaches professionalism, ethics, and risk management. Dr. Graskemper has authored many peer-reviewed articles, lectured, published nationally and internationally, and recently published two books, Professional Responsibility in Dentistry: A Guide to Law and Ethics and Leadership and Communication in Dentistry. He may be reached atfor comments or consultations.