Mastering the art of communication

April 1, 2000
3M Dental is proud to sponsor the Dental Economics year-long "Mastering the Art of Communication" series.

Part 4

The Art of Helping Patients Choose

3M Dental is proud to sponsor the Dental Economics year-long "Mastering the Art of Communication" series.

Sandy Roth

Almost anyone can afford almost anything he wants.

Almost no one can afford everything he wants.

Almost no one wants everything he can afford.

Indeed, every person must make choices about how to use his or her personal resources. The way in which your patients go about making those choices, however, can be both confusing and frustrating if you don`t understand a few simple, yet important, principles of human behavior. In this fourth installment of our series, Mastering the Art of Communication, I`ll introduce some of these principles to help you better understand the people you serve through dentistry.

Every day, people make hundreds of small and large decisions about how to spend their personal resources of time, money, and energy. Just how do people go about making these decisions? On what basis do they choose from among the vast array of options available?

Although the process is highly complex and unique to each individual, some elements are easy to understand and are common to us all. The first is that human beings are motivated to spend personal resources in ways which they believe will improve the quality of their lives. If we believe the choice will make our lives better, we are more inclined to select it, all other things being equal. Choices which we perceive will make our lives worse are avoided.

Now, decisions sometimes turn out to be bad ones or result in consequences that we would rather have avoided. But, in the moment and without the benefit of hindsight, we can almost always justify a choice through rationalization. That`s the process of searching for and locating enough good reasons to support a particular option. For example, we all know cheesecake is loaded with sugar, fat, cholesterol, and calories. Yet many people can periodically justify eating a slice because "It`s a special occasion," "I`ve been so good all week," or "The pastry chef in this restaurant is famous for her cheesecake, so it would be a shame if we didn`t try it." In hindsight, we can lament the choice, wishing that we had not done it or had done something else. But that doesn`t change the fact that, in the moment, we made what seemed to be the right choice under the circumstances.

You probably have received some advice about how to get people to make the choices you want them to make. I`ve heard much of this advice as well. You may have heard that good communicators can get people to do the right thing by focusing on the benefits. Likewise, you may have been led to believe that the goal is to get people to want what they need. Or perhaps you have heard it said that successful communication is overcoming objections.

I see these concepts differently because each of these ideas fails to acknowledge an important principle of choice-making: people make choices for their reasons, not yours. The advice that we have all heard is based on the presumption that you are in a position to know better than your patients what is in their best interest. I take issue with that notion. Although you may be an expert on clinical dentistry, your patient is an expert on himself or herself. You must not ever get that distinction confused. Your clinical expertise and opinion guide you in identifying problems and opportunities, as well as suggesting solutions and treatments. Your patients` expertise will guide them in determining what problems and opportunities they wish to respond to, as well as what choice they will select when they do respond.

Moreover, you will never know enough about a patient`s life to presume to know better than he what is in his best interest. Your patient will always be in a better position to make a decision than you. Patients` lives are complex, so the casual and sometimes superficial relationships dental practices have with their patients leaves them ill-equipped to judge what is really in the patient`s best interest. Knowing about a person`s hobbies, children, or pets is nice, but these bits of social information can`t be confused with really knowing a person.

Dentistry is just one choice among many in a person`s life. Although you may wish that a patient had chosen dentistry rather than a trip to Hawaii, you cannot know if dentistry is more important than a vacation in that person`s life. That choice is his alone. Thus, good communicators are skilled at helping people make choices first by understanding what is important to them and second by supporting their process of prioritizing. The following example will introduce the choice-making model which is the centerpiece of this article.

Last year, my husband, Doug, and I bought a new car. For the past 10 years, we had had just one car, and I often found myself without transportation when I wanted it. After some discussion and preliminary research, we went to a dealership, where we were helped by a salesman who asked lots of questions about why we wanted a car and how we intended to use it.

We told the salesman we wanted a second car for weekend outings in nice weather and to provide me with some fun transportation (outcome). After listening to us and asking a few more questions, he recapped what he had heard and invited us to test drive one car which he thought would fit the bill (means). If we had intended the vehicle for shuttling children or hauling tools and equipment, he would have recommended something other than the sporty convertible he suggested (and which we eventually purchased).

When we agreed that the car he suggested was the one which fit the purpose, we had to sort out whether we wanted it enough to pay the cost (prices). Because we`re normal people, of course, we wished it had cost less, and we took some time to think about it (price-testing). Because we are normal people, we had to decide what to forego in order to have the car. (Remember, almost nobody can afford everything they want.) We had to decide when it would be right to buy the car, given our other obligations. Our experience with this salesman provided a great example of someone who knew how to facilitate choice-making. He had mastered the two skills I introduced in the last two installments of this series: asking questions and listening. He understood that the right car for one person could easily be the wrong car for another. To help us make our choice, he helped us clarify both what we wanted in a car and why we wanted it.

* Desiring an outcome. Outcome is the answer to the question, "What will we have accomplished when we are successful in working together?" Outcome is the meaning of the dentistry to the patient. Outcome is how the patient`s quality of life would be changed positively by the services offered in the dental practice. Outcome is what gets a person to walk into your door and what keeps him or her coming back. From your patient`s perspective, outcome can only be understood in lay and social-oriented terms because outcome is not the hardware of dentistry.

Patients do not want crowns, bridges, prophies, implants, or veneers. They might want what a crown, bridge, prophy, implant, or veneer could do to improve their lives, however. This is the meaning of the dentistry to the patient and what you must listen for and understand if you are going to help people make choices. For example, when people tell you they are interested in improving their appearance, they are talking about an outcome: how it looks. When they seek comfort (or the elimination of discomfort), they are identifying an outcome: how it feels. When someone tells you he wants to eliminate food trap areas or clicking dentures, he is identifying an outcome: how it works. When patients express an interest in greater confidence that their dentistry will last and not let them down, they are talking about an outcome: peace of mind.

At the end of the day, outcome is solely the domain of the patient. You might wish a patient valued appearance more highly, but you don`t get a vote. Certainly, you can invite a patient to consider another outcome and you can attempt to influence his thinking, but outcome must be owned by the patient before he can participate in creating solutions. The automobile salesman was wise not to try to convince me that I should want a vehicle for hauling heavy loads or for shuttling a soccer team to practice. Neither of those purposes is part of my life, and I would have quickly moved on to a dealer who could help me select a car for my purposes.

* The means in your tool box. Means refers to the methodologies, hardware, and clinical services you have to offer. I like to think of them as what`s in the dentist`s tool box. The dentist has full responsibility for identifying the means which she is prepared to offer. In this arena, patients do not get a vote, just as you do not get a vote about your patient`s outcome (and, as you will see, the prices he is willing to pay).

No one can make the dentist offer any means which falls below her standard of care nor force her to provide any service which violates her clinical integrity or philosophy. The means question is simple: "What, doctor, in your professional opinion, are the ways to achieve the outcome your patient wants?"

* Adding up the prices. Prices are all of the varied costs the patient must pay in exchange for the services (means) to accomplish the outcome. Time, money, energy, courage, and comfort are the five prices each patient might potentially pay for what he wants.

Again, you do not get a vote about what prices the patient is willing to pay. There are some people who have the money, but who lack the courage. Others are very comfortable with dentistry, but are not willing to take the time. Still others are able and willing to pay all the other prices, but are not willing to spend the personal energy necessary.

* Is the outcome worth the price? The process of price-testing requires a patient to determine whether he or she wants the outcome (not the means) enough to pay the prices. Doug and I had to determine whether we wanted the outcomes the car would give us enough to pay the prices to get the recommended car.

If the outcome is perceived as worth the prices, the patient will authorize you to provide the service if the prices necessary also are affordable. That is, the patient may agree that the outcome is worth the fee, but may not find the fee affordable, given other financial or time obligations. Thus, price testing involves both worth and affordability.

Choice-making is the process of price-testing outcome

The service of helping people make choices requires an understanding of the difference between clarifying outcome (patient work supported by members of the team), determining appropriate means (dentist work) and testing prices (patient work, again supported by members of the team).

We all know that many patients get stuck when it comes to questions of price. For some, the barrier is money. For others, it`s time. These patients are not yet ready to pay the prices necessary for the dentistry. I often find that patients who are stuck cannot get unstuck because they haven`t developed a clear sense of outcome. When this is the case, they are price-testing means, not price-testing outcome. Listen to the difference between: "Does Mrs. Jones want a bridge enough to pay $X?" and "Does Mrs. Jones want confidence and peace of mind enough to pay $X?" The distinction may sound minor, but I assure you it isn`t. Patients who have a clear sense of the outcome are more often able to make the best choices because they are choosing what they value. In the absence of a clarified outcome, no amount of convincing or expert advice will make up for this major missing piece. Focus on outcome until everyone is clear about what you are trying to accomplish together.

People come to your practice wanting your opinion. But unless they believe that opinion will help them accomplish something important to them, they will either disregard it, talk it over with their husbands forever, delay responding, ask for another predetermination, question your motives, or perhaps even leave the practice and go elsewhere. When you focus on learning about outcome and supporting people as they go through the natural process of price-testing, you become better communicators because you help more people make their best choices.

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