I saw this quote from Dr. Donald Berwick, the Director of Medicaid and Medicare and it really made me think. He said, “Healthcare is broken. We have set up a delivery system that is fragmented, unsafe, not patient-centered, full of waste, and unreliable. Despite the effort of the providers, we built it wrong. It is not built for modern times.”
When you really think about it, we could say the same thing about dentistry. We’ve set up a delivery system that is fragmented, unsafe, not patient-centered, full of waste, and unreliable. I don’t think it’s the same extreme as the healthcare system is but there’s a lot of truth in that statement. We see this from patients all the time.
Online we often see posts like ….
“Why do I keep getting cavities? I brush, floss, and rinse with fluoride twice daily.”
“Six months ago I was at the dentist and they didn’t do x-rays and said my teeth looked okay. This time, they did x-rays and said I had 7 cavities and would need a crown!”
“This is my third dentist, and I like him, but he cannot tell me why I keep getting cavities.”
Does this sound familiar? The sad reality is that these patients exist in every practice.
It’s going to take a new level of thinking to turn this problem around. It is often said that “We cannot solve our problems with the same thinking we used when we created them.”
Many practices are focused on repairing the damage, but when we really think about it, we should be focused on preventing the disease in the first place.
Too often patients don’t receive answers, guidance, or instruction on how to prevent the problems, they only receive information on how to repair the damage.
So how do we do this? Through engaging our patients at a higher level, partnering with them in their long-term dental health. In order to do this, we need to talk about how we can motivate behavioral changes. The reality is though, that you can’t motivate behavior changes. Thinking that we can motivate behavior change is an outdated view that removes personal responsibility. Our job is to facilitate behavior changes.
Our job is to build the patients understanding. As a moderator on multiple hygiene forums, I see a lot of scary things. In one practice, the doctor had written on the white board “If patient doesn’t want quads, fine. Write in the chart. Explain. Then give them their free cleaning. Better than the hygienist doing nothing and the patient not coming back.” To me, this is a clear example of lack of engagement. The team is often at a loss for what to do in these situations.
Here is another example – this was from a hygienist, “I worked for an office and did a regular cleaning on a perio patient. After informing the patient, documenting that the patient had perio disease, that patient went to another dental office six months later, and they denied them any cleanings except the scaling and root planing. The patient said, ‘Well, my last office did a regular cleaning.’ New office says, ‘You could sue.'” They did and won.
In both of these examples it was the patients lack of understanding that contributed to their reactions. They perceived that they were being upsold into services that they didn’t need. The patients saw the situation like a car wash – you can choose between the basic or the supreme wash. They didn’t understand that they were dealing with a disease that can become life threatening.
How can we build patients’ understanding? I am going to use periodontal disease as an example, because I think it’s a challenging circumstance that we all face.
To build patient understanding, they need to know what you know. BUT it needs to be explained in a simplified manner so they can understand it. If you have heard me speak before, you have likely heard me talk about the biggest breakthroughs that have come from studying biofilm and its effect on diseases.
There are 500,000 deaths each year from biofilm disease and we now know what we are dealing with – an oral biofilm infection. And we’re learning more and more through science what this can do to the body. We’re dealing with highly resistant, primarily anaerobic bacteria that can cause disease. Some of those are cariogenic but others are periodontopathic. We know a lot more now than we did even five or ten years ago about that biofilm and the risks that exist for the patient.
We’ve seen that the overuse of antibiotics and antimicrobials have contributed to the development of super bacteria that are incredibly resistant. This is what we are dealing with, in chronic periodontal infection. Now if we have a biofilm infection in the mouth, what does it really mean to the rest of the body? If the patient has periodontal disease, we know that the rest of the body is at risk. It wouldn’t be possible to write about all the evidence we have in one article, but I want to share with you a few very compelling pieces of information that you can take back to help you build your patients’ understanding when they have this disease.
So what we’re learning from all of this, if you shared even just a fraction of what I shared with you now when you’re discussing the infection you see in your patient’s mouth, does it help create a deeper level of understanding with your patient about why they need what they need?
This is how we facilitate behavior change. I talked with a couple hygienists who took these ideas back after hearing me speak. One was able to take a patient who had come in for regular cleanings every six months, but had ten-millimeter pockets. He always declined periodontal therapy. By helping build that patient’s understanding, he moved forward with treatment!
Remember, patients don’t know what they don’t know. In building patients’ understanding we have to guide them and help them learn why this is important, why it’s important to them, and why it’s more than just a ‘cleaning.’
We can gain a higher level of patient understanding by asking really great questions, helping motivate and inspire and facilitate behavior. Helping them choose more for themselves. And that’s really part of what our role is helping them chose more. To become champions of patient engagement, we have to understand what our patients value, and help them see the connection between what they value and where they are. This is how we begin to facilitate different behavior to help them achieve their goals.