Staying in the Question - one of the most powerful dental patient communication tools you can use - Part I.
Mary Osborne wrote this article in 1997. I consider it a classic in health-centered or relationship-based dentistry. Mary is a member of the ISOC advisory board.LDC
Staying in the question has more to do with how you come to communication, than what you say.
The strategy is not complicated, but the attitude it requires can be difficult to cultivate.
It is much more than a technique - it is an attitude. It involves letting go of assumptions, refraining from giving information prematurely, and becoming more open. It requires curiosity, patience, and a deep belief that the person with whom you are communicating has something to say which is important for you to hear.
When you learn to stay in the question you can hear the values on which your patients and clients base their decisions about health. You can give them information that responds to their needs. You can engage in communication that is more relevant to them and more rewarding for you.
It's valuable to understand what it means to stay in the question, how it enhances your ability to facilitate the decision-making process of your patients, how it can help you encourage patients to pursue higher levels of health, and how it contributes to the process of co-discovery. We'll also talk about the kinds of questions that contribute to the process, and those that are more likely to inhibit the process.
It's valuable to understand what it means to stay in the question, how it enhances your ability to facilitate the decision-making process of your patients, how it can help you encourage patients to pursue higher levels of health, and how it contributes to the process of co-discovery.
Internal and External Information
We all want our patients to make healthy choices for themselves. We understand the importance of informed choice.
As a dental hygiene student many years ago, I was told that my primary role was that of a dental health educator. Like most in our profession, I believed that all I had to do was give people enough information and they would make good choices for themselves.
Later in my career, consultants told me that my job was to sell dentistry. I was taught the skill of asking questions, which would lead patients to the answers we wanted them to have. I was never quite comfortable in this role. I saw this process as manipulative, and I don't believe manipulation promotes health.
Healthy choices are those that are made freely and without coercion. They are made with clear expectations about outcomes and a clear understanding of the price to be paid in order to achieve the desired outcome. Healthy choices are made with intention.
Helping your patients make healthy choices begins with your confidence that they are capable of making healthy choices. It further requires an assumption that people want to make healthy choices. You may say, "Well, of course." However, I mean you must trust that all of your patients and clients want to make healthy choices - even those who seem to resist your best efforts. Trusting the process with them can be very difficult.
A hygienist that attended a workshop I presented on this subject wrote with great candor that she struggled with really listening well. She said, "Part of my problem with listening may be that with many individuals I don't feel the need to listen because I want to control the conversation." I understand that feeling, and I know that other dental professionals share this sentiment. Our greatest challenge may be to really understand the importance of listening, and to give up our need to control the situation.
We all understand the importance of information in making choices about health. As health care providers, we have traditionally seen ourselves as the people with all the relevant information about good dental health. We are well aware of our responsibility to provide patients with that information. What we need to be more aware of is another source of information just as important to our patients' decision-making process.
The patients themselves are an invaluable source for information, as they come to us with important realizations and knowledge about who they are. The internal information they possess about themselves is just as important to their process as the external information we can offer them.
Dr. Albert Schweitzer once said, "Patients carry their own doctor inside. They come to us not knowing that truth. We are at our best when we give the physician who resides within each patient a chance to go to work."
Our patients and clients pass the information we give them through the filters of their own experiences, fears, assumptions, and values. Clients may not be aware that what they believe to be true, is really an assumption that may or may not be true. They may not be conscious of the way their previous experiences are affecting their feelings about the present situation, or how that could change.
They may not be able to relate the values that play out in other areas of their lives, to the choices they make in dentistry. Helping them access that internal information and make those connections is our challenge. Facilitating their process is our opportunity in dentistry today.
Facilitation bridges the gaps between what we know about dentistry, what our clients know about themselves, and the choices they have to make about their dental health.
Your role as a facilitator is to make it easier for your patients and clients to make healthy choices.
Your role as a facilitator is to make it easier for your patients and clients to make healthy choices. Try to approach your conversations with the belief that better health is something your patients want to achieve but they find various obstacles in their way. You can help them work through those obstacles.
Our role is not to judge their process, but to accept them wherever they may be in the process. Our judgments get in the way of our effectiveness. Our patients will not let us into their process if they feel judged, or have to justify their thoughts and their behavior. Our role as facilitators is to support them in their process.
The most important element of facilitation is preserving the confidence that others can work through their barriers and solve their own problems. Preserving that confidence is not compatible with a need to control the situation. Letting go of that need to control is essential to good facilitation. Even young children can learn to take responsibility for their own health.
They may not be capable of envisioning a lifetime of healthy smiles, but they can learn to make small choices for themselves that empower them to make bigger choices in the long run. For example, we can ask a child to chew a disclosing tablet to see plaque. If he says no, he has made a choice. It may not be the choice we wanted him to make, but it is his choice. It is a harmless choice, and one that empowers him to make future choices.
If another child agrees to chew a disclosing tablet, but doesn't want us to clean off the plaque, that is also a choice. We could ask her how she would get it off. Staying in the question with her may lead to an opportunity to help her brush it off. That's an empowered choice! We could even let her leave the office with red stain on her teeth. That is a choice we can trust a child to make, if we have confidence that she will learn at her own pace. I believe it will be easier for that child to learn to care for her teeth, than it will be for those of us in dentistry to learn to let go of our need to control that situation.
It's not always easy to make healthy choices. We have a responsibility to gently challenge our patients to step beyond whatever factors limit them. These factors include their assumptions, their fears, and their ambivalence. To be effective, we must approach this challenge with genuine acceptance for where they are now in their process to become healthier. We must be confident that they can choose to become healthier. By asking questions you can help them learn about themselves, as you learn about them.
Healthy challenge is a process of co-discovery. I can't know your answers, but I can help you discover them. If I think I already have the answer for you, it isn't challenge - it's nagging. A truly productive challenge assumes that we can access the information we need, we have the ability to make the choices we have to make, and we respect each other's competence and integrity.
One of the most difficult issues on which to challenge patients is smoking. We know the effects of smoking and we have a responsibility to challenge the patient about their habit. On the other hand, smokers frequently feel as though they are being judged when discussing the issue and try to defend their habit.
I would want to approach the subject with great sensitivity. I might say, "Ms. Black, I'm sure you're aware of the health concerns about smoking. I don't want to give you information you don't need, and I don't want to nag you about your smoking. I do, however, want to make sure you know everything you need to know about how smoking affects the health of your mouth. Would you mind talking with me about your decision to continue smoking, what you know about how it relates to your health, and how I can help you best?"
Years ago I had a client whose name was Takeo. He was a heavy smoker and had significant perio disease. I told him I was concerned and asked what his thoughts were about quitting. He said he knew he should, and that he would try to stop smoking that day since he was having his teeth cleaned. When he came back three months later he reported that he quit smoking for about two weeks after his hygiene visit but then started again. He said he wanted to commit Hari Kari.
I told him Hari Kari was not exactly health enhancing, and he shouldn't be so hard on himself. Stopping for two weeks was a step in the right direction. I asked him how I could help him. Jokingly, he asked if he could talk to me every two weeks.
Staying in the question, I asked him if he thought that would really help and he said he thought it would. He agreed to call in two weeks to check in. Starting that day, I got a call from Takeo every two weeks for several months. Takeo quit smoking for good.
I'm proud of the part I played in Takeo's process. I share this story to illustrate that genuinely accepting people where they are in their process creates a safe place for them to work through their own problems. I would never have come up with the idea of calling Takeo every two weeks to help him quit smoking. The idea had to come from him to be successful. Takeo helped me learn the power of faith in another's ability to change.
Part II and III will follow.
Staying in the Question - the most powerful dental patient communication tool you can use - Part II.
Staying in the Question - the most powerful dental patient communication tool you can use - Part III.
This article appeared in "Practice Renewal" and was published in 1997.
Mary H. Osborne's Practice Renewal is published by Mary H. Osborne, Resources. This leadership guide accompanies an unabridged version on audio tape. Both are designed to challenge, inspire, and support dentists and their teams.
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© 1997 Mary H. Osborne, Resources. Please share what wisdom you gain with others. Attribution is appreciated.