Leverage the Psychosocial Aspects of Practice

At every level, health care providers are in the people business. If clinicians are not successful in their relationships with patients, colleagues, friends, family and the community at large, they will never be fully satisfied with their professional or personal lives. With the fundamental health care goal of helping patients achieve optimal health, let’s explore ways in which dental professionals can improve their clinical — and interpersonal — success.

In a previous guest editorial (“Pathway to Professional Excellence,” July 2016; available at decisionsindentistry.com), I suggested that satisfaction, joy, security and a sense of value to others are the foundations of a happy life. The editorial also examined the path of professional development, noting that while prelicensure dental education concentrates on technique and biology, the personal, business and psychosocial aspects of professional life become our individual responsibility (Figure 1). After graduation, these must be learned and refined in a self-directed, lifelong learning endeavor.

It has been said you cannot lead others where you have never been. Consequently, understanding ourselves — and why we do what we do — is essential to understanding why others act as they do. Health care providers who practice with a patient-centered, wellness-oriented philosophy will find the following tools useful, as they are designed to help dentists and their teams identify “where they are,” as opposed to where they wish to be. These tools provide a broad introduction to the psychosocial aspects of health care practice. By utilizing key resources and remaining open to personal growth, clinicians can improve their interpersonal skills while helping patients achieve better oral health.

• Aptitude tests measure an individual’s strengths and challenges¹
• Empathy evaluations measure the ability to understand and relate to others²
• Didactic background knowledge underlies a broader and deeper understanding of psychosocial skills^3–11
• Individual, customized counseling/coaching is critical to behavior modification and growth^12,13

HUMAN BEHAVIORAL DRIVERS

Survival is the most basic behavioral driver, followed by our need for safety, belonging and affection, self-esteem and self-actualization (Figure 2). Although we fluctuate among these levels many times in life as circumstances change, the ability to achieve each higher level rests on our success in fulfilling and maintaining lowerlevel needs. Patients struggling with survival and safety needs, for example, have different priorities than individuals living at the upper levels. Helping patients thrive should be a priority, but health care providers must consider the level at which a patient is operating — and modify their professional approach accordingly.

BASIC PATIENT DESIRES

The common denominators of patient desires for dental outcomes are consistent. Patients wish to:

• Avoid pain, either from disease or treatment
• Have an attractive appearance
• Chew well
• Maintain their natural dentition for a lifetime
• Keep dental costs “reasonable” (by their definition)
• Like and trust their dental team, and have confidence that patient concerns rank above office concerns

Each day in practice, dental teams have an opportunity to help patients achieve these goals by motivating individuals toward lifestyle and health care choices that will lead to overall wellness. Building strong interpersonal relationships among teams, patients, families and communities will facilitate success in this endeavor, and provide the emotional and professional rewards that health care providers seek.

Toward this end, reading, study and practice are necessary to ingrain a patient-centered, wellness-oriented philosophy in each team member. Outstanding dental offices manifest common emotional features that reflect these basic patient desires. Because typical oral health care curricula tend to be weak in this area, a key component of a team’s continuing education focus should be building powerful interpersonal relationships with patients. This begins with the first contact, and matures as the team continually reaffirms a patient-centered strategy that will motivate patients to achieve their health care goals.

Psychosocial Resources for Health Care Professionals

Didactic background for contemporary nonpathological human behavior began nearly 100 years ago, as psychotherapists realized that, in addition to the psychotic and neurotic patients treated and studied by pioneers such as Freud, Jung and Adler, “normal” individuals were seeking therapy to improve interpersonal relations and accelerate personal growth. This led to the creation of the field known as humanistic psychology. In 1954, Abraham Maslow, one of the field’s developers, explored what he called the “hierarchy of needs” in Motivation and Personality.³ Carl Rogers studied under Maslow, and, in 1958, published a landmark paper enumerating the characteristics of helping relationships (Table 1).⁴ Nate Kohn and Ed Green relied heavily on the principles of humanistic psychology in their 1970 text, Selection, Hiring, and Training of Dental Auxiliaries.⁵ In 1971, Art Combs and David Gonzalez wrote Helping Relationships: Basic Concepts for the Helping Professions.⁶ Further refinement in helping-profession strategies took shape in Daniel Goleman’s 1995 best seller, Emotional Intelligence: Why It Can Matter More Than IQ,⁷ which was followed by books from Bill Miller and Steve Rollnick about motivational interviewing.⁸ Lynn Carlisle’s In a Spirit of Caring⁹ and his more recent Motivational Interviewing in Dentistry: Helping People Become Healthier¹⁰ provide insightful summaries of relationship-based, wellness-oriented dentistry. Expounding on the patient’s view, David Clow’s A Few Words from the Chair: A Patient Speaks to Dentists¹¹ offers perspective that clinicians may find helpful. Other resources — including those offered by Bob Frazer,¹² Allison Watts,¹³ Don Deems,¹⁴ Mike Robichaux¹⁵ and Bill Brown¹⁶ — help crystalize these concepts as they apply to dental practice. Knowingly or unknowingly, many of today’s leading dentists rely on these principles in daily practice.

REFERENCES

1. Johnson O’Conner Research Foundation. Available at: jocrf.org. Accessed October 12, 2016.
2. Empathy Quotient. Available at: psychology-tools.com/empathy-quotient. Accessed October 12, 2016.
3. Maslow AH. Motivation and Personality. 3rd ed. New York: Harper and Row; 1970.
4. Rogers C. The characteristics of a helping relationship. Personnel and Guidance Journal. 1958;37:6–16.
5. Green EJ, Kohn N Jr. Selection, Hiring, and Training of Dental Auxiliaries. Philadelphia, PA: WB Saunders; 1970.
6. Combs AW, Gonzalez DM. Helping Relationships: Basic Concepts for the Helping Professions. 4th ed. Boston, MA: Allyn & Bacon; 1971.
7. Goleman D. Emotional Intelligence: Why It Can Matter More Than IQ. New York: Bantam Books; 1995.
8. Rollnick S, Miller WR, Butler CC. Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York: Guilford Press; 2008.
9. Carlisle L. In a Spirit of Caring, Revisited. Kindle Edition: Amazon.com; 2011.
10. Carlisle L. Motivational Interviewing in Dentistry: Helping People Become Healthier. Kindle Edition: Amazon.com; 2014.
11. Clow D. A Few Words from the Chair: A Patient Speaks to Dentists. Amazon.com; 2008.
12. Frazer RL. Success Strategies for Dentists and Dental Teams. Available at: frazeronline.com. Accessed October 12, 2016.
13. Watts A. Practicing With the Masters. Available at: itunes.apple.com/ us/podcast/practicing-with-the-masters/id947061776?mt=2. Accessed October 12, 2016.
14. Deems D. The Dentist’s Coach: Build a Vibrant Practice and the Life You Want. Available at: drdondeems.com/dental-coaching-books. Accessed October 12, 2016.
15. Robichaux, M. Wellness Is a Shared Experience. Available at: mikerobichauxdds.com. Accessed October 12, 2016.
16. Brown B. Dental Intelligence. Available at: http://dental-intelligence.com. Accessed October 12, 2016.

From Decisions in Dentistry. November 2016;2(11):12–14.