Health care professionals are consistently focused on providing evidence-based and up-to-date treatment and advice on oral health practices. We don’t know how our patients process this information and the guidance provided to them. Are we assuming our time and effort spent educating and providing oral hygiene instruction is a waste?
Motivational interviewing is a different approach to educating patients to improve their oral and systemic health.
Understanding the Value of Dental Care
Years ago, I worked at a dental office in White Rock, British Columbia. My boss and his office thrived off a business theory incorporating empathy, compassion, and sentiment. We collaborated daily on how we approached patients, presented treatment, and delivered care that patients valued, required, and deserved.
I didn’t realize we were eons ahead of our time then! However, I pondered our approach because my colleagues at different offices didn’t practice this way. Often, I wondered if we cared too much about what the patient wanted or thought about dentistry versus directly telling them what they needed.
I often encountered patients who needed help understanding the value of treatment and the quality of care being proposed. There was a massive disconnect between the quality of care and dollar value in exchange. Some patients are inclined to think that dentistry is expensive and that some treatment options are unsuitable or financially unavailable.
This tends to be a preconditioned mindset that North Americans seem to have regarding dental care. Many of these thoughts arise from an inadequate understanding of the need for care. Some may argue that consumerism also consumes the average human, validating dental care to be thrown onto the back burner.
For the most part, compliance is achieved with most of our patients. After all, we preach to the choir in our chairs. At least, I like to believe that. However, we still battle with the resistant few.
Motivational Interviewing
I recently learned more about motivational interviewing (MI) through my degree program and its implementation in the dental setting. We want to focus on emotionally supporting the patient through open-ended questions, counseling them to verbalize their wants and needs, listening to the patient, and encouraging behavioral change via positive reinforcement.
Motivational interviewing comprises several stages:1
Expressing empathy: Understanding patients internally and validating their emotions and limitations (physical, financial, or mental).
Developing discrepancy: Highlight the difference between the patient’s current behavior and the benefits of a changed behavior.
Rolling with resistance: Allowing the transition to take time and reinforcing positive minor changes moving in the right direction.
Supporting self-efficacy: Validating emotion and encouraging consistency with change implemented or transitionary.
The essential foundations of a successful approach to initiating behavioral change are all hidden in these few stages. As providers, we never want to come across as aggressive or dismissive of the patient’s personal beliefs and values. Patients like to feel in control and in charge of their financial and dental well-being.
We want to overcome resistance to dental treatment and treatment options. By collaborating with the patient’s personal goals and financial limitations, we will create a mutual understanding of treatment options. Open-ended conversations about the patient’s desired outcome will ignite intrinsic motivation and rule out other factors with the patient.
The idea is to enable the patient to create a substantial internalized behavior change towards dental care, which can only be self-induced.2 As providers, we only guide the conversation and behavioral change with positive and constructive feedback. Remember that change is never overnight and may require days, if not weeks, before results are palpable.
With the correct implementation of MI, a practice can change significantly. You will see a healthier patient base and an increase in patient case acceptance and compliance. This may be harder to implement in larger group practices that don’t offer consistent and calibrated care among practitioners. However, if implemented correctly, the impact on the patient’s oral health can be substantial.
In Closing
If you haven’t already, I suggest taking a course or reading a book on motivational interviewing and behavior change and the impact it can have on patient care. Although it may seem like a concept that leaves you with little control as the provider, you are still in control via a different approach to caring for patients.
The journey of implementing MI will only bring you a better understanding of your patients and their goals, values, and potential. It’s just about asking the right questions and being patient during the change.
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References
- Gillam, D.G., Yusuf, H. Brief Motivational Interviewing in Dental Practice. Dent J (Basel). 2019; 7(2): 51. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6631588/
- Catley, D., Goggin, K., & Lynam, I (Eds.). (2010). Motivational Interviewing and Its Basic Tools. In C. A. Ramseier & J. E. Suvan, J., Health Behavior Change for the Dental Practice (pp. 59-90). Willey-Blackwell.
