Our appointments often consist of 90% clinical skills to help patients get rid of stain, plaque, calculus, or disease. We provide therapy to support patients on the road to a healthy oral environment and systemic well being. We often get frustrated because we feel we're working harder than our patients, and as soon as they leave our treatment room, they'll go back to the stain, plaque, calculus, or unstable state of their mouths.
We have honorable intentions in our "educate and implore" self-care instructions. We hope that the more information we provide patients about their conditions, we will eventually hit on a reason that will cause them to change. We hope the next time we see them they will not have reverted to their old ways of no flossing or brushing or water picking, etc. If education were the only tool needed for positive change, then no one would smoke, drive drunk, or eat double/double cheeseburgers.
In school we learned entry-level information about behavioral science. Yet we spend our early years in dental hygiene developing our clinical skills and knowledge, and the importance of these behavioral principles are forgotten after we pass our final exams.No matter how proficient or up-to-date we are on the newest product or clinical technique, our power as hygienists is still limited when it comes to non-compliant or reluctant patients. What I've found is that hygienists are very good at solving problems such as dental hygiene diagnosis and restorative treatment options, and providing solutions and product recommendations. Many are extremely confident that they can solve any of their patients' oral health issues, and they enthusiastically tell patients what to do. Yet preaching about and influencing behavioral steps are not congruent self-care strategies. This is where the world of coaching combined with solid psychological theory and evidence-based practice is allowing us to learn new tools and skills for influencing positive behavior in patients.
We need to be the experts and guide patients based on their values and oral health needs. Yet when patients do not agree to our recommended treatment plan or self-care product advice, we often become defensive or judgmental of the patient. Bringing in the coaching perspective can help us build on what is working with the patient's oral health rather than trying to fix or judge what is not.
Coaches believe that their clients, or in our case patients, can find their own answers. Many of us are fortunate in that we have strong relationships with our patients. This is imperative in moving away from being the "expert" to the "coach." Yes, we must provide our professional skill, expertise and judgment, yet we can allow patients to reflect, clarify, focus and make decisions that meet where they are in their health, not where we think they should be.Coaches help people align their most important life value with their goals, thereby connecting with the person they want to be. Many clinicians are making strides learning what their patients value. Discovering what is important to patients regarding their oral health (i.e., white smile, chewing on both sides of their mouth, being caries or inflammation free, running errands at lunch or after work) gives us a powerful opportunity to learn coaching processes and add them to a systematic system in our clinical practice. The coaching model can transform the way we work with patients.
An interesting distinction between what coaches do and what clinicians do is that coaches focus completely on the other person's agenda. They silence their own agenda (i.e, updating X-rays or selling services) and ignore the voices in their heads that are dying to tell clients what to do. Have you ever had a very inquisitive patient? Or a patient who came in for a hygiene visit, yet had obvious dental concerns that needed to be addressed? Think back to whether or not you embraced all the questions and welcomed the time for learning, or whether you were thinking, "If this patient doesn't stop talking I'll never get anything done." Do you ask patients with problems why they didn't alert the office about their concerns, "because this is hygiene time, and we did not schedule time for a toothache?" Or are you able to move away from the scheduled treatment to really focus on what is going on with the patient at that exact moment?
Hygienists who use coaching skills focus on asking powerful, open-ended questions, such as what would it take for you to keep your hygiene visits, remove your dentures once a day, or clean between your teeth? Asking open-ended questions or inquiring with compassion sends the message, "I believe you know the answer and can solve this problem." Once we help patients connect with their values and identify behaviors they can perform, such as power brushing, mouth rinsing, and keeping the next appointment, this takes the focus away from a "defeatist attitude." With this coaching approach, it doesn't take long for patients to feel more positively about their oral health.
Hygienists with coaching skills navigate discussions so patients have "ah-hah" moments. The patients find the truth, evaluate possible solutions, decide to take action (or not), and commit to the next step, such as scheduling a restorative appointment, applying for CareCredit, or purchasing a self-care aid. Learning to "coach" instead of "tell" teaches that we do not need to jump right into a conversation about solutions. I often see hygienists who are unsure about a problem, yet plunge in with more "solutions" to the perceived problem. Having the skills to allow patients to feel empowered or at least part of the process will open the door for their commitment to move forward. The key is to allow patients to work harder than we do to find a solution. This requires training and practice. So after all the fact gathering, assessments, and diagnoses are complete, we can switch to a coaching hat that gives expert advice no more than 50% during patient education, and devotes the other 50% to helping patients develop their own answers for their own sustainable behavior.
Acknowledgements: My emerging coaching skills could not have been possible without the mentoring of Joseph Williams III, DDS, MAGD (www.nhdentist.com) and Patty Mansfield. Each day at the office they are my mentors who inspire me to learn and trust in the coaching process.
Kristine A. Hodsdon RDH, BS
Contact Kristine at [email protected] for information about her newest "well-being" and "coaching for behavioral change" CE programs.