Guest Blog: Matthew Allen, D.D.S.

Guest Blog: Matthew Allen, D.D.S.

Learn strategies from DentaQuest Institute consultant Dr. Matthew Allen, D.D.S. about what to do when patients/parents come back and a self-management goal is not met.

We hear this question often, “What do I do when the parents come back and goal is not met?” This is a great question, and first of all, let me congratulate you in the fact that you were able to help the patient set a goal in the first place!  The skills and workflows necessary for good self-management goal setting require that we don’t just add something on top of our existing processes, but we re-imagine new and often better ways to discuss goals with patients.  So if you’ve helped the patient set a goal with re-imagined workflows and skills, you’ve come a long way already!

So what do we do when the patient hasn’t been successful?  Well, let’s step back to the prior appointment before we address this question.  A couple things I like to do after a patient has set a goal:

  1. Ask the patient for permission to follow up at the next appointment.  We don’t want to help a patient set a good goal and then, with a finger-wagging tone, say, “Now you better accomplish the goal because we’ll be checking in with you next time.” We’re not hall monitors, getting people in trouble when they don’t do what they know they should or want to do.  Asking for permission allows the patient to consent to our follow up, and when framed in this way, helps the patient understand that we are partners with them in achieving their goal.
  2. If the patient is relatively confident they can achieve the goal, affirm them in this confidence.  And it’s okay to tell them that you’re still proud of them and here for them even if they DON’T achieve their goal.  “It sounds like you’re really confident you can do it, and based on everything you’ve told me today, I have the utmost confidence in you as well.  If it’s okay with you, I’d love to follow up with this at your next visit (see above).  It sounds like we’ll be giving you lots of high fives for a job well done.  And even if it doesn’t go as well as you hoped, we’ll still be here with lots of high fives, and perhaps we can help you troubleshoot any issues that arise.”

So now, the patient is here, and the parent says they haven’t achieved the goal.  First, and perhaps most importantly for the continued engagement of the parent/patient in both the short and long term, I like to affirm the patient and reinforce our partnership.  “So it hasn’t been going as well as you hoped.  That’s totally okay!  You showed up today, and that says a lot in terms of your commitment to your son’s teeth.  We’d love to help you troubleshoot today, and figure out exactly where you were having issues so you can get back on track.”  Sometimes, the patient is partially achieving the goal.  This is a good time to figure out what has helped the patient find this partial success.  “So on the days where you were able to brush your teeth before you went to bed, what helped you have success on those days?”  We can build on that success.  It’s also a good time to find out from the patient if they have any ideas for closing the gap to 100% success.  “So generally, you’re able to brush most nights, which is great, but you’re brushing at different times every night and find it hard to brush when it’s late and you’re really tired.  What ideas do you have for helping solve this problem?”  Often, the patient will give you an idea that will work for them (brush earlier, set an alarm on phone, put sticky note on mirror, etc), and when they’re coming up with the ideas themselves, the evidence says that they are more likely to accomplish the goal (and stick with it over a longer period of time).

What about the patient who has had no success at all?  “So, you wanted to floss your teeth to keep your gums from bleeding, but you haven’t been able to floss at all since you left our office last time.” In situations like these, I like to find out how important the goal is to the patient using a scaling question (perhaps we didn’t explicitly do this in the previous appointment, and our intuition about the importance to the patient was wrong).  “On a scale from 0-10, where 0 is not important at all and 10 is super important, how important is it to you to start flossing your teeth to help your gums bleed less?”  If it’s super important to the patient, we can return to the question we talked about above.  “So it’s really important to you.  You haven’t started yet, but you’d really like to start and continue on doing this.  What do you think might help you to get started?”  If it’s not important to the patient, it’s then that I introduce the idea that perhaps the goal might not be right for the patient.  “Well, it sounds like you’d like to have your gums bleed less, but flossing doesn’t sound like something that’s super important to you right now.  I wonder if you have any other ideas that you think might be more doable for you to help you achieve your goal?”  And if they don’t have ideas, I often use the Explore-Offer-Explore framework to share ideas with them.  “If it’s okay with you, I’m happy to share some ideas that I’ve heard have worked for other patients.  Great.  I’ve heard that a lot of people like to use a Waterpik (which I’m happy to explain more about if you’re not sure what that is), and other people like to use mouthwash.  I also know that some people are hesitant about using regular floss, but really like the floss picks once they try them.  I wonder if any of those ideas resonate with you?”

That’s a lot, but hopefully gives you all a few good ideas and practical examples of things you can try the next time your patient comes back and isn’t achieving their goal.  And just in case you don’t happen to remember everything above… ☺

  1. Affirm the patient
  2. Reaffirm your partnership
  3. Find places of existing success
  4. Share information and new ideas via Explore-Offer-Explore

To learn more about Effective Communication and Self-Management Goals:

Watch our past Effective Communication and Self-Management Goals webinar here:  https://www.dentaquestinstitute.org/learn/dental-caries-management-pract...