Know Your Patient

Build your relationships first….then your dentistry. ~ Bob Barkley

Know Your Patient

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We all want to get along and be liked. We also want to make good decisions, so when we make decisions regarding issues that we know little about, we often use a cognitive-social approach by asking our friends for advice, observing other people’s behavior, or seeking out and reading testimonials.

In the world of the social sciences, this cognitive-social approach, is known as “social proof” or “informational social influence”.

Psychologists tell us that we make assumptions about most things via a rather incomplete fact-gathering process often tainted with bias. And sometimes this process may even be completely devoid of facts.

We see this phenomenon frequently in dentistry, as patients enter our practices with all kinds of preconceived notions picked up from their social environment, or through experience – and how much of it is true is unique to the individual.

Some patients function off of ‘survivorship bias’, which is based on our tendency to assume marketplace “winners” are those who are most visible. In other words, in the popularity contest of life, less visible and better options are often not even considered. A current example of this is the growing public assumption that every “all on four” case is successful long-term, and every patient is happy with the outcome. This distorted perception has been created by some very clever and persistent marketing which conveniently skips past potential down-sides.

As a marketing executive friend of mine once told me, “If you are not in the top three of top-of-mind, you may as well not exist.” This marketing truth can open the door to all kinds of moral arguments regarding marketing, and about which our profession has struggled with for over fourty years. I will leave the probing of this issue for another day, but suffice it to say that the “marketing issue” is full of moral fog, and if marketing is not done in a principle-centered fashion, it can lead to some very undesirable outcomes for patients and consequently the reputation of dentistry as a profession.

Our patients also have a tendency for what psychologists call “loss aversion”, which refers to our tendency to strongly prefer avoiding losses over acquiring gains. In other words, we have a psychological tendency to seek out bargains instead of quality, unless a strongly assertive argument and expectation is established for the later. Consequently, the “race to the bottom” with regard to viewing dentistry as a price-sensitive commodity by the public is real, and it is rooted in loss aversion. Hence, establishing a brand expectation for quality is a challenging but essential step for health-centered / relationship-based dentists.

Our patients are also influenced by what is known as the ‘availability heuristic’, which is a little mental glitch in our heads which causes us to assume that the first things which come to our minds are the most relevant to us. For instance, when people think of Delta Dental they think of saving money, and not that the policy is limited to $1000.00 a year, is highly restricted, or that dental “insurance” is really a defined benefit plan which has nothing to do with their overall dental health.

And finally, many of our patients often come to us with a ‘confirmation bias’, which refers to their tendency to search for -and favor- information which confirms their beliefs, while simultaneously ignoring or devaluing information that contradicts those beliefs. An example of this is seen when a patient comes to us believing that all dentists will hurt them, or that any dentist who is not on their insurance plan will take advantage of them financially.

You can easily see from this brief discussion, that the psycho-social nature of our relationships with patients before, during, and after treatment is complex and potentially full of cognitive distortions which can lead to undesirable behavior and poor decision-making. Consequently, successful helping relationships emerge only when we are aware of where potential distortions may lie and tactfully manage our patient’s expectations toward more successful treatment outcomes through collaborative relationship-building, and co-discovery.

L.D. Pankey put it another way, “Know your patient”, because it is the only pathway to health-centered outcomes in patients with complex needs.

Paul A Henny, DDS

Thought Experiments, LLC © 2017


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