Compliance vs. Commitment

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

Compliance vs. Commitment

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There are two distinctly different ways patients can say “yes” to treatment. Some say “yes” because the dentist has positional authority and is perceived to be the “expert.” In this case, the patient COMPLIES without significantly understanding what is going to happen or why the treatment has been proposed.

On the other hand, others make much more deeply informed choices through facilitated choice-making. These decisions are based upon their values, goals, and vision for themselves going forward. These decisions represent COMMITMENT – commitment to seeing the process through AND to an outcome they significantly value.

Achieving commitment* is an essential step when providing complex restorative, esthetic, and/or expensive treatment. (Commitment is less critical when proposing less expensive primary or emergency treatment).

Problems arise when patients COMPLY but do not fully COMMIT, particularly when some aspect of the treatment process goes off-course…it was more uncomfortable or inconvenient than anticipated…the implant failed to osseointegrate…the crown was never comfortable to chew on…the new fillings were sensitive…the root canaled tooth always felt odd…the front teeth never looked exactly like they thought they would.

These discrepancies potentially create resentment, or a level of disappointment which may or may not be expressed. In some cases, the patient might even leave the practice as a result without ever saying a word. And of course, in the worst case scenario, the patient might pursue legal advice.

Co-discovery, pioneered by Bob Barkley, was designed to help patients to more consistently move toward commitment. And this is important, because complying is not necessarily collaborating, and therefore it does not always involve the patient taking ownership of their problems – a critical boundary issue and key to successfully resolving the inevitable unexpected challenges which can occur along the path of a complex treatment process.

Commitment is different as it IS more collaborative, and therefore when problems or challenges arise, there is an openness within the relationship to discuss, negotiate, and more easily resolve them. It places ownership in the right place ( via a shared – interdependent relationship ). Commitment should always be the goal for every relationship, and being patient and willing to wait for it to emerge via facilitation is the key to success- because compliance without commitment is a dangerous place to be with others.

Paul A Henny, DDS


* Commitment requires a psychological process that Jean Piaget PhD called “adaptation” where significant adjustments are made by this person with regard to their perspective and how they approach a problem. With commitments, often times fundamental assumptions have been changed – “paradigm shifts” which are both significant and values-based.

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