Help your patients think

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

Help your patients think

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Why do rational models such as those used in economics, and classical decision-making theory routinely fail to accurately predict patient behavior? The answer to this question lies within the emerging field of neuroeconomics, which is the confluence of psychology, economics, and neuroscience.

Classic Decision Theory (CDT), is represented by a person making decisions which involve choices regarding a course of action among a fixed set of alternatives with a specific goal in mind. 

The three components of a decision in this model are:

1. Options or courses of action available 

2. Beliefs and expectancies associated with those options 

3. Previous experiences (memories) which are then used to project an expected outcome associated with each option.

According to this theory, people make decisions based on their desire to maximize gains and minimize losses. This represents a rational and logical left cerebral cortex objective type of functioning.

But anyone who has practiced dentistry for a day knows that this model fails to explain many of the decisions people make, particularly when they are complex and influence long-term health. In other words, simple decisions like: “Should I get this filling replaced because it’s broken?” or “Should I let them help me get this tooth to stop hurting?” are rather predictable. But what is much less predictable, is whether or not a person will want us to equilibrate their occlusion and restoratively reestablish proper function and esthetics.  

Or is it really that unpredictable?

It turns out that a person’s beliefs and experiences drive their decision-making. And these represent memories with specific meanings to each person.  So, if we fail to take the time to understand what a person’s beliefs are and what they mean to them, then surely as the sun rises in the morning, their decisions will appear unpredictable to us.

On the other hand, if we know our patients well on both a personal and emotional level, (including their belief system and other thought structures), then the game changes; their likely decisions become quite predictable. 

And then if we add another layer to this by prompting the question to ourselves: “Am I ok with the decision they are likely to make, and is it in their long-term interest?” then the game changes yet again, because we are querying ourselves about the fundamental purpose of our practice.

If we don’t like the way a person’s thinking is influencing their decision-making, then we need to “get them to think differently,” as Bob Barkley used to say. And by this he did not mean manipulation, rather he meant, creating an optimal learning environment in which a person could safely re-evaluate their current beliefs and thought structures so they could see if they are still serving them well.

The re-assessment of beliefs, modification of them, or outright replacement of them represents a right hemisphere process and a brain function known as ‘inductive thinking.’ For this purpose, Bob and Nate Kohn, Jr. designed a very intentional and specific way to facilitate it. They called it Co-discovery, and those who understand how and why it works will find that it can change the way they practice dentistry forever.

Paul A. Henny, DDS


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