Pain as a Motivator: Part II
As part I of this article detailed, one of the most essential
elements that contributes to the establishment of a proper pain management plan
is the determination of a patient's preoperative treatment objectives. While
numerous subjective factors contribute to the motivation of each patient, these
individuals demonstrate several unifying characteristics. In the broadest
sense, patients' motivation can be divided into two categories:
- The pursuit of something.
- The avoidance of something.
It is essential for the clinician to ascertain which category best
describes each patient in order to adapt treatment accordingly.
People who approach dentistry in a positive light have a
desire to accomplish definitive objectives. The patients may wish to enhance
their health and well-being, look better, feel more confident, or just improve
themselves. These patients traditionally approach life in a positive manner.
Even if they are in a painful situation, these people may still be motivated
beyond that physical reference in order to achieve a more positive existence.
The manner in which these types of people present to you may at first not be
obvious. While "positive thinkers" are often stereotyped as smiling,
enthusiastic, and jovial, that is not always a valid description. Although
patients may not exhibit the aforementioned characteristics, they may be
bolstered by a good attitude that affirms their approach to life.
Patients who operate on an avoidance value system will
approach dentistry as an attempt to avoid a greater problem. People in this
classification may be motivated by previous painful, embarrassing, or stressful
experiences that they do not want repeated. As with positive patients,
society's mental image of this kind of person may not be entirely accurate.
Such patients may not be all "gloom-and-doom" but rather actually
pragmatic in their approach to life, preferring to be regarded as realists
instead of pessimists. Despite the efforts of countless researchers and
healthcare workers, pain is inherent in human existence.
How can a clinician distinguish between the two? The most
straightforward approach is to question the patient. In their descriptions of
what they desire from the clinician, patients will reveal their frame of
reference. While a positive person often commences with a statement such as
"I want," a patient on the avoidance system will begin with "I
don't want." A positive person will speak in terms of benefits he or she
seeks (ie, "I want implants so I can chew better."). A pessimistic
patient speaks in terms of negatives (ie, "I don't want to have a lower
denture that floats around.").
Which of the two is the better patient? In actuality, both
are equally good or bad, according to how the situation is handled by the
clinician. Patients can be perfectly satisfied and will be loyal to a practice
as long as the clinician has determined the treatment objectives with a degree
of accuracy.1 Positive and negative patients, however, can be
quickly dissatisfied with inadequate treatment. Approach-oriented people may
leave a practice if they're not satisfied, knowing that the next clinician will
fulfill their objectives; negative patients may exhibit the same behavior,
hoping that the next clinician will be more capable.
The key to the successful treatment of either type of
patient is in the listen - cushion -
question- answer formula. Knowing the patient's desires and requirements
prior to the initiation of treatment will provide an accurate objective for the
treatment. Both types of patients will respect a clinician for the concern and
knowledge that enables the provision of excellence in dentistry.
CR. Pain as a motivator. Pract Periodont Aesthet Dent 1998;10(3):330.