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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. 

 

Positive

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.

 

Negative

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.

 

Classification

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.

 

Reference:

  1. Brown, CR. Pain as a motivator. Pract Periodont Aesthet Dent 1998;10(3):330.
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