Communication skills are critical for the success of a dental practice.1,2 To achieve both practice success and the well-being of patients, dental professionals need effective communication skills to do the following:
- – establish rapport with patients;
- – elicit information from patients that is necessary for the protection of their health and the development of appropriate treatment plans;
- – motivate patients to engage in healthy behaviors;
- – persuade patients to accept treatment plans that are essential for their health and well-being.
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DISC SYSTEM
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Unmotivated patients are a significant challenge for dentists,3 and coping with uncooperative patients also may be a source of stress for dentists.4 Strategies developed by behavioral scientists and human resource professionals may help to alleviate some of these problems. The premise of the DISC system is that people have distinct and recognizable behavioral styles that influence how they interact with their environment. People may be classified as having a "dominant" (D), "influencing" (I), "steady" (S) or "cautious" (C) behavioral style. Dentists and dental team members who learn to recognize patients’ DISC behavioral styles and tailor messages to those styles may have greater success in motivating patients to accept treatment plans and adopt behaviors that are beneficial for their oral health, such as stopping the use of tobacco or increasing the frequency of oral hygiene practices.
William Moulton Marston (1893–1947), the developer of DISC, was a Harvard-educated lawyer and psychologist who taught at American University in Washington and Tufts University in Medford, Mass. Marston, who also developed a rudimentary form of polygraph, first described the DISC behavioral styles in his 1928 book, "Emotions of Normal People,"5 which focused on how people react to favorable or unfavorable social environments.
Another psychologist, John G. Grier, is credited with obtaining the copyrights to Marston’s works and developing a DISC profiling system in 1958.6 Variations of the DISC system have been used widely by psychologists, marketing professionals, human resource personnel and motivational speakers. An Internet search using the Google search engine and the terms "DISC" and "personality" yielded more than 5 million results. Variations on the DISC system and copyrighted tests for assessing peoples’ DISC behavioral styles are sold by a large number of businesses specializing in human resources and interpersonal relations.6–8 In addition, a number of books about DISC have been published.9–11 Many articles in professional journals from such diverse areas as human resources,12–17 real estate,18,19 law20 and business negotiations21,22 describe the use of DISC. I should point out that various advocates of DISC disagree regarding whether it describes behavioral styles, personality types or something else. However, there is general agreement regarding the basic characteristics of the DISC behavioral styles.
The purpose of this article is twofold. First, I briefly explain how to recognize the four DISC behavioral styles, based on descriptions published in the professional publications cited above. Second, I describe how dentists and dental team members, by recognizing DISC behavioral patterns in patients, can communicate better with them and tailor motivational messages to increase the likelihood that patients will accept treatment and adopt behaviors that will improve their oral health.
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RECOGNIZING PATIENTS’ DISC STYLES
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The "D" in DISC stands for "dominant." The person with a dominant behavioral style usually is caricatured in popular cultural stereotypes as the hard-driving business executive: the man or woman with a "take no prisoners," "win at all costs" attitude. People with a dominant behavioral style tend to be brusque and businesslike, as well as self-confident, change-oriented and impatient. They are interested in results and the bottom line. They typically like to solve problems and make decisions quickly, and they enjoy taking charge. The character of financier Gordon Gekko in the 1987 film "Wall Street" (played by actor Michael Douglas) is a typical example of a person with a dominant style.
The "I" in DISC refers to people with an "influencing" style. The influencing person typically is an extrovert, a talker, a so-called "people person." People with an influencing style tend to be dramatic, animated and gregarious. They are quite verbal and like generating enthusiasm and motivating others. They enjoy participating in groups and relating to others. People with an influencing style want to make a favorable impression and desire praise and approval, but they also may be disorganized. Former President Bill Clinton is a good example of someone with an influencing style.
The "S" in DISC denotes a person with a "steady" behavioral style. (Some versions of DISC refer to "S" as "supportive."9) The steady person typically is more quiet and introverted than dominant or influencing people. Steady people tend to be relaxed, easygoing and agreeable. They tend to conform to standards or the status quo, and they may be resistant to, or afraid of, abrupt change. They tend to be averse to risk. However, they are loyal, patient and good listeners. Celebrities who have been characterized as having an "S" style include actors Tom Hanks,15 Jimmy Stewart20 and Fred Rogers,18 the avuncular host of the long-running children’s television program, "Mister Rogers’ Neighborhood."
The "C" in DISC refers to a person who has been labeled as "cautious,"15 "conscientious"9,16,22 or "compliant."19,20 There is general agreement that a cautious person is task-oriented rather than people-oriented. The cautious person is a critical thinker who is detail-oriented, organized and concerned with accuracy, quality and precision. Cautious people value structure and need time and information to make decisions. They tend to be averse to risk. Cautious people "dot all their i’s and cross all their t’s."15 Given the exacting demands of clinical dentistry, the proficient dentist is likely to share many characteristics with cautious patients.
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MOTIVATING PATIENTS AND TAILORING MESSAGES
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Dominant patient.
When motivating a dominant patient, dental professionals need to be brief and to the point. The typical dominant patient is likely to be impatient and wishes to make decisions quickly, so an inordinate amount of socializing with him or her may be detrimental to treatment acceptance. Dental team members who have an influencing style and who value getting to know patients may need to monitor their tendency to socialize too much when interacting with dominant patients.
Dominant people like innovation, so they may be especially receptive to new treatment modalities or products.
Although dominant people may be disorganized themselves, they dislike disorganization in others and resent having their time wasted. Thus, case presentations should be well-organized, and preparation is essential. Dentists and dental team members should provide patients with a focused and direct case presentation, centered around three major points:
- – This is what you need.
- – This is why you need it.
- – This is what will happen if we do not proceed.23
Dominant patients may become impatient and overwhelmed by too many details. Dental team members who have a cautious behavioral style, focusing on the details as their standard approach to case presentation, may need to limit the amount of detail they provide, unless the patient specifically asks for more information.
Dominant patients may be intimidating, especially to team members with a steady or cautious behavioral style. On the plus side, dominant people like innovation, so they may be especially receptive to new treatment modalities or products.
Influencing patient.
People with an influencing behavioral style like to talk and socialize, so it is important to get to know these patients by spending sufficient time with them before presenting treatment plans or discussing the need for behavioral change. An extended new-patient interview2 may be important to create an environment that is conducive to effective case presentation and treatment acceptance.
A reflective or active listening approach may be effective when interacting with an influencing patient.2,24 Geboy24 described reflective listening as a three-step approach: "(a) actively attending to the words and nonverbal signals of the speaker; (b) decoding their meaning by synthesizing all of the verbal and nonverbal messages and (c) feeding back in your own words what you understand to be the speaker’s message." Influencing patients tend to be motivated by accurate reflections of their feelings about a particular course of action or treatment plan. This approach also requires that dentists and dental team members avoid the tendency to multitask when communicating with these patients (such as making notations in the patient’s medical record or dealing with equipment in the operatory). Influencing patients are likely to value the undivided attention of dentists and dental team members.
Influencing patients are particularly attuned to feelings and emotions. While a collection of anecdotes does not constitute scientific evidence,25 anecdotes may be a more effective mode of case presentation when interacting with an "I" patient. Patients’ testimonials, describing how other patients have felt as a result of treatment, are likely to be a more valuable approach to case presentation than are data and statistics. Placing too much emphasis on details is likely to bore an influencing patient, just as it is with a dominant patient. However, much like a dominant patient, the influencing patient is likely to be enthusiastic about new treatment modalities or products.
Steady patient.
A patient with a steady behavioral style is likely to be friendly, affable and agreeable, but he or she is more guarded and introverted than an influencing patient. It may take somewhat longer to develop a relationship with a steady patient than with an influencing patient. Attaining patients’ trust is essential to building effective dentist-patient relationships,1 and patients’ trust has been linked to a greater likelihood of having a dental home, as well as with frequency of dental office visits.26 Building a relationship based on trust is especially important for patients with a steady behavioral style.
Steady patients typically are averse to risk and dislike confrontation or aggressive approaches. Thus, when interacting with steady patients, dentists and dental team members probably will find that a slow, steady and low-key approach is likely to be most effective.15
As with influencing patients, "S" patients are likely to be most receptive to reflective listening. Dentists and dental team members should pay particular attention to patients’ fears and concerns. Citing key statistics and exhibiting empathy by addressing these concerns and fears directly will help motivate the steady patient to accept the treatment plan. In general, patients have greater concern about safety in the dental office than most dentists realize, and, in many cases, they may be reluctant to voice these concerns.27 These tendencies may be even more pronounced in steady patients. Thus, an emphasis on security, safety and tried-and-true methods may be effective in achieving case acceptance with these patients. In contrast to dominant or influencing patients, the steady patient may value traditional, time-tested treatment modalities and products, rather than what is new and innovative.19
Cautious patient.
The cautious patient is likely to perceive most situations as threatening or unfavorable. Although no data exist to suggest that they exhibit greater levels of dental anxiety than do other patients, the tendency of cautious patients to be somewhat suspicious and averse to risk suggests that trust and sincerity are particularly important in the dentist-patient relationship.
Fortunately, cautious patients are logical, systematic and data-driven. The cautious patient is less convinced by his or her feelings than by facts and evidence. Much like the fictional detective Sherlock Holmes, who once exclaimed, "Data! Data! Data!" and "I can’t make bricks without clay,"28 cautious patients are reluctant to make decisions without having sufficient information. Consequently, an evidence-based approach29 to case presentation probably will be effective with cautious patients. Dentists and dental team members may find it useful to summarize the results of relevant clinical studies or systematic reviews when making a case presentation. Similarly, intraoral cameras, digital photography and/or radiography, as well as imaging software, may be effective tools for making a case presentation and achieving treatment acceptance.
In all likelihood, cautious patients will be skeptical and need complete information before making a decision regarding treatment. It is important that dentists and team members fully explain the dental treatment options available, the reasoning behind these options, and the advantages and disadvantages of each option. A hard-sell approach or brusque dismissal of patients’ questions and concerns probably will reduce the likelihood of treatment acceptance.
Cautious patients also are likely to be slow to decide and need time to absorb the details of the proposed treatment plan. Because these patients need to be sure of their decisions, it is important for the dental team to provide them with materials to take home to review while they make their decision. Some cautious patients may fall victim to "paralysis by analysis."15 Therefore, it is critical that dental team members follow up with these patients to remind them of their options, answer any new questions they may have and bring them closer to accepting the treatment plan.
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CONCLUSION
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The DISC system suggests that one size probably does not fit all when it comes to the most effective methods of motivating patients and presenting treatment plans. Patients in different DISC categories may be receptive to different modes of case presentation.
It takes time and effort on the part of the dentist and dental team to interact with patients and identify their DISC style. To prevent this task from becoming a significant burden on any one member of the dental team, interaction with patients needs to be a team effort. The processing of new patients, including initial telephone contacts, reviewing health histories and new-patient interviews, can provide team members with multiple opportunities to observe patients and recognize their DISC style.
The DISC system may not work effectively for all patients. Patients may have multiple reasons for rejecting treatment or resisting behavioral change that are unrelated to their behavioral style. In addition, it may be difficult to identify some patients’ DISC style. One publisher7,9 of a DISC instrument studied a sample of subjects and found that a majority had a combination of behavioral styles. While the representativeness of this sample is unknown, certain combinations of styles with shared characteristics, such as "DI" or "SC," were more prevalent than other combinations with divergent characteristics, such as "IC" or "DS." The commonalities among some combinations of DISC styles still may allow dentists and dental team members to take advantage of the strategies outlined above.
The DISC system is a tool that dental practices can add to their patient management armamentarium. The benefits of using DISC may include an increase in the rate of treatment plan acceptance and an improvement in patients’ behavior with regard to their oral health. An additional benefit of using the DISC system may be identifying the DISC styles of dental team members. Doing so may improve office relationships, resulting in improved efficiency and reduced conflict.
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ABSTRACT
DISC SYSTEM
