How Motivational Interviewing Transformed My Clinical Practice

You're listening to the Phil Klein Dental Podcast. Motivational interviewing. We've all heard this term at some time or another. Is it worth learning about and does it really work? And the real question is, can it help our practice? According to Michelle Strange and other pundits on the topic, it can do wonders for building trust between you and your patients, improve case acceptance, help you achieve amazing long-term clinical results, and provide you with incredible career satisfaction. All the while, motivational interviewing builds your practice with a dedicated and appreciative patient base. To tell us more about motivational interviewing is our guest, Michelle Strange. Michelle is a registered dental hygienist with a master's in dental hygiene education. She brings over 20 years of experience to her numerous roles in dentistry. You can get more information on Michelle by visiting levelupip.com. That's levelupip.com. Michelle will be joining us in a moment, but first, when it comes to fighting dental disease, we all understand the importance of an effective prevention strategy. This includes patient home care compliance, regular hygiene visits, and using the best prevention products available. That's why so many dental practices rely on VOCO's award-winning preventive care product line. Recommended by top dental clinicians, Remin Pro, Pro Fluorid Varnish, Admira Protect, and Grandiose Seal are tried and true products that are effective, easy to apply, and result in successful clinical outcomes with high patient satisfaction. Whether it's for fluoride treatment, to seal pits and fissures, or to treat hypersensitive teeth, Voco's premium preventive care products help you win the battle against tooth decay and sensitivity. So when you're thinking prevention, Think VOCO. Request your free sample today at vocoamerica.com. Michelle, it's a pleasure to have you on the show. As always, I'm happy to be back. So talking to a patient. as in life with anybody, talking to your wife, talking to your friends, talking to your teacher in school. There's a psychology behind the conversation. There's an approach to every conversation, especially with a dentist who is talking to a patient for the first time, for instance, and you need to build trust and so forth. So this psychology is very important and it's the way you present. And some dentists are very good at it naturally and they... of that, they quickly build up their patients on record, and they also do very well with their case acceptance. With your experience, you have some recommendations to make, and it begins with motivational interviewing, as you call it. And we've heard that term before. So to begin this podcast, what is motivational interviewing? I love that you bring up that it's the psychology of it, because before I answer that exact question, I think back on... was in hygiene school almost 20 years ago in my very first classes. I was learning about the Maslow's hierarchy of needs and the psychology of patient care. And all I could think back when I was, you know, 20 years old, can I just see some teeth? I need to see some teeth and I need to see a paycheck. Like that's what I'm here for. And I think back. on that and go, gosh, I wish I had paid more attention because I'm doing so much work to like make up for it now to learn psychology and how to engage patients. And one of the things that I stumbled on probably eight years ago was motivational interviewing. MI is what a lot of us call it is really this collaborative approach. client or patient-centered counseling approach. We see it used in many settings like healthcare, dentistry, counseling. I was just at a, you know, intensive three-day course where social workers, I was literally the only medical or dental person, but nutrition counselors, dieticians were all talking, using, learning MI. And so really it's designed to. facilitate a behavior change by helping individuals explore and kind of resolve their ambivalence. And for us, it's to their goals about maintaining their health, their oral health. How do we get them to brush more and use the prescription things that we recommend or say yes to the restorative treatment that we're recommending? And it focuses on evoking that person's intrinsic, their internal motivation and commitment to change rather than. imposing external pressures. Like I tell you, you do, right? Like I just, it never works for me as a patient. So I don't know why for the majority of my career, I thought me telling was going to work, but it just doesn't. And so MI techniques involve active listening, empathetic communication, open-ended questions so that you can help individuals articulate their goals and take. steps towards that positive change in their oral health. Right. So that was very well explained. Every patient is different, as we know, right? So there's a certain amount of listening, obviously, that's extremely important, as it always is, to ascertain what is the personality profile of that patient? What are their real interests in coming to the office? What are their fears? And then you need to kind of tailor that. motivational interview to meet that patient. How much education does a dentist need to be able to do that? I mean, I know you do that very well, and I think you teach it, in fact. How does a dentist begin to get skillful at that where he or she could really get the trust of the patient quickly and move into a treatment plan that they accept? I'm going to paraphrase a quote from that three-day course that I was just at recently. And it was along the lines of when I went to go learn MI, I thought I was going to learn how to help change patients. And really, I was like, damn, it needed to be me that needs to make all the changes. And so really, it's kind of parking your wants. and your desires and your treatment plan, you know, what you want to see them do and centering the patient and that just giving them autonomy. Because when you think about it, when you take away every other choice, all they have to say is no, they're going to say no. Right. And so it's really kind of moving away from that provider centered care. I know things, you do things and centering that patient. It's treating patients as partners in their healthcare journey. It's considering their values, their preferences, their goals. MI is a tool used for that patient-centric care. And so I think one of my favorite ways or where I started was adjusting my questions to open-ended questions and getting very creative about how I ask. questions can you give an example can you give an example absolutely so i now ask what's working for you every day to keep your mouth healthy because i'm trying to imply what they do at home is going to hopefully result in health and i am curious it's not are you brushing and flossing what tools Because there's a variety and I want to also emphasize the importance of choosing the right tools to bring us health. So what tools are working for you every day to manage your mouth at home or keep your mouth healthy at home? Do you have a preferred toothbrush or do you have a preferred toothpaste? What do you like to use? to clean between your teeth. If I like a rating scale, that's something I have also learned at MI. It was on a scale of one to 10, how healthy would you say your mouth is today? And sometimes they'll be like, it's a six. Gosh, I've been drinking so much coffee and tea. They're so stained or, you know, that one tooth is always so cold or, you know, every time I chew, it's bothering me. So like they're giving me details that sometimes I might not even ask them about. And so if they tell me it's a six and I'm like, oh, so it's. White teeth to you is really healthy. Is there anything else with the foundation of your teeth that is concerning you today that would not make you a 10 on the scale? Or if it's a six, what would make it a 10? So I like to ask those kind of questions. I get a lot of weird looks from people, especially if that's the first time they've interacted with me that way. Or I always say, if I have any suggestions today, are you open to hearing those? And sometimes they'll be like, obviously, that's why I'm here. And I'm like, but you always have the option to say no. I am happy to shut my mouth and do what I need to do because I don't think you want to hear me any more than I want to talk to the wall. Are you open to those suggestions? And so those kinds of things have really changed just that alone, how I interact with the patient and how I center them in the conversation versus like, you really got to be brushing more. You're missing down here. And I, you know, that oscillating, you know, head or that, you know, electric toothbrush that we sell would help with that. You know, it's like, what works for you? What has worked in the past? Tell me more. We'll be right back with Michelle in a moment, but first, if you're looking to make teeth whitening a successful part of your practice, then you need a system that not only dramatically whitens teeth fast, but also ensures little to no sensitivity. Philips Zoom Whitespeed does both. Whitespeed's light -accelerated technology speeds up the whitening process, clinically proven to whiten up to eight shades in one visit. And what's really impressive is that 99% of patients surveyed experienced little to no sensitivity with Philips Zoom. Philips offers two professional whitening solutions, in-office whitening using Philips Zoom Whitespeed, and take-home whitening, with a range of whitening gels for either daytime or nighttime use with custom trays. for a comprehensive, tried-and-true, state-of-the-art whitening solution for your practice, check out Philips Zoom Whitespeed. To learn more, visit philipsoralhealthcare.com. So what is the difference between motivational interviewing and patient-centric care? Patient-centric care is kind of the more holistic approach to engaging patients where you give them autonomy and you're kind of creating, the principles are more like shared decision-making, just respecting their autonomy, focusing on their personalized care plans. And then motivational interviewing is more of the technique I would use to kind of empower their decision-making. I think a big part of... motivational interviewing under the umbrella of patient-centered care is reflective listening and kind of hearing what they're saying and listening to those cues of change, like that behavior change. I am not flossing so much, but I know I need to. But, you know, the kids are just like driving me crazy at night and I just don't have enough time. But I heard I know I need to. And so I can kind of spin that of like. oh, well, it sounds like life is just incredibly busy and you want to do something different because you know, your behaviors would actually help your health in the chair today or something like that, you know, where I am hearing what they, I heard that little nugget, that little pearl, and I kind of pull it out and hopefully expand on that conversation so that I can better understand like. Maybe they're going through depression. Maybe they are struggling with sleep. Gosh, the one thing that I have learned so much with MI is airway and sleep issues. Just because I'm asking, like, tell me, how are you sleeping? Are you sleeping okay these days? And just... and expanding on that and centering that patient and what their struggles are, because I don't care how good I am at educating a patient and finding every tool that has ever been made on the market for home care. If that patient is tired, if that patient is stressed, if that tool does not work in their life. It's not going to work. It just won't. And so that's going to be your more patient-centered care. And then using MI as a way to kind of pull out those little pearls of change and expand and hopefully guide them to that change. Now, is this something that's done more by the hygienist or the dentist or both? I'd say everyone in the office, quite honestly, even your front office team. Because, gosh, you'll hear some random things when they call in. I can't do this treatment plan because X, Y, and Z, or I can't make it to this appointment because of that. I think if we all just kind of take this approach of like, tell me more, what's going on? Are you okay? Is there anything else that I can do? I have other options. If you are open to those options, I'd love to make those suggestions. I think everyone on the team could have this technique in their back pocket. So this is what you're talking about now is really so important for practice success, for a dental office to be successful. This is a big part of it. You need to have all the other things that go along with it. You need marketing. You need infection control. You need all the right equipment. You need the training, continue education. But you can't neglect this because this discussion with the patient and building the trust and understanding how to proceed with treatment plans based on the specificity of that patient's needs and their lifestyle is just critical toward having a successful treatment plan. pan out into predictable clinical results. So is MI hard to learn? Is it something, we don't learn it in dental school. We don't learn it in dental hygiene school, I don't think, and correct me if I'm wrong, but I would assume there's not a lot of that in dental hygiene school, which there should be, but the curriculum in dental schools right now are so packed. They keep adding more things and there's just no room. There's no room for this stuff. And they probably look at this as kind of extra fluff or whatever. I don't know. What's your feeling on how difficult it is for a dentist to master this and get his staff, hygiene, the front desk, everybody on board so that the patient is handled in this way throughout the office as a culture? So there are not a lot of schools that are teaching this across the board, but there are some, there's actually some in research studies and some of the literature out there. And I even have some people that'll message me and be like, I learned this in school. Thanks for the reminder. I know how to do this. So that's fun. But I think it's probably for me, it has been the hardest thing for me to learn. But I say that because it was me that had to change. I had to stop. focusing on what I wanted the patient to do and how I was going to and shame and blame them quite honestly how was I going like you don't want to take those x-rays let me tell you all the reasons that you need to take those x-rays instead of like you're concerned about these radiographs today tell me more how do I make those changes because and I'll tell you the one thing Like I said, I've been practicing this for years. Not every day is a good day for me. I revert back to that provider-centered care. It's usually when I'm exhausted and patients are like, well, every time you do that, my gums bleed. And then I go right into like why their gums are bleeding and why they're unhealthy and why they lost teeth for a reason, you know? But it is the more we practice. and the more that we play with each other with it, like ask these open-ended questions. You're going to have to baby step into it, quite honestly. But it was one of the hardest things that I did learn, but I think that was because I came from, you know, I started practicing in 2000, very provider-centered time. I come from a family that is like, we're there to challenge. We're there to fight. We're there to argue. And so to kind of counter my perspective of like, there's something else going on here. It's not just about what I know and what I want them to know. It's about what they want to know and how they're going to hear me right now. That's been the hardest. So if you don't have some of those kind of foundational things that you have, those walls that you're going to have to bust through, probably isn't going to be too hard. It's just adjusting your approach to the patient and not centering you and your procedures and the cool things. You've got a new scanner and, you know, you're not centering your practice and you is you're centering the patient. And you really learned a lot about yourself at that motivational interviewing course that you took. How long was that course? So this one is a three-day intensive beginner. And then I'll go back and do a more advanced one. That was from Dr. I think it's called Berg Smith. motivational interviewing course. But honestly, I have about five or six books and some of them are specific to the dental industry. If you honestly Googled motivational interviewing in the dental setting, Dr. Rolnick, he was one of the founders of MI. They have a new edition of that book out. And just listening to people like Dr. Matt Allen, he is in Colorado. He's fabulous. He's one of the only dentists in the Mint Network, which is like motivational interviewing network of trainers or something like that. He's the only dentist in that. So following him and working with people and just honestly change to open into questions and then get that book and start centering your patient. How long do you think it will take a dentist once they start to? use this, even though they're not experts, but they start to use it pretty quickly, this technique, once they do a little reading and get a little training, where they'll start to see a difference in their case acceptance, in their patients on record, the number of people that are referring more patients to them. Does this happen pretty quickly? So for me, it took me about a month. And mostly I was just screwing up and saying all the wrong things. thinking I knew what reflective listening was, which back then it was just parroting, just saying the same thing to them that they said to me. But really it's... That took me a little longer. I still think I practice that to this day. But within a month, I started seeing patients respond back to me. And I can always think of my very first patient that came back to me after doing MI. And I was disclosing them for the first time that also helps me with my MI and, you know, biofilm management at home. And he sat in that chair all grumpy, like he usually did, and was like, I don't want to see any of that purple this time. And I was like, wait a second. That means you paid attention last time. Wait. So, so tell me more. What have you done differently this time? I'm so curious. I love hearing like it's affirmations too. That's fabulous. Oh my gosh, that's a big change, but like also calming it just a little bit because they're a stoic person. They don't like a lot of emotions. So like backing it down. So I would say I saw the first remnants of that after my first recall at three months, but I started to engage with patients. And one thing that I would like to just build on real fast before we finish this. is that MI helped make me a less frustrated clinician. So it is about the patient. It is about engaging them differently. But quite honestly, at the end of the day, I keep doing this because I don't have nearly the burnout that I used to have. Because I... How many of us get so frustrated? They come back and six months later, it's the same stuff. That's another area of disease. Nothing is changing. They're not listening to you. And what does that do to you after a time? That's so disheartening because I think as us as healthcare providers, like we care. When a patient changes, it's a win for us and that keeps us motivated. And when there is no change and there is no development, that's so frustrating. And so eventually I would get to a place where I'm like, what does it even matter? I don't need to have this conversation. I've had it every year for the last five years. What does it matter anymore? And when I get to that mental state, then I get frustrated. I'm not helping myself. I'm not helping the patient. And so MI has been one of those things that. helps us both. Yeah, no, that's very well said and very true. We didn't release this podcast, but I did a podcast with a periodontist recently. It hasn't been released yet. And he was talking about patients that come in that say, doctor, I'm a dental failure. I've been to six dentists. I have periodontal disease. Everybody's been trying to fix it. I have decay. I've had tooth extractions. I'm coming in because I was sent here by my current GP, you're supposed to be a good periodontist, but I'm telling you right now, I'm a dental failure. This is what the way, this is the, it was sad. It was, it was kind of tragic. Makes my heart cry here. Yeah, because this person actually wanted to save their teeth and had all along the way, they had hopes of saving their teeth and they've been disappointed throughout their dental experience. Just plain disappointed. This guy, he was a friend of mine who he actually came into our studio and did the podcast with me. Dr. Millman, he just retired in Austin, Texas. He talks about it, but basically he said, listen, I'm going to be your partner here. We're in this together. That was his approach. Yeah. He said, you're not just a patient here. We are a team. So I'm going to do what I, everything that I'm possibly can do to get this to improve. I'm going to do my part as a team player. And then I really hope that you do your part. And I think you will do your part. But we're not going to be dental failures together. We're going to transcend that whole concept of being a failure. And meanwhile, through a couple of years of treatment. The patient turned out to be very, very good as far as their teeth. They got it stable. They had restorative work and he turned it around. But it was really that, I don't know what would that be. I don't know if that's part of MI or what that is, but it was a discussion of partnership. There is a way of, oh gosh, I'm trying to remember this term, but they call it the four Ps. of patient-centered care, something like that. And one of the Ps is partnership. It's collaboration. It is, they always say like, there's two experts in that room, you and all of the things that you know about dentistry and then the patient and everything they know about their lifestyle, what has worked in the past, what will work in the future, what are they able to do? Like, so leaning on each other for your expertise is where you get it. And there's going to be some times where like, okay, like I did a camera protocol. These are the things I'm going to recommend coming back. Nothing has changed knowing that the patient's not the failure there. They have tried. And even if they have tried and life happens to them, I don't think that makes them a failure. And I also hate when patients come in and they're like, I'm just lazy. And I'm like, no, you're not. I don't believe in lazy. I know there are some parents of teenagers that would disagree with me right now, but I don't believe in lazy. We just haven't found what works for you. It hasn't worked for your life. What fits in your hand? What is a priority to you right now? I don't think you're lazy, but we together, if you're willing to work with me, I could figure it out with you. I know a lot of cool stuff. And if you're open to hearing it, like let's, let's go after it. Yeah. And that partnership is so important, not only to bring the patient in to succeed and get good outcomes, but also for the satisfaction of the provider. Like you said, who wants to go to work, even though you're making money every day. Who wants to go to work when you're not seeing results? Because then you feel like you have no impact. And this is very similar to people learning. I started this company 25 years ago. When it first started, we had limited bandwidth. Very few people knew what a webinar was. We used to call them webcasts. Now we do 70,000 webinar views per month. We have 400,000 users. And the pleasure that we get at Viva Learning is because we have impact on so many people around the world that are listening to people like you, Michelle, and many other key opinion leaders where they can actually improve their lifestyle, improve the way they practice dentistry and just implement things the next day. And it just... That's the thing. It has impact. Otherwise, what's the point? You know, money's good. You need to pay your bills, but it's not enough to give you real happiness without that, knowing that you're doing something for society and the world that is positive. Well, anyway. Totally agree. Yeah, I think I've talked enough. Michelle, you were great on this podcast. I loved it. So many good points you made. Can you tell our audience how to get in touch with you? Regarding the training you have because I know you offer some amazing training with infection control coordinators and so forth Yeah, so I have two companies. I kind of try to keep them separately. But one is Level Up Infection Prevention, where I train the infection control coordinator. I do try to teach you some of this MI because to get your team members to want to do infection control properly does take some coaching and guiding and moving from ambivalence. And then for my other stuff that I do on Instagram, I'm known as the roaming dental hygienist because I roam the country. And then you can find me on my website, all of these things. It's michellestrangerdh.com. And I do a lot of speaking, writing, content creation, and education. Yeah, fantastic. Thanks so much for your contribution to dentistry, Michelle. You've brought so much insight and important information to our users across the world. And we really look forward to having you on podcasts and webinars in the future on Viva Learning. Thank you so much. Thank you. If you're enjoying this podcast, please leave a review or follow us on your favorite podcast platform. It's a great way to support our program and spread the word to others. Thanks so much for listening. See you in the next episode.