A synopsis of Primespeak

Dr Michael Sernik, February 2010

Why do we need PrimeSpeak now more than in the past?

Medicine and dentistry have shifted in many respects over the last century. There was a time when it was expected that the doctor adopt a paternalistic role. The patient was given a diagnosis and was expected to follow the good doctor’s advice.

We are now in a consumer age. The patient/consumer can be more discerning and does not necessarily blindly follow the doctor’s recommendations. Most dental treatment is discretionary and costs are high. The Dentist is caught between being expected to give an opinion as to the treatment required, but any attempt to talk the patient into expensive treatment can easily damage the relationship irrevocably. On top of this, patients are wary of being sold to.

All ethical clinicians care about their patient's well-being and want the patient to choose the most appropriate treatment for the condition. However, if the clinician tries to simply instruct the patient, the patient will not necessarily simply follow orders, especially if the cost is high and the condition is chronic (and painless). The clinician may try to explain all the options carefully and then leave it to the patient. This often results in a patient that asks the clinician to make a recommendation. Once again, the patient can become mistrustful of the dentist's motives if the proposed treatment is expensive and for a long-standing, painless condition. And so, the dentist needs a way to influence the patient to want appropriate treatment in such a way that can never damage the delicate and fickle clinician-patient relationship.

How we avoid “selling”
When we want to convince someone to buy or do something, it is intuitive to ‘talk-up’ the positive attributes of what we want them to buy or do. In sales training, this is known as benefit selling. All of us 'benefit sell' in one form or another everyday. When we say to our children "eat your vegetables so you’ll grow up big and strong" (benefit) or "you should try and see that movie, it's really great".

When a patient says, "what would you do if this was your mouth?" it is natural for us to respond to the patient's question with some sort of benefit statement "I'd have an implant because it’s the best solution for a missing tooth".

PrimeSpeak is the antithesis of traditional sales techniques. One reason that PrimeSpeak seems counter-intuitive is that we get better results without benefit selling the optimum treatment. Essentially, the PrimeSpeak new patient exam goes through several broad stages of influence and none of these stages has any benefit selling:

  1. The first stage has the clinician gather information from the patient and build rapport. There is no danger of the patient perceiving a sales agenda, provided that no mention is made of any particular treatment solutions for the patient's condition.
  2. The second stage requires the transfer of information from the clinician to the patient. Patients usually need a certain amount of dental education in order for them to be able to make intelligent decisions. The focus should be on the damaging results of an existing condition rather than the solution to a problem. This information should be woven into a conversation that is not specifically about this patient, but a general comment about what can happen with this particular condition. We still have not done any benefit selling because we have not talked about solutions and we have not talked specifically about this patient.
  3. The third stage involves the patient overhearing some charting from clinician to DA. The language used is simple, descriptive and factual regarding what can be seen. No mention is made regarding treatment. The patient can see the images and is involved in a conversation regarding what they can see. Still no mention of solutions however the visible facts are indisputable. If we have created appropriate concern about the degenerative outcome of that particular condition, the patient is ready for treatment options.
  4. The fourth stage involves going through the various options. The clinician needs a treatment objective to work towards and to guide the patient to. But the patient must not know the treatment objective. We want the patient to feel like this is entirely their decision and we will support whatever they choose.

The PrimeSpeak clinician would guide the patient through the various options from the suboptimal treatment upwards. The undesirable options are progressively eliminated using a PrimeSpeak technique called guild and tarnish. This leaves the optimum treatment as the natural default. The advantage of the system is we are not sounding like we are selling anything and the patient has been given no proposal to resist. The patient will have ownership of their condition and their solution and the dentist CANNOT feel rejected.

Ethics of PrimeSpeak
The ethical clinician has a responsibility to influence the patient to desire optimum oral health. A deficiency in communications training results in a deficiency to reach the desired treatment outcomes.
PrimeSpeak teaches Dentists powerful communications techniques. All communications training can be viewed as manipulative. However, the ethical application of this training is a function of the clinician’s integrity. The ethical clinician’s optimum treatment objective should be what treatment the Dentist would want if he/she had the patient’s condition.

{Published in Australasian Dentist Magazine February 2010}

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