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Rule 2: Patient's Wants and Needs

Posted By Stephanie Wilhelm, Friday, August 11, 2017

The Basic Rules of …..

Basic Rule 2: Patient’s Wants and Needs


We all have wants and needs. Needs are necessities or obligations. Life rolls along a lot smoother if our needs are taken care of and we are not in “dire need” of the basics of life. Wants, on the other hand, are desires or wishes. What then do our patients want/need? It is critical that we identify their wants/needs before we embark on comprehensive care (Figure 1).

 Figure 1: We must understand our patient’s wants and needs


Sandy Roth in her book “Defining The Mission of Dentistry” explains that every patient is unique and every patient will always make a better decision for themselves.1 This holds true whether it is wants or needs based. Our job is to act as consultants and help our patients clarify their goals all within the confines of their reality, our core values, and accepted dental standards of care.2,3 We listen carefully to our patients in our initial interview and we define what the patient qualifies as a need and what is qualified as a want. We optimize the placebo effect (Basic Rule 1) by realizing that “everybody wants to be treated like a somebody”. Needs could be pain relief or cosmetic anterior tooth replacement. Wants could also be cosmetic anterior tooth replacement, for example a fixed partial denture, or replacement of non-tooth coloured restorations with tooth coloured. Although it is tempting to do what the patient wants as a priority, that approach might come back to haunt us later in the relationship. The patient has to be cognizant of the delicate wants/needs balance and make wise, customized decisions on the information provided.4,5 Clearly we need to address the patient’s chief concern (want or need) first, but it is essential that the patient’s needs are addressed as quickly as possible. The wants, after clarification and after realistic expectations have been set, are then addressed.


I don’t know about you, but we find that the more time we spend consulting with a new or existing patient, the fewer problems we have. We want to find out as much about our patients wants and needs to better facilitate their decision making. We consult as often as the patients’ requests. We keep the consultation visits to under an hour. Usually all that is required is just one consultation appointment. It’s probably because we have set in our minds that we are not in any hurry that it only takes one consultation. Having stated this, occasionally we might see the patient three or four times. Relationship building and clarification of patients’ wants and needs are too important to be rushed. Please do not forget that with each consultation we also thoroughly document what transpired.


In our practice our patients’ chief concerns are respected, be it needs or wants based. We are not foolish about this approach and it does have its limitations. For example, a patient presents with a chief concern of a cosmetic anterior tooth replacement, say a fixed partial denture, even though the patient in question has posterior edentulous areas with associated bite collapse. This is wants based. A needs based solution of posterior stabilization first with anterior fixed partial denture provisionalization or adhesive cosmetic bonding could readily satisfy the patient’s wants as well as provide the needed and necessary care. Whatever and wherever the chief concern leads us we definitely deal with needs issues in our practice as soon as possible before we tackle the wants knowing full well that it is the patient’s wants that motivate them to attend dental offices.6-9   Remember, we listen to our patients and respect their value system but work with our core values and accepted dental standards.10,11


There is another spin to this wants/needs equation that involves us, the team. As oral health care providers, we have needs such as seeing a certain number of patients and performing a number of procedures to provide our practices with a certain amount of cash flow. Qualifying the type of patients or procedures that we would preferably seek out to do, fits the wants department. This is all fine and dandy in a world where we could do whatever we want, provided we have the skill set. The need to pay the bills should not overcome our abilities to perform comprehensive dental care and the taking on of cases that are beyond our skill level.2 To improve our skill levels so that we can perform to a level that comprehensive care demands is noble and mandatory, and I encourage it before biting off more than we can chew. The dental team although faced with these practice considerations must look beyond their own plight to advance the cause of the star of the show, ie. the patients, and place their wants/needs first.


For the dental team a well choreographed balance between needs and wants has to be found for the patients’ best interests to be honoured. For the patients, they must be listened to.3,4,9-11  After the chief concern has been entertained their wants are addressed with respect for their needs. It’s a difficult balance to strike at times but with patience, perseverance, and proper planning we will get the job done to everyone’s satisfaction.


Further Suggested Reading and References:


  1. Roth SR. ProSpective volume two. Defining the mission of dentistry. Seattle: ProSynergy Press; 1995.
  2. Malament KA. Prosthodontics: achieving quality esthetic dentistry and integrated comprehensive care. J Am Dent Assoc 2000;131:1742-9.
  3. Schouten BC, Hoogstraten J, Eijkman MA. Patient participation during dental consultations: the influence of patients' characteristics and dentists' behavior.
    Community Dent Oral Epidemiol 2003;31:368-77.
  4. Liebler M, Devigus A, Randall RC, Burke FJ, Pallesen U, Cerutti A, Putignano A, Cauchie D, Kanzler R, Koskinen KP, Skjerven H, Strand GV, Vermaas RW. Ethics of esthetic dentistry. Quintessence Int 2004;35:456-65.
  5. Priest G, Priest J. Promoting esthetic procedures in the prosthodontic practice. J Prosthodont 2004;13:111-7.
  6. Smith RN, Smith ME. Marketing the cosmetic practice via television. Curr Opin Cosmet Dent 1995;:100-6.
  7. Demas PN, Braun TW. Esthetic facial surgery for women. Dent Clin North Am 2001;45:555-69.
  8. Alsarraf R, Alsarraf NW, Larrabee WF Jr, Johnson CM Jr. Cosmetic surgery procedures as luxury goods: measuring price and demand in facial plastic surgery. Arch Facial Plast Surg 2002;4:105-10.
  9. Schouten BC, Hoogstraten J, Eijkman MA. Patient participation during dental consultations: the influence of patients' characteristics and dentists' behavior.
    Community Dent Oral Epidemiol 2003;31:368-77.
  10. Klages U, Bruckner A, Guld Y, Zentner A. Dental esthetics, orthodontic treatment, and oral-health attitudes in young adults. Am Orthod Dentofacial Orthop 2005;128:442-9.
  11. Schouten BC, Eijkman MA, Hoogstraten J. Dentists' and patients' communicative behaviour and their satisfaction with the dental encounter. Community Dent Health 2003;20:11-5.

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