#110: Why Patients Say Yes - Commitments & Consistency (Part 2)

In this episode of the Dental Marketing Secrets podcast, Mark Thackeray delves into the principle of commitment and consistency from Dr. Robert Cialdini's book, 'Influence: The Psychology of Persuasion.' He explains how small commitments can lead to larger decisions, particularly in the context of dental practices. Discover the importance of helping patients build a positive identity around their health and the role of small agreements in fostering treatment acceptance. He also discusses practical applications for dental marketing and patient engagement. 

Takeaways

• People want to act consistently with their self-identity.
• Patients need to feel aligned with their health decisions.
• Dental practices should focus on building patient identity.
• Encouraging small yeses makes larger decisions easier.
• Marketing should reinforce positive health behaviors. 

Chapters
00:00 Understanding Commitment and Consistency
10:03 The Power of Small Commitments
19:30 Applying Principles in Dental Practice
29:35 Marketing and Patient Engagement

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Transcript

0:00

All right, welcome back to another episode of the Dental Marketing Secrets podcast. This is episode 110, Why Patients Say Yes, part two. And we're gonna be talking about commitment and consistency and why small yeses lead to big decisions. My name is Mark Thackeray, your host. Excited to be here with you today to continue our discussion. And it's based on this book called The Psychology of Persuasion. It's called by Dr. Robert Cialdini. Influence the psychology of persuasion and he outlines six principles of why people say yes the influence why people say yes and we're going to be talking about commitment and consistency today and Really what that means in a nutshell is that people don't usually Say yes or no in one single moment but it happens that decision happens in stages over time and the resistance typically comes when you're asking for too much, too fast. So that's something to remember as we go through this. And the key idea really with this principle is that people want to act in ways that are consistent with the person they believe they are. And I'll show her some examples on that here in just a second. I'm gonna use a number of examples that he used in the book. And then we'll also dive into examples within the practice too. Okay, and just to recap, if you haven't listened to the first episode on reciprocity, that is 109. Be sure to listen to that. But it is oh this again, this little series I found so fascinating because that really is, that's really what marketing is all about is understanding why people say yes. You know, how to help people that are the right fit. for your practice in this case or for treatment, uh find you as a provider and go through with treatment. mean, that's kind of what it is. How can we help them understand that this is a great option for them and help them make the best decision possible? Okay, and this is not, I don't want you to feel like this series is on how to manipulate or strong arm people into into treatment or anything like that. I don't, I want to make that absolutely clear, but I think it's also important to realize and recognize the different factors that influence our decision. And we can use this, we'll see this in every life. So it also helps arm you against practitioners that are trying to use this in an unethical way. it's, again, I found this book extremely fascinating. I've read it several times. have the audio book, I have the written one, and I have notes. all throughout the book that I've written in the margins and little note cards that I keep on there. it's just, it is really, really interesting. So let's get into this principle on commitment and consistency. Again, the main premise of this principle is that we want to stay consistent with the type of person that we think that we are. So, and we, again, we see this all the time in our life, right? Give you an example. My wife is a personal trainer. She is a nutritionist and is very healthy. And people know her as such, right? They know that she eats healthy food, that she takes her time. She doesn't, uh takes the time to prepare whole foods and things like that. Yes, she eats sweets on occasion. Yes, she's not 100 % perfect, but the fact that people know her as... a nutritionist and that she does do what she, you know, do what she says, recommends other people to do, it helps her stay consistent with that. She knows she's healthy and that helps her make better decisions on a daily basis, right? We see this with kids, we see this with adults all the time, especially those who have received a label of some sort and have uh don't want to say embrace that label, but they've let that work into their identity. know, things like on the negative side that they don't understand math. They're not good at math or I'm not a good test taker. I hear that a lot. Or it could be they're disrespectful or they're there or on the flip side, they are, you know, athletic or they're they're creative. They come up with great ideas. They're really good at improvisation. You know, I mean, things like that. When you when you embrace that label, then it makes you want to stay consistent with that. Your brain is subconsciously trying to find ways to make you compliant with that so that we can stay consistent. And it's just something that we do because it's easier. Like it's easier on our mental capacity, our computing and things like that. uh But when you make a small commitment, you want to stay consistent with that. I mean, that's really what this principle is all about. like to, it's rational, it's responsible, it's aligned, you know, and saying yes once makes future agreements or future yeses feel more natural that are again, in alignment with that original statement or within with in alignment with your identity. We see this all the time in the political arena where Opponents are saying well you did this and now you're saying this, know, there's this this idea that changing inconsistency is negative, you know and which I think is True to some degree, but I also think it's pretty pretty erroneous like it's pretty harmful, you know, it's like well if I didn't change and evolve and learn more and and Alter my identity alter my behaviors, then I would still be doing my paper out You know, mean that I would do a paper route. That's what I did. when I was growing up and I would still be doing that and I would still be making a dollar an hour, whatever it was. And so it's silly to think about it that way, but it does make sense because we see this all the time. We do want to stay consistent. So let me give you a couple of examples from the book. So there were these homeowners, this is the drive carefully yard sign study by Friedman and Frazier. And they asked homeowners to place a small sign in a window in the front of their house that read, a safe driver. know, it's pretty small, eight by 10. It's not a big thing or anything like that. Be a safe driver. Almost everyone agreed. Two weeks later, The same homeowners were asked to install a bigger, honestly much uglier roadside sign saying the same thing, drive carefully. And this big prominent one, you stick in the ground and it's, you notice that, right? You might not have noticed the smaller one in the window, but you notice this one. And those who had agreed to the small sign were over four times more likely to agree to the large sign. And that's because the first action really defined who these people were in that sense. You know, that they said, yes, I promote safe driving. And now they viewed themselves as someone, as an advocate for that. So saying no to the second sign, the larger, you know, not quite as discreet sign, felt inconsistent with that identity. and it was easier for them to comply. So it's those small public commitments that reshape your self identity, right? And let me give you a few more and then we'll dive into what this looks like from a dental standpoint. Well, I'll just dive into it now actually. this is why those semi-annual cleaning appointments are so important because it reinforces the idea or the identity that this person, this patient truly cares about their mouth. They care about their health. They're on top of it, right? That's why that is so critical because it helps shape that behavior. It helps cultivate that idea that I'm the type of person that I care for my health. This is important to me. I value being healthy. I value a good looking smile, a confident, being confident in my hygiene. and I recognize the importance of that. That's why those cleanings are so important, because it really helps to shape that behavior and make them feel comfortable so that when things do come up, as they inevitably will, as far as other issues, other treatment, they will remember that they're the type of person that does what they need to do to make sure that they're healthy. Okay, going back to my wife's example, she's gonna do what she needs to do to be healthy, to eat healthy. She's big on, it's not just nutrition because healthy extends to so many different areas of your life. It's sleep, it's making sure that she gets adequate sleep. It's taking those mental breaks, you know, and meditation and just uh unplugging from devices and connectivity and all that stuff, right? So the same thing applies with your cleanings. Let me share another one from the book that I found very interesting too. This was a prisoner of war compliance example. So in the Korean War, which was backed by the Chinese in particular, but they kind ah of engaged in a more psychological warfare with prisoners of war. They weren't as... I mean, yes, there were some obviously physical deprivations, but the main way that they gained compliance from uh prisoners of war was through these small commitments that on the outset felt totally, totally innocent. You know, I mean that they weren't these big things because they actually ended up getting a lot of prisoners of war to betray their country and share information that they weren't supposed to, right? Names and any information about breakouts and things like that. it was interesting how they did that. They weren't asked outright to betray their country. Instead, they were asked to make and really agree to these small statements, things like, The US is not perfect, right? And another one was unemployment is not an issue in a communist society. And someone who's just thinking, especially a younger person, is probably like, yeah, that's technically true. Everyone has a job in a communist society or socialist, and America isn't perfect, right? Yeah, most of us would readily agree to that, right? But then those things, they slowly built on those small commitments, those initial commitments to eventually, betray their country outright. So they started to then proceed to, well, US isn't perfect, so give me an example of how the US is not perfect and they would write these mild criticisms of the US. And then what happened is that they would then ask them to read those aloud and then they would even take those statements, those statements that they read and broadcast those to other prisoner of war camps. And so now, I mean, ultimately it led to these people changing their identity. These prison POWs were, oh man, I have betrayed. You know, I'm a betrayer. I've gone against, you know, I'm complying with the enemy. And that became part of their identity, unfortunately. And it led to other things as well. But each step in that process made the next one that much easier. until the prisoner's self-image just totally shifted. And that's just a cautionary tale of how powerful and dangerous this principle can be when it's misused. I'm not advocating that you do this with your patients. What I would recommend is we really are trying to help patients be as healthy as they can. We want them to adopt that identity on their own. My suggestion and what I, when I consult with clients, I recommend that they are always trying to build their patients up and say things like, I am so glad that you're here. This just shows how important you value your oral health. You value your smile, you value your teeth, that you're taking the time to come in. This is awesome. It's so great to see you. Things like that that helps to reinforce that. that identity, that's a positive identity. They derive a lot of benefit from that. Okay. And then it's again, I'm not trying to, we're not trying to back people into a corner, paint them into a corner and say this, Hey, you said you're going to do this. So you got to do it. No, I'm not. I want to be very clear. I'm advocating to help them see why being on top of your, your oral hygiene is such a benefit. and how that can positively influence their life. Now there's someone who does prioritize coming to the dentist on a regular basis that they value resolving any issues that they might have, okay? Things like that. There was another one that I thought was so interesting as well. happened to the author. So he found himself in the department store, toy store in January and he's in line getting this toy that he'd promised his son that he would get and he sees this neighbor, he used to be his neighbor and he's like what are the odds? I saw you this same spot last year and they start talking about it and his neighbor's like that's not, it's not a coincidence at all. This guy had actually used to work for one of the toy companies I think, where he had knowledge of how toy companies worked. said, that's not even a coincidence at all. Let me tell you why. He said, but first let me ask you a few questions. He said, did you tell your son that you would buy this gift? They were, can't remember what they were getting, a robot or something like that. And the author's like, yeah, yeah, I promised him. He'd seen all this stuff on TV. big advertising campaign and like all the other kids said, I want that and dad's like, okay, I promise I'll get it to you. And he's like, okay. So he's like, okay, that's strike one. Strike two is when you went to go to the store before Christmas to go pick it up, where they sold out. And the author's like, yeah, yeah, they were, you know, I mean, I was kind of surprised because they big advertising campaign and they were sold out. And And his friend said, and that didn't that happen last year too? And the author thought for a second, said, yes, the same thing happened last year. And it's starting to kind of dawn on him and what's going on. And he said, that's not this friend said, no, that's not, not a coincidence at all. What they do is they, they will spend a lot of money on these advertising campaigns, get their, get kids to get their parents to essentially promise that they'll get these. buy this gift and then in order to boost sales in January, they won't have that one. They're not gonna have the main item in this case, the robot or whatever it was, but they're gonna and you're gonna feel bad for not getting them something. So though you'll buy something else as a substitute and then come January to boost their sales. They'll say, we have these now in stock and you have to make good on your promise, right? So he's like that's strike two. And by this time the author's like, this is so dumb. I'm not letting these people pull one over on me. And he was about to leave and his friend said, whoa, whoa, whoa, Didn't you, what is the reason? Why did you come here in the first place? Didn't you promise your son that you would give him to get him this toy? He's like, yes. Rolling his eyes, grumbling. Yes, I did. He said, what's changed? He said, don't you still, you can't go back now. I mean, you don't want your son to be, to know you as someone who didn't, who broke their promise, who didn't say what they were gonna do or didn't do what they were gonna, said they were going to do. And the author was even more upset because they knew he was caught and eventually, you know, went and bought the robot or whatever the toy was. his friends, that's strike three. And it's just that power. of commitment, right? And this happens all the time with kids. I see this all the time. My kids constantly use that against me. You said, you said haunting words and it's true. You just automatically feel the need to comply with that because you want to stay consistent. Very, very powerful. Okay. So let's get into a little bit more on how this applies in a dental setting. Okay, we talked about the cleaning, semi-annual cleanings. um And I think, and really the desire to help people adopt that mentality of I am someone who takes care of my teeth, my smile. I'm gonna come in, I recognize that it's so much easier to stay on top of it than to wait for something major to come up. So I'm the one who's gonna, I'm being proactive. I will be proactive about my oral hygiene. It's this is I think pretty unique in that in the health care space. I don't get many providers dental or otherwise that are really good or effective at helping me build that identity. Most are very transactional to be perfectly clear. They just they want to make it easy and comfortable and and do as honestly as little as possible sometimes, but they don't go out of their way to help me realize the value in these checkups, the value in making sure that I'm healthy and strong and seeing the signs if there are any of potential dangers down the road. And so I think this is a big opportunity for a lot of practices, a lot of providers to connect with their patients, to really build them up. and to applaud their efforts for coming in. And even those people that have waited just say, honestly, I'm so proud of you. A lot of people, when they get to this point, they don't wanna come in at all. They're just so petrified of what might happen or what they might find out that it stops them from coming in. So I'm so, so proud that you are here today and we're gonna make this a good uh outcome for you regardless of what you decide. even just knowing what's happening in your mouth, what's wrong, what the issues are, that alone provides tremendous value for you. Now you know and you have clarity around it and your mind's not just conjuring up all these worst case scenarios. Now you know what direction you're gonna go instead of going any of these 12 options. Now you know, okay, option B is what I need. So much clarity and so much peace of mind comes from that. But a lot of practices don't do this well. Like I mentioned, it's not just dental, but healthcare in general. They are asked for the entire treatment all at once, or especially with people that haven't come in. You know, that's a big jump to get them to agree to everything all at once. And it happens, right? There's a lot of people that realize that either they're in so much pain or that something's gotta change that they comply. They agree with that. But I think we can be better at this, at not just jumping straight to full treatment or cost or overloading patients with all of this information, but instead focusing on smaller incremental agreements so that they can build up that confidence and build up that consistency. I don't, not saying at all to pressure patients. ah really it's about providing them clarity and options and applauding them for just coming in. Honestly, again, I think it's making sure that they feel comfortable coming in because that improves your chances of them getting the help that they need, hundredfold, right? I had someone years ago say that they are, the division that they had for treatment acceptance, was, you know, it's, I'm 100%. That's my goal, you know, and it doesn't have to be. And the way they articulated it was it's not about just today. I don't look at it in terms of, oh, did they accept treatment? They did, they did not. Some do, 27 % do, the rest don't, know, 73 % don't. It took me a minute to do that math on the fly. But it's about the long-term vision. of over time they're all going to accept it because I'm not going to pressure them to do it all at once. I'm just going to continually encourage them, you know, we'll look at it and maybe they don't need to do it right away. Maybe they won't have any issues. then, but down the road, we'll keep evaluating, keep looking at it, keep encouraging. And ultimately they're going to see how much uh either the issue gets resolved and it's not as big as we initially thought. or they're gonna accept treatment. And that is the mindset that they have. And I think that was, that's beautiful. It's an amazing way to look at it because it's so much less pressure on the patient. It's so much less pressure on you, the provider or your team to have them accept treatment. just a great, great mentality to have with that. So let's look at a few other things too. before we finish. So some practical examples, again, just kind of reinforce that we're not here to, or my recommendation would be to avoid saying we're gonna decide everything all at once today. But instead to focus more on today's just about understanding what's going on. Let's just figure out what's happening. And then we'll have a better idea of what our options are moving forward. Get those, again, very small commitment. That's something that I think almost everyone would readily agree to. Commit to listening to them. You know, I promise I'm gonna answer all your questions. You know, and just little commitments, things like that. Get these micro yeses during the consultations. So does that make sense so far or does that sound reasonable? Does that sound fair? Would it be fair to say you want to avoid any issues down the road? Again, you're just trying to provide clarity, but also help them see and really uncover the type of person that they are. And you know, you're trying to, again, you are trying to encourage them towards choosing a healthier lifestyle, towards being more proactive about their oral hygiene. But it's... you're allowing them to choose their adventure along the way. You're not assuming, you're not pressuring, you're helping them see that, yeah, you're the type of person that, I mean, you're here, obviously you value your health and you wanna take care of it down the road and you wanna avoid any problems that you could. If there's any problems that we could avoid, would you be okay with that? Absolutely. I mean, come on, right? But each small yes builds that alignment and it helps create that identity that we want to naturally stay consistent with. Okay, so if we, if you're showing them, you know, the diagnostics you're looking through and you're seeing, you're seeing the issues that might, it could be a cavity, it could be a root canal, it could be, oh, well look here, look at this area, it's starting to erode. Look at all this decay, look at this nerve, look at this. this chip, look at this movement in your teeth and help the patients see and agree that there is a problem. I can see that there's a problem. You know, I mean, that's simple. And we've gotten a lot better as providers over the years in doing this to take that patient along that journey and visually show them as well as just verbally what's going on. And again, you could what would help? is saying this is where it's at now. I'm going to show you a couple of different examples. One is, you know, this in the worst best case scenario, it kind of stays like this. It might get a little worse, but not to the point where you're in a ton of pain. Show what that might look like and then show what is likely going to happen is that over time it will progressively get worse and you can show what that looks like. Again, I know We're doing better at verbally sharing this and explaining this, but it's nice to show visually. It reinforces what you're saying. So any way you can do that, the better. It's nice to have a few examples at the ready, you know, of other patients, other cases, obviously not sharing any patient information as far as names or personal identification, but showing scans, showing the progression. It'd be very, very helpful. When you get to the, know, there's a part in the book, he talks about people that write out their agreements or make public commitments, those, they last a lot longer. They're much more effectual, they're much more effective in compliance. you know, and helping that person stay consistent or comply with that identity. So treatment plans that are reviewed together, which again, I would say on the whole, everyone's pretty good at this, is working through that plan together. Notes about what you're seeing as a provider written in front of the patient helps. Again, it kind of reinforces that you're both in this process. both going through this journey together. those digital scans pointing out visually that what's going on, what the issues are. And then having even something as simple as having the patient fill in the date and time of their next appointment has proven to dramatically improve show up rates and reduce cancellations. So not just doing it for them, but having them physically write out the date and the time of their next appointment on that little appointment card that can improve. their compliance. Again, it helps them stay consistent with who they are. They've written it down. They've taken that action. Now they want to say, oh made this appointment, so I'm going to keep it. Right? These are little things, but they have a tremendous effect. And again, I want to stress that we're doing this to help them. I want to do this in the spirit of helping them improve their health, to feel better about their oral hygiene, about their smile, gain more confidence. and their ability to take care of themselves and really applaud, we're about applauding their efforts along the way. Seeing those little commitments reinforce. Scheduling, again, having that mindset that, hey, if they don't do it right now, we're gonna do it in the longterm. As long as that issue persists, we're gonna help them resolve that over time. Scheduling is a great commitment, you know, just getting them to come in down the road, even if they're not ready to accept that treatment. have a big, ah they have a of procedures, they have a big treatment plan. It's okay. Just say, I understand you've got to let you're thinking about a lot of things for now. If they're not ready to move on for now, let's just let's I want to see you back in a couple of months and we'll just we'll just talk. You know, I just want to see how you're feeling. See what we can dive in and look at. Do an exam and see how things have progressed. Just make sure that they know that you're concerned about them and want them to not feel that pressure. But again, maintain that identity that they're gonna, we're gonna keep looking at this, we're gonna do this together. That's a great identity to build. That I am here for you and together we are gonna figure this out. So how does this, what are some other ways that this applies to marketing? Right, I mean I think all these things are marketing related because it's the, they all shape the experience that you're delivering for the patient. And that's marketing, really. I mean that's exactly what it is. So, but what are some other ways that you can do this? Well I mentioned being a huge advocate for patients and them coming into the practice. and then being proactive about their care. Applaud them. Do that every chance you get. You know, if they make a first appointment, oh, I am so excited. We are so excited to see you. It's so awesome. You are the type of person that takes care of your health. We love that. It can just be a one-liner that you add into any confirmed appointment. Just make it one of those things that they hear all the time when they come into your practice, like the Chick-fil-A My Pleasure. You know, you have those sayings that reinforces how patients feel when they come into your practice. Okay. And help them feel that they are ones that commit to good oral health. So something as simple as that, it could be things like if they, if you have put together a video series, any type of educational content, a PDF, a guide, things like that, always in the beginning is a great idea to reinforce their decision. I can tell that you're the type of person that cares about their teeth. Something simple like that. You know, because you've taken this action, it's clear that you want the best for your oral health. These small little things that go a long way, right? And again, those public commitments tend to be lasting commitments and that's another Reason why getting patient testimonials, patient reviews are so vital. I mean, if we needed another reason, we shouldn't because they're already, they're one of the top ranking factors for SEO and showing up on Google. They are a tremendous power, wield a tremendous influence on our peers, you people that are also considering your practice for reviews. We're gonna talk about social proof in the next episode. But it also leads to greater loyalty to the practice. They remain patients longer. Those that speak up for your practice are more likely to send referrals. Because they wanna, you know, they're gonna talk about, oh, I heard that you go to this dentist and yeah, I do actually and they're amazing. They're gonna back up what they say. They wanna stay consistent, especially to those people that have heard about what they've said or what they've read. So again, another, it's so important to get those reviews and if you can do them on a video, all the better, all the better. mean, reviews are amazing and they're a lot easier to get quite frankly, more convenient, but I would schedule twice a year, twice a year, maybe more if you wanted to, but twice a year, we're gonna have a little media day for our patients. We're gonna get them to come in and and do some do some reviews some video reviews gonna have some snacks have maybe have a gift for them in exchange for that take some pictures take a little quick little video on the phone doesn't have to be anything high production but man you did that twice a year you're adding you know each time 10 to 15 new video testimonials 30 you know 20 to 30 new ones a year forget about it that is power that is some some great commitment one, but it's very powerful social proof. It's gonna help a ton with your SEO as well. If you post those on your Google business profile listing or your website, they love that rich media. Man, they love that rich media. It's so good. Videos are so powerful that way. So again, that's an easy one. Easy, yeah, I say easy because it's simple. And once you do it once or twice, it actually does become pretty easy. You have the process, but you do have to, there's some initial effort in doing that. I know it's not always in your. in your wheelhouse. uh So getting outside of that is going to take a little bit of momentum, but trust me, it's going to be so, so worth it. Okay. uh Right. I think that's all the ones that I really wanted to share. I'm just going to go through my notes really quick, but I would just, the action items for this episode would be to look through your practice process. know, onboarding is a great one for patients or just as you walk through the in-office experience, how can you reinforce the patient's desire for a healthy mouth? How can you applaud them in their efforts for coming in and getting the care that they need? Caring for their teeth in a great way, right? So look at what kind of things can we say on the phone? What kind of things can we say during their visit? to reinforce that behavior and really shape that identity. And then how can we adjust some of our approach, some of our verbiage when we're talking about treatment plans and we're trying to just, we're not trying to overwhelm. know, obviously there's scenarios where they need the help and they need it right then. You and you help do your best to convey that, that it is in their best interest. But for those that don't decide on that, make sure that they know that you're here for them, that you still wanna see them. You want them to come back and we'll just check on it and we'll reevaluate. But we're not gonna strong-arm them. We're not gonna put them in a full Nelson until they comply. But that's commitment and consistency. I challenge you also to look at this where this shows up in your life. The more you can see this, the better you'll be able to understand it and the better you'll be able to deal with that if you're not wanting to comply, but also just see that and recognize how you can use it for good in this world. So next episode, we're going to be talking about social proof, like I mentioned, and why patients trust other patients more than marketing and how we can use that to our advantage through reviews and testimonials and stories and how they influence decisions. Okay, so the big takeaway really for this week though is that patients want to stay consistent with the perception of who they are, right? They need to feel aligned. And when you help patients say yes, make those small yeses, the bigger yeses become more natural. Okay, so if you've liked this episode, please leave me a review. That would be tremendous wherever you're listening. And that would just help me out a uh lot. I would really appreciate that. And if you have any questions on this episode or any other episodes, please reach out. You can contact Maria, my assistant, maria at markthackerry.com with any questions or comments. Love to hear from you. Otherwise we will talk to you next week.