Awareness Characteristics Series (Part 2): Steps 4–3 — The Patient’s Responsibility

In Part 1 of this series, we covered Steps 7–5 (Ruin, Effect, and Fear of Worsening) — the stages that are the doctor’s responsibility. At that point in the journey, the provider is leading the conversation by showing patients what they may not realize, screening for sleep issues, reviewing results, and explaining risks if untreated. 
 
Now, we move into Steps 4 and 3: Need for Change and Demand for Improvement. These are the stages where the responsibility begins to shift to the patient. The doctor has shown the problem and explained the risks. Now it’s the patient’s turn to process, reflect, and express their desire to change. 
 
 
Step 4: Need for Change 
 Why it matters: 
Awareness becomes real when the patient starts to acknowledge that living with their condition is not acceptable. It’s no longer just the doctor’s concern — the patient begins to feel the impact in their own life and recognizes that something needs to change. 
 
What this sounds like from the patient: 
• “I don’t want to keep feeling this tired every day.” 
• “It scares me that this could affect my heart.” 
• “I can’t imagine living like this for another 10 years.” 
 
How to encourage this conversation: 
• Ask reflective questions: 
• “How do you see this affecting your daily life?” 
• “What would it mean for you if this continues?” 
• Provide quiet space for the patient to process and respond. 
• Reinforce what they’ve said: 
• “You’re right — continuing this way could make things worse, and recognizing that is the first step toward getting better.” 
 
 
Step 3: Demand for Improvement 
 Why it matters: 
This is the point where the patient takes ownership and declares their desire for improvement. They move from acknowledging a need for change to demanding a better future for themselves. 
 
What this sounds like from the patient: 
• “I want to fix this.” 
• “I don’t want to risk my health anymore.” 
• “What can we do about it?” 
 
How to encourage this conversation: 
• Ask outcome-focused questions: 
• “If you could improve your sleep, what would change in your life?” 
• “What would it feel like to wake up rested every day?” 
• Validate their desire: 
• “I’m glad you said that. Wanting to improve is what makes treatment successful.” 
 
Tools to support this stage: 
• Patient education videos (English and Spanish) to reinforce that improvement is possible 
• Testimonials or case studies that show real patients who experienced change 
• Visuals showing before-and-after outcomes of airway treatment 

 
The Clinician’s Role: Listening Before Solving 
 One of the most important skills for providers in this stage is learning to listen for where the patient is in the process. 
• If a patient is still in Step 4 (“I don’t want to feel like this anymore”), they are not yet asking for a solution — they are still processing the problem and acknowledging the need for change. Jumping in with treatment options too early can feel rushed or sales-driven, and the patient may resist. 
• If a patient moves to Step 3 (“What can we do about it?”), this is permission to share a solution. At this point, the patient has taken ownership, expressed a desire to improve, and is ready to hear about treatment. 
 

Why this matters: 
Patients who have not reached Step 3 are less likely to commit to or follow through with treatment because the motivation isn’t coming from them. By waiting for the patient to ask, you ensure they are invested in their own improvement. This shift transforms the treatment conversation from “the doctor telling me what to do” into “me asking the doctor how to get better.” 
 

Tip for Clinicians
 Think of yourself as a guide, not a lecturer in Steps 4–3. The goal is to draw the awareness out of the patient, not to push it onto them. 

• Use open-ended questions. 
• Give space for silence and reflection. 
• Mirror back what the patient says to validate their feelings. 
• Wait for them to reach Step 3 before you move forward. 
 

Why These Steps Are the Patient’s Responsibility
 Steps 4–3 represent a shift: the patient must take personal ownership. The doctor can present the problem and its risks, but the decision to want change and improvement must come from the patient. This is where case acceptance begins — when the patient feels invested and motivated to move forward. 
 
 
Wrap Up 
 This is Part 2 of our Awareness Characteristics Series. In this post, we explored Steps 4 and 3: Need for Change and Demand for Improvement — the stages that are the patient’s responsibility. 
 
Join us next week for Part 3, where we’ll cover Steps 2 and 1: Solution Awareness and Product Awareness. These steps bring the responsibility back to the doctor, as you present the treatment options and introduce the Vivos solution to meet the patient’s needs.