Beyond Practice Management: Doctor, meet patient

2009 06 04 14 09 47 485 Drb How To Bug

"Hi, Mrs. Jones. I'm Dr. Smith. Open wide, please."

Way, way gone are the days when dentists were so revered and trusted as to be able to simply introduce themselves and start uncovering dental problems and treating them.

Would your patients say they feel strongly connected to you? Do they have a huge amount of trust in you? Do they feel completely heard and listened to? Do they understand their dental conditions and the options (yes, plural) for treatment?

In tough economic times, it's difficult to avoid the temptation of skipping a lot of steps necessary for an excellent doctor-patient relationship and getting to the treatment part -- the part we get paid for providing. Yet patients -- uh-hum, people -- are demanding that we listen, respect them, offer them options, and not be so rushed to "do something" to them. If we rush the process, nearly all people will search out a dentist who will do the things they are asking.

Watching pending treatment totals skyrocket is truly difficult as people spend less on dental care. Yes, their problems are still marching on, but many are choosing to wait -- wait until it hurts, wait until it looks bad, wait until it breaks. You and I know that's a recipe for disaster, but do they? People are postponing or stretching out intervals for routine dental hygiene visits, even if all they have is a small co-payment.

What are positive steps you can take in your practice to help your patients accept more care?

  1. Record your conversation with at least five new patients. (It's best to ask their permission; it is, after all, for training purposes.) That's the easy part; the hard part is listening to yourself. After the painful task of listening to the recordings, ask yourself the following questions:

    1. Who talked the most? It should be the patients by a long shot.
    2. Did I respond fully to the patients' questions, or did I gloss over them?
    3. What did I do to build trust?
    4. Did I ask open-ended questions?
    5. Did I give the patients an opportunity to ask me questions?
    6. Did I really understand why they chose me and why they were in my office to see me?
    7. Did I learn at least three nondental things about them?
    8. Did I feel connected to them, and them to me?

  2. Evaluate how you are introducing patients to your practice. You may need to change your protocols, or perhaps be more flexible.

    1. Examine every "moment of truth" patients have with your office. Believe it or not, they will have upward of 30 or more impressions of your office before they ever meet you. (Do you know what those are?) Discuss these with your team members because they are the ones who have the majority of the interactions with the patients before you do.

    2. Was plenty of time allowed for focused conversation, as well as a complete exam?

  3. Present treatment at the appropriate time. If you're doing a complete exam and taking the time to listen and develop trust with the patient, it may or may not be appropriate to present treatment just yet, despite your eagerness to do so.

    1. Does the patient TRULY understand his or her condition? Most will respond "yes" because no one wants to appear as if they don't understand. Asking them "Do you understand?" will elicit a "yes" response the vast majority of the time, so it's a worthless question. Try asking an open-ended question, such as "Mrs. Jones, tell me what you understand so far about your dental condition." This approach is much more likely to give you the feedback you need in order to know how to proceed.

    2. Does the patient TRULY believe you can provide the appropriate care for his or her needs? This is a relatively new question more patients are asking, the "why" of which could be debated. Nevertheless, for them to accept your care, this is also a critical question that they have to answer for themselves. You cannot answer it for them. Their answer depends on everything they have seen, felt, heard, and experienced to that point in your practice. Evaluate each of those items in your practice.

    3. Have you thought through your treatment recommendations for options for the patient's treatment and developed a collaborative approach to deciding on care? One of the great dentists of our times used to advocate presenting only one treatment option. Doing that now will result in your patient leaving. If there's not an option, there's not, and tell the patient that. If you believe your option is the only option, then you best have done a fabulous job to this point. Yes, we all have succumbed to providing "heroic dentistry" to help a patient save money ... and have it fail on us. The keys are to have a great relationship with the patients in the first place, then to make sure they understand what you are doing for them instead of the better or best treatment option, as well as what they should expect from the alternative as to avoid "buyer's remorse" -- or a lawsuit.

  4. Be patient and willing to work with patients by completing treatment in phases. Most people are not willing to pay for complete treatment all at once, but they are willing to commit to having it completed over time as they are willing to spend their money.

    1. Make sure patients understand you don't have a "crystal ball" and that you are basing your treatment phases on many factors, some of which may only be intuition and experience. If they decide to proceed in phases -- as most will today -- be sure they understand that their dental problems won't stop until they're ready to proceed with care. Again, your relationship with them is important.

    2. Offer outside financing options. I know you are just as sick of hearing about that as I am, but it's a reality that we must embrace, probably for years to come. You should understand that the percentage that a credit company takes from your fees comes right from your profits, so be cautious about this. You'll have to pay closer attention to your overhead expenses more than ever. Unfortunately, most people are used to making monthly payments on everything -- include dental care -- and not paying in full with cash, even if you offer a "bookkeeper's allowance" or other "discount." Remember, these fees and discounts reduce your profit, although you should likely be factoring this in your budget by planning on this happening.

    3. Avoid "hounding" patients about unfinished care. They'll resent it, and it may even drive them away from your office, no matter how gently you reminded them of unfinished treatment.

    4. The single best time to collaborate with patients and develop a plan for their care is when they're in your office. It's in your office where you can have a direct, face-to-face conversation with them. Prepare for their visit in your morning meeting by having the whole team know who has unfinished treatment so that extra time can be spent with the patients to revisit their treatment needs, answer questions, develop deeper trust, understand their concerns, and so forth.

There's plenty to re-evaluate, right? The best marketing in the world is the marketing that takes place in your office, especially that special relationship called the doctor-patient relationship. Don't take it lightly. It IS about you and developing the skills necessary to have that great relationship that will have patients willing to accept more of your care and refer more patients to you.

Dr. Deems is a professional personal and business coach and a practicing dentist. For the 7th year in a row, he was named to Dentistry Today's Top Leaders list and is the author of several books, the most recent, The Dentist's Coach: Build a Vibrant Practice and the Life You Want. He can be reached at

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