Do you promote yourself as a holistic or a mercury-free dentist? If you do, then you know that working with this special group of patients brings a unique set of challenges. Recently, I conducted a Team Teleconference with a group who was struggling with how to best serve these patients.
Their goal: To better understand these patients and learn how to connect with them more successfully. In other words, how can we align with what they want?
Here’s the email they sent me to establish the agenda for our session:
Holistic calls seem to always be the challenging call in our office. The patients are always very detail oriented and can really throw us off with some of the questions asked. Another problem we face is they take so much time on the phone. I immediately guide them to our holistic website and walk them through our holistic approach when removing Amalgam.
There seems to always be a lack of understanding by the patient about what is involved. What I constantly hear from these patients is that they don’t want to have an exam, (don’t want) x rays and just (want to) have their amalgam removed.
How can we efficiently handle these calls? How can we handle these conversations to help the patient better understand why the exam and digital X rays are important? How do I get these patients to understand our process without coming off “rude” or “condescending”?
Keep in mind we do offer the consult as a last resort to help convert the call to a future appointment.
Our session brought about some clarity by breaking down the knowns and unknowns.
To start, the team identified some common themes that emerge when working with these patients:
1) They do a lot of personal research on the Internet.
We know that there is an equal amount of incorrect information as there is accurate information out there and each patient will struggle to discern what is fact and what is fiction. When they call your practice, they already have a set of beliefs which may or may not be correct. If what you tell them goes against what they have begun to believe, they will experience some internal conflict.
2) They self-diagnose or have been told by a trusted authority that the mercury in their mouth is;
1) toxic and 2) may be making them sick.
This may or may not be true in their case but you will not change their belief system in a short phone call. It is what it is. Gaining clarity about what they believe is essential and you must use this as the CONTEXT for which you will begin your relationship with them.
3) They are apprehensive and slow to trust.
They may believe you want to perform other procedures that aren’t necessary or will also be harmful. Some individuals may have had negative experiences with health professionals in the past, which leads to their distrust. They have a story and you must take the time to learn what that is.
4) They are health-focused.
Some of these patients place high importance on their diet and their exercise regimen – sometimes to the point of obsession. On the other hand, they may have a multitude of health issues and their life revolves around illness and doctor appointments. This is a part of the story you will uncover and must understand in order to determine IF you can help them, and if so, HOW you will offer to help them.
Because of these issues, they will consume more time than your typical patient, asking questions and discussing their unique circumstances. There is no way you will change this. If you are going to serve this special group, you MUST be prepared to take the time required to fully understand them.
Also, there is a BIG difference between being efficient, and being effective. Efficiency relates to paper and processes while effectiveness relates to working with people. And effectiveness can’t be measured by whether or not you convert the phone call to an appointment. Not all callers are ones you will want to invite to become your patients. You must know when to cut your losses.
During our session, we broke it down into bite-size pieces to come up with a more effective way to work with these patients when they call.
What do they want?
In quality of life terms, what are these patients hoping you will help them with?
-They want to feel better
-They want peace of mind in knowing the possible toxins are gone
Above anything else, this is what you are providing. The procedure of removing the amalgam fillings will simply be the means by which you will help them get there.
How do they want you to accomplish this?
-They want it done in the least amount of steps necessary
-They want the safest procedure possible
-They want it done for the least amount of money
What don’t they understand?
-They’ve been told or read something they have come to believe that is different from what we tell them.
-Why xrays are necessary.
-Why a thorough exam is both clinically necessary and required by law.
How can you help them get what they want?
Because you don’t know what might be necessary just by talking with them on the phone and the approach requires a thoughtful process considering their unique situation, you will need to provide the context for why this is important in their case. Experiment with the following process and refine it as you get more successful:
1) Find out more about their unique situation – learn their story
When a caller begins the conversation by asking about mercury-free dentistry or removing amalgam, find out why they have an interest. It’s as simple as saying;
“That’s a great question. You’ve called the right place. Tell me a little more about your situation and let’s see how I can help you.”
2) Be quiet, listen, and take notes.
The patient will choose to tell you those things that are most important and can provide you with the foundation for how you will relate what they want with what you offer.
(Sidenote: if the caller begins by telling you every little detail that happened years ago, there are several ways in which to determine whether you must 1) disengage because of red flags, 2) focus the caller, or 3) offer to refer them to a source of reliable information (like your web site), and call them back at a later time. More on this in a separate article.)
3) Use what you have discovered to provide context to the solutions you recommend.
It doesn’t matter that the protocol you use for each person is the same. You must make what you recommend unique to their particular situation. Remember to:
-refer to them by name
-acknowledge what you have heard
-explain what you recommend based on what you have heard
-get their approval
Here’s an example:
“Barbara, because you mentioned you suspect the mercury in your mouth may be causing some of your health issues, Dr. Holistic will want to learn all about those concerns. She will also want to evaluate what other things might be occurring in your mouth that you would want to be aware of and whether they may be contributing to your problem. I would like to suggest we arrange a time for you to come in to discuss your concerns with Dr. Holistic and she can to determine what diagnostic tests may be appropriate to discover the best way to help you. These may likely include xrays to see what the human eye can’t see going on under the surface. How does that sound?”
(Another sidenote: the subject of xrays and some patient’s reluctance to allow them is another layer of the story. You must peel back this layer in order to understand why this is a problem for them. Don’t assume you know what it’s about. Stay curious and relate to what they are telling you. If you would like to know more about how to address this issue, contact me for a primer on the subject.)
The TAKE HOME MESSAGEs:
Stop telling and start listening.
Use what you learn to create the framework for how you will help them.
Make it personal and unique to their situation.
You can use this same approach with ANY patient. It will help you connect more personally to each caller, begin to develop trust and help you establish a strong relationship from the very beginning.
We may not like it but we are constantly in a state of change.
Some change is hard. For instance, It’s time to upgrade my iPhone but I have to upgrade my Mac’s operating system first, which I’ve put off because if I do, my database management software isn’t supported and it will need to be upgraded too. That’s not my idea of fun and it doesn’t come easy to me so I’ve avoided it.
But change can also be good.
You see, once I upgrade all my devices, I’ll be able to do things better, quicker and with less effort than I did before. So, I have to embrace change, take the plunge and not fight progress any longer.
Things change in your patient’s lives too.
What might not be a problem for them last month might now be an issue. Their priorities, their job, their perspective can all change quickly and you must be prepared to adjust to those changes as well. The more you adapt, the greater your success.
Change is uncomfortable but necessary
Think about all the changes that have occurred in your practice over the last year or so. Equipment, procedures, staff, your patient base. It’s likely that those changes were met with some level of cynicism or resistance before people realized the benefits. Just like the bad boyfriend or girlfriend, once you make the decision to change the situation and do something different, you probably thought to yourself “I wish I had done it sooner”.
I want to help you embrace change.
To start, ProSynergy has made some changes and we have a brand new web site. I would love for you to check it out and let us know what you think. As an incentive, I’ve posted a link to the home page for you to receive a free two-hour audio program called:
No Two Days are Alike: A Survival Guide for Successful Change
It is my gift to you for taking a look and learning more about how we can help you become more successful in the face of inevitable change.
This has been a topic of conversation lately. And while it may be fun to watch on Survivor, the gossip, taking sides, stirring of s@#$%t that takes place in a practice can be toxic and damaging. I dug up an article that Sandy Roth wrote a while back and with her permission, pass it on to you:
Triangulation and Forming Alliances: How to eliminate it
Why can’t we just get along? I suspect one of the reasons is that we don’t know how. First, the fancy definition: Triangulation occurs when one person, having an issue with a second person, takes that issue to a third person. Now for the street version: Triangulation is talking about people behind their backs.
Triangulation is a serious problem for many teams, and it can often get a group in big trouble. Although triangulation is a behaviorally immature approach to disagreement, many adults engage in it without understanding the full implications of this choice. When I observe this behavior, I ask about it. Often, team members are simply unaware of what they are doing. They have learned to gripe but not to address their problems directly; so they simply do what they have always done.
• Triangulation solves no problems
The only route to solving inter-team conflict is a full, honest and open discussion of the issues with every person’s active participation. All problems ultimately belong to the group and not a secret subset of team members. Here’s why. Let’s say Jeanne and Jane have a difference of opinion. When their individual efforts fail to resolve this difference and either party secretly takes her frustration or anger to a third person, that third person is now involved in a clandestine discussion. This unhealthy dynamic now “infects” the entire team. People always know who is mad at whom and who is part of a faction.
• Triangulation creates new problems.
Triangulation fractures the group by putting a greater emphasis on differences than on understandings. It almost forces people to focus on the negative aspects of their culture. Moreover, this strategy creates an environment of distrust and disrespect, which tends to undermine healthy aspects of relationships. Practice attention must then be shifted from patient care to team dynamics. What a waste.
• Triangulation creates false alliances.
Jane is angry with Maggie and goes to Susie to dump. “Have you noticed Maggie doing such-and-such?” Jane asks Susie. Now, Susie hasn’t noticed this, and initially she has no beef with Maggie herself. “No,” she answers. “Well, I have,” adds Jane. At this very point, Susie will most likely make a choice between aligning herself with Jane or standing in defense of Maggie. Susie will find it difficult to disagree with Jane. After all, Jane has come to confide in her — an act of “friendship.” And just because Susie hasn’t seen something doesn’t mean it hasn’t really happened. Human nature will more often result in a secret alliance between Jane and Susie against Maggie which is based on incomplete information and a pact to tell no one else. If she tells Maggie, she has violated Jane’s “confidence.”
The confidential information Jane has shared is now almost impossible to ignore. (Don’t think of an elephant.) Even if Jane drops the conversation at this point, Susie is now predisposed to seeing Maggie in the negative light of Jane’s characterization. She is now more likely see those things which confirm Jane’s picture of Maggie and selectively ignore information to the contrary.
• Triangulation encourages factions
Under the guise of “checking it out,” a team member triangulates with a third party (Sometimes this person is the dentist). First, let’s agree that this is tattling. If the initiator really wants to check things out, he or she can go to the only person who can answer the questions. The real purpose of this behavior is to gain allies. The more people who agree that you are right and the other is wrong, the stronger you feel and the more righteous you become. Once the number of allies begins to grow, the opposition is forced to counter. Before you know it, the practice is split and there is a full-scale civil war.
So what are the alternatives?
• Always go to the source
The cleanest way to handle any problem is to go to the source. Yes, this can be tough, but eventually the problem will have to be aired anyway and it won’t get any easier under the unhealthy circumstances triangulation creates. Forget about rehearsing, making sure you are “right” before you raise an issue or gaining evidence. None of these excuses justify triangulation.
• Never agree to keep triangulation confidential
If someone asks you to enter into unhealthy alliance by sharing secret information with you, simply refuse to keep it secret. The proper answer to “If I tell you something, will you promise not to tell anyone else? “ is “NO.” For what honorable reason would someone call your attention to a problem if she didn’t want some help actually solving it? If the real reason is to get your support in the civil war, refuse to be drafted. You can agree to help the person raise an issue, but you must never agree to be a secret-agent.
• Ask for facilitation if you need help
If a co-worker tells you about an issue she has with a team member ask the following: “How did you raise that issue and what happened as a result of your discussion?” Too often, you will hear that there was no discussion. At this point, encourage your friend to raise the issue immediately and offer to facilitate the process. Facilitate does not mean gang up. Facilitate means to insure that each party is heard and understood.
• Return the problem to the group if necessary
Of course the team needn’t handle every issue. But when reasonable attempts to resolve disputes prove unsuccessful, it is time to ask for support from the entire team before the relationship deteriorates needlessly. Be sure to ask team members to listen to the issues and avoid taking sides. The only side which matters is the onein the best interest of the practice as a whole and the patients whom you serve. Principles, core values and promises to patients matter. Egos must get out of the way.
Help! My Staff is Holding Me Hostage!
The voicemail message sounded desperate. “Call me back as soon as you can. I need your help right away!”
What caused such distress? What made the situation so urgent? As it turned out, the dentist was having difficulty keeping a chairside assistant and was faced with hiring for the third time in less than one year. His receptionist had left but he wasn’t happy with the performance of her replacement. Each day brought another drama with the hygienist whose personal life was in total disarray. The practice was totally unstable and he feared losing another employee every day. What would his patients think when every time they came in there were different staff members?
After a short discussion, it was quickly clear his staff was calling the shots:
“My hygienist didn’t show up for our meeting yesterday and didn’t even offer an explanation. We are constantly bailing her out of personal situations. I know it’s hard for her – she’s a single mother and doing the best she can. Then, my chairside assistant refuses to do things that are part of her job. I end up having to pick up the slack at the end of the day before I leave. I overheard them complaining in the lab today about a continuing ed program I was paying for them to go to on their day off. They joked that they would just sit in the back and text on their phones. I’m afraid to lose them because our patients seem to love them and I’d have to spend time breaking in new staff but I don’t know how much longer I can go on. I feel like a doormat”.
While this scenario may vary from one specific practice to another, the problem is basically the same in many: dentists who neither know nor enforce their boundaries and expectations because they are afraid they may lose staff. Indeed, their staff is holding them hostage. How does it get to this point?
Let’s examine the factors that contribute to this phenomenon:
1) The dentist’s personal relationship with staff makes it awkward to set and maintain standards and/or fire a low-performing employee
While we all have busy, challenging lives that can effect our professional lives, these issues should never dictate office policy. This is an area in which many dentists confuse their personal relationship with their work relationship. It stands to reason that because you work together closely all week, you might easily develop a strong bond with one another. You may find yourself identifying with your staffs’ personal problems, like managing a home and family and trying to make ends meet. Express your empathy, of course, when appropriate, but as an employer you must establish clear boundaries. Do not advance paychecks, pay rent, loan cars, or pick up kids. Do not make concessions for days off outside a very rare and unavoidable situation. By doing this you will set a very dangerous precedent. Other employees will consider it favoritism and they will expect you to afford them the same concessions.
If you have already “let that horse out of the barn”, you can reverse this trend. Gather your group together and apologize. Explain that you care about each person on the staff and this has clouded your judgment. It has created a problem for you and others. You must now establish a new set of boundaries that are in the best interest of the practice and your patients. Then you must outline where you went wrong and what you are no longer willing to sponsor. They may not like it but they will understand.
If you believe your personal relationship with an employee has gone so far that the two of you can no longer be effective working together, give us a call. We can help you sort out what the appropriate next step should be.
2) Even if it’s written down in the manual, not every employee will know what’s expected and will follow through.
Your employee manual means nothing without two things. First, your staff needs to understand the bigger picture. It is your job to clearly convey to each person what your practice is there to accomplish and how their efforts are expected to help make that happen. The big picture is crucial. More than the step-by-step guide that a manual provides, your explanation of the practices’ purpose, as well as your beliefs and tangible examples of how this purpose is played out on a daily basis is vital. It will give them a guidepost to follow in their day-to-day challenge of making decisions about what is in the best interest of the practice and the patients.
Second, every employee must be on board with your purpose. Each must be in alignment with your belief system and share the same basic values. And you must have their agreement about their role and responsibility. This can best be accomplished as a group discussion where each staff person has an opportunity to ask questions and gain perspective. Time consuming? You bet. But without this clarity your staff will be working without a clear direction which often works at cross-purposes with the practice goals and will cause a great deal of frustration for everyone.
3) Hiring and training the right way often takes a back seat to retaining under-performing staff.
A good way to think about your problem employees is the bad girlfriend or boyfriend you may have had. You knew long before you broke it off that things weren’t working out but you avoided it hoping things would get better. They rarely do. Then, when you finally got up the nerve to end it, you thought to yourself, “I should have done this a long time ago”.
Your under-performing staff are robbing the practice. Pure and simple. You simply can’t afford to work with people who are inefficient, ineffective, and cost your practice time, money and resources. The focus and energy these employees sap from your patients and practice deprive you of much more. You can not be as effective in your job when you are worrying about staff doing their job. It stands to reason that the under-achievers aren’t dedicated to your practice purpose and patients are not receiving the same care and attention you strive to provide.
While hiring and training (and doing it right once) requires time and energy, doing it over an over again takes you away from focusing on dentistry. And it’s not a lot of fun. Cutting your losses and embarking on the hiring process can be an opportunity to make a course correction. If you approach this process correctly, you will avoid having to carry dead weight on your team. You will have a solid and stable group of individuals for a longer time. Approaching the hiring process correctly is essential.
You can bring your new hires on with a strategy for success that includes a thoughtful training plan designed to help them succeed. Equally important are periodic evaluations (for everyone) to keep your team performing at a high level, stay motivated and focused on the big picture.
There are way too many dentists “making do” with staff because they are afraid they won’t find a better replacement. While high-performing employees are more rare and difficult to find, they are out there. It is just a matter of knowing where to find them and how to attract them. They may be disenchanted with their current job or looking for a greater challenge or more responsibility. Perhaps they don’t feel they are appreciated or they deserve more compensation for what they do. Those are your candidates. It just requires more diligence on your part to find them. It takes a dedicated effort, creativity, and a solid plan to attract that exceptional staff member. It starts with an exceptional ad that is masterfully written and trying new and innovative strategies to distribute your ad. Most practices do a lousy job at this and dread the process. The pool of candidates often reflects the quality of the ad, which often misses the mark.
Are you being held hostage? Stop letting your staff dictate what happens in your practice and take control. If you believe it is a matter of establishing clear boundaries and re-establishing expectations, start the process today. You can no longer afford to allow this to go on. If you know in your heart that there are one or more staff people who would be better off somewhere else, start making plans today to embark on the hiring and training process.
Of course, we can help guide you through this. We can help you clarify where you need to make changes and develop a thoughtful process for implementation.
If you plan to hire, consider calling on us for support or using the tools in our hiring kit. You can learn more by clicking below or calling us at 800-848-8326.
Laying Down the Law With Patients
While it’s clear that our patients have expectations – sometimes valid, sometimes unrealistic – we have expectations too! And how often is it that our patients disappoint us because they don’t do what we expect of them? While this blog article could turn into a full-on gripe session about those darn patients and how they constantly let us down, I believe how we think and what we do or don’t do, have a great impact on how our patients act and if we want them to change, we have to change first.
Here’s the deal; First, there are some things that we don’t get a vote on and there are other things we do. Second, how can we hold our patients to accountable to any expectations if we don’t come right out and have an honest conversation about them? Expectations are reasonable only when they are clearly conveyed, discussed and agreed-to by both parties.
So, what are the valid expectations? In our opinion, we believe there are only four things you can ask of your patients. I think you will strongly agree;
1) SHOW UP – and on time
I could devote a book to this subject. How often does a patient let you down by no-showing, or arriving late (and thinking it’s OK, I might add)? How dare they? First, this is a professional business arrangement. It can’t be treated casually. Having your patient sign a form with your “office policy” is not good enough. (How many people read it anyway?) You must look your patient in the eye and tell her you have reserved this time with “fill-in-the-blank” just for her, you will be fully prepared when she arrives, and ready to get started. “Can I get your commitment to that?” THAT will get their attention.
What doesn’t work? A recall system or any other communication that conveys the message that you “request the courtesy of — hours notice in the event of cancellation”. You’ve, in essence, given them a ticket to reschedule. And putting them in the penalty box by “fining” them for not showing will just put a strain on the relationship without addressing the problem. Instead, speak to the obvious;
“Bob, we were expecting you this morning for your appointment with Dr. Norris and honestly, we are disappointed you didn’t make it. We had that time set aside just for you.”
How can you assure this won’t happen in the future?:
“ I can arrange your next visit in one of two ways; a deposit of $fill-in-the-blank will reserve your time or, I can call you on a day when an opening avails itself to see if that will work with your schedule.”
Same thing with people who habitually show up late. Speak to the obvious;
“Lisa, I’m glad you finally made it. I only have 35 minutes of time left before my next patient arrives so, I promise I will get as much accomplished as I can. It might mean we will need to schedule another time to have you come back to finish what we can’t take care of today.”
Message: you’re late, I run on time. I will not inconvenience my next patient, you will still pay for your full appointment, and you might have to come back again. Reasonable? I think so.
2) PAY AS AGREED
Aside from insurance claims, there should be no reason for you to have any outstanding accounts with patients. Period. How is it that practices get into the accounts receivable business with patients in the first place? Unspoken or unclear understandings about 1) the fee and 2) the terms for paying the fee.
No dentistry should be performed without an actual discussion about the cost associated with the treatment recommendation, what the patient will be expected to pay, how that fee can be made, and a mutual agreement with the patient on the terms. Something as simple as:
“Gentry, the fee for the treatment you have chosen is $fill-in-the-blank and our first preference is that be paid (in full at the first appointment or a % to reserve the appointment and remainder on the first appointment, etc.). Will that arrangement work for you?” If it does, great. You are done. If it doesn’t, you find an alternative that works for both of you.
Remember, it is better to NOT do the dentistry than to do the dentistry and NOT get paid.
3) BE HONEST
What would we want our patients to be honest about?
#1 on the list: Let us know how you are feeling and what you are thinking.
You can’t read your patient’s mind. You need to know if he is apprehensive, if he isn’t sure the treatment you’ve recommended is right, or if finances are an issue. That is why having a dedicated and gifted facilitator on your team can help you connect with patients at a deeper level and help them voice what might otherwise be left unsaid.
#2 Lifestyle, health issues or recreational/prescription meds. These have a huge impact on what your recommendations might be and the outcome.
#3 Don’t make an appointment if you don’t intend to show up, or agree to treatment if you aren’t sure, etc.
These could be uncomfortable conversations. Coming right out and asking your patient to be honest may imply that you think they are lying. So, how do you convey this very important value? You can suggest the ways in which you hope they will tell you the truth. If you use context to frame the idea, it will make the conversation go more smoothly;
“Some people are reluctant to share personal lifestyle information with us such as their recreational drug use or the state of their health but these issues have tremendous impact on how we might treat someone or the outcome of treatment. I want you to encourage you to be as open as you can with us and know that we will respect your honesty and never make judgments based on what you tell us. In exchange, we will never mislead you or withhold information that we believe is in your best interest.”
Or encourage honestly by speaking to the obvious…
“Something tells me you aren’t fully committed to the treatment we have recommended. Before we go any further, please share with me what you are thinking and what concerns you still have.”
4) BE GOOD NATURED
We’ve all had them. The patients who show up on your schedule and you break out in a sweat. You plan a strategy to be in the lab when she arrives. You avoid engaging her in conversation and ignore the terse comments. In my opinion, that is NOT OK. If there are patients in your practice who are bullies, they need to be called on it.
When my kids were little and one of them would come to me complaining, “Mom, Casey’s chasing me”, my reply would always be, “Then stop running”. The same is true with nasty-tempered patients.
Yes, it is uncomfortable to address someone when they are behaving badly but it can be done with grace and one of two things will happen: it will either defuse the situation and she will recognize, apologize or explain herself OR she won’t get it and the relationship will end. Either way, you win.
Here’s the grace part:
“Hilda, I get the sense that you aren’t very happy about something, and if it’s something we’ve done to make you that way, we would want to know about it. What’s going on?”
You will know very soon by her response where to take the conversation next.
“ Goodness, I had no idea. Thank you for being honest with me. Let’s see what we can do to make it right.”
“You know, Hilda, it is becoming clear that despite our best efforts, we may not be able to make you happy. I am more than willing to transfer your records to another provider if you like.”