Mercury Aligns With Mars

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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.

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Laying Down the Law With Patients

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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.”

Or

“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.”

Conveying your expectations makes such good sense because it prevents a myriad of problems before they occur. And you will find that there are many remedial systems that can be eliminated when you front-end your relationships with a conversation about expectations.

Having direct conversations with patients about these expectations requires team members with courage, confidence and finesse. It requires level thinking, maturity and most important, time. That is a big investment but pays off quickly by eliminating many of the issues that cause us stress. 

Great Expectations

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girl full of dreams      It’s prom season! If you or your children have gone through the prom experience, you know there are a lot of expectations about this life event – your date, the friends you will go with, what you will wear, the transportation to get you there, where you will have dinner beforehand and what afterparty you will attend. If you were like me, my expectations for this magical night were not the same as my reality.

What does this have to do with dentistry? While as teens, we gave a lot of thought to prom and we discussed it at length with our friends and our parents, the expectations our patients have may not be as thought-out or clear.  BUT THEY DO HAVE EXPECTATIONS.

These expectations aren’t tattooed on their forehead – they are internal. And they are formed over a period of time based on previous experiences. Patients rarely leave a practice and move on if they are happy with their dentist. Consider that most people who call your practice are recycled patients who, with the exception of having just moved to the area or their dentist has retired, have likely not had their needs or expectations met.

In a recent Facilitator Study Club teleconference, we discussed this topic and gathered a list of some expectations patients might typically have:

Time: How much time do they think it will take? Do they want an appointment quickly? Do they want to get in and get out quickly or do they want the dentist to spend a lot of time explaining or answering questions?

Conditions and treatment: What do they believe the dentist will find? What do they hope the dentist will find? What do they believe the solution will be?

Pain or discomfort: Do they think it will hurt? Do they expect it not to hurt? Are they hoping to have sedation?

The practice: Do they expect simply the basics or do they anticipate amenities like refreshments, entertainment options, warm blankets and the like? What about clinical standards?

Communication: How do they expect to be treated? Do they have a certain way they wish to be addressed? Are they accustomed to getting a reminder call, or text, or email about their next appointment? Do they like to interact socially or prefer you cut to the chase? Would they prefer more specifics and detail or just the bottom line?

Fees: How much do they believe it will cost? What are they prepared to pay? What role are they thinking insurance will play in their decision-making? How do they expect to pay for their treatment?

I’m sure you can come up with your own extensive list.

If you don’t know what your patient’s expectations are, how will you ever be able to meet, or better yet, exceed them? You would hate to find out what those expectations are by disappointing them. And more important, if your patient’s expectations are unrealistic, you would want to know sooner rather than later so you can prevent misunderstandings before they occur.

Your patients will tell you their expectations if they believe you:

1)    are genuinely interested

2)    will do your best to meet or exceed those expectations

How do you find out? The natural answer is YOU ASK.  But as simple as this sounds, it is often overlooked and not practiced consistently.  We see this play itself out in practices all the time. Team members guess, make things up, base it on assumptions, which are based on previous experiences with patients. Our own personal expectations or preferences may also play into our assumptions.

And because some patients may not be good at expressing their expectations without prompting, it is essential for you to create a curious culture and a framework for finding out. Make time at the onset of the relationship to have a conversation with your patient about what they expect and come to an understanding about what you can and, in some cases, cannot do. Don’t hand them a form to fill out. Instead, you might use a questionnaire as a guide to help you in this process. (If you would like a sample questionnaire, email me). Allocate time in the schedule for these conversations and assign the responsibility to the most behaviorally gifted person on your team. Provide this team member with additional support and training as well as the private space in which to have these conversations with patients.

The fact that you work at understanding your patients in this way sets you apart from most other practices. Through this information-gathering conversation, patients become clearer about what is important to them, you become clearer about how to serve them better and you establish the foundation of a strong relationship with more successful outcomes. Less patients will move on to be recycled again somewhere else.

NEXT TIME: Conveying practice expectations to patients.

Contact me for a copy of our sample questionnaire or to learn more about the Facilitator Study Club,

My Prediction for 2013

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Good news!  U. S. News and World Report has announced their list of the top jobs (those in greatest demand) for 2013 and topping the list at number one is dentist!  Following in the number ten position is dental hygienist! At the risk of angering some of you, I’m going to say it. No more whining! You can position your practice and seize the market. But you must decide to take a good hard look at your practice and make some improvements.  Look at these FIVE ELEMENTS and ask whether you are making the most of each opportunity:

1) Your Physical plant

Patients have very little in which to judge your expertise or competence and some will assess you by the appearance of your practice. From the exterior and signage to the decor, wall art and clutter, look at your practice with new eyes or ask a third party or professional to give you their honest opinion. And while you must like and be comfortable in your surroundings, the more important issue is who you are targeting and what will appeal to them.

2) How are patients welcomed?

The best investment you can make is to train the team members entrusted with answering the phone and welcoming new AND existing patients. NO AMOUNT OF ADVERTISING OR EXTERNAL MARKETING WILL BENEFIT YOU until your team members learn how to connect with people in the most effective way. The challenge is that you rarely know how your team members are engaging people because you are focused on doing dentistry. Enlist the help of a professional to both assess and train your team appropriately.

3) Work on building relationships

This may sound like a no-brainer but there is more to building a relationship than learning where your patients work, their children’s names or where they went on their last vacation. Everyone who works in the practice must be capable and willing to learn communication skills that will carry your relationships beyond the superficial. This requires learning why patients come to you, what they are asking and expecting of you, and how you can connect with them in ways that help them get what they want. The end result is more patients authorizing more dentistry sooner!

4) Fostering referrals

It stands to reason that if you manage expectations and give patients what they want, they will be happy and continue to come to your practice. Far too often, we don’t ask our best, most satisfied patients for referrals. Do you and your team know the art of asking for referrals in a genuine way? Do you have a referral program that encourages people to voluntarily share their experience in direct and viral ways? Enlist the help of a professional to AMP UP this highly overlooked goldmine.

5) Marketing

For you old-school guys and gals, WAKE UP!  It’s 2013 and if you aren’t getting your business out into the community, you will be left behind. For those of you who have marketing plans in place, now is the time to re-assess their effectiveness.  Keep these three essential elements in mind as you craft your campaigns:

Reach – who you are targeting

Frequency  –  how often you are sending messages out

Top of the Mind Awareness/Familiarity  –  being in the consumer’s mind when they are in the market or have a need

I encourage you to consider more non-traditional means of promoting your practice with a heavy emphasis on education and good-will marketing. Think creatively and out of the box. Don’t rely on a team member to try to implement your marketing when they “have time”. Instead, hire someone who can focus on it.

I predict that if you tackle all five of these goals this year, your practice will SOAR. I would love to help you with each of these areas to make 2013 your greatest year ever and be poised for success for years to come.

The three most annoying things patients say about dental insurance …and how to respond.

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Dental insurance will play a factor in how you will pay for what you want. Dental insurance should never dictate what you want.

Recently, I took a pole among our clients and asked what were some of the most challenging and annoying things patients say about dental insurance.  I compiled the responses and among the answers I read a lot of frustration. I chose the top three and hope to provide some constructive ways to handle these statements in the future.

Let’s get something out of the way right up front. Most patients don’t know what their dental benefits cover. They don’t understand how dental insurance works. For the most part, patients aren’t informed and let’s face it, who wants to take time to read the benefits manual? Just thinking about it makes me want to stick forks in my eyes.  So what do they do? They look to us.  Why is it that they think we would know? We’ve taught them this behavior.

Because we allocate our precious manpower and resources to make calls on their behalf. Because we investigate their benefits. Because we communicate with the insurance provider for pre-authorization. Because WE read the terms of their policy, we have, in essence, assumed responsibility for their insurance so they don’t have to! We, and I’m talking dentists as a whole, have created our own nightmare.

On the other hand, the insurance companies work very hard to create the perception in the patients’ mind that they are a vigilant benefactor who stands beside them and protects them from you, the greedy dentist. Because patients don’t understand the nature of dental insurance and the fact that the goal of the insurance provider is to NOT pay, we become the casualty.  And as a result, when insurance benefits pay for only a small amount of the procedure or deny the claim, or refuse to cover any costs, the practice becomes the bad guy. The patient takes it out on the messenger. We must learn to remove ourselves from being the “middleman”.

So how do you reverse this destructive trend?
You sit down with your patients and you have a dutch uncle talk with them about insurance realities. You have an opinion, knowledge, experience, and insight they don’t have. You can influence the way they think about their benefits. You can expose the insurance game for what it is. You can begin the process of getting them to own the responsibility of understanding what their coverage does, and does not provide. Part of your discussion should include these two non-negotiable philosophies:

1)  The insurance company’s goal is to make money and KEEP that money.  Our goal is to have the health of our patients influence our recommendations and that is not one the insurance companies share. We have never heard this as part of the insurance company’s mission.

2) Dental insurance will play a factor in how you will pay for what you want. Dental insurance should never dictate what you want.

Now, on to those annoying questions/responses:

#1  I have XYZ – Do you take my insurance?
There should be nothing annoying about this question but when you get this call, chances are you automatically form an opinion and label the caller. They are just trying to take advantage of their benefits. Insurance is like a coupon and they are trying to find out if you take their coupon.

If you do, the next thing you need to find out is if they understand the limitations of that coupon.
“Yes we do. Tell me, what is it you have been led to believe about your coverage?”, would be a great way to find out how much they know. Then you are able to start increasing their involvement from the very first call.

If you do not “take” their insurance, find a way to answer the question without saying NO. Avoid don’t, can’t, and use affirmative language.  Tell them what you CAN offer. Here are some examples of how you might approach it:

If your plan is one that allows you to choose the dentist you think is right for you, you can come to our practice. We would love to welcome you here.”

Here is what we can promise you. We will make make sure you get every reimbursement you are entitled to. Most importantly, we won’t allow insurance to dictate our standard of care and we will be honest with you about what we recommend based on what’s important to you.”

Mrs. Jones, XYZ insurance has some interesting rules. They will allow anyone to come to our practice. This is how it works…

#2  Oh, my insurance will pay for everything.
If they think their insurance will cover everything, we will have a problem. It is a given that no plan covers 100% with no “out of pocket” expenses, in any circumstance. There will always be some limitations. So it is a given that every dental client in this country with some kind of coverage will likely be disappointed.  Shift the focus away from us to some place else where it rightfully belongs. Try a response that will begin to shift their expectations from the very beginning:

Well, isn’t that wonderful.  Almost all of our patients find that’s not the case and are very disappointed. Bring in your benefits book and I will highlight those things you will want to be aware of before we begin so you won’t be disappointed with us when they (not us) let you down. We will help you in every way to get the benefits you are entitled.”

#3  I don’t want it if my insurance won’t pay for it.
Where do they get the restrictive mindset?  The insurance company.  When they emphasize “preferred providers” or  “standard and customary”  they send messages that they know what’s best for the patient when that couldn’t be farther from the truth.  We haven’t done our job to turn that thinking on it’s head. Patients don’t understand that their employer negotiates with the insurance company and they are the ones who decide what benefits their employees will receive. They don’t understand that insurance was never meant to provide full coverage for procedures. One way to present it to patients is;

Dental benefits are designed to keep healthy people healthy.  And sadly, unlike medical insurance, dental insurance has an annual cap of around $1000. Plus, there are lots of restrictions designed to discourage you from getting the care you have chosen. Your insurance will help with some of the expense but unfortunately, the coverage your employer provided you is not comprehensive enough to do much more. I hope that will not prevent you from choosing what’s in your best interest.

So, the question should be:  “Are you prepared to pay (fill in the blank) to get what you want and have (fill in the blank) help with a small portion of that?

I hope this has made you think about how you might be contributing to the insurance mindset and how to change it.  Use these tools to shift the influence of power and get your patients thinking differently about their benefits.

What annoying comments or questions about insurance are you hearing? The following statements were among some of the other top contenders. Knowing what you know now, how might you address these comments in the future?  Use this as a team discussion and send me your responses.

Are you a preferred provider?

Just submit my insurance and I’ll pay the difference when it comes back.

I’ll decide after you do the pre-determination.

My insurance company says your too expensive.

I have to see another dentist because you aren’t in network.

Reality Check: A Commentary on 10 Reasons Why Your Dentist Probably Hates You Too

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Reality Check: A Commentary on 10 Reasons Why Your Dentist Probably Hates You Too

This week, a blogger stirred up dentists and patients alike with her most recent entry: 10 Reasons Your Dentists Probably Hates You Too.  It was clever and funny and written tongue in cheek but it had a ring of truth that rang out loudly for some. It is clear from some of the responses that the points she made resonated with dentists who are frustrated with their patients.  A big thank you to Laura, the author, for your wisdom, insight and graciousness! I wanted to dissect her points and comment on them from a behavioral perspective. Here goes:

1) The first thing you say when you sit down in my chair is, “I hate the dentist.”  Really?!?  Did your parents teach you any manners?  Did they ever teach you that it is impolite to tell someone you hate them the moment you greet them?  What I really want to say back is, “aww, I hate you too.”
First of all, it would be easy to take offense. But don’t – it is not about you. When patients make comments like this, don’t assume you know what it’s about. Ask them. Behind the comment lies a whole host of different reasons – some of which the patient might not even be aware of until you take the time to ask. Replacing your judgment with curiosity allows you to truly find out what is holding your patients back and starts the process of behavior change through discovery. Never mind whether the answer makes sense or not. However they respond, it’s a legitimate issue-for them.  Don’t stop there. Find out more. For instance, if they comment that they don’t like the sound of the drill, ask why? Stay in the question – what is it about the sound that bothers them? Are there things we can do to make that less of a problem for them? – you get the idea…keep being curious!!!

2) You come to your appointment, and it’s obvious you haven’t brushed your teeth in days.  I’ve had some people with great hygiene come in and apologize because they’ve just eaten lunch and couldn’t brush.  This is not what I’m talking about.  I mean food and thick plaque everywhere.  After 10 years of seeing blood and rotten teeth and some really nasty things, this is still the 1 thing that makes me dry heave.  You know when you come to us that we have to be in your mouth.  Would you clean your home before having company?  Additionally, I have spent hours literally bending over backwards repairing your teeth.  Could you at least pretend that you are caring for the work that I have struggled to complete for you?
Speak to the obvious. If what you are finding tells you that they don’t spend a lot of time caring for their teeth, make an observation – not a judgement. “There seems to be food and thick plaque throughout your teeth. This tells me that you may not be brushing very often. Tell me about that”.  Then be quiet and listen.  Don’t go into the telling mode. Find out what they know and what they don’t know. Use it as a discussion opener for achieving better oral hygiene.

3) After we have spent hours of meticulously repairing your teeth, you complain about the bill.  Would you walk out of the grocery store with a bag full of groceries and expect not to pay?  I’ve just helped you to continue to smile and eat comfortably, two pretty valuable things that help your quality of life.
Dentistry is a “below the line” expense. After a person pays for all their  “necessities”, they would rather spend what little they have left on something they enjoy. Dentistry is rarely that and they aren’t happy about re-allocating funds or spending their discretionary income for it. This is their way of expressing their unhappiness. Invite them to talk about it, empathize with them, and don’t take it personally.

4) I tell you that you have a cavity and you need a filling, and you wait months or even years to get the necessary work done.  Eventually the tooth starts hurting.  Two weeks of pain go by, and you call me on a Saturday night while I am at dinner with friends because your tooth that needed a filling a year ago and that started hurting 2 weeks ago is suddenly an emergency.
Pain is a great motivator. But patients create the thing they fear the most by not acting until they are in pain. You get to decide whether you accommodate patients who choose not to act until they are in pain. You don’t have to support that behavior if you don’t want to. You know the State Farm commercial  where the guy (Jerry) calls his old agent when he’s in an accident – “Oh Jerry, I’m so sorry. I would love to help but remember you dropped us last month”….Same in the case of an “urgency” (Key word here is urgency because if it was truly an emergency, they would go to the ER). You empathize, offer the options you have and they get to decide. With your support, they could experience a shift in their thinking in the future – ie: “Jerry, you expressed that you wanted to avoid pain at all costs. If you don’t ever want to go through that again, we recommend (fill in the blank).”

5) You come to me so I can help you, but you make it hard for me to do a good job.  You wince and make faces when it’s not hurting.  The idea that I’m hurting you makes me just as uncomfortable and stressed as you are.  If it hurts, please tell me, and I can help you with that.  But if it’s because you don’t like the whole experience, you are only causing me to work in undesirable conditions, making it harder to do my best.  And when you push your tongue in the way, or you don’t open wide enough, it makes it physically impossible to get my work done.  Don’t you want it to be easy for me to do the best job for you?
Those darn patients get in the way of doing dentistry! Being a dentist would be great if people weren’t attached to their teeth but that’s not the case. Sometimes there are things you just have to deal with. As for the hurting, are you SURE you aren’t hurting?   Again, you can speak to the obvious – “Linda, I can’t help but notice that you are wincing. I want to make sure that you aren’t having any discomfort”. Ask them to hold up a hand if they want you to stop at any time.

6) You call and say, “my tooth didn’t hurt before you worked on it.”  You came to me with a cavity.  I did not put it there.  You did.  I am simply fixing a rotten hole that was in your tooth.  To do so, I must use a tiny drill to cut the rot out of your tooth.  If I took a drill, cut a hole in your femur bone, and then filled it in with a foreign material, don’t you think it might be sore for a while?  Same concept.
Great example.  This is where knowing your patient’s expectations and preparing them for what to expect can prevent a lot of issues later in the relationship. You could use a similar analogy and explain they might experience some discomfort, and if they do, explain what they should do about it. If they expect it, it won’t be a surprise. If they don’t, even better!

7) When we try to take an x-ray, you won’t bite down on it.  We have to do this to see what is going on with your tooth.  Without knowing the problem, we can’t properly treat you.  I know, in some cases some people really can’t do it; but some people could and won’t just suck it up for 15 seconds.  I’ve had x-rays too, and they hurt and dig into my gums, but I just do it.
Acknowledge the brief discomfort, move on. If it keeps them from letting you get an xray, let them know that your diagnosis will be based solely on what you are able to see from the outside and it will be incomplete. Their choice.

8 ) You tell me that you bought my car for me after having a crown done.  Contrary to how it seems, you actually didn’t buy me a car.  You bought yourself a crown.  I have spent hundreds of thousands of dollars on an education, and have spent hours making this crown fit precisely in your mouth, so maybe you helped me make a portion of a student loan payment.  But you certainly didn’t buy my car.
Agreed.  Rude comment. Even if they said it to be funny, there is something behind the statement. I believe it’s OK for dentists and their teams to challenge patients on this stuff –  ie: “Wow. What would make you say that, Mr. Smith?” or “Do you believe the fee for your treatment is out of line?” Then be quiet and listen. Yeah, it takes time and skill. By becoming curious, gaining trust and being honest you can change the patient’s perception of the dentist.

By the way, they aren’t buying your “crown”.  They are buying the solution to a problem – something that will make their life better.

9) You no-show an appointment or cancel last-minute.  Some things are unavoidable, but when it’s because your hairdresser got a last-minute cancellation and you had to take that appointment instead, this is just rude.  Not only am I unable to fill the 2 hours of my schedule that I reserved specifically for you, but someone else who wanted to get in had to wait 2 weeks for his/her appointment.  And on that note, when you have the first appointment of the day, and you show up late for your appointment, I am late for every other patient the rest of the day.
This is a two-parter. The no-show or cancel at the last minute issue deserves a blog all it’s own. As for the patient who shows up late, if you are always late, you teach your patients the bad behavior of being late. If you strive to stay on time, your patients will begin to show up on time.  There are occasions where your schedule will be off and when you acknowledge it, apologize and explain how concerned you are for your patient’s time, they appreciate that. If the patient shows up late and it does not allow you to do the procedure in the remaining time, you have two choices – do it and run late or explain that you are unable to complete the procedure and will have to reschedule. Your patient will be annoyed and you will lose revenue for that day but it will be less likely to occur in the future.
There will always be exceptions – patients who are always late – to everything! Again, speak to the obvious. “Betty, it seems like you are always running a bit behind to your appointment. This doesn’t seem to be working very well. If we don’t have adequate time, we aren’t able to provide you with the care we promised. How should we handle it from this point forward?” Have them help solve the problem and hold them to it.

10) When I tell you that you grind your teeth, you deny it, as if I am accusing you of having a horrible disease or being a baby murderer.  It’s not that bad to be a tooth grinder.  I’m just pointing something out and maybe offering a way to prevent more problems in the future.  This observation is concluded from signs or symptoms that are based on real science, not myth.
OK.  I’m beginning to sound like a broken record. Patients believe what they believe – find out WHY.  Replace your assumptions and judgment with curiosity.  Example:
“Helen, the wear I am seeing on your teeth is something I typically see on patients who grind their teeth.”
“Oh, I don’t grind my teeth”.
“OK.  Then we have a mystery.  What else do you think might be causing this wear?”
“I dunno.”
“Well, let’s talk about your lifestyle and see if we can figure this out.”. You can learn more from what THEY tell YOU than from what YOU tell THEM. Help them through the discovery process.

Have you begun to see a pattern in my responses? All of these challenges can be minimized if we apply behavioral principles to the situation.
Here are my TOP TAKE HOME MESSAGES:

1) Patients voluntarily call/walk into your practice with a problem they are hoping you can help them solve.

2) Patients are pre-disposed to liking you. They would not come to your practice if they didn’t or felt like you were incompetent or not a good fit for them.

3) Almost every patient is a recycled one looking for a place that will provide what they haven’t gotten in the past. If you listen closely, patients will tell you how they wish to be treated. It’s how you respond that will make all the difference. If what they are asking for is reasonable, responding with something as simple as “Mrs. Jones, I’m sorry you had that experience. You can be sure that we will do everything we can to make sure that doesn’t happen here” can start you on a long and successful relationship.

4) Patients price-test everything before they buy.  Dentistry is no different than tires for the car, a new dishwasher, groceries for the month or tuition to private school. They believe that it will buy something that will make their life better. Dentists need to present their dentistry with some context. Not “you needa crown” but instead “if you want (fill in the blank) then you need (fill in the blank)”.

5) Almost anyone can afford what they truly want and almost no one wants everything they can afford. Patients get to decide how they allocate their money and what they choose. We can’t want it more than they do. Set your judgement aside. We can only gain their trust and try to influence their thinking.

6) You don’t know what you don’t know. Don’t make it up. Don’t shift into your smart dental telling mode but instead into your curious learning mode. You will learn how to help your patient better.

7) If a dentist wants to stay sane and positive over his or her lifetime in the profession, it requires a commitment to learning behavioral skills. This area is rarely taught in dental school and it is often not considered in many practices but it is one of the most important factors in being successful. Consider surrounding yourself with a behaviorally gifted staff who can work with your patients in a different way. And consider adding a dedicated full time facilitator (patient coordinator) to spend the necessary time getting to learn your patient’s story and how they hope you will make their life better. By learning the patient’s OUTCOME, helping them PRICE TEST, and offering what will make their life better in a way they can understand, you will become more successful with patients and it will enrich your professional career.

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Reconnecting with Wayward Dental Patients

Link

Once a month, we teleconference with a group of dedicated Patient Care Coordinators, Facilitators – team members whose primary role is to work with patients and help them make choices about their care. During our Facilitator Study Club, these smart women come up with some great case studies for our learning and contribute great ideas for being more successful with patients.

Our November discussion had to do with the most appropriate ways to follow-up with patients without being aggressive or overbearing. They wanted to know; when is too much? And what are the most effective ways to connect with patients outside the practice? What came out of our discussion were some helpful ideas that I wanted to pass along.

First, what may be appropriate for one patient may not work for another patient. There are some generational and lifestyle differences that may determine the way in which a patient responds. For instance, an older person might appreciate a personal phone call. The elderly woman who lives with her cats might be much more receptive to a call and return a phone message than the busy single mom who works full-time. The graduate student may respond to a text or email while your voicemail message will go unanswered.

How do you know what might work best and when?  You ask – preferably at the beginning of the relationship. Simply state that there will be times when you will want to follow-up with them about treatment or appointments and ask what he or she prefers. If treatment isn’t scheduled on the day the patient is in the practice, ask them when, how, and how often they wish you to follow-up.

If you are following up in the hope that your patient schedules treatment, it will require more than a phone call or text.  We all have busy lives and forget about things so you will want to provide more details than simply; “We are concerned about your dental care and are calling to schedule your treatment”. An effective tool, regardless of your patient’s age or lifestyle, is a letter. Patients often don’t easily comprehend examination findings at the time they are discovered, and usually aren’t presented with a review in a way that is easy for them to understand. The environment for learning about their condition is less than optimal. The office offers distractions. They may be fearful, worried about finances, or not very motivated at the time. And even though your examination may have been quite thorough and engaging, what was discussed is often lost with the passage of time. A letter with a simple recap can help jog their memory and encourage them to reconsider your recommendations. We have also found that although they may not respond the very day they receive it, the letter rarely goes in the trash. They set it aside for reference when they are ready to take action.

The key things to remember when composing the letter are:

1) Be sincere

2) Make it personal and relevant

3) Write it in easy-to-understand language

4) Encourage action

It needn’t be long and detailed. The point is to recap where you left off with the patient, what they expressed concern about/interest in (OUTCOME), and the implications of doing nothing. Also, hand write the address when you send it. This insures that they will open it. Here’s an example:

Patient follow-up letter

Notice that the letter asks the patient to call the practice.  This hands the responsibility back to the patient. Even though the letter encourages the patient to call the practice, you may opt to make a follow-up call/text/email about a week or two after the letter is sent. A simple, “Just following up on the letter I sent you” will do, with an invitation to call if they wish to make an appointment or have additional questions.

Give it a try and see whether this helps bring some results. Let me know what happens.

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