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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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.

The Dying Bamboo

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Recently, Sandy and I had dinner with a dentist and his wife before we visited their practice for observation. The restaurant was in the airport hotel where we were staying.  We were greeted and seated immediately and as we settled in, both of us noticed the centerpiece; a trendy looking slate stone vase that held a single bamboo shoot.  Sounds like a great concept, right?  If only the bamboo wasn’t falling over and the leaves weren’t yellow and wilted.  It was downright sad.

Immediately, this symbol of good luck became a depressing sign, so we removed it from the table.  It might also have been a sign for the lack of attention the restaurant received from the management and employees. As the dinner progressed, I noticed the bread was stale, the water glasses sat empty without a refill, and the meals were plated with little care. I began to wonder whether the food prep area was sanitary. Was the walk-in refrigerator temperature to “code”? Did the employees wash their hands? I didn’t have high expectations for the meal. Luckily, our server was decent and our food was acceptable but the experience was less than what I expect from this type of restaurant. I left underwhelmed.

What we discovered were telltale signs that no one was paying attention to the details. If those details weren’t being tended to, what about the things that really mattered?  In their book,“In Search of Excellence,” Peters and Waterman make the following observation:

“When there are coffee stains on the tray tables, passengers wonder about the quality of the maintenance of the airplane’s engines.

These signs undermine confidence. The same is true in your practice. For example, on a recent consultation visit to an upscale cosmetic practice, I immediately noticed something that seemed out of place. The sign in front of the building and the landscaping was top notch. The reception area was gorgeous and it was obvious an interior designer was consulted. The environment was warm and the sounds were soothing. Then I saw it. The spot on the carpet. It did not belong. When I asked the group about it later in the day, most of the team had no idea what I was talking about. Two staff members did recall the spot and said that it had been there for as long as they could remember. No one seemed to feel it was a big deal. That spot was as significant as the dying bamboo centerpiece.

Point 1: Patients have no way to judge your clinical abilities and the indicators they will use to gauge your expertise are the physical plant, the environment you create and the way you engage your patients in the process. If the little details aren’t tended to, your patients will wonder if the things that truly matter – proper diagnosis, clinical expertise, sanitation standards – are also being overlooked.

Point 2: Your team must be vigilant all the time. Create a culture where your staff is encouraged to pay attention to the little things – the stain on the carpet, the full trash can in the patient’s bathroom, a patient’s concerned look or the negative comment he or she might make on their way out. Everything matters. Patients notice. You can’t let down your guard.

Over the course of the next several articles, we will review the physical plant and environment and shed light on those areas you may want to pay more attention to in your practice. If there is a specific area you would like for me to address, please comment below or email and let me know.

Occupational Half Life – I don’t think we’re in Kansas anymore!

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Recently, regarding his book, The World is Flat, published in 2005, Tom Friedman said; “I looked in the index under F. Facebook wasn’t in it. Facebook didn’t exist. Twitter was a sound, the Cloud was in the sky, 4G was a parking place, LinkedIn was a prison, application is what you sent to college, and for most people Skype was a typo….”

Which brings us to our topic: the world is changing rapidly –  to the point where information, innovation and technology is evolving exponentially.  It’s a challenge to keep up and requires more time and effort than it did a mere 5 years ago.  Essentially, it’s like trying to out-run a tornado!

Photo credit: National Oceanic and Atmospheric Administration/Department of Commerce

Continuous change requires continuous learning. I don’t have to tell the doctors reading this. You get it. You know the importance of staying current in the clinical arena. But what about the team and the other areas of the practice?

Over 13 years ago, Jim Harris, PhD said something that caught Sandy Roth’s attention and it is just as relevant now as it was then:

“Another HR trend is the idea of occupational half-life, which asks the question, ‘How many years does it take for half of your work skills to become obsolete?’ In 1970, it took about 15 years. [That means] by 1985, half of your original skills were no longer useful. Today, the number is 2 1/2 to 3 years. That means in less than 30 months, half of what you’re doing will be obsolete.”

Whoa! This concept of occupational half-life is huge. It has major implications for anyone in almost any profession but it is especially true in the healthcare field.  What does this mean for your team? Well, for one thing, change is not an option. And to take that one step further, if one does not adopt a personal commitment to lifelong learning, they will quickly become irrelevant and obsolete.

Here is Sandy’s message to team members:

Learning cannot occur only within office hours. Academic and conceptual learning occurs outside of office hours. Practical application learning comes with the doing, where your practice is your learning laboratory. Indeed, there is a great deal that can be done during the hours of your employment, but it will never provide enough time to delve into the creative, the new and the innovative. And that is exactly where you must take yourself if you want to stay on the cutting edge and guard your future.

Your value to the practice will go down if your skills don’t go up. What is valuable to your practice right now will be less valuable in the future. Which half of your skills will be obsolete in three years and how will your diminished impact harm the success of the practice? You cannot expect your compensation to rise when your skill-base is stagnant.”

Did you get that last part team members?

So what role do you, the dentist, play in this? Certainly, you lead by example; taking continuing education courses, reading trade publications, learning how to implement new technology into the practice, networking with colleagues, learning from those smarter than yourself (that includes your team), involvement in professional organizations. While some of this may occur during practice hours, a lot of your learning and growth happens outside of the practice and at the expense of spending time with your family.  And why do you do it? While you know it will make you a better dentist and keep your practice growing, my guess is you have a curious mind and a strong commitment to lifelong learning.

Can the same be said for your team? Do they understand that their own growth and future potential lies in their own hands? Are they willing to invest in themselves by taking the initiative outside the practice? Are they spending their free time learning something new?  Do they have the mindset to “look it up” if they don’t know?

And are you encouraging and supporting them by providing opportunities for learning? Are you sponsoring independent learning, workshops, online courses or distance education?

I hope so.  That tornado is looming large in the distance.