Why Dialing for Dollars Doesn’t Work

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Recently, ProSynergy added a new phone line. As you probably know, there is a period of time before the number gets added to the “Do Not Call” list, and during this time, we have received more than our fair share of marketing calls. First of all, the callers struggle with pronouncing my name. With the last name, “Head”, you would be surprised how many times they get it wrong!  They are hesitant, sound like they are reading a script or have rehearsed a couple of lines, and just want to get to the next call. I want them to move on too!

Why do these types of calls annoy us so much? I find them impersonal, the timing is never good and what they have to say is irrelevant to me. In many ways, follow up calls to patients are very much like telemarketing. Why else would we call it “Dialing for Dollars”?

Because the economy is not as good as we would like and people’s financial situations are challenging –  many patients may be choosing to delay dental care they perceive as not vital or that can wait until times get better. Others may be putting off even basic care that is not urgent. Of course, we want our patients to re-think that strategy and in some cases there is a lot of pressure being put on staff, usually the “front desk” or the scheduling coordinator, to call and “get people in.” Thus, the DENTAL TELEMARKETER is born.

Team members,who experience the frustration of calling patients and not getting them to answer and leaving endless voice mails without returned calls are likely to question whether this futile effort is worth their time. And they would be right to wonder.

Let’s examine this a little closer. The first thing you must understand is that your financial anxiety cannot be laid on your patients. When dentists get fearful about the “holes” in the schedule they put pressure on the staff to fill them – as if it were merely a matter of calling the thousands of people who have been dying to get in but who have been put on hold by the practice. Let’s be honest. The only people who will respond to this kind of approach are those who have asked either to come in sooner or be seen at a time more convenient to them. It is a wanted call that delivers a wanted service. No problem here.

But for those other patients who, for one reason or another have chosen to put their care on hold, the call – leave a message – rinse – repeat approach will do the opposite. It will discourage people from following up with you when their circumstances do change.

Let’s think like our patient for a moment; Things are a little tight right now. You have some dental concerns and Dr. Baker has offered some solutions. You agree with his recommendations and you’d like to proceed but you heard layoffs are coming at work. You share this with him and, buying a little time, you mentally put it on the back burner.

Two months later, although you didn’t get laid off, your car is towed to the repair shop for some needed repairs at about the same time you get a message on your voicemail from Barbara, Dr. Baker’s receptionist:

“Donald, this is Barbara from Dr. Baker’s office. I’m calling to see if you’re ready to schedule those crowns yet. We are concerned about your dental health and what could happen if you neglected this needed care. Please give me a call to make your appointment.”

Ugh. The car thing is something you hadn’t planned in your budget and since your teeth aren’t hurting, you’ll have to wait on the dental work.   A month later, you see on caller ID that it’s Dr. Baker’s office again. The voice message she leaves pretty much says the same thing. You’re still paying off the car repairs and now your visit with the hygienist is coming up. If you go, you know they will ask you again to schedule the crowns and you really aren’t up to having that conversation. You begin to feel guilty because you hate to disappoint Dr. Baker but you don’t know how to tell him “no” without hurting his feelings.

Then you decide to call after hours one night to cancel your hygiene appointment saying that something has come up and you will have to call them back to reschedule. Now you are avoiding the calls to reschedule your hygiene appointment!

Crown call. Hygiene call. Crown call. And you can pretty much guess they are not happy with you now. You ignore them all.

Several months later, work is going well. In fact, you’ve gotten a promotion. The bill for the car repairs is long gone. You are ready to take care of your mouth but you are so embarrassed that you just don’t know how you can face Barbara or Dr. Baker or your hygienist. Instead, you decide to start fresh and call a new dentist.

Another patient lost.

You can begin to understand how the method of calling, reminding and finally, nagging and guilting has caused another patient to leave. And it could easily have been avoided with a different, more effective approach.

Consider a personalized letter outlining the patient’s concerns, the doctor’s findings and recommendations and what the implications of the decision to delay might mean for them. By thoughtfully putting it in writing, it provides a relevant, clear opportunity for your patient to safely re-engage when the time is right. A detailed example follows:

Dear Donald,

We have been thinking about you lately, and since a bit of time has elapsed since we last spoke, we wanted to give you a written review of what is pending. You may remember that we made some recommendations when we saw you last April. At that time, you were quite concerned about the appearance of your front teeth, the food that was packing between your back teeth and the puffiness you were experiencing in your gums. We suggested the following:

*Porcelain veneers on your four upper front teeth which would replace the stained old fillings and eliminate the new decay that has formed around those fillings. If you choose this option, we will be able to not only stop the disease that is progressing but also create a beautiful appearance for your front teeth. We are concerned that delaying this will only make the situation more difficult to treat, and, of course, we would wish to avoid that if possible.

*An aggressive approach to battling the gum disease you have developed. We are as concerned as you are about this ongoing problem, and we believe the most appropriate clinical approach is to begin treating the disease before it gets worse (which you know it inevitably will do, if left untreated) and causes other problems you wish to avoid. The treatment would consist of four sessions with Jean, our dental hygienist who would deliver thorough yet comfortable therapy. We remain concerned that in delaying this treatment, your disease may progress and be harder to treat.

*Gold crowns for those four teeth in the back which are allowing food to be caught and annoying you to no end. New crowns will solve this problem by making sure there is enough space between teeth for you to clean yet not so much as to allow normal chewing to pack food into the gaps. While this is not the most pressing situation for you, this situation can contribute to further decay and gum problems if left unaddressed.

Donald, we certainly want to offer you the right help at the right time. From a clinical perspective, the time is now, for none of these problems, or the conditions that are causing them, will get better on their own.

Perhaps there are some personal issues which have made it difficult for you to choose this care for yourself right now. If that is the case, we may be able to suggest an interim approach to getting your disease under control until you can opt for the more long-lasting and durable solutions. Of course, we can only help you if share with us what you are thinking now, so I hope you will take this letter as encouragement to call for an appointment to re-evaluate your condition and strategize with us.

I have asked Barbara to give you a call in a few days to follow up and learn what you are thinking at this point, so I do hope you will respond to her call.

Best regards,

Dr. Randy Baker

PS – Please let us know if this is not the right time for you so we can look for another approach which might work better. While we have expertise on clinical matters, only you know what will fit into your life. For these reasons, you will always be in charge of the timing that will best suit you.

More work? Yes.  Lost patient? Highly unlikely.

This approach to contacting and maintaining an open link of communication with your patients will give you a better chance of helping them when they are ready.

Dialing for dollars? Leave that to the telemarketers.


		
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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

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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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