By Daniel A. Bobrow, MBA, president of American Dental Company, a Chicago-Based dentistry marketing consultancy, and executive director of Climb For A Cause^tm. He is also a certified sales trainer, mediator and arbitrator.

There are a number of dentists who are very good at sharing their knowledge and experience with treatment presentation and expertise at treatment acceptance.

To understand then why I, who have never held a hand piece (a very good thing) would be asked to share his thoughts on the subject, it is hoped the reader will accept that clinical proficiency has little to do with successful case acceptance. It is more about effective communication. And this is a subject about which I do know something.

The purpose of this article is to share some skills and procedures for you to consider applying as part of your treatment presentations to maximize case acceptance.

I would, however, be remiss if I did not also touch upon what happens before the case presentation begins because, what your patient experiences before they ever get into your chair is at least as important as the presentation itself.

Most dentists agree that some people are easier to “sell” than others. Often, they notice a pattern. The most common pattern is that internally generated, that is, ‘word of mouth’ patients seem to more readily accept treatment than patients attracted through external means e.g. website, direct mail, TV, etc. While I do not doubt the veracity of these claims, by delving into why this is the case, valuable insight may be gained.

Indeed, it would be surprising if a patient, who actively seeks out a dentist for treatment, did not accept treatment more readily than someone who responds to an invitation to visit the practice. However, it is important to realize and accept that today’s ‘tire kickers’ are tomorrow’s ‘trigger pullers.’ The key is to allow the patient time to get to know you, like you, and trust you (and your practice). Another key is to recognize just how delicate the beginnings of a relationship with a new patient can be. The person who has agreed to visit your practice probably knows nothing about you. People are naturally and understandably fearful when placed in unfamiliar surroundings. They are particularly sensitive to any ‘negative vibes’ that might, consciously or subconsciously, be directed their way. In other words, beware of the negative self-fulfilling prophesy.

I wrote in another Issue of DPR (June 2007) about the specific measures a practice should take to communicate with new and prospective patients, with a goal of establishing the practice as the credible dental expert, so I will not do so here. Suffice to say that, by ensuring your communications with all your patients, whatever their place on the ‘patient life cycle,’ are consistent, professional, and informative, you will see your rate of case acceptance increase.

“Dentists tend to focus their time and energy only on the treatment aspect of presenting care.” says Judy Marcus, president of Standard Solutions, a Des Plaines, IL based firm specializing in case acceptance. “A common approach is for the doctor to say to the patient ‘You need [procedure]’, possibly followed by some explanation of the procedure(s). The patient is then expected to decide if she wants that treatment. Of course, the patient has next to no idea why she should want it so, more likely than not, is will say ‘I’ll think about it.’ Unfortunately, what this really means is ‘I have no idea what you’re talking about, but it’s obviously important to you, so I’ll be polite and pretend I understand you and am seriously considering whatever you just said.’”

Marcus continues. “The patient may ask ‘What does my insurance cover?’ This is another way of conveying that she understands almost nothing of what she’s just heard. It should be obvious, as the question is a non sequitur. Faced with this reaction, the dentist is apt to conclude that ‘We’re attracting the wrong kind of patient’ and/or ‘We need a better marketing strategy.’ As this is hardly ever the actual problem, the ensuing ‘solution’ changes nothing.”

One can easily see how frustration within the practice then feeds upon itself.

My brother Michael practices dentistry just north of Chicago. In his 21 years as a dentist, he has built four successful offices, running the gamut from high volume urban to suburban ‘boutique’ practice.

“One must acknowledge the demographics of the community in which one practices” says Michael. A stable patient base permits one to be, well, more patient with presenting treatment. When I practiced in a highly transient area I knew that, no matter how hard I tried, my ‘closing percentage’ was going to be lower than in one of my other practices. Logically then, the only way for me to hit a given number with a lower percentage of patients accepting treatment was by increasing the number of patients I saw, so I devoted a lot of resources to getting people into my office through external marketing.”

So, before a dentist beats himself up for having a low case acceptance percentage as compared with some “average,” she would do well to carefully consider the demographics of the community, and further recognize that these are unlikely to differ appreciably from her patient base.

Of course, your presentation must also carefully consider the nature of your relationship with the patient. You will most likely want to craft a different approach with a new patient than with a patient of record, as the latter has had time to become acquainted and comfortable with the practice and staff (if not, they would probably no longer be your patient).

For new patients, it is especially important to ‘let your humanity show.’ For me this means letting the person know my interest in them extends beyond simply what brought us together today. It may seem like a digression, but it is a great way ‘connect’ with your patient, that is, show them you are able and really want to understand, respect, and like them. If you’re like me, this is easy because you are a ‘people person’ who genuinely enjoys meeting new people and learning through hearing of their experiences.

This is not to say I do not occasionally come across people with whom I do not ‘click.’ When this happens, I do a quick ‘reality check’ of what I am feeling, and whether these feelings really have anything to do with the person (as opposed to some irrational association or ‘trigger’). In almost every instance, I am able to gain a new perspective, basically breaking the ‘negative linkage’ I am experiencing, and start fresh. It works for me; perhaps it will for you.

When I became a certified mediator, I was given a lapel button that reads When I listen, people talk. Listening is one of the greatest ways to show someone, not only that you understand, but also that you empathize with them. Once you’ve made that connection, you’ve laid the groundwork for a successful outcome.

As you will see, the majority of the groundwork should be laid before the presentation, or even diagnosis, takes place.

State The Purpose

The goal of the Purpose Statement is to gain agreement as to why the patient is there, that is to confirm mutual expectations, and to let him know his wishes will be respected. This has the almost miraculous effect of dissipating any stress the patient may feel about ‘being forced to make ADMsion.’ Anyone experiencing that kind of pressure is typically too distracted to concentrate on what you are saying. Just as you want your presentation to take place in a quiet, comfortable environment, the last thing you want is ‘static.’ Assure them that you will provide them with everything they need to make the ‘right’ decision ‘today’, and that a timely decision is in their best interest.

Plant The Seed

My brother’s ‘secret sauce’ when it comes to new patients is “I’ll come in to do an exam, but first tell the patient that I am going to write up a treatment plan following the exam, and ask them to commit a half hour next time so we can review our findings and agree on how to proceed. Then, at the next appointment, before I make the presentation, I sit down with them, eye-to-eye and knee-to-knee, and say “I am going to share with you the treatment necessary to bring you to [fulfill the stated want/need]. I want to be sure you completely understand what I am proposing, and why, so please let me know if anything I say is not clear. Also, I want you to know that it’s perfectly okay to say ‘no.’ You won’t hurt my feelings. It‘s your mouth, and your health. I only ask that you be prepared to make a decision today so we can be clear on how best to serve you and when.”

Probe for Opportunities

Once you have achieved Agreement on the Purpose, your next task is to show your patient how your proposed treatment will help them to achieve their goals. Your goal is to get the patient to share with you what is important to them. Once that sharing takes place, your next task is to confirm you hear and understand what they are saying. Most often, ones goals involve either fear or desire (certainly altruism, honor, duty, love, commitment, etc. also play a role). Because no one responds favorably to being ‘forced’ to do something, tread lightly at this point. Remember that silence is your friend: when someone is silent, it usually means they are considering your point and want the ‘space’ to arrive at their own conclusion. So, when in doubt, remember: less is more.

Say you just completed a cosmetic evaluation for a patient. You might say: ‘I’m going to share with you some exciting opportunities to help improve your appearance. To be sure I am offering you the treatment that is most appropriate, could you share with me what brings you in today?”

The foregoing is an example of an open-ended question (also known as an open probe). Open probes are a great tool for collecting information about what is motivating or causing the patient anxiety, as well as letting them feel ‘in control.’

In all likelihood, your patient will tell you his ‘story.’ Body language, eye contact, and active listening will demonstrate to the patient you are ‘getting’ what they are saying. So must your reply.

Confirm Opportunities

Depending on the patient’s response you might say “If I hear you correctly, you’re tired of being embarrassed to open your mouth in public, and you feel/think/imagine* that it is interfering with your relationships with people, is that right?” Concluding this question with ‘is that right’ makes it a close-ended question (or closed probe). A closed probe can only be answered by a single word e.g. yes/no. By having the patient conclude the exchange with an unambiguous reply, they have given you an opportunity to satisfy their need. You can either move on to the next step or continue probing for more opportunities, for example by asking “Is there anything else you’d like to share with me about how we might be able to help?” If the answer is yes, simply ask “What is that?”

Transform Opportunities To Needs

The next step in getting to ‘yes’ is to link the opportunity to a solution you offer and have the patient confirm this as a need. Continuing with the above example, let’s assume your probing determined that your patient has been interviewing, and his self-consciousness about the appearance of his teeth has caused him to feel anxious and lack confidence during the interview. You might say “I can only imagine how having to worry about your appearance adds to your anxiety. You’re right that, while people should judge us on our abilities, it’s often our appearance that tips the balance. Well, I’ve got good news. We can provide you with a choice of solutions to get you to where you’ll look forward to sharing your smile with everyone, friend and stranger, AND we’ll be able to do it in time for your next interview.” If your patient responds with something like “That would be great doctor!” you’ve just confirmed a need, which is the ‘fuel’ that drives someone to accepting treatment.

Depending on the situation, you might instead emphasize the consequences of not accepting treatment. This must be done with particular care, however, as the patient may ‘shoot the messenger,’ that is, project the fear they feel onto you.

The next step (and this is almost always mandatory), is to summarize your recommendations, being sure to relate each procedure to how it will address the stated need of your patient. Upon successful completion of this step, the patient is ready to be handed off to your Scheduling Coordinator to handle the “paperwork.”

Your Practice Within A Practice

One of the best ways to increase treatment acceptance is through the hygiene department. More than just a profit center, it’s actually your ‘practice within a practice.’

“[Too often]….prophies are done instead of necessary quadrant scalings…and the quality of care is jeopardized.  Your hygienist needs to be trained and given the tools to make treatment standardized, objective, and reproducible in your practice. When this occurs, treatment plan acceptance and overall compliance improve substantially, leading to increased productivity and profitability for the practice" say Steve Rinaldi, DMD of Andover MA.

So investigate new techniques and technology that permit you to objectively evaluate and present your patient’s state of periodontal health in a way that compels them to accept comprehensive therapy.

Final Thoughts

Just as successful treatment delivery requires preparation, an understanding and application of sound principle, consistent and reliable systems, as well as technique, the same applies to successful treatment acceptance. If any of these are missing, lacking, or out of sequence, effectiveness suffers. Remember: a chain is only as strong as its weakest link.

Do not make the mistake of believing the value of a patient is linked to its source. If you see a pattern suggesting a link, consider the possibility that somewhere there is either a self-fulfilling prophesy at work, or some weakness in communication may exist.

Become an expert on your community’s demographics, as it is unlikely they will vary appreciably from those of your patient base. This will strongly suggest what is reasonable to expect in terms of case acceptance.

And finally, avoid the Success Trap, which occurs when you and your staff decide you’re too busy to waste time on ‘tire kickers.’ Today’s tire kickers are tomorrow’s trigger pullers. It’s all in how you ‘treat’ them. The seeds you plant today you will reap tomorrow (or at lest next ‘season’).

Mr. Bobrow is available for a complimentary thirty minute consultation by calling 1-800-723-6523 or at Info@AmericanDentalCo.com.

*There is a wealth of information about how to know the exact type of words to use in communicating with a given individual as a function of their personality type and how they process information. The area of study is called neuro-linguistic programming (NLP). NLP classifies people according to how they process information. The three general classifications are kinesthetic (tactile), auditory (sound) and visual. For more on this fascinating discipline visit: http://www.nlp.com/

SIDEBAR

The Acid Test For Practice Growth

Test your and your staff’s attitude toward two seemingly different types of patient.

Two calls are received at the time.

On line one is Bill, your good patient Fred’s best friend. He is getting married, and wants a complete smile makeover in time for his Big Day.

On line two is someone who just received one of your New Patient Invitation Mailings, and wants to know how much a crown costs.

Who would you rather talk to?

If you’re like most people (and you’re not fibbing), you’d much rather talk to Bill.

BUT if you really want to grow your practice, you and your staff need to learn to anticipate and want to speak with the caller on line 2!

Why?

Because the caller on Line 2 represents the future of your practice.

Bill is already sold. Line 2 is simply at a different point on the ‘communication curve’. If you and your staff have the proper call handling skills, you should be happy to speak with the caller on line 2.

When you are your staff successfully make the shift to this mindset, you will be amazed at the results. People you were sure would never become ‘good’ patients will pleasantly surprise you.