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Nov. 1, 2012
The program is called "Wait Watchers" and it works like this. Dental practitioners fear being labeled "aggressive" or "expensive." This fear can be so strong that many become "Wait Watchers."

by Janet Hagerman, RDH, BSDH

The program is called "Wait Watchers" and it works like this. Dental practitioners fear being labeled "aggressive" or "expensive." This fear can be so strong that many become "Wait Watchers." They postpone complete dental diagnosis and treatment planning, opting instead to observe – to watch it. Thorough preventive restorative treatment is stalled because Wait Watcher practitioners think the patient doesn't want to hear about it. Instead they wait and watch until a much more serious, even painful, situation develops, which then justifies their treatment for acute pain. They even document this potential malpractice by leaving a paper or electronic trail of Wait Watcher notes like "No. 30 – watch for cr." If it's worth watching, isn't it worth fixing? What are we waiting for?

My friend Debbie waited at the suggestion of her Wait Watcher dentist. Her true story inspired this article.

My dentist had no trouble selling me a program of "watchful waiting" for two troublesome molars that had large old fillings. Like most people, I dread having dental work done and was more than happy to put off the inevitable reconstruction. Every six months my dentist reminded me I'd need those crowns EVENTUALLY but not until they started giving me "problems."

In the end, "watchful waiting" cost me an extra $2,500 and months of unnecessary pain.

Debbie eventually contracted excruciating pain simultaneously in both teeth resulting in full crowns and root canals.

I have a fairly generous dental insurance policy, but I had used up my annual benefit paying for the two crowns, so I bore the cost of the two root canals myself. That extra $2,500, nearly three months of constant pain, and the stress of all that dental work was completely unnecessary! If I had crowned those teeth when they first showed signs of deterioration, I would have saved myself a bundle.

Well, you can wait for agony to set in and then watch your bank account grow smaller, but not me. Dr. Watch-n-Wait is no longer my dentist. Never again will I let my teeth deteriorate just because they don't yet hurt. With my new doctor, we have designed a pretty aggressive reconstruction and maintenance plan that maximizes my dental benefits and seeks to avoid any permanent damage to my teeth. It may cost me a little more up front, but I now know from experience that I'll save in the long run.

Does the Wait Watcher program preside in your office? Wait Watchers is for losers! Patients lose money, comfort, and valuable tooth structure. Practitioners lose patients and credibility. In some cases, doctors lose in malpractice court cases.

So, why do it? Why wait and watch? The most common answer is that doctors do not want their patients to be overwhelmed with the costs of comprehensive treatment. Somehow they think they will get reputations as money hungry wallet chasers. This is a legitimate concern. Most dentists are not Wait Watchers from deliberate neglect. Rather, an attitude of misplaced patient compassion causes Dr. Wait Watcher to observe needed treatment instead of treating it. Dr. Wait Watcher's compassion compels him/her to diagnose the patient's pocketbook rather than the dental condition. Somehow, waiting for the patient to return in pain justifies the treatment. Wouldn't it be better to take that misfocused compassion and redirect it toward total comprehensive care in a way that won't scare away your patients? How do you do that?

If you are a Dr. Wait Watcher, how do you change? You can't! That would require a basic change in the compassionate part of your character. If this is you, compassion is one of the things people love about you! Instead, turn your compassion into action. Take your strength (compassion), which has become your weakness (waiting and watching), and transform it into a higher strength (action).

A great transformational wait-watcher conversation might sound something like this:

"Mrs. Jones, I'd love to watch that big old black filling; however, you'd risk the possibility of infection, abscess, or fracture. Because I am absolutely committed to conserving as much of your tooth structure as possible, I'd like to protect that tooth with a crown now."

As a Dr. Wait Watcher, you are probably wonderfully compliant, nonconfrontational, and have great patient rapport. Continue to be who you are, and enhance your compassion to become more effective. Build on your compassion by adding a new dimension that compels patient action. Here are five great strategies for effective treatment presentation.

1. Ask your patients' permission to share with them ALL your findings during their examination.

2. The "treatment triad" – Translate all treatment into one of three levels of service:

• "911" emergency treatment gets patient out of pain NOW.

• Preventive treatment designed to keep patient out of future pain; may be prioritized over time and coordinated with patient's budget.

• Cosmetic is totally elective and fun to explore.

3. Prioritize the treatment plan in order of urgency. Creating long-term prioritized treatment plans gives patients time to plan their financial commitment as they move toward comprehensive oral health. Patients will appreciate you for offering thorough diagnosis and complete treatment in a manner that respects their budgets. Patients also want to be a part of the planning process. Remember my friend Debbie who said, "With my new doctor, WE have designed a plan." The "treatment triad" is the perfect partnership vehicle to manage this planning process.

4. Give your patients the full menu of services you provide and let them select with your guidance. How would you feel if your waiter never told you about the lobster special because he thought you looked like you couldn't afford it? It's always a mistake to prejudge what you think someone can afford. People in this country have the money for what they want, whether they need it or not. Our job in dentistry is to help them to want what they need.

5. Use words and phrases that improve patient-perceived value like:


-added value

-comprehensive care

-affordable financial plan


It is imperative to share with your patients their complete diagnosis and comprehensive treatment plans in a manner that does not overwhelm. Following the above five guidelines will enable you to do just that. Finally, an effective script to follow up on your treatment presentation is this: "Mrs. Jones, I want to give you enough information to make a well-informed decision."

This message is not just for dentists but for hygienists as well. While regulations typically prohibit hygienists from diagnosing, hygienists can indeed be a huge support to the doctor in their proactive assessments and restorative observations, informing the patient in preparation for the final doctor diagnosis. Dentists and hygienists should meet regularly over case reviews to ensure that they deliver the same congruent message to their mutual patients. Indeed, this article could serve as a topic for the entire team at your next staff meeting.

Waiting and watching is not only detrimental to you, your patients, and your professional team; it can also be a legal liability. Being a Wait Watcher is a dangerous and destructive habit that wreaks havoc on your patients' oral health, as well as their loyalty to you and your practice.

Are you losing on the Wait Watcher program? If so, transform your patient compassion into patient action today.

Janet Hagerman, RDH, BSDH, kicked the Wait Watcher habit, and so can you. For more information about the "treatment triad" and effective treatment presentation and acceptance, visit Janet's website at www.janethagerman.com.

Janet Hagerman, RDH, BSDH, is an international speaker and author, advisory board member, and consultant. A graduate of the Medical College of Georgia, her focus on creative communication and leadership empowers health professionals nationwide. To learn more, visit Janet's website at www.janethagerman.com or contact Janet at [email protected].

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