How did the Readers Digest article affect patients trust?

July 1, 1997
controversial Reader`s Digest cover story on "How Dentists Rip Us Off." Here`s what patients in a focus group said about the article and what you can do to strengthen their trust in you.

Suzanne Boswell

A "mystery patient" researcher queries patients about the

controversial Reader`s Digest cover story on "How Dentists Rip Us Off." Here`s what patients in a focus group said about the article and what you can do to strengthen their trust in you.

Controversy in the dental profession whirls around the cover story of the Reader`s Digest February issue. Questions from the profession abound about the "investigative report." However, two crucial questions remain: How do patients interpret the article, and what impact might this latest challenge have on the profession of dentistry?

As a dental-patient researcher, I wanted to hear the patient`s side of this debate. Our research group conducted an in-depth focus group with senior citizens, who form the primary readership group of Reader`s Digest. We included males and females that had received dental treatment within the past year, and we ensured that none of the participants had read the article.

Participants were told only that the focus group would be on the topic of dentistry. No other information was provided that might influence attitudes or responses.

Rating trust in dentists

At the onset of the session, participants were given a brief survey to establish their attitudes prior to any discussion. Participants were asked to:

- Rate your trust of the dental profession in general.

- Rate your trust level of your own dentist.

They were asked to rate these two items on a scale of 0-10, with 10 representing the highest level of trust.

The survey forms were collected, and then a copy of the Reader`s Digest article was given to each participant to read. Again, we requested that there be no discussion while reading the article. We told participants that they could make notes on any part of the article that especially piqued their interest or concern.

Immediately after reading the article, the participants were given a second survey with the same questions on it as the survey they completed earlier. Our objective was to establish any variance in attitudes prior to reading the article and after reading the article.

Did the article affect their feelings? Absolutely! Though it increased their concerns, there also was a positive interpretation to their responses.

Our participants indicated that they had a higher trust level of their own dentist than of the profession in general. This attitude existed before reading the article and remained after reading the article.

After reading the Reader`s Digest story, their trust levels dropped, but the trust level of their own dentist dropped far less than that of the profession in general. In our discussions, they often noted, "Well, I really don`t think my own dentist would do that ... but I`ll be very careful if I ever change dentists."

Getting a second opinion

The Reader`s Digest article threw a spotlight on two major concerns to patients: Being overtreated and being overcharged.

Though these concerns frequently are raised in focus groups with other demographics, they are magnified in the seniors making up Reader`s Digest primary readership group. For this group, the article only served to reinforce their fears.

Because this demographic group often struggles with the challenges of the rising cost of living on a fixed income, the fee issues addressed in the article were a particularly significant matter for them. They indicated that if their own dentist quoted a sizable fee for a treatment, they would be more likely to seek a second opinion as a result of reading the article.

The vast majority indicated they would tell their present doctor of their plan to obtain a second opinion, but wouldn`t tell him or her who they would go to for the second opinion.

Rising to the challenge

The Reader`s Digest article shook up many in the dental profession. However, in any profession, business or industry, you can find examples of poor quality in service and care. This reality exists independent of any anecdotal report or possibly slanted article. To think otherwise is overly idealistic and folly. Our purpose in this focus group was not to validate or invalidate the Reader`s Digest article, but to learn how patients interpreted it and how dental teams might manage this interpretation.

What we learned affirmed what has come out in our other focus groups and our surveys - the quality practice must definitively differentiate itself in what is an increasingly competitive marketplace. Patients are now vigilant consumers when it comes to health care. For the practice to manage these challenging times, many must reinvent themselves. This can`t be done without truly understanding the marketplace and prevailing patient attitudes.

The Reader`s Digest article is not the first time such a challenge has presented itself to the profession of dentistry. You`ve dealt with the challenges before and you will continue to be faced with them. For the service-minded, patient-centered practice, this latest challenge is viewed not as a threat, but as an opportunity ... an opportunity to continue to nurture the trusting relationships that already exist in the healthy family practice. If patients ask you about the Reader`s Digest article, thank them. They`re giving you the opportunity to reaffirm what you do and how you are different from others.

Suzanne Boswell is a patient researcher, mystery patient to dental practices and dental-practice consultant. She is author of the book, The Mystery Patient`s Guide to Gaining & Retaining Patients (PennWell Books, 1997); host on the American Dental Association video, "The Patient Friendly Office"; and author of numerous staff-education materials. She may be contacted at Suzanne Boswell Presentations, 3767 Forest Lane, Suite 116-470, Dallas, TX 75244-7100, Phone: (972) 243-2086; Fax: (972) 406-8738; e-mail: DentalPt@


Now that they`ve read the article, what do patients expect?

So what do patients really feel are the best ways to manage the two concerns spotlighted in Reader`s Digest? Here`s what they`ve told us, both in written surveys and in our focus groups:

- Educate your patients. It is the primary means of ensuring patient comprehension of value and validation of your fees.

- Explain the clinical exam. This is part of educating the patient. When the patient knows what you`re doing, there`s greater understanding of value and its relationship to the fee.

- Educate the patient about his or her condition. This is where the dentist staves off questions about overtreatment. From previous focus groups with numerous demographics, we found that excellent practitioner communication, along with use of an intraoral camera, is most powerful in achieving this end.

- Phase treatment. Patients consistently request this and communicate a value for the practitioner who understands the patient`s desire for it. Patients will appreciate phasing the optimum clinical treatment and/or offering alternative treatments, though practitioners` views on these two philosophies vary.

- Explain fees fully. Effective explanation of fees includes or is preceded by thorough patient education. This should include a discussion of clinical procedures in terms the patient can understand, as well as an explanation of expected resultant quality with each option. Most importantly, this needs to be a two-way conversation in which patient questions are encouraged.

- Offer payment plans. Patients want to use credit cards and will be more likely to accept treatment when you take credit-card payment. Also offer access to other plans, so patients know you want to help them find a way to accept treatment.

- Partner with patients. Patients rail against the rigid practitioner who talks and doesn`t listen. They value the practitioners who increase dialogue and decrease monologue. Patients even rate these doctors as better practitioners clinically than those who don`t listen!

These are but a few of the many ways you can establish a solid foundation on which to build a long-lasting and mutually beneficial patient-practice relationship.

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