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The appointment wrap-up B.O.AT.

July 1, 2008
Keep your boat afloat by using this approach to establish value for your services.
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Keep your boat afloat by using this approach to establish value for your services.

For more on this topic, go to and search using the following key words: value, benefits, outcomes, additional treatment, oral health, dental problems.

For many clinicians, the end of an appointment represents the completion of the procedure, but it is actually the beginning point of the most important time you spend with patients — the time when you communicate and establish the value of the services you have performed for them. This is the time you want patients to remember when they leave your office and talk about the services received with friends and family. Too many dentists spend their final minutes with their patients hunched over the chart, writing furiously, all the while leaving patients sitting in the chair, twiddling their thumbs. If patients are lucky, they may get a "Thanks, see you in two weeks."

Every patient is different and requires differing amounts of reassurance and explanation, but nearly all patients should receive a quick, but comprehensive, appointment wrap-up. You, as the clinician, will need to adapt your style to the personality of each particular patient. Some patients respond best to reassurance; others respond more to an explanation of possible consequences.

I have developed an approach to the end of the appointment that is called the B.O.AT. None of us wants to see out patients floating aimlessly around the dental world, with a little palliative treatment here and there.This B.O.AT. will keep their oral health above water (pun intended). Without a solid B.O.AT., many patients will leave your care unaware of what services were performed, what was gained by having the work done, what else still needs to be accomplished, and what can be done to prevent the same problems from reoccurring in the future.

Benefits (establishing ownership)

Upon completing a procedure, patients should be informed about what was done to enhance their oral health. They should be told how great it is that the problem was treated today instead of tomorrow. The benefits of the procedure should be explained to the extent each patient needs. Some will require a more thorough explanation of these benefits; others will be satisfied with a cursory overview.

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An emphasis on the benefits of treatment helps patients assume emotional ownership of the disease. Done correctly, the explanation will provide patients with a clear idea of why they should continue to take time out of their busy schedules and pay you a significant amount of money to do this for them again in the future.

The benefits talk might also include what consequences were avoided by having the treatment performed. This is the time to emphasize how their new crown saved their tooth from cracking or how their root canal treatment eliminated the infection they had, or how their periodontal treatment helped their gingiva and reduced the risk of heart disease. Your patients should leave your practice thinking, "I'm glad I had Dr. Painless treat my cavity today!" instead of "The dentist did a filling on me today."

Some patients respond to the carrot (benefits) and others to the stick (consequences). When discussing the benefits and consequences of a procedure, try to customize the discussion to include the factors that motivate each particular patient. Some will respond better if you tell them how beautiful their new restoration is, while others will respond more to talk of how this cavity could have needed a root canal if it were left untreated. In my experience, most patients respond best to a little of both. Whatever your benefit (or consequences) discussion includes, it should create emotional ownership of the disease.

Outcomes (establishing loyalty)

After sitting in a chair with you tugging and poking at them for an hour, don't send patients on to the front desk without first discussing the outcome for the procedure. Let them know how well the actual procedure went. The outcome is a discussion about the specific results of the procedure.

As most practitioners know, the patient should have been informed about the possible need for adjunctive treatment before showing up for his or her appointment. This often shows up as informing a patient about the possible need for root canal treatment on a tooth with a deep carious lesion. This is the type of discussion that should be held at the new patient exam and at the beginning of the appointment.

The outcome discussion is the time to tell the patient how the procedure went and what this treatment might have prevented (i.e., "Mr. Patient, it doesn't appear we will need to do the root canal after all"). The outcome discussion is where you become the hero — where you saved them from needing something more invasive or expensive. Again, learn to tailor the discussion to each specific patient.

Some will be happy with nothing more than, "Your new filling looks beautiful!" Others will need a more thorough explanation of what you specifically did for them today and why it's so wonderful (dentists rarely have a hard time discussing this). Your auxiliaries can also play a strong role in emphasizing the outcomes by complimenting your work in front of the patient.

The benefits (and/or consequences) are the emotional side of the appointment wrap-up, where you foster a sense of ownership of the problem. The benefits of patients seeking and following through with treatment are their responsibility and they deserve the credit (or a gentle reprimand). The outcomes are what you as their wonderful dentist have been able to do for them in the treatment of their disease and how great the result really is.

The great thing about the discussion of benefits and outcomes is that when patients assume responsibility for their oral health, it motivates them to follow through with their care. At the same time, it reinforces what a great dentist you are and what great things you have done for them.

Additional treatment (creating motivation)

It may seem fairly obvious, but patients need to be informed about other problems they have and what you are going to do about them. This is the time to help guide them toward an active approach to their oral health. Some will be motivated by focusing on the end point of their treatment and how the next appointment will lead them further down this path. Others will be better off hearing about the next problem that needs to be addressed. That's because some patients may have a hard time dealing with the big picture and need to focus on smaller steps.

Wrapping it all up

You established ownership by discussing the benefits (or consequences), you earned the patient's loyalty when talking about his or her positive outcome, and now the patient needs to be led to a place where he or she actively seeks you to address his or her remaining problems. Inform the patient of any remaining problems, not remaining treatment. Again, this talk needs to be tailored to each specific type of patient. Allow patients to reach that place where they nearly (or actually) ask if you can address their problem at the next appointment. Patients generally perceive procedures as something they have to endure, but they view their problems as something they want to have treated. Don't let patients forget that it is they who are seeking treatment for their problems. Don't send your patients to the front desk to have their disease and treatment questions answered.

Appointment notes can be completed by a well-trained assistant during the wrap-up. If you prefer to write your notes, these are probably better completed after the patient has been excused. Don't leave patients waiting in silence while you scribble in the chart. This is face time; use it wisely.

I recommend that the wrap-up B.O.AT. be performed by the dentist. Although auxiliaries can be trained to answer questions and explain treatment, patients want to know you care about them and that they are more than just a procedure to you. The wrap-up talk shouldn't take more than a few minutes in most cases, especially as you gain patients' trust.

The B.O.AT. is your time to shine as their dentist. Even though it takes only a few minutes, it can make all the difference in the world in patients' perception of how much you care. It leaves patients with a clear understanding of where their oral health stands, how you have expertly cared for their disease, what needs to be done in the future, and how to maintain it. The B.O.AT. reinforces ownership of the problem and empowers the patient to maintain continuity of care. Dentistry becomes easier when the patient owns the problem, trusts and respects your ability to treat it, and knows what other problems still need to be addressed.

Dr. Todd Schoenbaum maintains a private practice with his father in Valencia, Calif. He is also a lecturer at UCLA in the Department of Restorative Dentistry, assistant director of Continuing Education, and coordinator of the General Practice Study Group. Dr. Schoenbaum can be reached hy phone at (661) 255-3924 or by e-mail at [email protected].