Think case conversation, not case presentation

Oct. 1, 2008
Many dentists go through their days like refugees from the Roller Derby. They madly dash around the office doing a little dentistry on a lot of people.

by Nate Booth, DDS

For more on this topic, go to and search using the following key words: case conversation, Dr. Nate Booth, comprehensive case acceptance, six stages of creative case conversation.

Many dentists go through their days like refugees from the Roller Derby. They madly dash around the office doing a little dentistry on a lot of people. They're busy, that's for sure. But busy isn't better for them, their teams, or their patients.

A few dentists have figured out how to slow down the game. They do more comprehensive dentistry on fewer patients. Their days are filled with a lot of quadrant, implant, and/or cosmetic cases. They don't necessarily have "boutique" practices, but they do have prosperous practices and bountiful bottom lines.

I love studying success. In addition to my dental degree and 10 years' experience as a wet-fingered dentist, I have a master's degree in counseling. I don't want to use my counseling training to help sick people get back to halfway functional. I want to help people that are already doing well do even better.

I worked closely with Tony Robbins for 10 years. Talk about a once-in-a-lifetime experience! From Tony I learned a process called modeling. The foundation of modeling is that success is not an accident; success leaves clues. So if you want to be successful in a certain area, study people who are already successful in that area. A key point about modeling is to study what the successful people are doing (their actions) and how they think (their belief systems, attitudes, and mindsets).

This is exactly what I've been doing the past 10 years with comprehensive case acceptance. I have discovered that spectacularly successful dentists don't make these three mistakes:

Mistake No. 1 — Pushing people into accepting comprehensive dentistry.

Many case acceptance programs available to dentists are way too pushy. They're based on sales concepts that are outdated or useful only in product sales. If patients feel pressured to accept care, they'll take one of three actions: they'll push back in subtle and not-so-subtle ways, they'll protect themselves by erecting barriers that block communication, or they'll leave your practice and not return. In addition, they'll spread the word to family and friends about your pushy ways.

Most people would like to have comprehensive dentistry. They don't always receive it because of four possible barriers: cost, lack of knowledge, lack of trust, fear. So instead of being a salesperson who pushes people to accept care, be a consultant who makes it easy for them to accept care by removing or lowering each of these barriers to comprehensive case acceptance. I will show you exactly how to do that in future columns.

Mistake No. 2 — Believing that case acceptance occurs primarily at one point — the treatment conference.

Comprehensive case acceptance does not occur at one point in time. It's a series of small steps beginning before the first phone call to your office. In fact, who's calling you (or visiting your Web site) and what they've heard about you is the most important step to case acceptance. Steps to acceptance include the first phone call, the time period between the first phone call and first visit, all the interactions that occur at the first visit, the time period between the first visit and the treatment solutions conversation, the treatment solutions conversation, and perhaps a series of recare conversations. As you can see, when it comes to comprehensive case acceptance, "This could take awhile." You need to be prepared.

Mistake No. 3 — Believing that only one person (usually the dentist) is responsible for case acceptance.

Many doctors erroneously believe that the person doing the case presentations is responsible for case acceptance. When done correctly, case acceptance is actually a series of events that involves everyone in the office. As a result, your team must understand the entire case acceptance system and their place in the system. They will need training on how to effectively fill their roles in the system and how to create smooth transitions to other team members.

Think case conversations, not case presentations

Does "case conversation" sound strange to you? In dentistry, we typically use "case presentation." I believe there are important philosophical, psychological, and practical differences between "case presentations" and "case conversations."

  • With case presentations, the information only flows one way — from you to the patient.
  • Wiith case conversations, the information flows both ways.
  • With case presentations, the tone is formal. You're the professional telling patients what you think they should do.
  • With case conversations, the tone is informal. You're friends discussing what's best for the patient.
  • With case presentations, the process is rigid. You have a set case presentation agenda.
  • With case conversations, the process is flexible. You respond in unique ways and go in unique directions to respond to what they say.
  • With case presentations, the patient rejects or accepts comprehensive care in one big leap.
  • With case conversations, the patient makes several small steps to the care he or she believes is best.

Change your mind-set first

In order to switch from the case presentation approach to the case conversation approach, you have to switch your mind-set.

The case presentation mind-set is, "I'm the expert. Here are your problems. Here is what I think you should do to correct them." The case conversation mind-set is, "I'm a friend and consultant who's here to understand your unique problems, desires, and life situation. Given the information you've shared with me and my knowledge and experience, here are a couple ways you can solve your problems and gain your desires."

I hope you are beginning to buy into the case conversation concept. I believe it's the right approach because:

1It's more respectful to your patients. They'll enjoy their time in your office more because they're active participants in the process.2 It's more enjoyable and interesting for you. Instead of being a professional expert who tells, you are a consultant who understands and serves. 3 It leads to higher levels of case acceptance. Now the patients and you are both winners.

Six stages of creative case conversation

The six stages in the creative case conversation process could take one day, one week, one month, or five years to go through. In the following list, I use the word "you" to designate yourself and/or one or more of your team members. I use the word "they" to designate the patients and people who help them make their decisions. In future columns, I will discuss the following one at a time:

Stage One — Interest

You offer an interesting service to them through internal marketing, external marketing, and public relations. They express their interest by responding to you — going to your Web site and/or calling you on the phone.

Stage Two — Connection

You connect with them, and they connect with you. If you want to do more comprehensive cases, you must increase the level of connection.

Stage Three — Understanding

You understand their life situation and unique concerns and desires, and they understand your office philosophy and the services you provide. It's important to understand before you seek to be understood. Understand their unique desires, problems, and life situations, and then they'll be predisposed to understand what you have to offer.

Stage Four — Education

You and they become educated about their clinical condition through the examination and records process. You educate them concerning possible solutions, and they educate you on their priorities and the general direction in which they want to proceed.

Stage Five — Solutions

You provide specific solutions and make care affordable. They make the decision that's best for them. Incidentally, this decision may take weeks, months, or years. If you push people too hard, you will probably lose them, and I wouldn't blame them for leaving.

Stage Six — Action

You follow up. They follow through. When you ask people to accept one of your comprehensive dentistry options, they're going to say, "Yes," "No," or "Maybe." You need to have a plan for each one of these answers.


Through this column, I want to have a conversation with you. If you have any questions or are having specific challenges with comprehensive case acceptance, e-mail me at [email protected]. I will do my best to respond quickly, and maybe we can use our discussion as the basis for a future column.

In my next column, I will discuss one of dentists' least favorite subjects — how to talk with patients about money. In the meantime, don't just do presentations by talking at people. Have conversations by talking with them. It's much more enjoyable and profitable that way.

Dr. Nate Booth is a speaker, consultant, and author who provides dentists with the information and systems they need to thrive in their dental practices. Dr. Booth teaches at the South Beach Dental Institute and is a practice management advisor for ChaseHealthAdvance. Dr. Booth is the creator of the in-office, DVD-based program, The "Yes" System: How to Make It Easy for People to Accept Comprehensive Dentistry. For more information, go to, or call (800) 917-0008.

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