Th 119495


Feb. 1, 2003
Ask your patients lots of questions! Careful probing will help you solve the puzzle of how to best present treatment.

by John A. Wilde, DDS

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Providing adequate dental care is not enough today. Disregard all of your concerns about maximizing practice financial success. Today's informed consumers demand access to the best available in dentistry. Also, as members of the healing arts, I believe dentists have an ethical and professional obligation — a moral imperative — to perform a complete examination and then present treatment that is ideal for each patient's needs. The treatment should be performed in a behaviorally correct manner that allows patients to clearly understand the benefits of the proposed care and the implications of not having treatment.

I've worked diligently for 30 years toward this end, with some modicum of success. My ability to achieve my goal has been greatly increased thanks to input provided by Dr. Pete Dawson in his excellent course, "How To Put Your Practice in the Top 10 Percent" and the marvelous book, SPIN Selling, by Neil Rackham.

The wisdom I've garnered from these resources has allowed me to increase the effectiveness of my critical new-patient examination. In fact, Dr. Dawson notes, "The entire practice is defined by the new-patient examination and treatment plan."

Contrary to most new behaviors — many of which feel awkward, at best — I find our approach to be intuitively comfortable because it allows me to occupy the role of educator and problem-solver, not salesman. The emphasis is on building positive new patient relationships that are essential to dental success.

Our new patient experience

We pick up our tale just before I enter my private office to meet the newest member of our patient family. Tonya, director of our new-patient experience, greeted the patient with a warm smile and firm handshake 30 minutes ago. She helped her complete a computer-generated medical history, took her on a brief tour of our clinic, and then seated her in my office and took her blood pressure.

A smile evaluation was completed in interview form, with Tonya asking the questions and recording the answers, while the patient studied her smile in one of our office's ornate hand mirrors. After completing these tasks, Tonya spends any remaining available time discussing our office philosophy. She then introduces the patient to me and excuses herself from my office.

I shake hands, request that the patient call me John, and ask what she would prefer to be called. So far, standard operating procedure for us ... but everything else that follows has been improved, thanks to Dr. Dawson and SPIN Selling.

The basis of SPIN Selling is that questions are much more powerful than statements. Questions allow the individual asking them to control the conversation, while retaining patient interest. (Who doesn't love to talk about themselves?) Four distinct types of questions are asked. After I've reviewed the medical history, I begin my inquiries.

Situation questions

These queries collect facts while building relationships. The majority of dentistry is accepted on trust, so virtually all treatment approval is based on building positive relationships. Relationship sales differ from other types of sales because they span longer time frames, require follow-up care, dictate an increased level of commitment from all parties, and involve long-term personal consequences. (Compare this type of sale to the sequence of events involved in the purchase of a book from a bookstore or a tie from a department store.)

For examples of "situation questions," I've borrowed most of the following from the best, Dr. Pete Dawson:

1. What would you like me to know about you? Thanks for sharing that.
2. What would you like to know about me?
(If you have the courage to ask the above-stated dauntingly candid questions, you'll be amazed by how quickly they help you establish a deeper level of intimacy.)
3. How may I help you?
4. What has been the nature of your past dental experiences?
5. What made you select our office?
6. Are you pleased with the appearance of your teeth?
7. Are you planning to keep your teeth all your life?
8. What actions do you intend to take to make certain that you will be able to keep your natural teeth throughout your lifetime?

Of course, these are only examples. Every question a dentist asks should conform to his or her unique values and be phrased in a comfortable manner. During these early moments of the interview, it is important to establish the dentist's role of asking questions and seeking information. It also is critical to use questions to control conversational flow. At the same time, you should be building an affinity with the patient as you help clarify his or her oral-health values and goals.

Problem questions

These probing queries are utilized in an effort to identify potential patient needs.

1. What bothers you most about your teeth?

2. Do your gums bleed?

3. Do you suffer from frequent headaches?

4. Are any areas of your mouth sensitive? To what?

5. Does food pack between your teeth?

6. Do you wish your teeth were whiter?

7. Have any problems occurred during the course of your past dental care?

Identifying specific problems helps clarify patient needs and begins to increase the patient's perceived value of our services by defining specific areas where we can resolve patient concerns.

Implication questions

Here, the genius of the system unfolds, as consequences of identified problems are discussed and the dentist honestly and candidly deals with the implications of not having treatment performed. The idea is to skillfully help patients understand the seriousness of their problems as they begin to comprehend that possible solutions are worthy of an investment. Dentistry is relatively easy to present. Every identified problem not treated harbors implications of greater dilemmas to come.

As you discuss problems that previous questions have identified, Dr. Dawson suggests you couch your query like this: "Has anyone ever explained the problems that can result from ..."

1. Bleeding gums
2. Sensitive teeth
3. Joint or facial pain
4. Food traps
5. Missing teeth that aren't replaced
6. Cracked teeth

(The manner in which I previously discussed this question for years, "Do you understand what causes ...?" risks offending the patient by making him or her feel ignorant.) Discussing problems and possible future implications answers the patient's implied question, "So what?" by establishing the possible seriousness of an existing condition left untreated.

Payoff questions

Through careful discussion, problems that some patients might have initially perceived as small are identified as potentially serious. (Consider bleeding gums and their relationship to heart and vascular problems.) By identifying them, you can explain why treatment needs to be performed as soon as possible and hopefully influence the patient to seek treatment immediately. After patients state a specific need ("I want my gums to quit bleeding"), you can present positive solutions to take care of the problem.These solutions are presented as benefits with statements such as, "If we both do our parts, we can ..."

1. Stop your gums from bleeding
2. Eliminate mouth sensitivity
3. End TMD and facial pain (stop headaches)
4. Prevent further erosion of teeth and gum structures by replacing heavily decayed teeth with crowns
5. Prevent pain and tooth loss from cracked teeth

After a topic has been discussed, probe for a lack of understanding or resistance by asking, "How would you feel about that?"As another example, you might say:."If we both do our part, we can stop your gums from bleeding. How would you feel about that?"

Need-payoff questions focus the patient on solutions, not problems, thus creating a positive atmosphere. Skillful questioning helps the patient discover — and possibly inform the dentist of — benefits that would result from proper treatment. The method of education in which skillful questions aid patients to find self-discovered truths is termed the "Socratic Method."

When every need has been identified and discussed, make sure the patient thoroughly understands all key concerns by asking if he or she has any questions. Briefly summarize all the benefits of your proposed care — then ask for a definite commitment with a statement like, "The most logical next step would be to ..." When the previous steps have been skillfully completed, asking for a commitment isn't "closing a sale," but rather "opening a relationship." The total fee required to restore optimal oral health is presented only after all needed treatment is fully understood.

Asking questions is the key

Asking lots and lots of questions is the real key. Careful probing will help you identify each patient's unique needs so that you can increase awareness of the benefits that your treatment will provide. After a patient's needs become explicit statements of his or her desires ("I'd do anything to get rid of these headaches!" or "I'd love to have whiter teeth."), only then should the doctor offer solutions to the patient's now-pressing problems.

My biggest case-presentation flaw before adapting to these techniques was jumping too quickly to my beloved solutions ("A crown will fix that!") before I had educated the patient about every possible benefit of restoring his or her mouth to complete health.

Offering solutions before creating maximum value can lead to objections and price concerns. By increasing worth before offering solutions, you don't have to deal with patient objections ... you avoid them! Today, I gently defer a patient's request for specific solutions until I possess "all the information I need to determine how to make your mouth healthy and keep it that way for a lifetime."

Now you have the information you need to optimize patient case acceptance. The challenge facing you is one of entelechy — turning potential understanding into beneficial action. Few people work as hard to develop a skill as they do to achieve knowledge and understanding. I hope this information has created a vision of a preferred future powerful enough to spur you to take action.

Begin by creating written questions consistent with your philosophy of care ... questions you are comfortable with. Don't let uneasiness with something new prevent your growth. Build your courage up to the sticking point and commit to implementing these ideas during your next 10 new-patient experiences. You owe completing this task to yourself, your staff, your family, and the patients who trust and depend on you.

Presenting care in this manner allows me to enjoy the satisfaction of knowing I've skillfully offered my best to all of my patients, no matter what their final decision might be about proceeding with this care. My case acceptance has greatly increased, along with my productivity and net income. The pace of our office also has slowed, as we perform more major procedures, thus reducing the frenetic hurrying from patient to patient that always had been one of my greatest sources of stress.

More importantly to me, I have developed closer relationships with my patients. We now share commonly-understood goals of helping them maintain their natural teeth in a state of health, comfort, and beauty for a lifetime.

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