Creating case acceptance magic

Aug. 1, 2000
There is no magic formula when it comes to case presentation. The real magic comes from your attitude.

There is no magic formula when it comes to case presentation. The real magic comes from your attitude.

Randy Shoup, DDS

The most gifted dentist, with the most advanced training, utilizing the latest in advanced materials, employing high-tech equipment, and supported by the most skilled team, is completely worthless until the patient says "yes" to treatment. The irony is that a less-accomplished dentist can be flooded by patients clamoring for his or her services.

Why does this occur? The primary reason is that the quality of the dentistry delivered is an unknown quantity to patients. Patients judge the competence of the dentist and the quality of the dentistry on an emotional scale, not a technical scale. This very critical issue that I call "the emotional buying decision" often is overlooked by many dentists.

Dentists dive head-long into the ocean of continuing education, looking for that magic course or product. Frustrating as it may be, there really is nothing a dentist can buy that will guarantee greater acceptance of a treatment plan. Dentists frequently return from a trade show or seminar very excited about a product or technique they`ve discovered, certain it will greatly increase case acceptance. But after the initial excitement subsides, rejected treatment plans start to pile up again.

Why try? Why bother analyzing complex or even simple cases? Patients routinely reject optimal treatment plans and go for the cheapest treatment. Why worry about developing wonderful programs to rehabilitate a patient to a lifetime of health when the patient will say "no" and you and your treatment plan will be shot down again?

The constant stream of rejections wears the dentist down. There appears to be no rhyme or reason to who says "yes" and who says "no" to treatment. Frustration and disappointment push the dentist into the "safe zone of just doing the easy stuff."

Slowly, over the years, the practice resigns itself to doing an uncountable number of fillings. Only a scattering of crowns and bridges are done. The full-mouth rehabilitations that the "big guys" do and the regular stream of cosmetic cases are but a mere drop in the dental office`s bucket.

The dentist tries to save a little pride and/or dignity by saying, "My patients can`t afford that kind of work," or "My patients won`t accept big cases," or "I`m not in the right location," or "I don`t have a very cooperative staff," or "Those new products aren`t even proven yet," or, finally, "I don`t like to sell dentistry."

Here`s the wonderful news: Your patients can afford your best efforts and the finest services! It doesn`t matter in what location you practice. Your team is everything that you need. The new materials and techniques are excellent and, even more important, you don`t have to sell dentistry!

Curing this malaise requires no big purchases or expensive training seminars. The only magic required is a change in your attitude and your focus. It is exactly like the Kevin Costner movie, Field of Dreams: "If you build it, they will come." By making an emotional and attitudinal shift, dentists can begin thinking about themselves, their team, and their patients in a totally different way.

These five steps (see box) deal with the doctor and his or her team. With the doctor and the team`s attitude readjusted and focused, the next phase is to convince the patient to take ownership in the disease process. If patients perceive that there is no problem with their teeth, why should they opt for any treatment? Dentists must be clear and emphatic about a patient`s condition. Phrases such as, "Well Mrs. Jones, there might be a little cavity under that old filling" or "I maybe see a tiny crack on the side of the tooth as well" are absolutely not acceptable!

Present your findings in a warm, compassionate manner, yet be very clinical at the same time. For example, use phrases such as "Mrs. Jones, I`m worried about this tooth. There is decay under this old filling. In addition to the decay, there is a fracture on the side of the tooth. Given both of these conditions, I`m very concerned for you and your tooth." Patients are far more motivated to seek a solution if the dentist is confident and clear about the problem. A wishy-washy or vague diagnosis will kill any motivation in the patient to seek treatment.

No tool is more effective in creating the appropriate ownership attitude than an intraoral camera. Every office should have and use one. A picture is worth a thousand words ... and the picture on an intraoral camera is worth twice that! When a patient sees the image of his or her own teeth on the screen, the ownership issue is 95 percent resolved.

When viewing their teeth on the television monitor for the first time, patients generally say, "Oh my gosh! That looks terrible! How do we fix it?" Those magic words - "How do we fix it?" or "What do we do?" - immediately tell the dentist that the patient now owns the problem. The patient is telling the dentist that he or she has transitioned from a position of believing there is no problem to a position of seeking a solution to the problem.

Wants vs. needs

Now for the solution. There are two types of desires: 1) wants-based and 2) needs-based. Wants are far more powerful than needs. Dentists have been taught to talk to patients about their needs in terms of what`s wrong, what`s broken, and what disease is present.

Need is based on necessity and governed by severity. Needs are very price-sensitive and are very low on the priority scale. How exciting is it when you need a new water heater, your roof repaired, or a brake job on the car?

On the other hand, patients are far more motivated by wants. Wants address how patients look and how they feel about themselves. Wants are fueled by desire and deal with results. Wants are value-sensitive and, as a result, are extremely high on the priority scale. Patients are more than willing to pay money for things they want and desire as opposed to those things that are necessities. Patients always seem to find the money to go on vacation, buy new golf clubs, or go shopping, yet they tell the dentist that there is no possible way they could ever afford high-dollar restorative treatment.

The key is to respond to the patient who now is saying, "How do we fix it?", not by describing complex dental options and detailed procedures, but by simply asking:

"Mrs. Jones, what do you want?"

"Mrs. Jones, which do you prefer: a tooth-colored restoration or a silver filling?"

"Mrs. Jones, do you prefer your teeth to stay in all the time or come out at night?"

It`s critical to erase the word "need" from the dental team`s vocabulary. Always use the term "want" when discussing treatment. When patients start to think about dentistry in the context of "wants," they will choose to have the work performed.

These types of questions guide the patient through their own mental "wants-processing system." The dentist follows what the patient expresses as his or her preferences. The treatment then becomes the patient`s idea. This process creates the unique environment where the patient is directing the dentist, as opposed to the dentist trying to talk a patient into having treatment.

Practice and a dedication to the techniques described in this article will result in an explosion of accepted treatment.

Five steps to repositioning the `altitude of your attitude`

Here is a five-step program on how to reposition the "altitude of your attitude." This will position you and your team to present comprehensive care in a way that will generate a "yes" response from your patients.

Step 1: Become responsible for big cases. By working through big cases with the entire office team, you create an amazing esprit de corps. The team looks at the dentist with more pride and confidence. The team starts approaching dentistry with more excitement. The practice goes into "the zone" of confidence. Even if you do not get acceptance right away, the practice of focusing on developing large cases is invaluable.

Step 2: Be mentally ready to stay the course. Big cases are difficult; oftentimes, they require coordination with other doctors. The big-case patients will be yours for a long time. The greater the workup done on these cases, the greater your clarity will be on all cases. What used to be a hard procedure now becomes much easier. Best of all, the dentist creates a "trophy patient."

Step 3: Be willing to devote the time that is necessary. A complete redo of the schedule often is required. Big cases take time, but they are more profitable. Seeing one, two, or three patients in a day and doing comprehensive care will bring in more money than seeing 10 or 20 patients in a day full of fillings. The stress of running around the office is gone. There`s more time to spend really doing the job well and enjoying your patients.

Step 4: Have the skills necessary to succeed. The amount of continuing education needed to do big cases is great. Most dentists already have the training that is required, but they simply never have fully utilized those skills. Remember: "If you don`t use it, you`ll lose it." Take your laboratory technician to courses and let him or her see first hand what is expected for the finished product. Get smart together. This will create a reputation in your area of being the best. Your confidence will soar as your patient flow increases.

Step 5: Make sure that the entire team is involved. Developing people is an extremely tough job. The investments made in team-building pay back huge benefits in loyalty, devotion, pride, and harmony. As team members grow in their level of technical skill, significantly fewer management problems will remain. Each team member will begin to feel a personal stake in the success of the practice.

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