The Art of Beginning Relationships:
A Second Look at New Patients
3M Dental is proud to sponsor the Dental Economics year-long "Mastering the Art of Communication" series.
The best relationships are front-loaded. The more attention paid to foundational issues from the onset, the greater the likelihood the relationship will start off on the right foot, become strong enough to weather the stresses associated with normal ups and downs, and remain healthy over the long term. It is significantly more costly in all currencies (time, money, energy, emotional stress, and other resources) to fix a broken relationship than it is to avoid the problem in the first place. Thus, how you and your team choose to structure your approach to new patients is a very important decision.
There are no "new" patients. Almost every patient is recycled from another dentist. They may be new to you, but their beliefs and attitudes have been shaped by their previous experiences and society`s images of dentistry. Why do people recycle? In some cases, of course, they move too far away for the previous practice to remain convenient. But most new patients choose to move on not because of relocation, but because their needs haven`t been met. They haven`t been understood. They haven`t been treated as they wished to be. They didn`t like some aspect of the dentist or staff. They wanted something they did not receive. How will you avoid being the next notch on their belts? How can you respond to and care for each person so he or she will remain a patient and stop the recycling?
In the July installment of our year-long series, Mastering the Art of Communication, I offered some foundational principles and introduced ways of thinking about and responding to new patients in urgent need of dental services. You may wish to review those introductory comments in preparation for our work together this month. In this second part of our exploration of beginning relationships, we`ll turn our attention to the new patients who recycle to you from other practices. We`ll explore five great opportunities to get on track and solidify the relationship from the beginning. We will also consider the implications of not taking the best advantage of these opportunities.
Let`s begin by reviewing the relationship problems that haunt even the best practices. See if you can relate to any of the following:
- Patients who cancel at the last minute
- Patients who expect total insurance coverage
- Patients who fail to pay their bills
- Patients who delay recommended treatment, yet expect the dentist to be available at a moment`s notice
- Patients who want the cheapest alternatives in dentistry, yet drive expensive cars and take four-star vacations.
These are the types of frustrations that result from either unexpressed or unfulfilled expectations between practices and their patients. Most are not easily addressed after the fact. If we review each one carefully, we`ll see that both the practice and the patient play a role in allowing the difference in perspective to develop. The practice, however, plays a greater role and has a higher obligation to avoid these relationship-damaging problems. When a dentist and team have expectations of a patient and fail to disclose those expectations and gain agreement, conflict is inevitable. You must therefore hold yourselves responsible for the quality of the relationships you create with your patients.
I have a dear friend who is a marriage and family therapist. On the wall behind her consulting room chair, in direct view of the patient, she displays a piece of needlepoint she stitched. It says simply: "What you tolerate is what you get." My friend believes that we create much of our reality by tolerating conditions which jeopardize relationships, instead of intentionally and collaboratively establishing the conditions that will make the relationship strong, healthy, and functional. I think she is absolutely right. If you agree, you must create new relationships with deliberateness rather than allowing human nature to take an undirected course. If you fail to take the initiative, you hardly have a right to complain about the result.
Expectation minus reality equals conflict
This is a simple formula which represents a predictable phenomenon. It helps us understand how important clarified expectations are. If expectations are high and reality is low, conflict inevitably follows. If patients expect one thing and receive another, the disappointment that follows will be proportional to the disparity between the two. There is a very simple way to ensure that you know your new patients` expectations: Ask them! If you believe patients come with a set of expectations, and agree that learning about those expectations is a prerequisite to a successful relationship, then you must construct your new patient experience accordingly.
Last month, I posed an important initial question to guide your approach to new patients: If you could somehow get inside each new patient`s head, what would you want to know? Recently, a team member answered this question by presenting her analysis of a patient relationship and how it had gone astray. "I think we moved too fast for him," she said. "We gave him more information than he wanted, sooner than he was ready to process it, and we left him in our dust. Had we known he wasn`t interested in a lot of details, we could have changed our approach."
You will always be in a better position when you have more information. Unmet expectations will cause most patients to recycle. Wouldn`t you want to meet a patient`s expectations if you could? Wouldn`t you rather tell patients you can`t meet their expectations than have them be disappointed in your services? Why risk the latter outcome if you can avoid it? Patients leave your practice when they don`t get what they want; they rarely leave when they are happy and feeling well-served. You want most patients to not only stay in your practice, but also take advantage of your services. Understanding their expectations becomes an important patient-retention tool.
Patients want you to know their expectations.They will reveal them quite freely if given a chance, particularly if they believe you will be responsive. Guessing, supposing, or making it up are ineffective strategies. Ask patients reasonable questions and let them speak.
Let`s look at how a relationship-based practice might approach new patients from the first phone call through the agreement on a treatment plan and financial understandings.
- Great communication opportunity one: The initial telephone call. Last month, I introduced the two most important first questions you can ask a new patient: "How did you learn about our practice?" and "What prompted you to call us today?" Once you have determined that the patient does not require the urgent attention of the dentist, you can begin to listen for expectations the patient holds and "outcome" statements. (For an in-depth discussion of Outcome-Means-Prices, please refer to the April installment of Mastering the Art of Communication.) Questions like "How are you hoping we will help you?" open the door to a healthy relationship. The sample telephone form on the preceding page will help guide and organize your thoughts.
It is not possible to script the rest of this conversation because the thread of the interview determines each response or follow-up question. Your question-asking and listening skills are profoundly important here. The goal is to gather enough information to begin the relationship. A focused initial telephone call will generally last about five minutes. The team member who is engaged in this call must be in a private, quiet space, and remain free from interruptions and distractions. During that time, the patient and team member agree on the next step which, in a relationship-based practice, includes a discussion with the facilitator, a comprehensive examination, and appropriate diagnostic records.
Differences of opinion exist about whether a cleaning is appropriate at the first appointment. Dentists I look to for clinical ethics suggest it is inappropriate to perform any clinical service in the absence of a proper examination, diagnosis, treatment proposal, and approval. From a behavioral perspective, it is inappropriate as well. Each dentist must determine the answer to the clinical question in his or her own way. I suggest, however, that patients are not in a position to agree to a procedure when they neither own the problem nor participate in creating the solution.
Limit your demographic data gathering to the basics. Use your time to focus on learning about the new patient`s beliefs, attitudes, values, wants, and hopes. This information is far more important than a social security number or date of birth.
- Great communication opportunity two: The welcome letter. This step is an important opportunity to both confirm and respond to the first telephone call. You will of course include a cordial greeting. Be sure to refer to how the patient learned about your practice:
We`re so pleased you have heard good things about our practice from your supervisor, Jim Warren.
Also refer to what prompted the patient to call at that specific time:
Because you have some immediate concerns about your darkening tooth, we will pay particualr attention to it during your examination.
Don`t overlook the opportunity to respond to any expectations the patient conveyed. Confirm your commitment to meeting those expectations. For example, if the patient indicated a fear of going to the dentist, you could address it by stating:
Because you have not always had comfortable dental experiences in the past, each member of our team will be particularly attentive to how you are feeling. We are all committed to giving you a very different set of experiences.
If the patient conveyed any wishes on the desired outcome, reflect them in your letter as well.
Be sure to review what you have agreed will happen at the first appointment:
We will begin by reviewing both your medical and dental history and exploring what you want us to know about you. We believe the more we know about you, the better we are able to help you. We will then learn about your mouth through a comprehensive examination. Following that, you and Dr. Roth will agree on what diagnostic records will help you make plans for your care.
Also refer to the fee and financial obligations:
We promise all of our patients that we will reach an understanding about both the fee and how that fee will be handled, before they commit to an appointment. We know this is an important consideration for you. As we mentioned, the fee for this first appointment is $. We have agreed that you will be prepared to take care of your account at the end of your visit.
Finally, this is a wonderful time to affirm the appointment date and time, and outline your expectations about honoring appointments:
We look forward to seeing you on Tuesday, August 8 at 2 p.m. We consider all of our appointments confirmed at the time they are made, so you needn`t worry about time changes or delays. If you would like a courtesy reminder, please let us know. We do ask, however, that you review your commitments carefully before reserving time with us to minimize appointment changes.
- Great communication opportunity three: Help us learn about you. Would it be useful for you to know what patients believe about their dental conditions, the role dental insurance will play in their decision-making, or whether they wish to create a long- or short-term approach to care? Of course it would! These and other fundamental issues become critically important in helping patients make choices about their care.
There are several ways you can learn about a patient`s perspective. One great opportunity is to send a simple information-gathering tool along with your welcoming letter. The patient worksheet above provides an example of the types of issues you might explore in this format. (If you would like to have a reproducible copy of this worksheet by e-mail as an Adobe Acrobat attachment, send your name and e-mail address to firstname.lastname@example.org.) This form invites the patient to identify preferences and beliefs. It also offers the patient an opportunity to emphasize which outcomes are important and what role prices will play in their decision-making. These concepts indicate what your patients hope to achieve, as well as barriers they may have to address. The form provides information to help facilitate that process.
- Great communication opportunity four: Initial interview. Now comes your first opportunity to begin acting on information you have learned about this patient. The initial interview is a relationship gold mine, and the facilitator must be provided the best chance to extract its full value. Anticipate the patient`s arrival, be prepared, and greet him or her warmly. Move quickly to a private and quiet place that is free from interruptions and distractions. You might begin by discussing the patient`s medical and dental history, then move directly into a review of the "Tell Us About You" worksheet which accompanied the welcome letter.
This is another time when question-asking and listening skills are great assets. A skilled facilitator can begin to address any gaps that exist between the patient`s expectation and reality. For example: "Susan, you seem to know a lot about your dental condition and believe your teeth are healthy. How will you feel if you and Dr. Roth discover something different during your examination today?"
A skilled facilitator will also begin to identify any differences of perspective: "Susan, I`m hoping we can encourage you to think differently about the role your dental plan plays in your decision-making. Most of our patients tell us they feel misled by their insurance carrier when the limits of their coverage don`t fit the care they want us to provide. I`d like to help you avoid that type of disappointment. If you can think of your dental plan as help in defraying some of the costs of of the services you ask us to provide, I suspect you will be able to make more realistic decisions for yourself."
- Great communication opportunity five: Introducing the patient to the dentist. When the facilitator and patient have completed their initial discussion, the dentist joins them. The facilitator should convey any vital information to the dentist.
Because the patient is present, he or she hears what the facilitator has learned and how it will be honored: "Dr. Roth, let me introduce you to Susan. I`ve learned a great deal about her, and I`d like to give you an overview now. Susan, let me know if I have misunderstood or omitted anything you want Dr. Roth to know. The first thing is Susan has not had comfortable dental experiences lately, and I`ve assured her that we are committed to changing that for her, beginning today."
It is very important that the dentist respect the facilitator`s role in framing the developing relationship, because the facilitator will be the primary ongoing contact with the patient. When patients see that the dentist is interested, is a good listener, relies on and has confidence in the staff, and that there is open communication about important matters, they are more likely to communicate openly themselves.
- Great communication opportunity six: A written report of findings. It is unreasonable to expect a patient to remember the details of an examination without the benefit of a written or graphic report. Just as you need documentation to help you remember what you learned, so would the patient benefit from a report of findings.
Dr. Bob Barkley, in his now out-of-print book, Successful Preventive Dental Practices, introduced the written diagnosis, a powerful form of patient communication.
In lay language, Dr. Barkley reviewed what he and the patient learned during the clinical examination. He correctly understood that patients were in a better position to understand and own their conditions when the information was readily available. He strictly avoided offering treatment recommendations in the diagnostic report letter, recognizing that treatment selection was a collaborative process.
A written report of findings is a superb tool to offer your patients. Unlike Dr. Barkley, whose book was published almost 35 years ago, we have the advantage of computers and software to make this process remarkably easy. Patients who receive these diagnostic letters routinely report that they feel respected and included. This form of communication can be a major contributor to building and maintaining a strong relationship with each of your new patients.
Each of these "great communication opportunities" requires thoughtfulness, time, skill, and coordination among members of the team. The investment you make creating these opportunities and building healthy relationships from the beginning will multiply exponentially.
In this month`s "Guided Team Meeting," Teri Goss and I provide a structure to help you and your team learn about your patient`s expectations early in the relationship. We encourage you to experiment with these ideas over the next few months and find the specific strategy that works best for you.
We remain dedicated to supporting you in providing the best advantage for every new patient.