The electronic block between you and success

May 1, 1996
There`s an inexpensive bit of equipment in your office that`s more important to the success of your practice than all the panoramic X-rays, ultra-speed drills and fancy patient-tracking computers put together. Use it wisely and your patients love you for it. Use it badly and they`ll curse you and 10 unborn generations of your offspring. The sad fact is you and your staff all too routinely misuse this dangerous bit of electronic gadgetry.

Your competence often is judged by how well you and your staff handle telephone calls.

R. H. Schaper, DDS

There`s an inexpensive bit of equipment in your office that`s more important to the success of your practice than all the panoramic X-rays, ultra-speed drills and fancy patient-tracking computers put together. Use it wisely and your patients love you for it. Use it badly and they`ll curse you and 10 unborn generations of your offspring. The sad fact is you and your staff all too routinely misuse this dangerous bit of electronic gadgetry.

What is it? It`s your telephone; that simplistic, century-old staple of communication. It`s the four-wire link to your patients. It`s so common you can get one free just for subscribing to a magazine for your waiting room-and that`s about how much regard most offices have for it.

Before you utter a superior snort of derision at the idea anyone still exists who doesn`t know how to use a telephone, read a bit further. The Vegas odds are at least three-to-one someone in your office doesn`t know how or doesn`t bother to use the phone properly. It may even be you! That`s the real reason for this nudge.

Like it or not, your patients quite often judge your competence and skill by how you and your staff handle this versatile brainchild of Mr. Bell. Though it`s anything but scientific, I suspect strongly there`s a shunt in the human ear going directly to your emotional center. It`s not a rational evaluation of our skill at seating a crown but raw, emotional impact our patients use to judge us.

None of us are immune to this visceral twang. Not even yours truly. In spite of the insight and intellectual control gained through more than three decades of private practice plus over 10 years of critically analyzing management ills and woes of my fellow practitioners, I still succumb to the negative impact of a bad phone call.

This was forcefully brought home to me not long ago when, in an unaccustomed role as a patient, I was reduced to pitiful pleading with a string of officious, ill-tempered supercilious biddies known formally as receptionists.

Without going into detail, I`ll grant my problem was not life threatening. Few dental situations are. Nevertheless, by the general reckoning within our profession, it was an emergency. Seeking treatment was when I discovered how badly a phone can be misused.

The first error I catalogued was minor. It was committed by my regular purveyor of solace, support and cuspal manipulation. When I dialed, a falsely, cheery answering machine announced the office was closed for vacation. Call back after a specific date and all would be perfect. I hung up and redialed to see if I`d missed directions for emergencies. My personal shining knight had goofed. There wasn`t any.

For someone who`s been in the tooth trenches, this shouldn`t be a problem. After all, I knew a basketful of competent colleagues. I hadn`t seen much of them since I retired, but my name should still open doors. I had a big leg up on the poor ordinary joker who might fight the dreaded front-office system with nothing more potent than wits and dogged persistence.

Boy, was I naive!

Call number two set the day`s tone. I gave my name (including the "doctor" prefix for emphasis) and declared an emergency. Before I could proceed with details, I was interrupted with two questions. Was I bleeding and would the pain pills I had on hand control my suffering? I answered "no" and a qualified "yes." That got me an offer of a work-in appointment next Tuesday, take it or leave it. I left it. The pain pills wouldn`t last beyond Sunday.

There was no way she`d put me through to her boss to authorize a new supply. She haughtily spouted some canned nonsense about office policy and unknown anonymous callers wanting pain pills. I may have known her boss for 20 years, but I hadn`t met her. Therefore, I was a nonpatient looking for a quick fix. I hung up before I succumbed to blistering her ears.

Call number three didn`t care if I was dying. I could be fitted in by the doctor in two weeks. No exceptions. I found this amazing, since I`d talked briefly to this particular practitioner a month before and learned his appointment book had more holes than a golf course with a gopher problem.

It took eight calls to get prompt relief from my affliction. I`d have taken the offer of the next day from call number five, but I was in a very bad mood by then and I`d had enough of being put off. Besides, the anonymous whiny voice was downright cranky that I`d called. I was determined not to be bullied.

Was my attitude, at that point, unreasonable? Possibly yes. In candor, probably. That is if you looked from "the efficient dentist" perspective. But, by then, I wasn`t thinking like a dentist or an ex-dentist or a practice analyst. I wasn`t mentally thumbing through the office manuals I`d advised on over the years to see what the policy said. I was reacting just the same way your patients do when they hit that implacable wall of resistance at the front desk.

If patients bounce off that wall enough, they end up in someone else`s office. If they bounce too many times, they start cursing the profession as a whole. I don`t have to spell out what that will do to the concept of private practice. Or to the mindset of a prospective juror in a malpractice case.

An equally-fatal sin is the electronic snub. I didn`t personally experience it, but I`ve heard of it often enough. This occurs when a patient calls and wants to talk to the doctor. Invariably, if it`s something the receptionist can`t shunt somewhere else, the supplicant is told "doctor will call back." Doctor doesn`t. At least not in a timely fashion.

It`s true, many of these calls are petty. Some are downright ludicrous. Most are nothing more than a waste of valuable time. You know that and I know that, but the patient doing the calling doesn`t. To them, it`s of sufficient importance to make them dial for answers. Some-times, those answers lead to good-sized fees. Even if there`s no potential fee, it`s good public relations that involves no out-of-pocket expense.

In this regard, I like to tell the story of Jake. He was one of my emergency patients. Period. If it didn`t really hurt, there was nothing wrong. To him, false teeth weren`t bad. His daddy got along fine with them, didn`t he? It wasn`t money, either. He had plenty. He just didn`t care.

One midnight, some 48 hours after his latest extraction, he called. He was distraught. His son had just lost his first baby tooth and there was no root on it! The tooth I`d just pulled had a root. Was his son deformed? There was real panic in his voice.

I woke all the way up and took a couple of minutes explaining everything was normal; but if he wanted, I`d get dressed, meet him at the office and check his "pride and joy" out. Fortunately, he decided that wouldn`t be necessary.

A week later, he made a real appointment for a real exam, the first in his life. He ex-plained, I`d been so accommodating that it was just possible I actually had his best interest at heart and, maybe, I wasn`t just after his wallet. (The resulting fee paid for a great vacation.) It was all due to my willingness to actually answer a phone.

I suspect many a problem where the unreturned call is the main symptom is a matter of interoffice-communication breakdown. The receptionist in good faith promises the doctor will call. The doctor has a policy that states he will return calls at a convenient time later in the day.

In spite of what the office manual says, sometimes the doctor doesn`t get the message. If he or she does, it`s not delivered in large, block letters impressive enough to demand attention. If it`s actually written down it ends up in a neglected stack of patient records, past-due bills, spousal grocery lists and gratuitous offerings for great deals on penny stocks cluttering the doctor`s desk.

If delivered orally, it`s passed on in the hall as the good doctor scoots to his next waiting patient. If the doctor remembers it at all, it`ll be late the next night when he`s brushing his teeth before retiring. By then, it`s too late. Whatever the patient wanted is moot, so the call is never made. And the patient feels ignored. Even abandoned.

Generally speaking, all these problems lie with the front desk. Years ago, one management consultant swore nearly 80 percent of the reasons ranged from unpleasant telephone voices through personality deficiencies to downright incompetence.

While the percentage may have changed somewhat due to the widespread technical-school training of auxiliaries, the basic proposition stands. Far too many receptionists are being hired for all the wrong reasons. The emphasis is constantly placed on clerical performance rather than personality and vocal abilities. It`s regrettable that only in larger offices or group practices is the work load heavy enough to separate the duties of a receptionist from secretarial work.

Even when someone is hired who has ideal credentials, there are still telephonic-communication problems awaiting the unwary. These are magnified in proportion to the distance from perfection that the receptionist sits.

If you suspect there`s a difficulty in your office, there are a couple of concrete things you can do to check.

The first is to monitor your calls. All of them. That includes incoming and outgoing. Readily available at most electronic stores is a simple, inexpensive device that will automatically record phone conversations. (Though legal in most states, you should check to see you`re not violating local law.) This gadget will allow you to hear what goes on during a patient`s call. This makes it possible to spot weaknesses and correct them promptly.

If you discover there is no problem with the receptionist`s performance, you should go one step further and check inter-office communication. When any call comes in that requires anything but an appointment, the time and nature of the call is recorded. When the person responsible takes whatever action is necessary, they should note the time and action taken.

In most cases, the responsible person ends up being the dentist and he/she will stoutly maintain it`s more important to do other things. The phone is secondary-or so the story goes.

That`s no more than an ego disease. Fortunately, there`s a cure. Several breaks in the schedule should be set aside for taking care of calls. Specific times are desirable since there is nothing more frustrating to a patient than to call first thing in the morning and have to wait until the end of the day to get a response.

If a delay of more than an hour is necessary, the patient should be informed when to expect a return call. The person who`s waited all day for your voice and then finally gives up and goes to the store won`t be happy to hear your self-righteous spiel on his/her answering machine. Lurking in the back of his/her mind will be the suspicion the blasted dentist deliberately waited until they went out just to avoid talking to them!

I know that sounds silly and irrational, but most patients are irrational when it comes to choosing and retaining a dentist. If you want proof, press your next 10 new patients for their reasons for relocation and communication problems. At your own risk, ask them why they chose your office.

Unless you yearn to go into the moving and storage business to capture those patients transferring across the country, you should listen carefully. The patients you lose are saying roughly the same things in the next office they visit. If your practice has phone problems, think of how far ahead of the "average" dentists you`ll be if you correct them!

The author spent 30-plus years as a dentist in general practice in Marble Falls, TX. His latest endeavors include a book, Dear Dentist: Stop Being Your Own Worst Enemy, published by PennWell Books.

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