Leading the complex care patient to health

Have you ever had a patient who, during or after your case presentation, looked you straight in the eye and said, “Well, thanks, but I've got to go home and think about it.

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Have you ever had a patient who, during or after your case presentation, looked you straight in the eye and said, “Well, thanks, but I've got to go home and think about it.” Have you ever wondered what it is they need to think about? Well, chances are they're thinking more about how your recommended treatment fits into their lifestyle as opposed to understanding all the technical aspects about the dentistry.

You might believe that treatment acceptance increases if you educate patients thoroughly. However, education really works best when the patient is ready for treatment. Nonclinical issues often impact your patients' readiness.

These include their budgets, what they're doing with their families, their hobbies, and their work schedules. This is especially true when the treatment plan is large, complex, and expensive.

Understanding the complex care patient

Based on more than 20 years in practice, I believe there are basically two types of patients: those with minimal care needs, and those with complex care needs. Minimal care patients have few problems with their teeth, and their dental conditions are not causing them much discomfort.

Chances are they're not experiencing pain and they're generally happy with their teeth and appearance of their smiles. Typical treatment plans for these patients cost less than $3,500 and require only a few visits. Your minimal care patients behave differently than your complex care patients and are much more ready for care, often at the first appointment.

In contrast, your complex care patients have significantly more dental conditions, which result in greater dental disabilities. Dental disabilities are how dental conditions get in the way of the patient's life.

Disabilities include emotional embarrassment, lack of confidence, or fear of losing their teeth. Patients like this know they need the dentistry, but are often not ready to receive it.

Complex care patients do not decline care because they don't understand what they need, but rather because the dentistry does not fit comfortably into their lives. This is the information — how the dentistry fits into their lives — that you and your team must uncover to gain the necessary understanding to become the patient's advocate and lead them to care, either now or later.

Identifying patient types on the initial call

To discover whether the caller is a minimal or complex care patient, the office manager needs to be curious — that's a key word — and ask about the patient's underlying condition. These questions are best asked after the patient has had the opportunity to discuss his or her reason for calling. A way to invite that information is to simply ask, “Nancy, what would you like the doctor to check first during your appointment?”

This way, the patient is invited to volunteer the information that she is most concerned about. Once you understand the patient's chief concern, a few simple questions will reveal the patient's underlying conditions.

For example, an excellent question is, “Nancy, I understand that you're concerned your front teeth make you look old. If you have a minute, I have a few questions for your medical record. Would that be okay?” It's important to get approval to ask the patient these initial questions.

One of the first questions I ask is, “Are you missing any teeth or have you had any replaced with a partial or full denture?” The reason this question is important is because partial endentulism (the underlying condition) requires complex care, such as dental implants.

Another good question is, “Are you pleased with the appearance of your teeth?” In this case, we already know Nancy is not pleased with her teeth, but if the caller does not volunteer this information, it's a good follow–up question. If the caller says, “No, I'm not happy with the appearance of my teeth,” chances are enhancing the appearance of the teeth will result in complex care (crowns, veneers, and tooth replacements).

Another question that will signal the complexity of care is date of birth. Generally speaking, patients over 50 are complex care patients. But keep in mind that these questions do not take a lot of extra time. All you need is one clue as to a patient's underlying conditions.

So if a patient says, “Yes, I'm missing a lot of teeth,” then your diagnosis of a complex care case is already made. One clue can yield a lot of information. If the patient is not missing many teeth, is pleased with the appearance of his or her smile, is generally young and doesn't have any outstanding disabilities related to the teeth, chances are this is a minimal care patient.

Be a leader first, clinician second

As clinicians, we are often comfortable talking about the “fun stuff” such as periodontal disease, cavities, crowns, and bridges. But I have found when it comes to complex care patients, it's important to be a leader first and a clinician second. There are two things you need to be a good leader: connection and confidence.

Let's start with connection. Leaders connect with their patients and get to know them as individuals, focusing on their needs. This requires they listen more than they talk. With complex care patients, you should ask open–ended questions that encourage patients to share their emotions, fears, concerns, and issues. Why?

Because I have found that complex care patients are older and have been to dentists many times. They have been told time and again that they need the dentistry, and they often have physical pain.

Yet, something prevents them from getting the level of care they need. Telling them, yet again, about their dental needs in a one–way conversation will not lead them to care — understanding them will.

Second, leaders speak with confidence that comes not only from having exceptional clinical skills, but from having an attitude of abundance. With complex care patients, dentists and their teams are often unsure whether or not they will accept care, and they focus on convincing them of the benefits of the dentistry.

Again, this conversation is usually one–way, with you and your team discussing why the dentistry is needed, instead of two–way, with the patient revealing his or her true barriers to accepting care. So, start with an attitude of abundance, and be confident that your patient will get the dentistry done at the practice. Truly, the only question is when treatment will happen — not if.

Take an outside–in approach

When you have an attitude of abundance, you work with your patient to solve the “when” issues — not reiterate the “why” issues through more education. This leads you to take an “outside–in” approach with complex care patients.

First, you understand what's going on in the patient's life that resulted in his or her declining the right level of dental care; then what's going on inside the mouth. Until the issues outside the mouth are resolved, the patient will not be ready for dentistry.

Once you have listened to your patient and uncovered his or her “fit” issues, you can provide solutions. There are many reasons patients find it difficult to fit dentistry into their lives. Because complex care cases are more than $3,500 and require multiple appointments, scheduling and money are often key barriers.

Having evening and weekend appointments available can help solve scheduling issues, especially for busy patients. Offering multiple payment options can help solve money concerns.

Using visual tools, such as a financial policy that lists all available payment options or CareCredit's online payment calculator, can be very helpful. By providing complex care patients with fit solutions before discussing the specifics of the dentistry, they will see how easy it is to accept care, either now or later.

As a leader and patient advocate, you can help complex care patients get the care they need by understanding lifestyle fit issues, and providing solutions that make dentistry fit their lives, in a timeframe that works for them.

Paul Homoly, DDS, is president of Homoly Communications Institute, a resource for dental industry professionals. Dr. Homoly is a comprehensive restorative dentist and a leading educator for more than 25 years. You may reach him at Paul@PaulHomoly.com.

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