Offensive Behavior

May 1, 1999
An unfortunate reality in dentistry is the fact that exhibiting superior clinical skill does not ensure practice success. This, perhaps, is more true now than at any time in our profession`s history. As consumers continue to focus on service - and demonstrate that they will pay for that service - our practices need to be ready to handle our patients` service needs. Most practitioners are convinced they already are providing excellent service, but how do you really know?

We can learn from our mistakes that turn patients off.

John J. Maggio, DDS

An unfortunate reality in dentistry is the fact that exhibiting superior clinical skill does not ensure practice success. This, perhaps, is more true now than at any time in our profession`s history. As consumers continue to focus on service - and demonstrate that they will pay for that service - our practices need to be ready to handle our patients` service needs. Most practitioners are convinced they already are providing excellent service, but how do you really know?

It truly is difficult to remove yourself from your practice and see it as an outsider would, much like a native English speaker could never know what English sounds like to a non-English speaker. We all do have extensive experience, however, as consumers ourselves. We have had wonderful encounters, and we have endured disappointing, frustrating, and maddening occurrences. We can learn from unfavorable experiences with retailers, telephone services, repair companies, and even fellow health-care practitioners. If we can find a dental analog to each offensive behavior, we can avoid that behavior, and even strive to provide the direct opposite in conduct.

Here, then, are my biggest consumer turn-offs. For each, I provide its dental counterpart and suggested alternatives to ensure a higher level of service.

1. "Thank you for calling; can you HOLD?" This common practice is very offensive to many people. The person receiving the call does not care enough to ascertain who is calling, and does not ask permission to make that person wait. There is seldom any mention of how long the waiting period will be. The newest version of this impersonal waiting game is the computer-voiced, number-pushing marathon encountered when calling even the smallest company. I don`t want to press "1," spell someone`s last name with my phone keypad, or say "operator" to a machine. I want to talk to a live person, who is probably sipping coffee while listening to me push buttons.

In a dental office, an abrupt telephone-answering technique might dissuade a potential new patient. It would also further frustrate any patient who is experiencing discomfort, or calling to complain about a statement, insurance matter, or previous service problem.

The missing element in this scenario is personal attention. First, dental staff members who answer the telephone always should greet each caller, state his or her name, and ask how they can help the caller. Once the caller has had a chance to identify himself and his concern, he can be informed that his needs will require special attention. An offer should be made to return the call, within a promised time frame, or the patient can be asked if he would like to hold, if that time will be no more than one or two minutes. This method of dealing with a temporary lack of time to take a call demonstrates that the practice cares about the individual calling and his/her specific needs.

2. "You`ll have to call back tomorrow." Often, a person taking a call does not have an answer for the caller. When the person who might be able to answer the question or concern is not available, a popular tactic is to ask the consumer to call back at a later time or day, when there might be a chance that person or answer would be available. This is impersonal and passive. It suggests that the person taking the call wants to get off the telephone, and truly is not dedicated to fulfilling the consumer`s needs.

Whenever a financial coordinator, scheduling coordinator, dental hygienist, or dentist is unable to take a telephone call, the patient should be informed that the team member taking the call does not want to give inappropriate information. The patient should be asked if that person could return the phone call. Again, a time frame is given. In this example, the patient is aware that the staff wants the best for them, and is caring enough to have the proper individual call them personally.

3. "I don`t know." It is frustrating to a consumer to be speaking with someone who does not know his or her product. It is more frustrating to have that person offer that lack of knowledge as an answer. Many retail companies stress to their employees that they represent the entire franchise when a customer walks in and speaks only to them. If that representative is ignorant, that is the portrayal of the entire company.

Whenever a dental team member does not have an answer for a patient, he or she must offer to find an answer from the appropriate source. This also applies to the dentist. When referring, for example, it is a much greater service for the dentist to personally call a specialist than to hand the patient a business card or a list of specialists. The two offices` scheduling coordinators then can make an appointment, while the patient is still in the office.

4. "If we had it, it would be out on the floor" or "Everything we have is on the shelves." This is an expansion of the "I don`t know" concept. In addition to a low level of personal service, this philosophy demonstrates no desire to give the customer what he is she is looking to find. No effort is made to listen to what the consumer wants, and no energy is spent searching for it. "I don`t know and I don`t care" is the message. I am impressed with businesses that have their employees ask if the customer has found everything, or that post signs asking customers to tell the manager what they cannot find, so that it can be ordered.

This may be a stretch, but I believe many practices currently are exhibiting the dental version of this mentality. How many dentists lecture patients who request `white fillings` on the evils of posterior composites, in an effort to talk them into a service with which they are more familiar - amalgam? How many offices routinely discourage patients from bleaching procedures or cosmetic veneers? What are you saying to patients who inquire about lasers, implants, abrasive dentistry, and the `perio pill?`

This is a problem. If we are to succeed, we must listen to our patients` needs and wants. I am not suggesting that we provide unnecessary or harmful care, but most practitioners who doubt and defame modern advances actually are not knowledgeable of those new alternatives. They are no different than the retail teen-ager who has no clue what is on that shelf around the corner and is taking the easy way out, hoping that the request will disappear. The request will go away, probably along with the patient. Constant immersion into continuing dental education is a must. Only when we are informed can we help our patients make sound treatment choices, and find the care they are seeking and requesting.

5. "No." I worked for seven years, during college and dental school, for Sears and Roebuck. We had a directive from Chicago hanging inside the customer convenience center which clearly stated that no one in the store, aside from the manager, was authorized to tell a customer "no." This document also warned that the manager should not be too eager to use that word either, as he or she would be subject to an override and reprimand from a higher authority.

Many business experts recommend that the word `no` be avoided even in cases where a customer`s request cannot be honored. They suggest that a reason be stated, an apology be made, and an alternative solution be proposed, all without ever saying "no."

This word is offensive only when it follows a consumer request. Obviously, in our profession, the word "no" is more than acceptable when following questions like, "Will this hurt?", "Do you have to pull this tooth?", and "Do I have to wait much longer?" When a negative response to a request is necessary, an alternative should be offered, along with its benefits to the patient.

6. "I`m sorry, that`s our POLICY." For me, this is the most offensive example in this article. There is not a more impersonal statement that could be made to a consumer. This phrase communicates that the consumer is neither unique nor special. It suggests that the consumer`s needs are not as important as following preset, arbitrary rules. It is ironic that this phrase begins with "I`m sorry," which could not possibly be the case, or something would be done to appease the customer. This is a true oxymoron.

This phrase unfortunately is very common in our profession. It is used when stating insurance protocols, cancellation practices, financial guidelines, and treatment philosophies. A patient looking to be treated as an individual will not be comforted to know that all of your other patients are treated according to a given policy. Every patient wants specific attention and service.

Did you catch all of the alternatives to the word `policy` in the last paragraph? Protocol, practice guidelines, and philosophy are all gentler methods of communicating the rules that govern your dental business. A better alternative, however, is the avoidance of this concept altogether. In its place, every effort should be made to oblige a patient`s requests. When this is not possible, it is best to listen to the patient`s concerns, show that you understand his/her concerns, and then explain why you must proceed in a given fashion. Benefit statements are critical to helping a patient comply with your recommended alternatives.

7. "I don`t know who told you THAT!" This extension of "That`s our policy" is used when a representative is faced with an allegation that a fellow representative offered a solution that clearly deviates from company policy. The current representative has two choices in order to save face: maintain order and obey policy. He or she can deny or doubt that anyone said what the customer claims to have been told. This often is approached by asking, "Do you know with whom you spoke?" or "Did you get a name?" The inference is that the customer is not reliably retelling the story, or that a fabrication is under way, both of which are insulting to the consumer. A second approach is to defame the previous representative by indicating that this person did not have the authority or knowledge to make such a promise. The consumer`s interpretation of this tactic is likely to be that the previous representative cared more and was willing to stray from the ill-conceived company policy to please the customer.

This statement, used in a dental setting, would be a clear indication that patient needs are not a high priority in that practice. It also suggests a lack of cohesion. I once heard a patient state - in an office where I was an associate dentist - that "the right hand does not know what the left hand is doing." This common retail occurrence has no place in a dental office, where patient trust is so important, so fragile, and so hard to re-establish once it is lost.

The best preventive measure would be a comprehensive office manual, supplemented by frequent staff meetings. Everyone should know what everyone else is saying to patients. The dentist also needs to stress the importance of the specific handling of patient requests, and the duty of each team member to exhibit the same caring, service-oriented attitude.

8. "You can talk to my supervisor, but she`ll tell you the same thing." When companies really have `policy on the brain,` even the supervisor is involved in defending company policy. By contrast, in retail sales, when one salesperson senses he or she will be unable to close, he or she often brings in a colleague. This is known as a `takeover,` a method designed to attempt to serve a customer in a way that the original representative could not. In service, employees should welcome opportunities to turn a frustrated, often irate, patron over to a supervisor, whose job it should be to ensure consumer satisfaction. When a service associate warns that the supervisor will `tell you exactly what I just said,` she changes her role from server to lecturer, while introducing a personal, emotional element that should not enter into the scenario.

Dental team members should not be unwilling to turn an unsatisfied patient over to a higher authority, but each employee also should be empowered to make adjustments to existing philosophy in order to appease patients. In this way, patients are impressed with the service rendered and instantly are aware that the dentist has given that practice representative the autonomy to make all efforts to please and appease. In order for this concept to work, all personnel must be familiar with the practice`s mission and thoroughly briefed in all aspects of the business particulars needed to solve problems spontaneously and correctly.

9. "Well, I`ll do it for you THIS time, but next time..." Occasionally, employees break down and alter company policy, but only grudgingly. They feel compelled to slap the customer on the wrist one last time and warn that this cannot happen again. Whenever this happens to me, I feel like saying, to the first part of that sentence, "Please don`t hurt yourself on my account," and to the last half, "Don`t worry: there won`t be a next time."

Customers and patients do not want to be made to thank us for every step we take to serve them. When they do thank us, we should sincerely inform them that it is our pleasure to do so, and that we truly want them to be satisfied. Consumers also do not want to be lectured. We have to be careful when instructing on home care, for example. There is a difference between teaching and preaching, between educating and pontificating. The best approach is an unemotional description of the problems diagnosed, with an informative explanation of the recommended solution.

10. "We`re very busy today." This statement is offered as an explanation for long waits, poor service, or to explain why special attention cannot be paid to a customer at the moment. This intimates that being busy is more important than delivering personalized, quality service, or that service is not needed since there is an abundance of customers.

Dental practices that keep patients waiting - in the office or on the telephone - or that do not have appointments available in the immediate future, could be sending the same message. If patients perceive that they are one of many, they will feel less special. They may be likely to look for another practice and are not very likely to want to refer friends or family, who would just be competing with them for the office`s attention. In the worst case, a patient might equate a hectic, busy office with a greedy, production-hungry dentist.

I always have contended, and taught dental students, that I can answer the question, "Am I the only patient here?" much easier than I can respond to, "Wow, this place really is hopping today!" While I can only shrug and apologize to the latter, the former gives me the opportunity to communicate, "Yes, you are my only patient right now. I have reserved the next two hours for you. You have my undivided attention." Powerful! Similarly, all patients who call during business hours with an emergency should be offered an appointment that day. Who defines the term "emergency?" The patient, of course. Being available and reserving time for each patient are two critical elements of patient service.

I have not addressed every consumer turn-off known to man in this one article. Hopefully, I have touched on some of the most common, most frustrating, and most dangerous examples. As members of a service-oriented profession, we must always strive to provide impressive service to complement our top-rate clinical care.

With all of the poor service that abounds elsewhere in the world, our patients will be pleasantly surprised.