C. J. Jayson, DDS, MA, FICD
As a long-term student of marketing and management, I must take issue with some of the statements and ideas offered by Dr. Levin in his article in the March 1999 issue of Dental Economics.
Dr. Levin indicates that dentists must use a new model for case presentation to gain case acceptance for elective dentistry. He offers that the old needs-based-services model will not work for the elective practice. He states, "Unfortunately, it is highly ineffective when presenting elective dentistry that patients do not need." Who determines the need? Perhaps elective care as viewed by Dr. Levin may be very necessary when viewed by the patient. Would a needs-based model work there? I think it might. Empirical research done by my colleagues and me indicates that patients who select both routine and elective care use necessity as the number-one determinant in making their treatment-choice decisions. In addition, they use other determinants during the complex cognitive process of selecting their dental health care.
Dr. Levin coins the term elective dentistry. He goes on to say, "Because purchasing esthetic or elective dentistry is an impulse, not a logical decision, we must take an entirely new approach." My long experience and significant research indicate that elective and cosmetic-dentistry treatment decisions often are complex, thoughtful, and completely logical. Ample evidence can be found in the marketing and cognitive behavior literature to support this statement. The literature on cognitive dissonance alone would be a good place to start. Perhaps Dr. Levin would share with us the empirical research that supports his assertion that elective-care decisions are impulsive.
Patient decision-making for health-care choices is a complex and not-well- understood process. Perhaps Dr. Levin has come upon the answer with his 18 steps for case presentation for elective procedures. I would like to see empirical evidence that he is correct. In the meantime, I will present treatment to patients in my practice based on their needs as diagnosed by my training and experience and as asked for by them based on their preceived need.