Money, Mr. Maloney, and me

Feb. 1, 1999
Just the idea of having lunch with Dr. Hawkins is a pleasure. He always buys and he makes me feel like a gentleman. He`s my kind of dentist; I`m blessed to be his associate.

The boss has a few pointers during lunch.

Donald Gutting, DDS

Just the idea of having lunch with Dr. Hawkins is a pleasure. He always buys and he makes me feel like a gentleman. He`s my kind of dentist; I`m blessed to be his associate.

I was prepared for an in-depth report on the dental society`s golf tournament, but found the conversation turned ever so gently to one of my morning patients, Mr. Maloney.

I knew something was wrong when Mr. Maloney grunted that he`d think about doing that inlay and left just as swiftly and silently as he could. I wrote it off as "one of those things" and didn`t realize the boss was aware of it.

"All I told him was that an old inlay was bad and he needed a new one. Then, wanting to get the unpleasant part over with, I told him it would cost about $300. He muttered something about having to think it over and walked out. What`s the big deal about it? He`s spending over $4,000 on his wife with you. What`s another $300 after that?"

"Dave," the boss quietly began, "you`re a fine dentist, even if your license is only three months old. You`re wise enough to know you`ve got a lot to learn about dentistry, and you`re a pleasant enough young fellow. That`s why I brought you into the office. The future glistens for you. But you can dump that future rather effectively if you don`t keep your patients. Now, I heard and saw most of what went on between you two. I grant you that Jack Maloney isn`t the world`s easiest person to talk to, but a little change in your voice, sentence structure, and nonverbal skills would have had a far-different effect."

"Boss, I think I`m about to be chewed out. I guess I`ve got it coming. But what does nonverbal skill have to do with telling the man `how much`?"

"Dave, it has a lot to do with it, and. I`ll talk more about that shortly. I know other patients you`ve had were aware of their costs and you didn`t have to tell them. It`s my fault for not having briefed you on the fact that this would be one of your jobs today, but I really didn`t expect you to fumble the ball. So Maloney`s inlay was failing, but you made it sound like the biggest piece of junk you`d ever seen."

"Well, besides not having much anatomy, there was an open margin with recurrent caries. What else could I have told him?"

"It`s not what else, young doctor, but how else."

I put down my Reuben sandwich, knowing I was out of ammunition. So, with chastened voice, I just said, "OK, how about if I shut up and listen while you talk? I don`t feel very happy about the whole situation, and they didn`t teach that in" dental school."

"Then consider this," Dr. Hawkins implored. "You don`t know if that inlay`s been there six months or 30 years. You don`t know if it was done for a state board, by a junior student for his first patient, or by his brother with 20 years experience. But, we can assume that he trusted whoever did it, and an insult to their work, justified or not, is an insult to him.

Now, what did you talk about before you started with the inlay and the attendant bad news?"

"Why, nothing," I answered. "He`s here for dentistry, not conversation, and I already was running five minutes late. I thought he`d want me to be businesslike."

Dr. Hawkins nodded and said, "He certainly has a right to expect that, but some respect for him as a human being is his right, too. It will pay you well to keep that in mind. A little small talk while you wash your hands costs nothing. A remark that you`re complimented that he came to see you sets him at ease and gets him on your side. Then, if you had looked at his chart ahead of time, you might have noticed he`s a big baseball fan.

"Let`s suppose you continued with something like, `Mr. Maloney, I`d like to point out a problem we`ve found that you might not be aware of. Have you had any discomfort or unusual feelings on your lower left side?` If he has, fine; you`re confirming them. If not, you`re glad to have uncovered something before it becomes acute and serious. Give him a hand mirror. Point out the problem without shoving in the explorer. Tell how the inlay has given good service, but it`s now time to retire it. It`s just like taking out a starting pitcher who`s faltering and bringing in Bruce Sutter. He can relate to that and he also knows that Sutter gets paid more than most starting pitchers. But don`t you say that.

"So far you`ve made him feel at ease, shown him you`re looking out for his welfare, and gotten him to agree with you. Then breathe easy for a few seconds. That gives him an opportunity to ask questions and `how much` is often one such question. If he doesn`t follow through, then it`s your turn to inquire if there`s anything you can clear up. But when the time comes to say `how much,` look straight at him, keep your voice going at its usual volume, tempo, and pitch, and tell him his investment will be no more than $296. Also tell him that you`ll do it as well for him as you would for your favorite uncle. Recall what you did. You looked at the floor, mumbled $300 and stopped."

"Now Dr. Hawkins," I interrupted. "I know it`s your established fee, but I`m still new and it does seem like a lot just for one tooth and me charging as much for it as you do. I guess I really was embarrassed to say so much for such a little thing."

He replied, "The charge for that tooth ($300) would be about a month`s payment on your student loan. It is a significant amount; I understand that. He could figure the same way, too. A few teeth fixed at that price would buy him a whole set of dentures complete with 28 teeth, and no more shots or fillings to boot! But he`s here for the best now and for a wonderful future that allows him to really enjoy life, not to present another obstacle.

"And about his wife`s full-mouth rehabilitation for $4,000 - think about this: Between insurance and a tax refund, he`ll be out of pocket about 10 to 15 percent. And the reason he wasn`t staggered by the amount was that he had heard similar figures from two other offices. My consultation took about 20 minutes and largely was social in nature. They were resigned to the amount when they came. They just seemed to like me better than the other fellows. And one of the other fellows happens to be my dentist.

"On a slightly different tack, you remember visiting Dr. Wilson`s office. What did you think of it?"

"Not much," was my reply. "The waiting room looked like it came from the bus station, and the office in general was tired."

"Accurate observations, doctor. Sam Wilson still does good dentistry and maintains self-respect, but he doesn`t command a commensurate fee. Some rather severe personal problems have diminished his drive, but not his abilities or principles. Many people would gladly pay Dr. Wilson more than he charges and he`d be worth it, but he doesn`t feel he`s worth it. So his patients get some of the best dentistry in town at a bargain rate and they never know it. I won`t say he`s unhappy and not serving the public, but he could be a lot happier and serving more people at the same time. Do you want to go that way?"

"You know the answer. Tell me more ... "

He said, "Since you are competent and have some drive and enthusiasm, and you make a good appearance, let`s build on that. You see, you feel presentation begins when a patient first walks through the door. That`s part of the nonverbal approach, just like looking at the patient rather than at the floor. Pay more attention to people and continually refine your surroundings. You can do this without catering exclusively to the Rolls-Royce crowd.

OBut be yourself. You can?t change your personality or successfully pass yourself off as something you aren?t for very long. You can?t succeed with every patient or every social contact, but you can succeed substantially more without compromising yourself. You?ll get better at these things in time. Now I can?t choose your words for you, but I can give you some ideas. How about making one change for a starter?O

OWhy not? Let?s have it!O

OWhy not plan out your approaches to people just as you would plan treatment? Don?t get me wrong. I?m not asking you to write speeches for each patient, but develop an accurate idea, maybe even an outline, of what you?re going to talk about, be it professionally or socially, and no matter how briefly. It really is as important as your treatment plan.O

OLook on each patient as a paying guest,O he continued. OEach patient is a paying guest and will, if you let him, enable you to live handsomely and happily. Your job is to make him want to do this and still feel he?s getting more than his money?s worth. Certainly, it would be nice if we didn?t have to talk about money. But, it is a fact of life ,and if you approach it matter-of-factly, the patients will accept it. They do expect to pay. It?s your job to have them conclude ? on their own ? that your services are worth the fees. Making them feel important goes a long way in that direction.

OAgain, when you?re about to quote a fee, look straight at them, tell them what they?ll get and mention the amount. Then right away continue with what they?re going to get out of it. Don?t ever say a figure of so many dollars and then stop. In fact, I don?t even use the word Odollars.O They know what the number alone means and it does soften the statement somewhat.

ODave, part of the reason you?re an associate is to get experience and that you will do. You may realize how painful some of that experience will be. You will learn more from your own mistakes than from anything else. I?m telling you this so you can learn some things less painfully. You see, I?ve made every blunder in the book, and I?d like some of your experience to come second-hand.O

Well, the Reuben wasn?t very tasty that day and it wasn?t the cook?s fault. But Dr. Hawkins? ramblings provided more nutrition for my patient relations than a porterhouse steak would have for my body. A good trade-off.

Mr. Maloney came in today to begin the new inlay. I shook his hand when he entered and asked what he thought of the Expos? chances this year. Then I apologized for upsetting him at the last visit and told him how complimented I was that he came back.

He shrugged it off, saying that Beth, our secretary, office manager, and general-office expert had sensed something, called him at home, explained it kindly and told him what a marvelous dentist I was. So I got another chance. How could I let Beth down?

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