Phenomenal case acceptanceThe reason your patients say yes and no

Oct. 1, 2003
I thought long and hard before putting this on paper. What really matters in a successful dental practice? The unequivocal answer is ... case acceptance.

by Dr. Steven Rasner

I thought long and hard before putting this on paper. What really matters in a successful dental practice? The unequivocal answer is ... case acceptance. Before you move on to the next article — excuse me, but you haven't heard this before — not like this. If you stop and think about it, how you spend your days — whether they are peaceful or frenetic, how many patients you treat each day, how able you are to set up and contribute to a pension plan, if you get lunch, if you are having fun — has everything to do with case acceptance. This article will reveal how one practice has maintained a consistent, extraordinary case acceptance with an average treatment plan of $4,100 in a community with a median income of $10,360, a poverty level of 25.2 percent, and ranked nationally as having one of the most challenging economic outlooks.

Communication skill of the doctor

We are not pulling any punches here: If you can't communicate, you are toast. Finished. Kaput. There is simply nothing more critical than your ability to talk, listen, look at, express, laugh, be serious, and connect with your patient. Obviously, there exists a plethora of books on this subject. This article is going to break it down so you can improve dramatically today!

The cornerstones of "yes"

The first fundamental to "yes" is to realize who is in front of you. For goodness sake, you don't need a book to tell you there are different personality types that sit in your chair. Respond to them! There are four types of patients:

The socializers — It doesn't get any easier than a socializer with money. They're fun, talkative, and gregarious. They're OK if you're busy or late. They'll put you in a good mood. They are open-minded. They will accept unanticipated changes in a treatment plan. They have lots of friends and want you as one. For case presentation, just be earnest and friendly and tell them what they need. P.S. They hug a lot.

The drivers — They are intimidating, but they are the second easiest group to accept your treatment recommendations. They're all about business, being on time, being productive, getting it right the first time. They don't care if you're their friend. They want you to be competent and professional. Every spare minute is important to them. They'll be on a cell phone or filling in their list of "things to do" while you wash your hands! Be confident and present cogent reasons to address their oral health needs. Don't give them five options. Talk like: "This is what we need to do" — and why.

The relators — This group is a challenge. They are warm, affable, considerate patients. They don't make quick decisions. They need to talk about your recommendations. They need to think it over and give it time. The results of your case presentation can be disconcerting. Since they are so nice and seemingly so accepting, you'll wonder, perhaps, what you did wrong. It's important to remember that these aren't first-day-decision patients. They will want to know how many times you've been successful with your treatment plan. They will respond well to before-and-after photos of completed cases or testimonials. Give a great presentation. Give them time, and you'll develop a special patient for years to come.

The thinkers — This final group, as the name implies, like to think it over. They are courteous, respectful, and inquisitive. They want you to be professional and informed. They won't take kindly to changes in their treatment plan, so get it right the first time or you might "eat" any additions. They'll ask you for a detailed accounting of their treatment plan and why. They'll ask you what makes noble metal "noble." So a case presentation to a "thinker" is like presenting to a colleague. Know your stuff! Be explicit. Bring them "onboard" with the treatment-planning decisions. Go over radiographs. Show them their needs. Having said that, you can give the presentation of your life and they'll still need to think about it. Don't be pushy. Just know who you are dealing with and there is a good chance you will treat them down the road.


The first fundamental tenet to "yes" is to have the ability to "alter your personality" to the person in front of you. Clearly there are books like Non-Manipulative Selling by Tony Alessandra, PhD or Dale Carnegie's How To Win Friends and Influence People. Both books would help anyone with these skills, but reality suggests you already have these skills. You do act differently at a football game than at a funeral. And you already react differently to the various personalities you encounter. Understand that applying these skills to the patients you meet each day is paramount to case acceptance.

What else counts?

Even if you have a PhD in mastering the personalities you encounter, you'll need a whole lot more if you want phenomenal case acceptance.

The screen

Phenomenal case acceptance begins with you understanding that you only have so many hours per week to present cases. If you spend that time randomly with people who don't share your value of comprehensive care, then everything else in this article has just been nullified.

Most patients call your office with a specific chief complaint — a broken tooth, pain on the lower left, or a tooth missing from their partial. They are not thinking about quadrant scaling, gold onlays, or equilibrating their occlusion. If new patients won't allow an FMX or complete exam (patients are informed of your approach at the new-patient phone call), then perhaps you could match them to an office with a more compatible philosophy. Extraordinary case acceptance requires that you not treat everyone!

The first five minutes

Many noted psychologists have recognized that most relationships are won or lost in the first five minutes. Here is a good way to think about this: If you are a comprehensive-care office — if you spend an hour or so at the initial exam, routinely do oral cancer screenings, a detailed soft-tissue analysis, examine the muscles and joints, take models, note wear patterns, and, of course, all the other expected and more common components of an examination — chances are that you diagnosed more pathology and the subsequent need for care. This costs more. Significantly more. And when a consumer is asked to invest more, a lot of things become critical that otherwise might not matter — like the first five minutes. Here is what counts: Make sure through the morning meeting that the front-desk team anticipates the new patient's arrival. It's easy. If the patient is due at 10:00, start looking for someone new at 9:45. When you see him or her, stand up, walk into the reception room, and say: "You must be Kelly; we've been expecting you. Make yourself comfortable. Can I get you a cold drink?" That's not fluff — it's good old-fashioned manners. And if you expect patients to make a serious investment, you'd better be polite ... you'd better make them feel valued, for starters.

The physical implant

It doesn't cost a lot to look "Walt Disney clean," but it does require job roles. Simply assign one of the staff to do this task. The job description would look like this:

Office "Fluff" Coordinator Duties —
• Check the reception room several times a day.
• Is the reading material neat?
• Are the refreshments "deli-fresh"?
• Are all the glass surfaces Windex®-clean? (Keep a bottle at the front desk.)
• Are the plants alive?
• Are the rugs spotless?
• Check the restroom.
• Are the sink, toilet, floor, and mirror immaculate?
• Stuff a basket with disposable toothbrushes.
• Buy some male and female cologne. (Big bottles are less likely to "walk away.")

Truthfully, you need one person assigned to this task, but everyone is responsible for "Walt Disney clean."

What to put in the reception room?

I'd basically wallpaper it with thank-you notes, testimonials, newspaper articles, and some special before-and-after photos of completed cases. You really can't overdo it. Whatever time your patients spend in reception couldn't be better spent than reading accolades about the dentist to whom they will entrust their care.

The staff

Whether you have two members or 20, they'd better know what you think is important. They'd better know that you are vigilant, and if you are going to remain a fee-for-service practice, what they do around this place matters. What does matter?

• They can't be moody.
• They must love their job.
• They believe you should be the president of the ADA or even the USA.
• They love people.
• They refer to patients by name.
• They remember "stuff" about everyone.
• Their affection for their teammates is obvious.
• They care about how they look.
• They dress great, smell great, have impeccable hygiene, and a killer smile.
• They're passionate — about something ... anything!
• You walk out of the treatment room, and they'll know what to say and what not to say.
• They're real hard to find. Be patient and start looking.

The one-to-one interview

Patients who commit to large treatment plans do so with offices they trust. That is what the interview is for. It takes all of five to 10 minutes. It's conducted by the new-patient coordinator. It's done in a room — out of the way — that provides some semblance of privacy.

Here is what to do: Have someone "spy" the new patient while he fills out those "so fun" medical history forms. Don't let the patient sit. As soon as he finishes, have the coordinator escort him to the interview room. The coordinator could say something warm and inviting like: "Before the doctor examines you, let's take a few minutes to get to know each other better." You are looking for three denominators.

Common bonds

If your practice is anything like mine, many patients make appointments who do not know me from "Adam." There is no better patient than a personal referral, but many patients still select our office based on random sources. So we want to bond. Reviewing even the driest of information is an opportunity to gain credibility. "So, I see you work at Duran Glass. Do you know Joe Williams, the plant manager?" You can do the same thing based on where the patient lives or what church he attends. One hundred percent of the time you will strike up a common bond. The coordinator will be able to reveal a patient you both know who already comes to you. And guess what — it feels good! Good feelings lead to "yes."


The interview is also a chance to see what the chemistry is of the new patient. If you have the office "people person" doing the interview, he or she will be able to tell you in a snap who you are about to meet. Is the patient uptight, anxious, fearful, introverted, shy, distrusting, depressed, happy, effervescent, funny, or open-minded? It's an opportunity for you to prepare that computer between your ears. Walking into a treatment room incredibly jovial, jazzed up, or aggressive may not be the best way to relate to your new patient who is on the verge of tears over the embarrassment of her oral neglect.

The financial IQ

I could have written a whole article just on this point. The financial IQ refers to the patient's perception of just who is going to pay for needed care. Many new patients visit your office because they "just got insurance." They erroneously presume it covers 100 percent. Other patients will let you know they have substantial needs but a limited budget. On occasion, patients will reveal that finances are not an obstacle (i.e., their children are out of college).

The point is that the doctor should have some sense of who he or she is dealing with even regarding the patient's finances. It is often an opportunity to discuss various patient financing available for out-of-pocket costs.

Remember, early in the one-to-one interview, we conduct a mini-dental interview. Pose questions like: When was the last time you saw a dentist? Do you have any missing, drifting, or shifting teeth? How do you feel about your smile? These questions can generate abundant information for the new-patient coordinator about both the patient's oral health and perception of oral health. It wouldn't be uncomfortable or unusual to say: "You know, it sounds like there is a bit more going on than just the 'chipped tooth' we previously discussed. Although your insurance will cover a portion of this, it won't cover it all. If you would like, we can set up an account ahead of time in the event you would like to use it for any out-of-pocket expenses you might incur."

Although this may sound extreme early in a patient's visit, it is simply another avenue to assist a patient with potential costs of dental care. It is really not very different from the assistance you get at department stores, when buying a car, or using your credit card at the physician's office.

The "examination"

There are a plethora of books written on "the exam." For the sake of brevity, let us consider only the most salient points.

The initial doctor-patient contact

Besides a "brief hello," this is what has been already accomplished prior to this interlude: the new-patient greeting, the one-to-one interview, an FMX, and a charting of existing restorations. The doctor has been "coached" on whom he or she is about to meet and has briefly reviewed the radiographs.

Here is what to do: Walk into the exam like you have all the time in the world — even if you don't. With no instruments in hand, sit down — eye-to-eye. Look relaxed. Smile. Say something like this: "Tell me, what was it exactly over the last week or month that made you say, hey, I've got to get to the dentist?"

There is no better way to focus on the mindset of your patient. If it's been some time since the patient has seen a dentist, they will tell you about financial concerns, fear, or just apathy. It allows you to adjust or center your recommendations. Then I'll proceed with something like this: "Well, there are a lot of dentists for you to choose from and we're not all the same, so before I even look in your mouth I would like to share with you my philosophy of care."

If you are a comprehensive care practice, then that begins with a comprehensive care exam. Such an exam leads to the diagnosis of more pathology — often asymptomatic. Early perio or caries commonly do not produce symptoms. The critical point here is that the majority of offices do not take such an approach. So it is new to your patient. Your job early on is to let this patient know — subtly — that this is your approach and why. These subtleties, although brief, are fundamental pathways to "yes." It is the author's opinion that you are better off assuming that this approach is different for your patient and to trumpet — not too loudly — the advantages.

Less is best

The next time you ponder whether your patient will appreciate a comprehensive exam, consider the following approach. Amend it to your own comfort level but keep the core message powerful.

"Our philosophy of care is that less is best. That means if I can do a filling for you — instead of a crown — it's less. If I have to crown the tooth but don't have to root canal it — that is less. Certainly, if I can keep your tooth rather than removing it and replacing it with a bridge or something removable — that is less! Less time in my chair. Less money — less! The only way for me to make that happen is to do what you pay us to do — a thorough exam so I may catch potential problems before they become big problems."

If you haven't done this before, it may surprise you how receptive and encouraged this new patient will be. The very fact you are even talking to them is unfortunately refreshing to most patients.

Review the radiographs

They're X-rays — not a cat scan. A four-year-old knows they are teeth, so don't concern yourself with your patient not understanding. Conversely, patients like it. It brings them into the treatment-planning process. It respects them. In less than five minutes, you can reveal early perio, caries, drifting, and extruded teeth. Patients are amazed by your "ability" to reveal sensitivity on a tooth they neglected to tell you about. It affirms what you have been telling them — comprehensive care is the superior approach.

This is what I would do

Let's get something straight. There are times when you can tell a patient their needs in 10 minutes. There are times when you'll need mounted models, additional radiographs, or diagnostic wax-ups. If their findings and treatment needs are clear, most of your patients want to know that day — not two weeks from now — what you recommend. They also don't want five options. Limit their options. Tell them the pros and cons of each and then say, "This is what I can do" — and why.

Final words

Phenomenal case acceptance is not by accident. It requires planning from the initial phone call to the doctor's demeanor at case presentation. Everything counts. A touching thank-you card in the reception room, an unexpected smile in the hallway, that intangible feeling that this place is different — this place is better.

It sounds laborious because it is. Case acceptance is the primary fuel that sets the tone for every day you practice. Picture this: Treating six to eight patients per day instead of running room to room to work on double that amount. Having a work environment less frenetic, filled with camaraderie and a common goal of distinctive service and clinical excellence. Feeling your appreciative patients are reaching their highest level of optimum oral health because you left your myopic eyes behind and provide comprehensive care.

Sounds peaceful doesn't it? It is more attainable than you might think. Although it will require some initial changes, planning, and abundant energy, the payoff is huge and worthy.

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