The first step toward `shaking on a deal` is to develop a relationship.
James R. Pride, DDS, and
Mark W. Adams, DDS, MS
Many dentists believe they have an adequate relationship with their patients. After all, they smile, shake hands, engage in small talk, and make the patient laugh. Why, then, are 80 percent of America`s crowns done in single units? Why does only 67 percent of the population see a dentist regularly? The failure of many dentists to convince patients to undergo needed treatment often is a failure to establish the kind of relationship that allows the patient to say "yes." Relationship-building is inextricably linked to selling. Let`s examine different sales techniques and the critical role of relationships in gaining case acceptance.
Dentists hate "hard selling," yet they use it
The very word, "selling," makes many dentists uncomfortable. In fact, some of them chose dentistry over other professions so they would not have to sell! The typical association we have with selling is the unscrupulous used-car salesman and the hard-sell technique employed to get the buyer to say "yes." What is the "hard-sell technique," and why does it make us uncomfortable?
A "sale" consists of four components: the introduction, the identification of the buyer`s wants and needs, the presentation of the product and the logic for its purchase, and the close. The discomfort we feel in the hard-sell scenario results from at least 40 percent of the effort being placed on the close, thus putting pressure on the buyer to say "yes." Comparatively little time is spent on the introduction - building the relationship with the buyer.
If we analyze the typical case presentation, we can find many similarities with the hard-sell scenario that makes us so uncomfortable. Little time is spent building the relationship, even though dentists often face patients they`re seeing for the first time. Since they are making a case presentation, dentists typically spend little time identifying the patient`s wants. The bulk of the discussion focuses on presenting the proposed dentistry and on the close. Knowing little about what makes a patient "tick," a dentist in this scenario tells the person what he or she needs, which by no means guarantees that the patient will "buy" into the recommendation. The irony is that while dentists oppose hard selling, the typical case presentation offers solutions to problems not fully realized and felt by the patient. It is very much in the hard-selling vein!
As progressive dentist-philosopher Dr. Robert Barkley observed decades ago, the doctor-patient relationship was critical in helping his patients to become healthier. He quoted psychologist Dr. Nathan Kohn as saying, "Unfortunately, through their psychological naivety, dentists blame the patients for not wanting the treatment instead of recognizing that the problem is their own inability to establish a relationship with the patient."
The failure of the case presentation is exacerbated by the training we receive, not only in dental school, but also in post-graduate education. An overwhelming portion of our training is devoted to improving technical skills. We become the "healers," adopting what Barkley called the "I-know-what-is-best-for-you attitude." We tell patients what they need, in our terms, rather than help them discover how our treatment can achieve what they want, in their terms. We say, "Mrs. Smith, you need a crown." It would be better to say, "Mrs. Smith, you`ve shared with me that you would like to improve the appearance of your mouth. In order to get you feeling confident about your smile again and to help prevent the tooth we`re discussing from possibly fracturing or breaking, I recommend a crown."
The ultimate frustration is to see dentists complete comprehensive post-graduate restoration programs, then continue to talk to the patient as if they were doing single-unit dentistry. Acquiring advanced clinical skills does not automatically give the dentist the tools to influence the patient to accept treatment. Instead of saying, "Mrs. Smith, you need a crown," after training, the dentist says, "Mrs. Smith, you need 16 crowns." This blows the patient away. In effect, these supremely skilled dentists are all dressed up with nowhere to go. Why? Because they have failed to build a trusting relationship, which leads to patch-and-fill dentistry, perpetuating the lack of trust.
Patch-and-fill dentistry is event-oriented, which is characteristic of a breakdown in the doctor-patient relationship. It`s a short-term, narrowly defined solution to a specific problem, rather than a long-term, broad-scale approach to the patient`s overall oral health.
The patient is repaired, but never put in a state of health, or made to understand the meaning and importance of such a state. A dentist can fill a hole without the patient`s participation, but to cure gingivitis requires a relationship in which the dentist educates and influences the patient to change his or her behavior. Doing it together as a partnership is the weak point for the dentist who is unable to get the patient to accept recommended treatment.
The long-term approach
Instead of just repairing the immediate condition, we need to look at the patient`s overall, long-term oral health, in a way that ties into the person`s wants and needs. It is through an understanding of the patient`s wants and needs that you will gain the patient`s trust and acceptance of your treatment recommendations. Such an approach removes the short-range, event-oriented nature of single-unit dentistry, and replaces it with a long-term, process-oriented approach to deliver the highest quality and most lasting result to the patient.
People with more money can be repaired faster, while people with less take more time. However, the end result is the same for all patients - comprehensive, quality dentistry. Money does not dictate what treatment your patients can get, only how fast they can get it. In the new paradigm, quality is consistent and uncompromised; time is the variable.
In the long run, who should receive the best dentistry? Is it only the rich, who easily can pay for it? Or is it the poorer patients, who cannot afford "re-dos" and must have dentistry that lasts? Because the best dentistry also is the most economical in the long run, it follows that the less money patients have, the more compelling is the case for comprehensive, quality dentistry.
The next paradigm shift, which enables your patients to see this great truth, is to switch your focus from trying to get the patient to say "yes" to treatment to building a deep, trusting relationship. If you focus on the relationship, the sale will happen naturally.
In the new system, the dentist spends most of the time asking questions - rather than giving answers - in order to encourage patients to reveal their motivations and to think for themselves. The dentist influences patients to accept needed treatment by allowing them some control. Help the patient understand and draw conclusions for herself: "Mrs. Smith, as we discussed, amalgams tend to break down over time. Now, what do you suppose happens when gaps form around and underneath the filling?" Thinking allows the patient to gain control.
By using the new method of selling, with integrity, dentists no longer feel like used-car salespeople; the superficiality disappears, the patient is committed, and the entire experience is richer and more rewarding for both parties. This approach brings fulfillment and satisfaction to dentistry.
Building a trusting relationship
Let`s revisit the dentist we described previously, the one who smiles, engages in small talk, and jokes with the patient. This dentist has only established what we`ll call a rapport, not a relationship. What`s the difference? The related article explains the differences.
How does the dentist go beyond a superficial rapport to foster the deeper bonding in a relationship?
A critical element in establishing a relationship is the new-patient experience. To foster a solid relationship, the new patient needs to see the dentist first for a comprehensive examination and consultation before reaching the hygiene department. Key elements of the new patient`s experience with the dentist include the preclinical interview, the clinical examination, and the consultation.
l The Pre-clinical Interview - Before gloving, take time to ask the patient questions. The purpose is to uncover powerful motivators and concerns that are essential to presenting your treatment plan. Ask questions that reveal the patient`s motivation for wanting dental work (avoid pain, improve appearance, or stay healthy) and the patient`s concerns about having treatment (the cost, pain, or time involved). These questions may include:
"Tell me about your past dental experiences."
"If you were to rate your own oral health on a scale of one, meaning you would need a whole lot of treatment, to 10, meaning your mouth is in good health, where would you rate yourself?"
"In the future, where would you like your oral health to be on that scale?"
"What role does insurance play in your decision to have dental treatment?"
Actively listen and encourage the patient to elaborate. Answers to these questions will help you personalize your case presentation for the particular patient. Asking these questions does not in itself establish the relationship, but it does begin the relationship-building process.
l The clinical examination - Use this exam to educate the patient and to engage him or her actively in co-diagnosis with you.
Before each section of the exam, explain what you will be doing, so the patient can follow along. For example: "We`ll begin by checking your head and neck. The reason we do this is ... . I`ll begin by examining your neck for any signs of ... ."
Call out results in nontechnical language to your assistant (e.g., "tooth-colored filling," "biting surface"), while the patient overhears and understands.
Without alarming the patient, use trigger words that communicate the seriousness of a problem. Avoid mild phrases that do not create urgency for needed treatment ("signs of wear," "a little bleeding"). Instead, say, when warranted, "worn and deteriorated filling," or "pus pocket and infected gums."
Use props, such as the intraoral camera or mirror, to show the patient both healthy and problem areas.
Pause periodically to ask how the patient is doing.
Engage the patient in codiagnosis. For example, explain the perio probe method of detecting gum disease, then ask the patient to listen for numbers greater than four as you call out pocket depths.
This unique medical experience of participating in their own diagnosis is far better for patients` long-term oral health than a snooze in the chair. Thus, any problems encountered become their problems, not the dentist`s problems.
l The consultation - Scheduling a separate consultation (unless the needed treatment is minimal) allows you time to prepare your treatment plan in terms of the patient`s motivators and concerns and to predict likely objections. When this appointment is complimentary and included in the new-patient exam, there is no cost-impediment to the patient`s acceptance.
"Mrs. Jones, you need three crowns," is not as effective in gaining case acceptance as "Mrs. Jones, so we can prevent possible tooth loss through fracturing or breaking, we need to replace those worn fillings with more permanent restorations. That`s why I`m recommending three crowns."
The preclinical interview, performed earlier at the new-patient examination, tells you a little about how Mrs. Jones thinks, so you can predict the kind of objections she will raise and plan how to overcome them.
Your best and finest care is the guiding principle in preparing the treatment plan. First, establish a state of health by eliminating decay, stabilizing periodontal disease, and removing occlusal disease. Then, restore, as the patient`s time and finances permit, in the months or years ahead. Let patients know your overall plan for their long-term oral health, and they will come to appreciate comprehensive dentistry.
After closing the patient clinically and quoting an approximate fee for phase I, pass the patient to the financial administrator to work out comfortable payment terms. Provided your accounts receivable are controlled, a variety of payment options will enhance case acceptance without undue risk.
Why settle for anything less than the highest standard of dentistry? However, for patients to recognize and enjoy the great benefits of comprehensive care, we dentists need to close the book on the traditional hard-sell model of case presentation and begin writing a new manifesto on understanding and influencing patients - "selling," if you will. We need to write the new text in the language of relationships.
For proven methods that you and your team can use to build patient relationships and improve your practice, call Pride Institute toll-free at (800) 925-2600, and we`ll send you a free, 28-page booklet, Taking Your Practice to a New Level.
Rapport is characterized as follows:
- Conversation is casual and centered on small talk (which is good for "breaking the ice" initially, but not for establishing a deeper level of understanding). Communication often is impersonal, scripted for all patients.
- No purpose to the communication is identified.
- The focus is on the patient`s clinical needs; the dentist tells the patient what treatment is needed.
- The situation is viewed as a short-term, isolated event to fix a particular problem.
A relationship is characterized as follows:
- Conversation is individualized for each patient.
- A mutually agreed-upon purpose is identified that is long-term and personalized for each patient.
- The focus is on the individual patient`s wants; the patient is engaged in the decision-making process.
- The situation is viewed as part of an ongoing process to achieve and sustain the patient`s oral health for a lifetime.
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