How to ask purposeful questions that ignite case acceptance

Your patient arrives for his five-year status exam. Unexpectedly, he refuses x-rays even though he’s done this before without complaint. But this time, the more the clinical team reassures him, the angrier he gets until he abruptly stands, tears off his napkin, and stomps out of the practice.

Meanwhile, in a different practice, a patient meets with a dentist for a second opinion. The dentist agrees with the original diagnosis. But instead of feeling relieved, the patient is furious and insists both dentists must be wrong because, (and you’ve heard this song before), “Nothing hurts.”

Are you wondering if it’s just dentists who have to deal with these illogical patients? Nope. Even surgeons have these experiences.

In his book, Supercommunicators: How to Unlock the Secret Language of Connection, Charles Duhigg describes a frustrated prostate cancer specialist. His recommendation to most of his patients is to monitor their health rather than risk the potentially devastating side-effects of surgery. The surgeon spends considerable time educating patients, providing literature, and citing studies that support this stance. Nevertheless, a large proportion of patients insist he operate, despite the risks.¹

Why communication misfires

Patients and clinicians might look like they’re communicating, but they’re actually engaged in distinct conversations, with each side making assumptions about the others’ needs and intentions.

Clinicians assume that patients make decisions based on objective data, so they educate patients with films, scans, models, brochures, and cool technology.

Patients, on the other hand, are immersed in their personal stories and filter medical information through the lens of their fears, beliefs, and self-identity. What influences them most are clinicians who respond to their questions, especially the questions they don’t have the courage to ask.

Welcome to the hamster wheel of conversational frustration: clinicians frustrated with illogical patients and patients irritated by condescending clinicians. Dentists stumble into these kinds of exasperating conversations because, sadly, they often don’t know what their patients want from them.

Duhigg drills (pun intended) conversational needs into three possibilities.¹

1. Hugs: Reassurance and support
2. Help: Information and assistance
3. Heard: Nonjudgmental understanding 

Dentists often assume that patients want help, which they interpret as objective medical advice. But based on the two scenarios I began with, this clearly wasn’t what these patients wanted.

3 questions to avoid

1. What brings you in today? Didn’t the patient share this information with your team when they made the appointment, record it in their paperwork, and repeat it to your assistant? You’re asking something you should already know.

2. How are you today? If it’s an emergency appointment, then you already know the patient is not happy. Simply express empathy. If it’s not an emergency, then most patients recognize that the response the dentist expects is a polite, “Fine.”

3. What do you do for work? First, does asking about work truly forge a connection or does it just remind patients of something else they’re stressed about? Plus, you should already know the answer because, hello! it’s in their paperwork.

Ask purposeful questions

Purposeful questions provide insight into a patient’s health and personal goals, their attitudes about dental care, and their mindset about money. Here’s how these questions could be upgraded to invite deeper answers.

• Instead of “What brings you here?” say, “I notice you’re here today for XXX. Tell me more about (what led you to schedule … what you’re hoping to get from us … what you’re experiencing ...)”.
• Instead of “How are you today?” say, “How do you feel about seeing a new dentist?”
• Instead of “What do you do for work?” say, “I see you work at XXX. What’s your favorite part about what you do?”

The bewildered prostate specialist changed his approach, and instead of focusing on patients’ medical records, he asked:

• What does this cancer diagnosis mean for you?
• How do you feel about this diagnosis? 

This simple change resulted in a 30% drop for surgery. Why? Because by listening to his patients’ stories, he could identify what they really needed from him at that moment: a hug, help, or to feel heard. Once he responded to that need, patients were able to trust his advice.

How to apply this to your dental practice

Let’s examine the new-patient model at many dental practices. Dentists, concerned about staying on time, limit their nonclinical questions to focus on what they see as the real goal of the visit—delivering a diagnosis. Even the terminology “treatment presentations” suggests patients will be passive listeners to the dentist’s monologue.

The result is low case acceptance, which dentists often attribute to money obstacles, (thus, conveniently throwing the front desk team under the proverbial bus!). But the truth is that most patients do have the resources to pay for treatment, they just don’t want to because they don’t see the value of treatment compared to the cost. And dentists struggle to highlight the benefits that would be meaningful for patients because they haven’t asked any meaningful questions.

Try this experiment

Identify a new patient who didn’t schedule treatment and answer these questions:

• What led this patient to make an appointment with you in the first place?
• What did they specifically want from you?
• How motivated are they to protect or improve their oral health? If you had to give their motivation level a number, what would it be?
• What are this patient’s goals or concerns about their overall health? How does this align or conflict with their dental motivation? 
• What are the patient’s past experiences in dentistry? How did this impact their decision to see you?
• What fears or behaviors could interfere with treatment acceptance?
• What role does insurance play in this patient’s decision?
• What life events could impact their dental decisions? 

If you can’t answer these questions, then this is a “Houston, we have a problem” moment. It suggests you didn’t ask purposeful questions that would identify your patient’s motivators and concerns. These are the drivers by which patients make their dental decisions. When you don’t know these drivers, it’s like diagnosing without x-rays. All you can do is guess.

Begin every new-patient appointment by asking purposeful questions instead of clinically focused ones. Your goal is to fully understand your patients’ motivators and concerns and determine whether they need a hug, help, or to feel heard.

Then, watch your patient relationships and case acceptance soar.

Editor's note: This article appeared in the September 2025 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.

Reference

1. Duhigg C. Supercommunicators: How to Unlock the Secret Language of Connection. Random House; 2024.