Break the rules ... and win!

March 1, 2002

by Paul Homoly, DDS

"Knock, knock."
"Who's there?"
"Ammonia who?"
"Ammonia gonna break one rule."

Sometimes you need to break the rules to win. One of the big rules in dentistry is the way we've been taught to process the rehabilitative-care patient. The traditional rule follows this sequence:

  1. Complete examination
  2. Consultation
  3. Treatment
  4. Referral

Let's label this sequence by using the prefix numerals — 1, 2, 3, and 4. The 1, 2 ,3, 4 is the textbook approach, and it is logical, but as with many processes involving human behavior, logic isn't always the best "rule." Often, the process through which the comprehensive-care patient enters our practice and receives care is determined more by patient preferences and lifestyle issues than by our "rules" of how we'd prefer patients to behave.

Most of us learned that our role is to modify patients' behavior and mold them into the text- book model of 1, 2, 3, 4. What most of us discover is that the energy, stress, and time needed to mold patient behavior creates conflicts and contests among dentists, patients, and team members. When it's obvious that you are dealing with a patient who is a candidate for rehabilitative dentistry, I suggest that you break the "rules." Process the patient into your practice in a manner that makes the patient happy and lowers everyone's stress.

New rules

A way to process patients that makes them happy and reduces much of the stress is to change your belief that patient care must proceed following the 1, 2, 3, 4 rule. Here's a way of looking at this issue. Take the sequence 1, 2 ,3, 4. Now, scramble the numbers in any order and you'll end up with 24 different combinations — i.e., 1 ,3 ,2, 4; 1, 4, 2 , 3; 1, 2, 4, 3; 2, 1, 3, 4; 2, 3, 1, 4, etc.

Select any combination and you've picked a sequence that a comprehensive-care patient might prefer to be treated at some time in your practice. In other words, the patient makes the "rules."

For example, here's a scenario for 3, 4, 1, 2. Mrs. Bamber comes in for an emergency appointment. You treat her chief complaint (3). She loves you and your team, and the next day she refers her best friend (4). Two months later, Mrs. Bamber returns for a complete examination (1) and one week later, she has her consultation for full treatment (2). She's happy and so are you!

Here's another example, this time of 4, 3, 2, 1. Mr. Adams works with your spouse, knows that you're a dentist, and refers his brother to you (4). His brother reports back to Mr. Adams that he had a wonderful experience. A month later, Mr. Adams has an emergency and you take great care of him (3). While he is still in the chair, he asks you about complete care. You have some time so you give him a good overview of what is possible for him (2). He likes what he hears and returns a week later for a complete examination and starts complete care (1). Hurrah!

The idea of 24 combinations of patient processing works best with complete-care, rehabilitative patients. If you get too far away from the 1, 2, 3, 4 model with routine- care patients, your practice will get chaotic.

When you think about it, haven't you had some great complete-care patients enter into treatment following anything but the traditional 1, 2, 3, 4 model? Why not loosen your collar, relax the traditional "rule," and let the complete-care patient go at her own pace. Sooner or later, after she trusts and likes you, she'll be glad to go along with your recommendations.

Dr. Paul Homoly coaches dental teams to implement reconstructive dentistry through his continuing-education workshops, private consulting, and seminars. This column is an excerpt from his new book, Isn't It Wonderful When Patients Say Yes? — Case Acceptance for Complete Dentistry. Dr. Homoly can be reached at (704) 342-4900 or via email at [email protected]. Visit his Web site at

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