Debra Engelhardt-Nash
A few years ago, a dentist asked me to help him acquire more new patients. The doctor said his office was attracting about 35 new patients per month, but he felt he needed more. "I get 100% treatment acceptance," the doctor said.
"Wow," I responded. "What is the dollar value of your average treatment plan?"
"$400 per patient," the dentist replied.
Is more patients what this dentist really needs? What if the value of the new and existing patients in the practice could be increased, generating more productivity? Is it possible that, by changing attitude and approach, a higher case acceptance rate could be achieved and the need for more volume eased? And is the dentist calculating the acceptance of a modified treatment plan or the total comprehensive plan presented to the patient?
In this article, the importance of presenting treatment with the right attitude and chairside manner will be reviewed, as well as the impact this will make on increasing patients' acceptance of the treatment you want to provide for comprehensive care.
The belief cycle is a psychological concept that explains how beliefs influence actions, which in turn reinforce or modify those beliefs. This cycle consists of four key stages: beliefs, actions, results, and reinforcement. Understanding this cycle is crucial for dental professionals when presenting treatment options, as it helps alleviate preconceptions about treatment acceptance. Let's consider each of the stages:
• Beliefs: These are pre-existing notions or perceptions that a person holds about a particular subject. Many times, while visiting dental practices across the country, I hear doctors and dental teams pre-determining patients' interest or financial viability for dental treatment before it's presented. They base their beliefs on patients' previous remarks or attitudes when recommended treatment has been presented, or they defer to insurance limitations and restrictions.
• Actions: These are the behaviors that stem from beliefs. For dental teams, these actions can include altering the treatment plan based on the belief the patient will not choose the most comprehensive care or will choose based on insurance annual allowance restrictions, or the doctor might opt to not introduce their preferred treatment plan at all.
• Results: These are the outcomes that result from the actions taken. In dental care, the results can be the patient not being made aware of the doctor's preferred treatment option. It can also mean the plan is presented in such a way that dissuades the patient from choosing the recommended care. The tone of our treatment discussion is less than positive and encouraging-if the treatment is presented at all. Remarks such as, "This is what we would like to do, but it won't be covered by insurance" can imply that the care is less significant than the patient's insurance coverage.
• Reinforcement: This stage loops back and reinforces the initial beliefs. Because the team believed the patient wasn't interested or couldn't afford the recommended treatment, it was presented with skepticism or not presented at all. This perpetuates the belief that patients don't want the care and can't afford it.
This belief cycle is often played out with patients of record during hygiene visits. The patient has been in the practice for years and has established a habit of not choosing previously recommend treatment. The hygienist has a belief that the patient isn't interested in moving forward with treatment and stops talking about it or doesn't call attention to the incomplete care. It is often presented in a "by the way" fashion-the importance is downplayed. The patient does not schedule an appointment for the care, and the belief is perpetuated.
Changing our belief changes our attitude and our approach. During the hygiene appointment this is a viable approach: "The doctor and I reviewed your dental history this morning, and we noted there is treatment that has been recommended but hasn't been completed. Tell me, what has prevented you from moving forward with your care?" This is a time intentional question. Sit facing the patient undistracted by the computer or operatory setup tasks. Be prepared to discuss the patient's objections or concerns. If it's cost, you may want to remind them that it would have cost less had it been taken care of when originally diagnosed and the cost will never be less than now. If it's fear of discomfort, they may be reminded that treatment is to prevent that, and, if it's time, that scheduling this planned treatment will help them manage their dental visits and the appointment time needed to meet their needs.
We are good people who are trying to help others. We are not trying to sell or convince our patients to do something that is harmful or hurtful. Although we want and need to run a profitable business, our purpose it to make good things happen for other people. Do that, and it works. If we never tell the patient what we have to offer, then we never give them an opportunity to choose our care.
Changing our belief and our attitudes about presenting treatment also changes our approach to what may appear as obstacles. Let's take insurance as an example. Instead of focusing on insurance restrictions, limitations, and exclusions, we shift the focus in the way we introduce insurance involvement in the treatment plan. "We will do our best to help you receive the dental allowance your employer has provided you. We feel professionally obligated (or it's in the interest of your dental health or expectations) to not let your insurance limitations restrict the quality of care we can provide."
Use the point of view that insurance can be considered a supplement that can be utilized to offset the cost of care and that we will help patients utilize that supplement.
Recently I heard a speaker tell their audience, "Push people and they will not go." This may be a shortcoming in some dental offices. Pushing people into treatment by telling them what they need may not be the winning approach to help patients appreciate and accept a doctor's preferred treatment plan. Instead of turning away from the patient and pointing to the computer screen, tablet, or written treatment plan, face the patient. Avoid telling the patient what you can do, what you want to do for them, or what they need. Instead, lean into the patient and lead the conversation with this question: "Would you allow me to tell you what I would like to do for you if you gave me carte blanche or if you were my brother/sister/aunt?"
My experience with this question is that the patient never says, "No, don't tell me." This is a non-threatening approach to introduce your comprehensive treatment to patients. The offices with whom I work have appreciated an increase in patients' interest and acceptance in their ultimate care.
Avoid the assumed obstacles that prevent us from doing all we can to help our patients achieve better health and improved dental appearance. Resist using comments like "Our patients are different" or "We have never done it that way." Educate team members on how to carry out service brilliance in systems and communications. Most time spent with patients is communicating with them-describing the quality of care they can expect to receive and explaining the systems that will help deliver that quality. Spend time training team members to be exceptional in their communication skills.
Incorporating the right belief, attitude, and chairside approach will make a difference in treatment acceptance. It will be a solution to increase patient satisfaction, team satisfaction, and practice productivity.
Debra Engelhardt-Nash is an award-winning trainer, author, presenter, and consultant who has been in dentistry for over 30 years. She is a founding member and served three terms as President of the National Academy of Dental Management Consultants. She is the immediate past president of the Academy for Private Practice Dentistry. She has also served on the ADA Practice Management Advisory Board.
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