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Case Acceptance Part 4

For most of us, it is normal to hear what we want to hear, and do what we have always done.  This is especially true in case acceptance.  If this is the first installment you have seen, you need to go back and re-read the previous 3 segments.  Even if you have read each segment monthly, I would recommend that you start with the first and re-read all of the articles and finish with this one.  Remove one step, change one script, or add your own slant on this system and you will not get the results we continue to get.  Remember:  Your systems are precisely designed to give you the results you are getting.  If you want different results (90% case acceptance or greater), you have to make changes.  Remember: There is no standing still in business.  You are either growing (which means you are making changes) or you are dying!

It never fails.  You have done everything exactly as I have described.  You use the scripts, a balanced confrontational approach, you’ve reflected the type of personality style the patient has presented, and the patient still seems hesitant to commit to treatment.  There are still areas that I see doctors trip on.  Since the beginning of dental offices there have been two large segments that each of us finds ourselves in — “donor practices” and “recipient practices”.  The donor practices are the ones that seem to continually run off patients.  They can be assertive and nonassertive, pushy or confusing, with good locations and adequate staff.  It just seems that they can’t get better at giving the patients what they don’t want.  True, they do have 100% case acceptance.  It’s just that someone else ends up doing the work.  They are the consulting clients that keep telling us they do every thing right.  It is just the patients, the location, the economy, or dental IQ.  They never take responsibility for their systems and results.  The recipient practice is just down the street.  They are not always the best technically, not the newest office, or largest staff.  They just seem to quietly grow into one of those dream practices by giving patients what they want.  They actually listen to their patients, fit treatment recommendations into the patient’s budget, and are available during patient hours.  Their patients would say that the doctor and staff are caring, compassionate, and convenient.  Today’s patients vote with their feet.  If you continue to have low numbers of new patients, and poor case acceptance, look around.  You’re the donor practice.

Let’s take a look at few of the things I see offices do wrong.  We have touched on a few of these, but this should nail it down (be sure and share these articles with your staff.  They can help you fine tune case acceptance).

  • Too formal of a presentation.  We’ve said it before and we’ll say it again: The office with the highest case acceptance is the one with no “formal” case presentation.  We sell “good feelings” and “solutions to problems”.  It will be an “emotional” decision, not a “logical” one.  Your patients want something that looks good, feels good and lasts a long time.  Give them this and they will never leave.  I keep seeing practices confusing what “core” is in a dental practice.  Figure it out and stick with it.  Every thing else is just fluff.  Let your clients define core and give it to them.  It’s always been cost, convenience, control, comfort and compassion.
  • Too many appointments to get it done.  The patients want a “low stress” way to meet you and find out what’s wrong.  Make it easy for them to say yes.  What does the patient want?
  • Too much presented.  We tend to overwhelm the patient if you do not present dentistry in a certain way.  Waiting until the doctor comes in before the patient finds out it was worse than they thought will kill case acceptance every time.  Go back and re-read each step.  It is the staff’s responsibility to help the patient own the problem, realize it is worse than they thought, and find out what they want in order to let the patient decide how quickly they proceed.
  • Doesn’t use staff to close and explain treatment and determinepatient’s budget.  Your staff must qualify, educate, and create trust.  The staff is the most important element in case acceptance.  They supply the caring, convenient, sensitive element in the relationship.
  • Too many technical terms.  Stop justifying your fees by talking doctor talk.  You and your staff need to communicate, not pontificate.
  • You don’t use a balanced approach.  Staff, if your patients come to the front confused your doctor is too non-assertive.  If your patients come to the front wanting a second opinion or just crying, your doctor is too assertive. You can’t confuse your patients.  Give them what they want and tell them what they need.  You assertive doctors need to remember this: the moment you want the treatment more than the patient wants the treatment, you have crossed the line.  Don’t look needy or desperate.  “Selling” in the traditional sense, makes you look both needy and desperate.
  • Not being on time.  It’s like putting a billboard outside saying you don’t care.  There is a double standard here.  You expect your patients to be on time but you never are.  It shows a lack of respect and caring.  Being on time creates trust.
  • How you bundle treatment and dollar amount.  You could be charging the least amount in town and still be considered the most expensive doctor.  How you present treatment says far more than the actual cost.  Give them what they want and tell them what they need.  Preempt any diagnosis with the permission statement.  It lets the patient feel in control.  It lets them feel like they can decide when and how fast you go.  Any other way makes it seem it’s your way or the highway.  People vote with their feet.  If you keep seeing the backs of people’s heads, you are doing it wrong.


We all have bad days.  There is always an exception to the rule.  Sometimes things just don’t work out the way we planned.  Let me give you a few bonus ideas that seem to create phantom pressure to help patients say yes.

  • Second opinions.  If you feel or your staff feels you are about to overwhelm a new patient, consider offering a second opinion.  There have been times when, despite my best efforts and those of the staff, we felt the patient just didn’t trust us or were not buying into what we were telling them.  They just didn’t own the problem.  In such a case, I have said:  “Mrs. Jones, you don’t know me from Adam.  I want you to be sure you are making the right decision on what to do and how quickly you proceed.”  I turn to the staff person helping me and ask her to make a copy of the FMX and give it to the patient so that they might get a second opinion.  This is often enough to insure they don’t go anywhere else.  It says we care and have nothing to hide.
  • Reciprocity.  Robert Cialdini in his book on persuasion says that giving someone something prior to asking the person for an action increases the positive response 300%.  We all give our patients toothbrushes, fluoride, bleaching gel, etc.  A great way to help your patients open up to your suggestions is to give them a gift coming into the appointment.  Not at the end.  Take a look at .  They have a “smilepac” that many of our clients have used for high end patients to trigger reciprocity.
  • Authority:  We started wearing scrubs 15 years ago in response to the publicity about sterilization in dental offices.  Prior to this we all wore ties, dress shirt and lab coat.  It is time to go back and recapture the authority afforded us by the way we dress.  Robert Cialdini demonstrates that this will increase our ability to sell dentistry.  He also said we should let our patients call us “doctor”.  I’m real bad about insisting that my patients call me Mike.  It is a mistake.  It lowers our ability to make recommendations that the patient accepts.
  • Same day service.  With the holes I see in many of your schedules just offering same day service will make a huge difference.  Just ask:  “Mrs. Jones, would you like to get this done today?” (NOTE: For the financial impact of this strategy in your practice, see the chart at the end of this article.  Be sure to watch next month’s newsletter for a complete explanation of this strategy.)
  • Pre-op phone calls.  These are like magic.  The doctor must make the call.  He calls the day before and just introduces himself and asks if there is any question he can answer or any thing he can do to make their visit more pleasant.  As many of you know I had three partners in my practice.  I stumbled onto this system in order to get more new patients to ask for the old guy.  It worked every time.  It was almost as if the patient had already met me.  They always requested that I do the check and it always seemed to help them say yes to proposed treatment.  You will also find that every patient will comment that they have never had a doctor do this before.  (Of course you still need to make a post-op call too).
  • Urgency and the hand-off.  Following any check or consultation you must tie urgency to the treatment.  I have just confirmed to a hygiene patient that they need a crown on an upper molar.  (You’ll notice I said confirmed, not diagnosed.  The hygienist or dental assistant has already discussed the crown, taken an intra-oral photo and x-ray, talked to the patient about crowns, and given them literature about the procedure.  They were also given the time to ask questions and have a one-on-one discussion with this staff person about when, where, how and why.  In this way when I enter to talk to the patient, every thing is done).  I then turn to Vickie and say “Vickie you make sure you get Mrs. Jones in ASAP.  You tell Kathy (the front desk scheduler) to get her in today or tomorrow even if she has to move some one”.  I turn to Mrs. Jones and say goodbye.  Vickie takes Mrs. Jones to the front desk and hands her off to Kathy by saying:  “Mrs. Jones needs a crown on tooth number three.  Dr. Abernathy said:  What ever you do get her in here today or tomorrow even if you have to move someone”.  Each person ties urgency and hands off the patient to the next person.  All of this is done by talking over the patient so she now has 3-4 staff that she will have to disappoint by not going thru with treatment and coming in ASAP.
  • Shade every tooth.  Every tooth should be shaded at the first appointment.  Just take the guide and hold it up to the patient’s mouth with out any comment.  The patient will ask what you are doing and it opens the door to a cosmetic discussion.
  • Camera and imaging.  Every patient should have the opportunity to have an intra-oral camera image made.  We have cameras in every operatory.  The only thing that has changed in the last few years is that we have used Macro lenses on digital cameras to take before and after images.  These extra-oral photos really seem to work better than a tooth-by-tooth intra-oral imaging.  The intra-oral photos have been more or less relegated to insurance documentation.
  •  This company shows that buying will increase with the correct scent in your offices.  Eugenol and oil of clove should never be in your offices.  At worst our offices should have no smell.  The use of electric hand pieces also remove a barrier by removing the “drill” sound from your offices.
  • Staff recommendations.  It is your staff’s job to build up your image in the minds of the patients.  Every thing they say and do reflect on the image and branding of your office.  Get your staff to use every opportunity to make you a super star in front of your patients.


Don’t forget to share this with every staff member.  Then have a staff meeting on what you could improve.  Continue to monitor your progress. Let us know how well you are doing.


Procedure Fees # Days ADDED $$
Adult Prophy $55 200 +$11,000
Extraction $99 200 +$19,800
Composite $139 200 +$27,800
Sealants (4) $140 200 +$28,000
SRP (Quad) $185 200 +$37,000
Bleaching $199 200 +$39,800
Crown $695 200 +$139,000
Average $1512 200 +$302,400


Procedure Fees # Days ADDED $$
Adult Prophy $55 200 -$11,000
Extraction $99 200 -$19,800
Composite $139 200 -$27,800
Sealants (4) $140 200 -$28,000
SRP (Quad) $185 200 -$37,000
Bleaching $199 200 -$39,800
Crown $695 200 -$139,000
Average $1512 200 -$302,400