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My Way or the Highway

No one would want to project a “my way or the highway” attitude with any consumer driven business, but in Dentistry more offices than not are doing just that.  Let’s take just one aspect of our daily routine and dissect where we might be dropping the ball.

Consider the new patient who calls in and wants to have their teeth cleaned.  In fact every new patient is going to ask your front desk one of two requests:  “I want to get my teeth cleaned”, or, “I have a tooth problem and want to see the doctor to get it looked after”.

Pretty simple so far.  Before we go any further let’s both agree that dentistry is one of those consumer driven businesses where nothing happens unless the client says yes.  Secondly, we need to agree that this first encounter will stage our entire relationship with this patient.  Handle it correctly and you have a patient for life.  Screw it up, and only the patient gets to vote on this one, and you have lost another potential client with potential referrals for the rest of their life.  NOTE: Screwing it up is defined by not giving the patient more of what they want and less of what they don’t want.

One of the most important points of getting the patient to say yes is to never say no to them.   Now I’m not one of those who believes the customer is always right, nor am I one of those who goes out of my way to create hurdles and barriers to giving the patient what they want.  So here we are.  The patient wants to get their teeth cleaned.  What do you say?

Hopefully it comes out as yes in the form of:  We can do that for you.  The problem is that many times we run into offices that don’t clean teeth on the first appointment.  That’s one of those “Duh” moments.  Here is a potential patient with a wad of money they want to give you twice a year plus return periodically for treatment for the rest of their life and you basically just told them that “no, it is our office policy that we never clean teeth on the first appointment“.  This is a great start.  Knowing that this puts the patient off by not giving them what they asked for, you can count on your referrals dropping to zero and cancellations and no-shows jumping into the stratosphere and new patients languishing at around 25 per month.  We call it the “threshold test”.  What does it take to get into your office?  If you don’t take my insurance, are not open consumer hours, and don’t clean teeth on the first appointment, I’m going to someone else.  Keep in mind, we want to construct systems to make sure that patients show up on time, pay for treatment, and refer everyone they know.

So why would someone not want to clean the patients teeth on the first appointment?

  • We don’t know if they need a cleaning or soft tissue scaling and root planning.
  • We want to spend quality time with the patient so that they will bond to the practice.
  • We don’t know how long to schedule.
  • Our hygienist doesn’t want to be surprised and have to confront the patient with needed treatment without letting the doctor diagnose them.

You get the idea, excuse, excuse, excuse, and the patient moves on down the street.

Let’s break down the excuses into the real why.

  1. We don’t know if they need a cleaning or soft tissue scaling and root planning.  Give me a break.  If you ask them over the phone how long it has been since they have had a cleaning, you have now forced them to lie and feel bad, or tell you the truth and feel bad.  Think about it.   They know the right answer: It’s 6 months ago.  If it has been longer they will lie to you or feel bad when they tell you the truth.  Both situations are negative as far as inspiring a potential client.
  2. We want to spend quality time with the patient so that they will bond to the practice.  Give me a break #2.  Too many struggling doctors define “quality” as the amount of time spent with the patient.  It is this very doctor that struggles to get new patients and referrals and wonders why everyone around him is doing better than he does.  Once again, only the patient gets to define “quality”.  The patient’s definition of quality is: Being seen on time, painless, fits my budget, caring and compassionate.  This no referral practice has no idea what quality is.  If they did and they gave it to the patient, they would have patients standing in line to see them.
  3. We don’t know how long to schedule.  Every new patient should get about 90 minutes including the cleaning, FMX, blood pressure check, oral cancer screening, probing, and exam.  It then falls upon the hygienist and doctor to make the decision to as to what or what not to do, but my money is on giving the patient what they asked for.
  4. Our hygienist doesn’t want to be surprised and have to confront the patient with needed treatment.  This is a good one.  The only person in the entire office who has had two years of advanced training on the treatment and maintenance of soft tissue doesn’t want to, or doesn’t have the talent or skills to discuss the needs of the patient with the patient.  Let them go (free up their future) and get someone with half a brain and a modicum of people skills.  Anybody can learn to clean teeth.  Few hygienists have the people skills to inspire our patients, but they are out there and you need to spend the time and money to find them.

 Let’s go one step further before we finish.  This ought to get all the hygiene consultants in a tizzy.  What do you do if someone comes in and really needs to do soft tissue treatment, but was told that they could come in for a new patient cleaning and exam?  Do you clean their teeth with the time available and discuss soft tissue problems and schedule them for another recall in 3-4 months or do you create the “my way or the highway” situation by becoming the hygiene proctor for your dental school.  (Keep in mind that we wrote and published a paper called “The Hygiene Factor” that includes all of the scripts and systems we use to keep our hygienists busy and inspiring.  Just give Max or me a call (or an email) and we can help you get a copy.  The cost is minimal and the information is gleaned from multi-million dollar a year practices.)

Let’s first look at the type of patient that would call and ask for a cleaning for their teeth that had been neglected so long as to need scaling and root planning.

  1. They are probably over 30 and have poor oral hygiene and eating habits.  Young people don’t normally have the parameters for soft tissue collapse and the attending need for treatment.
  2. They probably will find the cost of perfect care beyond their means.
  3. Their dental IQ is light years below yours.
  4. Keep in mind that you have zero rapport with them.  Where is the trust?  How do you inspire someone who doesn’t know you and obviously avoids dentists at all cost?
  5. They have put off the treatment for some time, so we know they don’t go to a dentist routinely.  Was it fear of pain, fear of ridicule, money, time, family beliefs?  Whatever it is, we should feel a great deal of responsibility and sensitivity to the fact that at this specific time in their life they have entrusted us with their care.  Adopting a holier-than-thou attitude just reinforces their beliefs and history with dentistry in the past.  (Keep in mind that I am not talking about a highly educated, money is no problem, I go to the dentist every 6 months but refuse to brush and floss while I smoke my life away patient.  With them you can come down hard.  They know what they should do and can afford to do it.)
  6. They already know they need help and are probably embarrassed at the condition of their mouths.  They want help, not a lecture.  Grace is the key word: Unmerited favor.

For me, I believe that every patient is important and different.  I will stand firm or be more flexible based on many of the six factors I just listed.  My goal and aim would be to make this patient a “patient for life” in my practice.  I will record the findings and treat the patient to the extent of their understanding and budget while being sensitive to their needs and ability to follow through.  I would rather do a gross debridement and have them return in a few months to be further educated and get them to a state of health than turn them away or off on what dentistry can do for them.

Everything in every contact with our patient matters.  We have to stop demonstrating a “my way or the highway” attitude and begin serving our patients where they are at the time they present.  Almost sounds a little biblical if you think about it.

Don’t forget.  Give Max or me a call (or an email) about the new report on “The Hygiene Factor” and start making you hygiene department a super income center for your practice.


Michael Abernathy, DDS
[email protected]

Max Gotcher
[email protected]