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Very few things are as important as your patients saying yes to your treatment suggestions. Most of us are looking for some magic script or top-secret system to push their acceptance into the stratosphere, when in fact we fail to realize that case acceptance begins before our patients enter our office and continues through every contact, until the moment we make our treatment recommendations. It is these precursors that set the tone and move an average practice with a 60% or lower rate to over 90% case acceptance. Case acceptance can be staged to almost guarantee having most people say yes and pay you. Every year we could see hundreds of thousands of dollars dropped into our pockets by increasing case acceptance as little as 5%.

In the past, I have written in great detail on the topics of “100% Case Acceptance” and “The Hygiene Factor” to help give you every verbal skill and protocol you could possibly need to double your practice. I want to take a different approach here by listing the reasons, from a patient’s perspective, that cause us to fail to perform at these high levels of acceptance so that you may begin the process of correcting each and every one of these short-comings. Being engaged and proactive in the successful staging of how you attract, process, and ultimately help patients want what they need is a systematic, ongoing strategy that ultimately changes all of your results for the better.

1. You have poor or no revues on the Internet. I am not talking about just Google. I am talking about someone typing your name in and asking for reviews for your practice. They will always include Yelp, Vitals, Healthgrades, Dr-oogle, and others. You need reviews on every revue site that is used in your area and they need to be no lower than a 4+. Anything else will cause cancellations and no-shows, or maybe not even the initial call. People always check your reviews before making an appointment. They may look at your website for a minute or two, but they will always take the time to look at and read your reviews. The more the better.
2. You didn’t pass the “sniff test”. It just didn’t feel right. Every patient enters your office the first time with a phantom list of things they are looking for in a new dental home. We don’t know what they are, but the patient will rate you by this list. They will compare you to every other dentist they have ever visited. If you come up short, the patient will not stay. You get one shot at this, so get engaged and be intentional about every process in the office.
3. The “threshold test” was too daunting. I define the threshold test as the barriers you place in front of a patient that makes it difficult for them to make it through the doors. Examples might be: Not being in-network for their insurance, not having consumer friendly hours, not welcoming the whole family (including the kids), or not offering all of the services they were looking for.
4. Incompetent or disagreeable staff or doctor who don’t have the people skills to handle various ages, personality types, or demands from an average patient pool. Like you, your staff needs to have incredible people skills and be self- motivated. These traits cannot be trained and without them you and/or the staff will fail miserably at representing your office in the correct light of consumerism.
5. Failure to help your patients actually figure out a way to fit this treatment into their budget. Multiple sources of outside financing are essential. Care Credit should not be the patient’s only choice. NOTE: Being out-of-network for patient’s with insurance is a sure-fire way to lower your case acceptance.
6. Overwhelming patients with too much treatment. Yes, you have to tell them what they need, but most of us fail to listen to the patient’s wants first, find out their dental IQ, and actual budget. Without these three areas being known, you can easily come off as wanting the Dentistry more than the patient does which creates the case acceptance death spiral. During the financial arrangement discussion with the patient, you should limit the estimate to the actual work the patient wants to do which should be their next appointment. Inspire and wow them with what they want, and the patients will move what they need into the “wants” column. Giving them the old computer generated walk out statement with the entire treatment outlined and summarized with the total fee is the fast track to case acceptance failure. You will always seem “too expensive”.
7. People don’t like you. Not specifically you, the doctor, but something about the overall office fails to inspire them. The best reflection of this is the percentage of your new patients coming from direct referrals. 50% is ideal minimum and much higher is always better. Failure here indicates serious internal problems.
8. Never clean teeth on the first appointment. Surely no one is still doing this, but patients who don’t need SRPs should be cleaned the first appointment. After all, the only two things new patients call in to make an appointment for will be them wanting to get a cleaning and checkup, or they’ve broken something and need to see the dentist. Keep in mind that this appointment for a cleaning and checkup needs to occur within 4-10 calendar days (not just work days) during peak demand times (7AM-9AM and 3PM-6PM Mon thru Fri plus Saturday).
9. The doctor always sees the patient first to do the diagnosis. Yep, here’s a he problem and you should never do this. Think how silly this is when we consider human nature. The doctor comes in and tells the patient (with whom he or she has no rapport and has earned no trust) that they need a bunch of Dentistry. The patient will always feel bad and overwhelmed. They will also have a sneaking suspicion that the doctor is actually “selling them” treatment and they, the doctor, wants the Dentistry more than they, the patient does. On the other hand, if you partner with your staff to triage the patient in a conversational manner while building trust and rapport before you come in, you will have a 90%+ case acceptance.
10. Multiple treatment plans. This only confuses the patient and very few people say “yes” to treatment when they are confused. They want to know exactly what you recommend and what you would do if it were your own mouth. Then all that is left to do is to figure out how to fit it into their budget. It is at this time that you can add another treatment option if they cannot afford what you would do for yourself. But not before.

Bonus: Being either too assertive or non-assertive. In case presentation you should strive to be more centered: Neither too aggressive nor too wishy washy in your recommendations. The overly assertive doctor always overwhelms the patient by being too pushy without considering the wants of the patient. You can tell if your doctor is too assertive if a lot of your patients need to speak with their spouse or want a second opinion (some times it shows up as increases in cancellations and no-shows after leaving the office that first time. They just made the appointment to get out of there, never intending to come back). The non-assertive doctors handicap themselves by not presenting comprehensive treatment and/or downgrading crowns to huge fillings. They tend to only tell the patient what they feel the patient will accept. You can tell if you are non-assertive if the patients come to the front desk and are confused about what the doctor wants them to schedule for.

These 11 topics act like a ripple effect to sabotage an otherwise good office. Your goal in life is to have patients show up, pay for their treatment, and refer everyone they know. Poor results in our demanding new Dental economy is like a dead spider circling the drain in your bathtub. They are still afloat but it won’t be for long. Take the time to become aware of each and every one of these challenges and share the responsibility of correcting them with your staff. That is how you Summit.

Michael Abernathy, DDS
[email protected]
972.523.4660 cell

PS. I will be speaking at an event here in the DFW area next month (Saturday, April 27). For more info just visit: