Why Patients Say “Yes”
Next, I would like to cover the goals of case acceptance and why patients say “yes”.
- Tie the patient to the office. Every approach works with someone, but our goal is over 90%. The bond that ties the patient to the office begins far in advance of you actually seeing them. It’s all about systems: That first phone call and how they are handled. Your goal should be for every patient to say that you, your staff, and office is caring, compassionate, convenient, and competent. What you need to remember is that each of these areas means something different to each patient and that your definition really means nothing. It is not good enough to just have a script or a set of guidelines for all your patients. You must hire staff members who are by nature caring, compassionate, and who truly enjoy dealing with people. You can teach anyone to suck spit or schedule. Only in this way can you be sure of giving each patient what they need in order to have them refer everyone they know. There are two types of practices. The Donor Practice — through poor systems and a lack of caring and compassionate staff and Doctor, alienate most of the patients they meet. The other is the Recipient Practice. They are the practice down the street that quietly builds a dental empire by treating patients right (giving them what they want, and telling them what they need in a caring, compassionate way). Both have almost a 100% case acceptance. Doctor Donor (DD) runs them off so that Doctor Recipient (DR) can complete the case DD diagnosed. Patients vote with their feet. If you keep seeing the back of their heads, you are doing something wrong.
- Never lose a patient. At first glance, this may seem the same as number one. Kind of like an office policy manual listing a long line of “rules”. There is office rule number 1, with all the other rules saying, “if in doubt, go back to rule number one”. This really is different. This refers to the personality and systems of the practice that seem to say, “it’s my way or the highway”. I know you would never do anything to give the patient this perception. Remember: Only the patient gets a vote. There are really two types of personalities when we talk about doctors. We have the “Assertive” (which we will abbreviate as ASS). This is the dentist turned time-share salesperson. They have the tendency to overwhelm the patient and are perceived as pushy and overbearing. You can tell if this is the case because a lot of your patients want a second opinion, or your CA/NS ratio is higher than 8%. These patients always want to think about it following an encounter with the ASS doctor. He becomes the dental stalker. Constantly following the staff around wanting to know why this or that patient has not scheduled for treatment. The other side, and equally bad, is the non-assertive doctor. They are so non-confrontational that they have difficulty even telling patients that they have anything wrong. They so want to be liked that they shy away from confronting patients with their needs. You can tell if you’re in this camp because patients will feel confused and unclear about the doctor’s findings and treatment recommendations. The bottom line is that we need to be confrontationally balanced in how we present our findings. You must learn to read the personality type, the patient’s budget, and mirror that in you presentation. NOTE: Make sure that you give this information in its totality to each staff member. I have often found, no, always found that doctors are legends in their own minds. They fail to see their own limitations and blame poor results on staff, the economy, and “bad” patients. Bottom line, it is always the doctor. They apparently have a great self-image for no apparent reason. If you, the doctor, are the only one that reads this, you will fall far short of your potential. You need everyone to be part of case acceptance. For most of us, our team will compensate for the things we don’t do well.
- Have a no contest approach. This is not an “I win, you lose” encounter with the patient. No “my way or the highway”. You must tell them what they need and happily give them what they want. Perception is everything and only the patient decides if they feel the trust and bond it takes to allow you to proceed. I will give you my scripts for this in our next installment. More than anything else this deals with your state of mind. You have not lost if the patient decides to only do the extraction or filling initially. We are looking at the lifetime value of this patient. Each will proceed at their own pace and budget. You must get used to the reality that the patient is in the driver’s seat. They have the final say. NOTE: 67% of all the dentistry you will do will come out of recall patients in hygiene. It takes time for patients to bond to your practice. If you don’t have an 80% or higher recall, you are destined to experience poor results. Don’t miss the fact that keeping patients is more important (and less expensive) than finding new ones.
- Never be perceived as “Selling”. Imagine the average practice: 20-30 new patients per month, $58K in production a month, 94% collection rate, 1.5 days per week of hygiene and an overhead of over 72% plus. When one of their new patients shows up on the book its “do or die” time — it is basic survival mode to sell and close on needed treatment. They need every patient to say “yes”. When that is the case, we revert to the “justify our fees” scenario with long explanations using technical jargon or we try to “crush sell” the patient using old fashioned sales closing techniques. Remember: If you don’t sell this patient, you do not meet your overhead. As a goal, every general practice should strive for 40-70 new patients per month. Some will be kids (who need very little), some adults (who need little), and some will need more extensive treatment. In the 40 plus years I have been practicing, it seems I must sift more sand (patients) to get the work I need to meet a BHAG (Big Hairy Audacious Goal). We average 250 new patients a month for a three-doctor office. About 47% are kids, which will leave about 60 adults for each doctor. When I do a case presentation I don’t really have to worry if they accept the treatment plan. I have 4 or 5 more new patients that day. The psychology of this is that patients don’t feel forced into making a hasty decision or feel like I am trying to sell them a used car. They know I will do what they want first. I will try to fit it into their budget. We will work with them to get their mouth healthy and do it at the pace they are comfortable with.
- Remember that it is always worse than they thought. If you find anything on examination, it will be worse than they thought. Our systems are designed to constantly revisit the fact that we understand it is worse than they thought. We will help them with a solution to their problems that they can afford in a time sensitive schedule. The ADA says: “Patients cannot afford even one $500 out of pocked expense without reaching into their savings”. If this is true, all of your patients will have trouble coming up with even the cost of a crown. Most of our patients come in for a cleaning having no symptoms — nothing they would consider a problem. No matter what you find, they were not expecting a single problem. A caring staff with the right scripts and preemptive measures can go a long way to pushing up your case acceptance.
One of your first steps would be to use the information presented here in a discussion during a staff meeting. Give everyone the document prior to the meeting so that each team member will have the opportunity to read and understand it. Fill out the monitor so you can share where you are. Finally, begin the process of setting goals (see form below) in each area of the practice. Each goal will deal only with case acceptance. Each staff member needs to understand how he or she interacts with the process. From phone call, to payment, and eventual referrals from a successful case presentation, there must be an intentional effort made by each staff member to position your office for 100% case acceptance.
Next, we are going to discuss the case acceptance system we use in our office. The only reason your patients should not be saying yes and completing treatment is money (we’ve included my payment option sheet – Financial Policies).
Just like many of you, I was taught to do a formal, very thorough New Patient “Experience”, a real 5-star production. Following this you should have the patient and the significant other return to hear an hour long talk on the benefits of comprehensive dentistry. A fee that reflects the “quality” of the “experience” is charged ($250-$500 and still no procedures done). Free exams and complimentary second opinions are unethical. Like many of you, I found out that this system of multiple visits is death to a practice. This is a sure way to give the patient exactly what they do not want. Bottom line: The highest case acceptance occurs with no formal case presentation. About 37 years ago, I was fortunate to stumble upon a video produced by Dr. Gordon Christensen at CRA. The “Auxiliary Oriented Diagnostic Appointment” changed my life. For the first time, I saw a system that took into consideration the wants and needs of the patient. An exam followed by a same day case presentation that was non-confrontational, caring, and compassionate. It took into consideration what the patient wanted and told them what they needed. It let the patient meet you, find out what was wrong, and decide for themselves what they wanted to do. And the best part is that the actual case presentation only took a few minutes of doctor time while the fact finding, and bonding was delegated to the staff. It’s can’t miss, works every time, like shooting fish in a barrel with a bazooka system.
As we move on down the road of our journey, we will next discuss the tried-and-true tricks to huge gains in case acceptance.
Michael Abernathy, DDS
(CLICK BELOW TO ACCESS THE FORM)