Building up your case acceptance levels

The KISS (Keep It Simple, Stupid) concept applies to dentistry as much as to any other business.

In a busy general practice, from answering the telephone to scheduling appointments, from accepting payment through welcoming and seating patients in the chair up to the complex procedures we undertake, everything we do should follow this principle.

Some years ago the manufacturers started to provide ‘idiot’ cards with the new bonding agents; were they trying to tell us something or were they following this principle?

Last month I wrote about case acceptance and how we need to increase our success in this area if we are to survive in today’s challenging economy. Applying the KISS principle and setting up a system that all team members buy into and communicate to patients will, I believe, help with this difficult area.

Let’s start with the supposition that we can take for granted that we all possess the knowledge and back-up to diagnose all the oral heath-related ills the patient presents with. Beyond that we should look to improve areas that would benefit from refreshing. The next step is to make the patient aware of all the cosmetic benefits on offer today.

In essence, we are breaking down case acceptance into mandatory, elective and cosmetic elements. Presenting in this manner will facilitate the patient’s comprehension and encourage acceptance.

I remember as a new graduate being upset when a patient wouldn’t accept my proposed treatment. I was, after all, the ‘doctor’ and had spent five long years acquiring the knowledge. Now, a mere 24 years later, wisdom has been gained and I can accept that the patient owns their teeth and it’s my job to guide using the knowledge gained over my 29 years in the profession.

With this knowledge came the realisation that it is necessary that we simplify our case presentations and have everyone singing from the same hymn sheet.

Mandatory items include broken and infected teeth, decayed or periodontally involved teeth, orthodontically deviated mandibles, crossbites and all Class 3 cases. The patient should be told these situations are urgent and in need of immediate attention.

Elective items include that dreaded word – ‘watches’ – old amalgams, defective margins, grey areas, missing teeth, sealants, night guards for bruxism, and inlays to replace large fillings. The verbal skills needed here are to inform the patient that we can prevent a future problem by dealing with it now and possibly saving pain, time and money in the future.

Cosmetic items include tooth whitening, veneers, replacing stained composites, orthodontics and replacement dentures or implants. The seeds for these elective treatments should be sown by the dental hygienist, before the patient even sees the dentist. These are your typical ‘want’ or emotional purchases, and involve asking whether the patient would like to know how we can improve their smile. This can easily be led up to by incorporating the following two questions into your health questionnaire:
1. Do you like the colour of your teeth?
2. Do you like the appearance of your teeth?

Assuming the patient doesn’t answer ‘yes’, it gives you the lead to ask: ‘Would you like me to show you how we can improve the appearance of your smile?’

Improving case acceptance requires an understanding of why patients often initially refuse treatment. Studies show this is down to four main objections:
1. They don’t believe they need the treatment
2. We’ve done a poor job of discovering what they want
3. Nobody explained the consequence of non-treatment
4. We’ve not discovered or overcome their objections.

This three-step approach of mandatory, elective and cosmetic also encourages flexibility, and advising the patient that it doesn’t need to be done all at once but can be in stages or stating that we can proceed as fast or as slowly as they like will build the trust that encourages acceptance.

If you follow up at routine check-ups by congratulating them on choosing higher quality treatment choices, it reinforces in the patient’s mind the need to upgrade their dentistry. Both the patient and practice benefit.

Dr Dick Barnes, a famous US speaker, said: ‘The most rewarding solution to increasing production is to present to the patient higher quality dentistry than he or she would have selected on their own.’

I believe the system I have outlined here will achieve this in all of our cases.

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