Once you have mastered comprehensive diagnosis there can be a tendency to provide too much detailed information on everything the patient needs that usually results in blank stares. Too much information leads to confusion, confusion leads to doubt and doubt leads to not scheduling. People will never value something they don’t understand. Treatment plans that are presented in Latin rarely create value. Patients don’t know anything about MOD, RPD, Endo, etc, so avoid creating confusion with a language your patients cannot understand.
“Mrs. Jones you have a large cavity under your crown on the upper right. Your crown must be replaced a soon as possible or you risk a root canal and or worse losing the tooth all together.”
We know that patients won't buy anything they don't value, so what really is the best way to get your patient to see the value of your treatment plan? And what is the best way to motivate them so they will schedule this treatment? The answer is ”Rapport.” In order for any treatment to be accepted by your patient you must first be in rapport. When you are in rapport you can move through your case presentations efficiently and expect a positive outcome. If you are not in rapport, and attempt to present your treatment plan based solely on the fact it needs to be done, you most likely will be confronted with endless questions and indecisiveness. This leads to uncertainty, and uncertainty leads to not scheduling.
Once you are in rapport, the delivery of your comprehensive diagnosis must be presented with absolute certainty. Your verbal and nonverbal communication must be decisive and to the point. Nobody wants a doctor to give him or her suggestions for their treatment and then ask them to decide on their own. Dentists have all the education and your patients rely on that education to help you make the best treatment decision for them.
The Presentation Triangle
Presenting your comprehensive diagnosis to your patient face-to-face is essential to a positive outcome. You cannot effectively communicate without eye contact, but unfortunately this is how treatment plans are presented in far too many dental offices. The dentist usually sits behind the patient and talks to the hygienist or dental assistant, making
reference to the computer screen or the patient’s chart. There is very little or no interaction with the actual patient sitting in the chair and the dentist wonders why they have trouble getting their patients to schedule their treatment.
The Presentation Triangle is a tool that will ensure your patient is part of the process when you are presenting your compressive diagnosis. The goal is to present clearly, decisively and with absolute certainty. You must first believe in the treatment you are proposing and that it is the best choice for this particular situation. If you present your plan in an indecisive and ho-hum manner, don’t expect your patient to be motivated enough to schedule with you. Patients have a million and one things they would rather do than spend the afternoon in your office, so it’s crucial they understand and associate VALUE of the treatment presented.
The Presentation Triangle arranges the doctor and hygienist in front of the patient during the treatment presentation. This alignment allows the hygienist to Close the Loop with the dentist while including the patient in the conversation. The patient has the opportunity, while sitting upright, to hear what was accomplished during their visit and the concerns that were discovered. The doctor can refer to the intra-oral pictures on the computer screen, in front of the patient, building even more value for the treatment recommendations. When you present your comprehensive diagnosis in this manner your patient will feel like they are part of the decision process and never feel like an outsider. This is their treatment plan that is very personal for them, so making them the center of the presentation is critical.
Four Stages of Effective Case Presentations
Effective Case Presentations have four distinct stages and the first step is to present the “Problem.” This is simply stating what is wrong with a particular tooth. It may be a defective restoration, decay, a fracture, etc. We want to let the patient know why this tooth is compromised and more importantly why it needs to be corrected.
Next, we present the “Solution” to that problem. You can explain what materials and procedures you will use that will produce an amazing result to correct their problem. In most cases you will have the opportunity to present a solution that is superior to what they had before. For example, replacing a silver filling with a bonded composite filling
certainly is a superior restoration from the patients point of view, because they are changing out a black filling for a white one!
After you present the solution to their problem it’s critical for you to inform your patient of the “Consequences” of not completing the recommended pending treatment could always allow the cavity to get larger or more expensive and turn into a root canal or even an extraction. It’s very important the patient knows what can and will likely happened if this treatment is delayed. Most patients won’t have any pain associated with your proposed diagnosis, and since it’s out of sight and out of mind they must understand this situation can and will get worse over time.
The consequences of delaying treatment lead us to the last stage, which is building “Urgency.” Since most people don’t want to be faced with a root canal or a tooth extraction, they will choose to follow your recommendation and schedule their treatment. However without creating some sense of urgency, patients will tend to fall back on "if it doesn't hurt then it couldn't be that bad” reasoning.
Patients need you to give them a timeline to have this recommended treatment completed. When I hear doctors say to patients “get in as soon as you can”, what this tells the patient is they have time and it’s not that serious. Because if it was serious they assume you would have given them more specific timelines of having this completed. Let’s face it, all of our lives are busy and even though your patient may have great intentions of having this treatment completed in the next few weeks, life’s schedules creep in and before you know it a few months have passed. I like to create in my mind what this tooth will look like in six to nine months and create the urgency based on that scenario, because if treatment is delayed, this is exactly what it will look like.
I have seen doctors do an amazing job building rapport, comprehensively diagnose, give an effective case presentation and when the patient agrees to the treatment the dentist just can’t stop talking. They go on and on about the interworking of the bonding procedure and details of the preparation design. The patient then becomes confused and scared and fails to show up to their appointment.
The most important thing to remember when presenting your comprehensive treatment plan is when your patient says yes….. STOP TALKING. This is your sign to change the subject, move on and start talking about something they are interested in that doesn't include their teeth. You have accomplished a successful effective case presentation when your patient says, "Okay, I’ll do it." Use this opportunity to build even further rapport or just make the transfer to the team member who will schedule their appointment. The important thing to remember is to know when you have reached your goal, internally congratulate yourself and move on.
Dentist: Mrs. Tyler, on your upper left first molar you have a crown. Can you tell me when that crown was placed?
Patient: I’m not sure, but I think it was about eight or nine years ago.
Dentist: I see. In order for a crown to be effective it must be sealed to your tooth. Sometimes, over time, bacteria or cavities can form on the root surface and get under your crown. Once the cavity has done this, the only solution is to remove the crown so we can accurately remove the entire cavity and create a solid foundation for your tooth. Once that is completed we will have our lab make a new all porcelain crown that more accurately fits and seals your tooth. I’m so happy you’re not having any discomfort at this time, however if this is not taken care of soon, the cavity may contact the nerve of the tooth and then your tooth would require a root canal AND a new crown. I’m sure you would rather just have the new crown and avoid the whole root canal thing.
Patient: Absolutely. I will make an appointment right away.
Dentist: Great, I’ll look forward to seeing you soon. By the way, how is your son, Alex, doing in college?
Keep it simple and straightforward
The intra-oral camera is the most valuable piece of technical equipment in any dental office. This simple camera system allows your patients to see exactly what you’re seeing. When used properly, it is responsible for creating the VALUE for the treatment you present to your patients.
Approximately 65 percent of all people are considered to be visual people. This means the vast majority of people tend to learn and absorb information by seeing it. You may have witnessed that some people will close their eyes to hear what someone is telling them. In fact, the next time you give someone directions, watch to see if they close their eyes in an attempt to visualize the route in their head.
The biggest challenge we face in dentistry is to build value for something that is out of sight out of mind and in most instances, without discomfort. Since the majority of people need to see what you are talking about, it only makes sense to show them. Using intra-oral pictures is the key ingredient to significantly reducing this challenge. We have all heard the saying "a picture is worth a thousand words" and it is not uncommon for a patient to look at these pictures and before you even comment they say, "that doesn't look very good". All you have to do now is go through the four stages of effective case presentation and they will respond with “how soon can you get me in”.
It’s no secret that the highest value for your treatment plan is created when your patient is actually present in your office. It’s also no secret that this value has a tendency to decrease a soon as they walk out the door. You never know who the decision maker in the home truly is, so one strategy to help reduce the “sticker shock” to their significant other is to send your patient home with printed pictures of the proposed treatment. Intra-oral pictures can help preserve that value you worked so hard to achieve. With pictures in hand that show why the treatment is needed, is far more effective than just a fee slip showing how much the treatment will cost, which can be the difference in having your patient keep their scheduled appointment or not.
You office policy should be one that all patients are required to have a minimum of four intra-oral pictures taken during their hygiene appointment. Take a picture before you begin cleaning the lower anterior teeth, showing the accumulation of tartar that we all seem to develop. This is a powerful image that can’t be missed. Then take two pictures of treatment areas that have been previously diagnosed, completed or newly developed. Very often previously completed treatment is out of site and out of mind, so for patients this can be a great opportunity to reinforce the high quality work they have already
receive in your office. For example, you can show how healthy the gum tissue is around a new porcelain crown and compare it to the inflammation and open margin around a crown you are proposing to replace.
At the end of the hygiene appointment take a final picture of the lower anterior teeth with all the tartar removed. This dramatic before-and-after picture creates tons of value. Display all four pictures on the computer screen for the hygienist to reference during the hygiene appointment and for the doctor to review during the exam while the hygienist is “closing the loop”.
When value has been created and your patient shows up for their restorative appointment, intra-oral pictures can continue to create even more value. During most of the dentistry we perform, our patients are not in any pain and they can't see the teeth we are working on, so we have an opportunity to use our intra-oral photos to bring them into the process. Our assistants are taught to take a minimum of three pictures during restorative procedures. We take a “Pre-Prep” picture of the tooth, usually showing the broken down silver filling or crown with an open margin that is going to be replaced. Next we take a “Prep” picture with all the old restorative material removed, still showing the black grunge and decay that was living beneath the old restoration. We then take a “Final” picture showing the completed restoration.
All three of these pictures are ready for your patient to review at the end of their appointment. This provides them with something visual to reference. If they can see it, they can value it!
These restorative pre, prep and post pictures are also valuable if a tooth remains sensitive after treatment. You are in a much better position when you can refer to a picture to remind your patient of the large cavity that was developing under their old crown or filling. Patients are quick to forget and more likely to understand just how compromised their tooth was before treatment.
We also include these pictures with the submission of our insurance claims. This allows the insurance examiners to understand the case in a more intimate level. Combining pictures with your narrative description can mean the difference between an easy approval or having the insurance company ask for additional information.
There is no question intra-oral pictures increase the value of the services you provide. The more value you create the more likely it will be that the patient shares their experience with their family and friends and more importantly refers new patients to your practice.
Phasing Treatment Plans
You can be certain that most of the time your patient will be slightly to moderately overwhelm with any amount of treatment you are proposing, so it’s important to acknowledge this. When treatment plans involve more than a few teeth, it can be beneficial to direct your patient’s focus on the area of most concern. Present everything you found that needs attention, but avoid overwhelming the patient with too much detail. For example, if the patient needs three crowns, there is no need to explain each tooth in detail because really describing one will allow your patient to understand the reason for all the others. Choosing a priority area, especially for new patients that have never had a treatment experience with you, can be wise. Most patients have some level of apprehension and past experiences play a huge role in a patient’s decision to move forward with any treatment until they know that everything is going to be okay and you not going to hurt them. Once they have experienced a stress-free appointment with you, they are likely to move rapidly through the remainder of their treatment plan.
Your goal is to diagnose everything that needs to be corrected and present the highest priority areas. Build value for that treatment and then let the patient decide how they would like to proceed. I've had patients with a quadrant of crowns and fillings to correct, that insisted on completing one tooth at a time. I will always honor my patient’s wishes, but I have found that once they are in your chair and you have completed the "one tooth" with no discomfort as they requested, they are likely to allow you to continue with the remainder of the treatment at the next appointment.
Phasing Treatment Plans is an important strategy, especially with new patients. This strategy goes a long way towards getting patients to begin treatment, which gives you an opportunity to create value for the rest of the treatment plan.
Maximize Your Treatment Opportunities
Master Confrontational Tolerance
Effective Case Presentation
Utilize Intra-Oral Photos