Lost In Vegas... By: Jon Norton, DDS

Dear Lost in Las Vegas,
I had a friend in high school that always got the girl. Eric wasn’t particularly good looking, athletic, or smart. Most of us leaned against our lockers in our letterman jackets and scratched our heads in total bewilderment. We wondered, “What does that guy have that we don’t?”

Now that the pressures of adolescence have long passed, I’ve been able to reflect back and see that Eric had no “tricks” or “moves,” rather, he was just a plain ol’ honest guy that made the girls feel important. He was more interested in them than he was in himself. Eric was a terrific listener that had a genuine desire to please. Now, if we think about treatment acceptance, we can draw several parallels. How many of us dentists lean against the locker in our letterman jackets (DDS/DMD degree, fancy equipment), scratching our heads? I know that early on in my career, I bought the fancy gear and stood back and waited for the patients to rush in. I expected to hear the endless roar of the handpiece with the ringing of the cash register in beautiful harmony. Instead I heard crickets chirping. Some changes had to be made!

Step One: Determine What The Patient Wants
First, I had to become interested rather than interesting. Being interested requires asking questions. I had to determine why the patient was seeking my care. I often begin a new patient exam with “How can I help you?” This opening question is simple, straightforward, and it gets to the heart of the matter. It puts the patient in a position of control and it gives you a great opportunity to understand her “wants.”

Please understand, at this point in the relationship I am more interested in the patient’s “wants” than the patient’s “needs.” If you begin telling your patient what he “needs” before he has the opportunity to tell you what he wants, you’re sunk. He may need full mouth re-hab, but if you try to push comprehensive treatment to someone who only wants a prophy, the patient thinks you’re a crook and leaves angry. Why? Certainly your comprehensive treatment plan is an appropriate diagnosis, but because your patient wasn’t heard, he’s frustrated. He goes down the street and gets some other dentist to do his “cleaning.” To make matters worse, you see this patient several months later with a brand new smile.

What happened? Eric stole your girl.

But wait. You don’t want to compromise your professional ethics. You have always felt that doing anything less than ideal treatment is malpractice. Your vision for your practice does not include patchwork dentistry. And the Holy Grail of them all: what will insurance cover?

Step Two: Build Trust And Confidence
Slow down. There is a way to blend your patient’s “wants” with their “needs.” You will not hit a home run every time, so don’t get discouraged. Once I have given my patient the opportunity to be heard, I blend her “wants” with her “needs.” For example, I demonstrate to my patient that she has a mixture of ideal, acceptable and unacceptable going on all at once in her mouth. First, I display with my intraoral camera a beautiful existing restoration. If another dentist did the beautiful restoration, I take a moment to compliment the dentist’s work. This builds trust and confidence and establishes a common ground to develop the relationship. The patient has elected to do ideal dentistry in the past so it makes sense to continue. In other words, you now have something in common: ideal dentistry! Showing your patient ideal dentistry makes her feel good about her past choices and it builds confidence to continue! If no such restoration exists, then I display a virgin tooth. I comment what a beautiful job Mother Nature did. I summarize that these are ideal conditions; and that I couldn’t improve them if I wanted. This gives the patient a brief description or definition of “ideal” and it puts into context what a mouth should look like.

Then, I display an “acceptable” condition. This may be a functional amalgam or a tooth with a craze line. Disease-free but stained teeth are other examples of acceptable conditions. I comment that these are situations I could improve–if we both decide to.

Step Three: Start With The Patient’s Chief Complaint
Next, I display the “unacceptable.” I ALWAYS start with the patient’s chief complaint. It confirms that I have listened and my patient was in fact heard. I go on to display the broken, the painful, the infected, and the diseased conditions. I comment that these conditions should be treated at once.

At this point, I check the status of our understanding and welcome comments from my patient. I take this opportunity to educate if needed. Then, I ask what conditions he wants me to treat. This is a great time to introduce quadrant dentistry. If the patient hates shots, I describe how we can treat neighboring teeth without additional shots and minimal time. I have found that many patients agree to replace the ugly amalgam at the same time we treat a diseased neighbor.

Step Four: Financial Arrangements
Once we agree on the treatment plan, we have a brief financial discussion. I feel it is critical that the dentist concludes the clinical appointment by offering a comfortable transition between the front and back office. I have spoken to hundreds of financial coordinators and they are very clear on what works best. They DO NOT want the doctor to participate in the specific fee discussion as the inevitable “negotiation” occurs. They DO want clarification and an understanding of any unique financial or appointment stipulations. As we wrap up the clinical discussion, I comment to my patient that we will make sure we work this treatment into his budget and that our financial coordinator is an expert at making his treatment affordable.

Almost always, my insured patients ask about their coverage. Again, it is critical not to dodge this inevitable question. I tell them they are very fortunate to have coverage and our financial coordinator is an expert at working with insurance. For the record, I have not accepted dental insurance in my practice for several years, but we do work very hard at getting patients reimbursed at the highest possible level. By collecting prior to treatment, your insured patient now has an added incentive to work with you against the insurance company. You may not realize it, but your practice already has several hundred insurance coordinators that cost you no additional payroll! Put your patients to work collecting their own benefits. Insurance companies respond quicker to the insured rather than the provider.

As the financial coordinator completes the financial arrangements, keep in mind, we only do the treatment the patient wants and the treatment he can afford! Give 5% discounts for cash payments prior to the beginning of treatment. Accept credit cards. Offer outside financing. Be sure and train your financial coordinator to present costs as affordable monthly payments. For example, a $5,000 treatment plan would be presented at “$115 per month.”

I would strongly discourage efforts to persuade the patient to do more than she is comfortable with. This leads to broken appointments, missed payments, and skeptical patients. These patients are usually the first to be unhappy with the work they “never needed” in the first place.

Step Five: Don’t Give Up
If you are unable to get your entire treatment plan accepted at once, don’t fret! Maintain contact with your patient, continue to develop the new relationship, and take future opportunities to re-visit the incomplete treatment plan. Don’t give up! Remember the magic of Eric: be interested, not interesting. Soon, everyone will be wondering, “What does ‘Lost in Las Vegas’ have that we don’t?”

Dr. Jon Norton received his BS degree from San Diego State University in 1984 and his DDS degree from UCLA in 1990. He has maintained a private fee-for-service dental practice in Solana Beach, California since 1991. In 1999, Dr. Norton founded Enhance Patient Financing, Inc., where he currently serves as CEO. Doctors interested in finding out more about patient financing can receive a free Starter Kit from Enhance Patient Financing by calling 877.436.4262. They can also visit their website at www.enhancepatientfinance.com.