Inside Dentistry
September 2007
Volume 3, Issue 8

Seven Key Distinctions That Enhance the Patient Experience and Increase Case Acceptance

Paul Homoly, DDS

There are seven key distinctions that set the bar for consistently delivering an ideal patient experience and increasing satisfaction, retention, and referrals. Making a “distinction” involves refining one’s thinking. For example, a baseball player must be able to distinguish whether a pitch is a fastball or a curve ball and decide how to react. If he cannot, hitting a homerun is practically impossible.


The most important distinction that drives the success of a practice is the one between excellence and leadership. Excellence involves a dentist’s clinical ability and clinical outcomes, which are important. But patients cannot perceive a perfect margin or tertiary anatomy. Leadership, on the other hand, is immediately perceptible by patients. It is the vision, direction, and tone of the practice, the team’s ability to work together; the communication skills; and ultimately the patient experience. Leadership must be the constant companion of excellence and must start with the dentist and be embraced by the entire team.


Educating patients is telling them what they do not know about their dental health, what the consequences are of delaying or declining care, and making treatment recommendations. Patient education typically goes one-way—dentists talk, patients listen. Unfortunately, sometimes no matter how much you educate a patient, they do not move forward because it does not fit their lifestyle requirements. This requires understanding, which is awareness of what is going on outside the patient’s mouth—budget, work schedule, family, and time constraints. When you spend time understanding patients as well as educating them, case acceptance will increase.


Input is what we do. Outcomes are what patients experience as a result of the work. The culture of dentistry has taught us to talk to patients in terms of input. However, patients respond more to outcomes. That is why when we present complex care to a patient, we must focus on the “wants” of the patient and the benefits of dentistry: “Before we start let me tell you that I really understand why you are here. You don’t feel good about your appearance and it is robbing you of your confidence. I feel good about our ability to completely restore your confidence in your appearance. The way I would do it is to remove the chipped and dark enamel from your front teeth and replace it with a new enamel-like material. This typically takes two to three appointments. I know you have a lot on your plate with business travel, so let’s figure out how to fit this dentistry into your life.” Of course, this type of dialogue does not stand the test of informed consent and we would need to further discuss the dentistry in terms of benefits, risks, and alternatives, but the initial conversation allows the patient to focus on what they want—a positive outcome.


The dentist must be both provider and advocate. The provider is the clinician who does the dentistry. The advocate is the advisor who guides, supports, and encourages the patient. The provider presents what is going to be done clincally. The advocate presents what the treatment is going to do for the patient, using words like “comfort,” “confidence,” and “peace of mind.” The foremost role for the dentist is the advocate, because the advocate helps patients make good healthcare decisions, regardless of the impact those decisions have on the provider. The more you advocate, the more patients believe you have their best interests at heart, and the more they will trust your clinical recommendations.


A condition is a clinical finding that is outside of normal or healthy limits. A disability is what the patient is experiencing in his or her life as a result of the dental condition. Conditions are clinical; disabilities are psychological and emotional. Patients respond to communication that fo-cuses on relieving their disability, not to the clinical account of how the condition is going to be fixed. When diagnosing, we need to associate a disability with the condition using an easy four-step process. First, create awareness of the condition with the patient: “Were you aware you have some old and broken fillings in the back of your mouth?” Second, illustrate what the condition is by comparing it to something they are familiar with: “Fillings can break like cracks in a windshield. It starts small, but over time can get worse.” Third, provide the patient with consequences of not fixing the condition: “Patients who have cracked fillings like this often find the tooth itself can crack or be lost.” Finally, associate the disability and create concern: “Does the idea of having a broken or missing tooth bother you?” Now the patient knows he has a condition, has associated a disability with the condition, and is more likely to be concerned about delaying or declining care.


Simple toothcare is for patients who need dentistry but do not require us to alter the anterior guidance, plane of occlusion, vertical dimension, or condylar position. Complex care is typically greater than three or four units of crown-and-bridge. The reason for this distinction is that simple-care and complex-care patients have different technical requirements and different relationship requirements. The complex-care patient requires much more time in treatment planning and the treatment involves greater risk. Because complex-care patients are often paying much higher fees than simple-care patients, they expect and deserve a more complete level of relationship. Of course, we do not treat simple-care patients with disrespect and apathy, but because of the extent of treatment required for complex cases, the patient may be much more apprehensive because they have greater disability in their life related to dentistry. The simple-care patient often does not need an in-depth clinical evaluation or a complex interview process. The complex-care patient, however, would require a longer conversation. This process starts with distinguishing the type of patient during the initial telephone conversation, which will allow the team to develop an appointment to give the complex-care patient the time he or she needs.


The patient experience typically deteriorates during the fee discussion because it is uncomfortable. That is why it is important to understand the distinction between fees and budgets. Fees are the dollar cost of the dental care. The budget is the suitability of the cost of care relative to the patient’s financial resources. Patients respond better to budgets. Ideally, before a fee is quoted, the team has an idea of what the patient’s budget is. You can begin to determine budget early in the diagnosis process by giving patients a ball-park figure range and watching how they respond. For example: “I’d like to give you an idea of the approximate time and cost involved in the treatment I’m going to recommend to achieve the goals we discussed. Similar cases would typically cost $4,000 to $4,500.” Then, during the fee discussion, start with the most comfortable payment option first. When you quote a fee, patients only hear the total amount and become focused on it. When you start by discussing the patient’s estimated monthly payment, a treatment fee of $4,500 seems more manageable in a budget when it is $150 a month. Using a program like CareCredit® (Costa Mesa, CA) will take you quickly from fees to budgets and help increase treatment acceptance.


When a dentist and his team are aware of these seven key distinctions and are able to implement them, they will better be able to predict and react to patient behavior. Instead of trying to change those behaviors, focus on these seven key distinctions that help you better understand how to manage and lead the case-acceptance process. You will experience a greater and more predictable level of case acceptance when you and your team can see, hear, and understand more.

About the Author
Paul Homoly, DDS
Homoly Communications Institute
Charlotte, North Carolina

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