Inside Dentistry
April 2012
Volume 8, Issue 4

The New Psychology of Patient Buying

Follow these steps to rebuild your cosmetic practice in the new economy.

By Roger P. Levin, DDS

A recent study in the Wall Street Journal1 analyzed the spending habits of consumers with household incomes between $200,000 and $250,000 per year and discussed how their purchasing behaviors had changed as a direct result of the recession. The study found that these individuals now focus on three key questions before making a purchase: Do I really want it? Do I want it now? Do I want to buy it here?

Consumers who once made impulsive buying decisions are now concentrating on these three questions and often postponing purchasing decisions, waiting for better deals or deciding to buy somewhere else. While the Journal’s data focused on high-income households, this author believes that this new spending dynamic is present in the behavior of all Americans when considering any discretionary expenditure, and directly applies to patients considering cosmetic dentistry.

In response to a new consumer market, Levin Group recommends learning and understanding The Five Stages of Closing™, a revolutionary new way of looking at case presentation. The 5 Stages Of Closing™—Awareness, Interest, Seriousness, Conditions, and Closing—are simple to understand and implement and will immediately increase cosmetic production.

Stage 1: Awareness

Awareness is always the first step. Only when patients are aware of the practice’s esthetic services can they accept treatment. Creating awareness requires the efforts of everyone on the team. Awareness is generated through the practice’s marketing program.

As part of building awareness in Stage 1, the New Patient Experience starts with a patient calling the office. The team should use Value Creation Scripting™ to build patient confidence about the doctor and the practice. This includes customized language that focuses on attributes of the practice (eg, technology), transfer of trust to the doctor, and a review of cosmetic services. The target is to have 98% of all callers schedule appointments, which will certainly result in more cosmetic production for the practice. When patients present to the office, it will be the first direct opportunity to impress them. The key is to make patients aware that cosmetic services are available and can make a difference in the quality of their lives.

Stage 2: Interest

Dentists often know when patients have an interest in cosmetic services. Consequently, dentists often jump directly from Stage 2 right to Stage 5. In the new economy, this does not work. Remember, how people make their purchasing decisions has changed.

Diagnosis is no longer simply about finding out what the patient needs. It now must be an interactive experience where the patient is involved along with the doctor. When the clinical diagnosis begins, patients must feel like they are part of the process—not just a set of teeth.

Focusing on the benefits of cosmetic dentistry is the primary objective of patient education. In fact, benefits matter more to patients than clinical details. In cosmetic dentistry, education must lead to motivation. If patients are not motivated by a cosmetic case presentation, acceptance is unlikely to occur.

Stage 3: Seriousness

Seriousness refers to the patient moving beyond mere interest to having a strong desire for having the service performed. Whenever information is provided to patients, they are likely to ask what could be called “frequently asked questions.” Patients want to understand why cosmetic treatment is being recommended. Remember that questions are part of patients’ “fact-finding tour.” As they hear your answers, patients will begin to formulate objections. Many dentists and team members react negatively and defensively to objections, feeling that their expertise is being questioned. In truth, objections are normal. The patient is basically saying, “If you answer my objections properly, I am very serious about having treatment.”

Similarly, “should-have-asked questions” are the questions that the patient did not ask, but if they had, they would have been more likely to accept treatment. Many dentists have told this author how they have been fooled into thinking that the case was closed only to find out this was not true. To keep such a situation from happening, cosmetic practices can say, “One question you might want to know the answer to is…” By anticipating important questions that patients did not ask, you build value for the treatment and motivate them to take the next step.

Stage 4: Conditions

Remember that the case is still far from closed. It is necessary to work out all of the arrangements. When patients ask themselves, “Do I want to have this procedure and do I want to have it here?” You want the answers to both questions to be “yes.”

Four main financial options need to be offered, and all patients should be made aware of each one. Patient financing, for example, is a critical option. Every cosmetic patient must be made aware of its availability. Remember, cosmetic dentistry is very discretionary. Make it easy for patients to say “yes” with convenient, flexible financial options. In the new economy, this matters more than ever.

Many dentists do not realize that an increasing number of cases are lost simply because patients cannot find a convenient time to schedule. Americans work more hours than any other industrialized country and are concerned about missing time from their job. Value Creation Scripting™ can play a major role in helping patients accept certain appointment times without feeling inconvenienced.

Stage 5: Closing

With the first four stages completed and all patient conditions met, the case will likely close. However, do not skip this stage or make assumptions. Many dentists have found out the hard way that patients can still fail to follow through at this stage.

Only when the patient has made the appointment and been placed on the schedule is this component complete. If the patient does not make an appointment that day, he or she should receive a call from the practice the next morning. An enormous number of patients actually intend to schedule when they leave the practice and expect to call in the next day or two to make the appointment and simply never follow through.

The deposit is the only optional component. In the recession, Levin Group began recommending 10% deposits for scheduling of appointments more than $1,000. The reason was that no-shows and last-minute cancellations were rising rapidly and when a 10% deposit occurs, the no-show rate is nearly zero. If the practice does not have any problem with no-shows, it can skip this step. However, do not be afraid to request deposits when necessary.

The ultimate proof that the patient will follow through with treatment recommendations is when they present for treatment. While scheduling and deposits are reassuring, the patient actually showing up for treatment is the true mark of success.


The post-recession patient is extremely different from the pre-recession patient. Practices that do not adapt to the new consumer mentality will have to settle for an under-producing cosmetic department. Practices that understand this system will be able to change their case presentations to suit the new patient spending paradigm and grow their cosmetic services.


1. Binkley C. Post-Recession, the Rich Are Different. Wall Street Journal. https://online.wsj.com/article/SB10001424052748703730804576317202215630540.html. Published May 12, 2011. Accessed November 16, 2011.

About the Author

Roger P. Levin, DDS | Dr. Levin is the CEO of Levin Group in Owings Mills, Maryland. For more information, visit the Levin Group Resource Center at www.levingroup.com or connect with Levin Group on Facebook and Twitter (@Levin_Group).

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