In this week’s episode, Jeff has some more helpful tips on how to increase case acceptance in your practice. He goes over some of the different ways you could be approaching your treatment presentations, and a couple of ways to better communication with your patients. Tune in for some insights on better practice management!
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Questions From This Episode
Why do patients say no to dental treatment they need?
Jeff says most objections, like "I want to think about it" or "it's too expensive," are polite ways of saying no. Some patients have a legitimate reason, such as refinancing a house or leaving town, and they will usually tell you. But in most cases, which he estimates at around 80%, the patient doesn't understand the treatment. They haven't grasped its meaning and significance, so they can't see its value compared to other things they could spend money on.
How much of what the dentist explains do patients remember?
Less than half. Jeff cites a 2007 New York Times article by health writer Jane Brody, based on a national survey, which reported that patients remember less than half of what a doctor explains during a visit, whatever their education level. Unless you and your team communicate very well, assume the average patient leaves without understanding most of what you said.
What communication mistakes lead to low case acceptance?
Jeff names five: not explaining what you want to do, why, and what happens if the patient does nothing; not allowing enough time to explain and answer questions; using technical jargon like "abscess" or tooth numbers; leaving the condition and treatment abstract instead of showing an actual implant, an old lab case, or an intraoral camera image; and coming across as judgmental, rushed, or aloof, which keeps patients from asking questions.
How much time should you set aside to present a treatment plan?
Enough to explain the condition, the consequences of waiting, and the treatment, and to answer the patient's questions. Jeff's rule is not to present a plan unless you have time to explain and close it. Schedule the patient to come back, or block uninterrupted time before your first patient or right after lunch. Asking someone who earns $60,000 a year to spend $8,000 or $9,000 in a five-minute conversation rarely works.
What can you do today to get more treatment plans accepted?
Jeff gives six steps. Don't present a plan without enough time to explain and close it. Avoid heavy dental terminology. Make sure the patient fully understands their condition. Explain honestly what happens if they do nothing and why you want to act now. Be friendly and approachable so they feel comfortable talking to you. And have the doctor state the fee, since it carries more weight coming from the doctor. Long term, he recommends communication training.
Episode Transcript
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So you've just finished a new patient exam, and it's time to present the treatment plan. This patient needs a few fillings, four crowns, and an implant. It's a decent-sized case. You present the treatment plan, it comes to decision time, and you hear, "I want to think about it," or "I'm very busy right now," or "I can't do this right now," or "This is too expensive," or "I only want to do what insurance covers."
And while all of these sound very nice, what do they ultimately mean? No. They all mean no. You might walk away from more than a few of these types of treatment presentations and think that you need more high-quality new patients, or your patients can't afford good dental treatment, or your patients have a low dental IQ, or your patients don't care about their teeth.
And sure, there are cases where a person may not care about their teeth, and there may be cases where you just have a person in your dental chair who's not a very nice person. But for the most part, most people are generally okay or nice, and they actually do care about their health somewhat. So why do people say no to something that they really need?
Well, that's what I want to talk about in this episode. I want to get into the real reason behind most of the nos that you're hearing, despite how they're couched, like "I want to think about it." And even more, I want to talk about what to do to hear more yeses. My name is Jeff Blumberg, and I'm your host.
To make things simple, let's look at the reasons people normally say no to things. It really comes down to two basic reasons. The first one, which I'm not really going to address in this episode but have talked about before, is that there's a legitimate reason for them to hold off. Right now they're refinancing their house, or they're leaving town for three months. They'll usually tell you about this. If you remember Episode 82, I talked about how to address patient objections. I'm sure you remembered it right off the top of your head, right? In Episode 82, I went over how to address patient objections, and I explained what a legitimate or real objection was.
But the reason for most of your nos is most likely a lot simpler than you think. The reason most patients say no is that they don't actually understand what you are trying to do, and therefore they can't associate value with it. They don't understand.
Let's define understand. The definition of understand is to grasp the meaning and significance of something. So it doesn't mean that you just know what it means. I know I've used "mean" twice there, sorry. It means you grasp the significance: how important is this relative to other things? A patient who understood would go, "Oh, this treatment is a lot more important than buying that new consumer product or going on that cruise right away." They would be able to see the importance of getting their treatment done if they grasped the significance of it. That's the whole point: meaning and significance.
You can see this even with training. You've done some variation of this. You've told your receptionist to smile when they answer the phone, so you've given them an action to do. "I have to smile while I answer the phone." I'm trying to smile as I'm doing this, on audio. But you haven't really explained why. Why is it important that they smile when they answer the phone, or that they're nice when they answer the phone?
You may think it's common sense, and to a degree you're right, but not everybody has common sense, especially somebody who's new to the workforce. They don't know what it's like in a professional environment. You haven't actually explained why, so they haven't understood the significance. The reason it's important that a receptionist is friendly and welcoming is that they're the first point of contact in the business, and a person calling in is going to start developing their whole attitude about our business based on that first phone call. So if you sound unwelcoming, irritated, rushed, or upset that they called, that's going to change their viewpoint of our business.
You see this in any type of training. Let's say you have a receptionist, and I've used this example before. You walk into a dental practice as a fly on the wall, or as a consultant, and you're watching their front desk operate. There's a patient who just walked in the door standing at the desk, the phone is ringing, and the receptionist has seen the patient and hears the phone. And the receptionist is busy filing something. They're filing a chart. Let's say they're still on paper charts.
You would go, "What's wrong with this receptionist?" Well, they just don't understand what's most important. Anybody who understands basic business or dentistry would go, "Okay, I've got to say hi to the person who just walked in, say 'Excuse me a second,' pick up the phone, and file when I have time." They can't assign importance to these three things, meaning which is the most important. The live person in front of me. The second most important thing is the phone. And the paper might not even be third. It might be fourth or fifth, because there could be two other things I haven't talked about.
So you see this with training. A person doesn't understand until they grasp the meaning and the significance of whatever you're trying to teach them. Well, the same thing applies to your patients to a degree, and I would do this as a thought exercise with you.
Think about something that you have purchased. It doesn't matter whether it was a consumer good, something for your practice, a service of some kind, or whatever. Something you had to go a little bit above and beyond to get, not a pack of gum. You wanted it. If somebody really wants something, they really want it: "I really need this. I really want it." They will go above and beyond in order to obtain it. You've probably seen patients who really wanted treatment but had no way to pay for it, and somehow they figured it out. They had their mom co-sign a CareCredit application or something like this.
In other words, if somebody really wants something, they really understand it, and they can see the value of it. They will go above and beyond to get it. So this all comes back to this basic understanding.
To accentuate this point, there was an article in 2007, and I use this in the Communication and Sales Seminar when I talk about the subject of communication. It's an article in the New York Times by their health writer, Jane Brody, and she pointed out, based on a national survey, that patients remember less than half of what a doctor explains during a visit. Less than half, educational level notwithstanding. It doesn't matter whether they finished high school or have a doctorate (unless it's a doctorate in dentistry, obviously). They remember less than half of what the doctor says.
So I want you to think with that for a second. The average patient walking into your practice walks out not understanding, or not remembering, more than 50% of what you said. That's the current scene, unless you're really good at communicating and your team is really good at communicating.
So we have a bit of a situation here. The patient doesn't, quote unquote, get it. That's why you'll go through the whole treatment presentation and they'll say, "Oh, yeah, but I really want to buy this purse," or "this TV," or "go on this cruise." And you go, "Gosh, what's wrong with this person?" You take it personally. This is a bad patient. They don't care about their teeth. It's none of these things. They just don't get it.
So why don't they get it? Why don't they understand? Well, it ultimately comes down to communication, and a couple of things about communication. Number one, I've toyed with the idea of doing a whole podcast episode on communication, and it does not translate well to a podcast, because to teach it properly it needs to be a little visual. There need to be diagrams and things of that nature.
That being said, if you want to learn how to communicate, I'd recommend two things. The first would be to ultimately come to the MGE Communication and Sales Seminar. We'll put a link to it on the episode webpage. That's what we talk about, folks: how to properly present treatment and how to communicate effectively with your patients. And that's why it gets these fantastic results, the $300,000 average increase in year one.
While you're waiting to do that, if you want to at least get a primer on communication and get into the subject a bit, you can check out our online platform, DDS Success. There's a course on there called Effective Communication. I did the course. I'm not trying to promote myself necessarily, but I get into the specifics: here's what communication is, this is how it works, these are the mechanics of it. It does not translate very well into a podcast episode, so I'm not going to do an episode on it. I'm going to do more episodes on specific sales techniques.
The reason I'm pushing this so hard is that you're trained as a healthcare professional, but you're going to need some degree of communication training, because not just your success and your livelihood, but your patients' health depends on how effective you are at communicating.
So how does this lack of understanding develop? What are the communication errors that create it? Let's look at some of the biggest culprits.
The first one is when, during whatever explanation you're doing, you didn't explain what it is you want to do, why you want to do it, and what the ramifications are if you do nothing. In other words, what happens if we do nothing, or wait? Say the patient's missing a tooth, and you told them the other one might super-erupt. Why is that a big deal? Maybe it's a big deal to you because you're a dentist, and to your staff because they understand it. The average patient thinks, "It's in the back of my mouth. What do I care if the tooth's missing?" Maybe they want to fix it, but not as something they have to handle now rather than five years from now, because implants are expensive.
Why is it a big deal? What are the potential effects of doing nothing about it? Or there's that crown the patient needs. What are the potential effects of doing nothing? The tooth could crack. I could end up losing the tooth. I could end up needing a root canal, which is going to cost me another $1,000 or $1,200. These are things patients just don't understand. The condition wasn't explained in such a way that I really got it, along with what's potentially going to happen if I don't do anything about it, or I wait. That's normally the first and biggest culprit.
The second is not enough time during the explanation. If you've listened to this podcast for any length of time, you know how I feel about dedicating the correct amount of time to presenting treatment. You have time allocated on your schedule for treatment, and you have time allocated on your schedule for diagnosis. Very rarely do dentists allocate time to actually present treatment, but it is something that requires time.
If you want a simple way of thinking with it: let's say you're asking this patient to spend $8,000 or $9,000, and they make, I don't know, $60,000 a year. You're asking for one-sixth to one-seventh of their yearly income in five minutes. Think of your own yearly income. If I asked you for one-sixth or one-seventh of it and talked to you about whatever I wanted you to buy for five minutes, would you buy it? Most likely not.
You have to allocate enough time not just to explain what's wrong, what you found, what the condition is, what happens if we do nothing, and what you actually want to do to fix it. You also have to allocate enough time for them to ask questions and to handle their considerations: "I'm worried about whether it's going to hurt. How is it going to look?" Anything that might be on their mind. This takes time.
The third culprit is using too much technical jargon during a treatment presentation. I've hit on this before. I wouldn't use words like abscess. I'd use words like infection. I wouldn't give them tooth numbers unless it was absolutely necessary: "You have a problem on number four, on the distal surface." I wouldn't get into that. Explain it in a way they can understand and they can see.
Which brings me to the next point: the condition itself and the treatment are somewhat inaccessible in their mind. You tell them they need an implant, but what does an implant look like? Well, it's a screw. I'd have an actual implant in my treatment presentation. I'd show them one: "Here's an implant. This goes into your jawbone." This is how I'd do it. They should actually see these things. What's a crown? You can use old lab cases, and you can use your intraoral camera. If you're explaining that a tooth is cracked or a cusp has broken off, have them see it on an intraoral camera. Make it accessible to them. This is all part of building understanding with them.
The next reason has to do with how you yourself are communicating. Take a look at something for a second. Imagine you've put yourself in an environment, maybe a medical environment, and you're seeing the doctor, and you really respect this doctor. People feel this way when they come into your office, because mouths can be dirty, mouths can have stains, and people are self-conscious about how their mouths look. In comes the doctor, and the doctor is really judgy, or seems rushed, or seems aloof, or has a bit of an attitude. That doesn't go over very well, and it doesn't make you comfortable. So part of this is making the patient comfortable communicating with you.
And I want to point something out in the very definition of communication. What does "co" mean? Co means together. Think of words like cooperation and coordination. We're working together. Communication is two ways: it's you to them and them to you. So if you come in and you seem judgy, or aloof, or upset, or rushed, I'm not going to feel very comfortable asking you questions, am I? Well, then we're not communicating, folks.
So how would you want someone to be if they were handling you? I know how I would want somebody to be, and that's how I aspire to be when I deal with somebody else. I try to be friendly, understanding, and accommodating. I want the person to feel comfortable talking to me regardless of what's going on. If they're horribly embarrassed about whatever condition they're explaining to me, I have to create an environment comfortable enough that they can explain it and not feel that I'm judging them or being critical of them.
You'd be surprised, and usually the last person to be aware of this is, in this case, the doctor. You're not aware that a patient may look at you with all of this respect and be afraid to say things to you, or afraid that you're going to see that stain on their tooth because they did a bad job with their home care. Patients get like this.
The funniest story I heard was from a client of ours, also a friend. She practiced for about 30 years and is retired now, but she took over her dad's practice, and the first patient she saw on day one had been one of her dad's patients for, I don't know, 20 years: an older lady. That morning, because she was seeing the new doctor, the lady had brushed her teeth with Ajax. For younger folks, Ajax is an abrasive tile cleaner. I think it even scratches some tile. She brushed her teeth with Ajax because she wasn't going to walk in with dirty teeth.
So that's what's walking into your practice. Patients walk in a bit concerned. They think you're going to think they're doing a bad job, or they're embarrassed, or whatever. So create an environment where the patient is comfortable actually speaking with you. Be friendly. Be accessible. I'm not saying to joke around and act as if you're their best bud or something like this. But I am saying be friendly. Think of how you would like to be treated. Be nice. Talk to them like a person, and you'd be surprised how many people actually open up at that point and communicate.
Because here's the problem. The patient doesn't understand what's going on, doesn't understand what treatment you want to do, and doesn't understand what happens if they do nothing. And then you hit them with the price tag: "This is going to be $8,000." Then they get a bit worried, because we have things like the internet, and there are lots of bad reviews. They can read about everything on the internet, how everybody's a scammer and this and that. They just came in today to get their teeth cleaned, and now you want $8,000, and they're going to leave you a negative review.
It also creates trust issues at that point, because you weren't able to actually explain it all properly. And remember, the one thing they will always understand is the cost. They have complete subjective reality on money, but they don't on this treatment you're explaining. It's very nebulous until it actually gets performed. So you want to make that treatment as solid and real to them as you can, as well as the condition they have and what happens if they do nothing.
So what do you do to handle this lack of understanding with patients in the long term? My suggestion is to get trained to communicate. I'm not saying this just to sell the MGE Communication and Sales Seminar or to get you to subscribe to our online platform, DDS Success. That's not why I'm saying this, although you'll notice how I placed that there at the end. It's just that your livelihood and your patients' health depend to a large degree on how well you communicate. You're going to have to become really good at this if you want to increase your treatment acceptance.
That being said, what are some things you could start doing today? Here are six basic things.
First, I would not present a treatment plan unless you have time to properly explain and close it. I'm not saying never present the treatment plan. Schedule the patient to come back, or schedule time so that you actually have adequate time to do it. There are lots of ideas on how to do this, and I've talked about them on the podcast before. You can carve out time in your mornings before you see your first patient, which is nice. Sometimes, if your first patient cancels at the last minute, you might actually get to start some of these cases. Or you can schedule time right after lunch. Ideally, you want the time when you're doing treatment presentations to be uninterrupted. You don't want to be pulled out of the room. You want to be focused on this patient completely, at 100%.
Second, don't use heavy dental terminology. Use language that's actually accessible to the patient.
Third, ensure your patient fully understands their condition: this is what's wrong. How would you make sure they really get it? Obviously, if they have a missing tooth, they'll get that, but they don't necessarily see what's going to happen if they don't fix it. That's part of understanding the situation. If there's a broken tooth, you can show them on an intraoral camera, et cetera. This is sometimes tough with gum disease, because it doesn't hurt. With pain it's easy to explain, but there are ways to make it more solid or real to a patient.
Fourth, make sure they get what happens if they don't do anything to fix it now, and why you want to do it now. Here are the potential ramifications or consequences of doing nothing. I wouldn't say it like that, but I would say, "Look, this is why I want to do this now. Here's what I'm concerned about." And you should be completely honest about this. If you really are concerned that tooth is going to crack, I would tell them that. If you're not, I wouldn't. Be completely, 100% transparent. If you think there's a chance that tooth could crack, because you've seen patients come in with it cracked, tell them. It could crack, it could not crack. What's the big deal if it cracks? Well, if it cracks down the middle, down to the root, you've got problems. You see? Make sure they fully get this.
Fifth, be friendly and accessible, like I've been saying. You're the doctor. Patients respect you, so make sure the patient is comfortable communicating with you.
And sixth, as I've mentioned in numerous episodes about treatment presentations, you should always mention the fee. The fee has a lot more weight coming from the doctor. It always does. You should have a treatment coordinator in the room with you when you're presenting the treatment plan, but you should go over the fee: "This treatment plan is $11,000. We're expecting your insurance to pay $1,500." You can take it further than that, and I've talked about that in other episodes, but at minimum I would suggest that you at least mention the fee. That in and of itself can increase your close percentage.
Like I said, getting yourself fully trained on this is the logical, long-term, profitable solution. But you might find that if you just do a few of the things I've discussed, you'll start hearing more yeses even before you get trained, which is a win in and of itself.
Anyway, shorter episode this week. I wanted to throw this out there because I've talked about case acceptance on and off throughout the history of this podcast, but I still run into newer clients or newer doctors who have never heard some of this stuff before. And really, if I had to estimate, in 80% of your cases, the reason patients are saying no is that they just don't get it.
Like I said, there are legitimate reasons patients can't do things. Maybe there's a true financial barrier they just cannot overcome. By legitimate, I mean there's a real reason they can't do it: "I'm leaving town for three months. My plane leaves tomorrow at 9:00 a.m. That's why I can't do this big treatment plan right now." That's real. There's nothing you're going to do about that. It is what it is. Or, "I'm refinancing my house right now, so I can't apply for credit, but my house should close in three weeks." You'll find that with these legitimate or real reasons, a person is more communicative. With these other reasons, it's just a nice way of saying no rather than just saying no.
Very rarely will you explain something to a patient and have them just say no. It just doesn't happen. They're going to say something nice to let you down easy. So hopefully you'll apply a little bit of what you learned this week. Get trained as a communicator. That's the long-term solution, and you'll hear some more yeses.
I hope this helps. I'll put the links to the MGE Communication and Sales Seminar and to DDS Success on the episode webpage. If you have any questions about MGE, you can find us online at mgeonline.com or call us at (800) 640-1140. Folks, have a great week, and we will see you at the next episode.