What makes dental care a valued investment versus a fix patients choose begrudgingly? 

One morning I had an automobile breakdown in my “beater” weekend truck. We have all been there – filled with the inconvenience and anxiety of dealing with a problem that came up unexpectedly. I was hoping to find a place that could get me home that day.

I googled around until I found a reasonable looking repair shop close to the breakdown. They worked me into their schedule so I could get the old truck back on the road. It was pleasing to have the problem fixed, at least for that day, but I measured this against how I have experienced service at the shop that takes care of my daily driver car.

Dental Service Emergency vs Dental Relationship

There were many aspects of the breakdown with my old pickup truck that reminded me of a dental emergency. I found someone convenient and they had the best intentions to provide a fix.

It was a shop I didn’t have a relationship with. They were kind and helpful, but there were so many things missing that would have been unlikely to happen if I treated my old truck like I do the car I have been so much more diligent in taking care of.

The shop focused on the problem that was presented to them, not looking beyond a simple fix to get me back on the road. While I was appreciative, it is very unlikely that the next problem (or even the true cause of this one) was looked for. I did not leave with any feeling that I wouldn’t be in a similar situation as soon as the next problem arose.

I reflected on the years I have spent with the auto shop that takes care of my primary car. I have a valued relationship with them. They know me and know that I appreciate them taking the best care of the investment I have in the vehicle I drive every day.

When I take my car to an appointment, they look over everything. They tell me when to expect maintenance and repairs in the near future and throughout the life of the vehicle. I trust them and know that they have my best interest in mind. In return, I am very appreciative, expressing gratitude when I write them a check for their services. I have never broken down in the cars they take care of for me.

To be continued …

Consistent case acceptance is a skill it can take years to develop. Part of the reason it can seem so challenging is that a patient’s true motivations may not be clear from the outset. We have to hone that sixth sense that can tell us what information or guidance would truly speak to a patient.

Two aspects of case acceptance in particular often go ignored because they either seem too obvious or are just not as fun to dive into: offering individualized options and making sure patients understand insurance.

Individualized Options for Case Acceptance

You may think the concept of individualized options is a no brainer, but that isn’t necessarily the case from a patient’s perspective. If you’re willing to provide this extra level of specificity, you can put many ‘maybe’ patients right into the ‘yes’ category.

We accept that car and other big purchases are often paid in installments, so why not do the same with a large investment like dentistry? Offering financing or other piecemeal payment options to patients is a game changer. It also makes comprehensive dental care accessible to a broader demographic. That in and of itself is valuable.

When dealing with patients, break the payment options down into easily understandable terms. Tell them the total fee, but decrease the stress by making it clear that there are different ways they can arrange to pay, including pre-pay, pay as you go, and Care Credit. Using a term like Care Credit is helpful because everyone is familiar with the idea of credit. When they ask for more information, you can lay out the details of payment plans.

Understanding Insurance for Case Acceptance

The real role of insurance is a mystery to most patients. Some may deliberately avoid understanding it because of how convoluted and frustrating it can be. They may have an entitlement mindset complete with the belief that the only healthcare they can indulge in is the kind covered by insurance.

Before you ever even look in a patient’s mouth, my advice is to have the insurance talk in low-stress language. Explain the actual definition of insurance and describe how dental insurance functions more as a maintenance plan. Use analogies to clarify the fact that just like with car insurance, its more of a backup fund than a way to pay for necessary yearly interventions such as a new tire or oil changes.

During an occlusion-focused hygiene exam, there are certain things the hygienist should pinpoint. This will help them develop a deeper relationship with the patient as well.

A Hygiene + Occlusion Exam

What the hygienist should look for:

1. “Can you eat/drink cold things comfortably?”
2. Subtle wear facets – those shiny spots on the edges of teeth.
3. Chipping of the edges of teeth. Can you get the patient to line up an incisal “chip” with a sharp edge of a lower front tooth?
4. Fremitis – that subtle shimmying of an upper front tooth when you gently place your fingernail on the facial of a maxillary incisor and ask the patient to grind side-to-side and front-to-back.
5. NCCL – could that be from clenching or orthodontic expansion? Both/and?
6. Persistent marginal inflammation that could be a sign of clenching (or an imbalanced bite).

The hygienist’s role is to raise patient awareness –  to “discover” changes that can be brought to the doctor’s attention for long-term protection of the patient’s teeth.

The doctor’s arrival for an exam is the time that real skill and teamwork begins. The hygienist takes the lead and informs the doctor what they (hygienist and patient together) have been discovering/discussing.

Many times, the most significant questions come when I am behind and feeling rushed. Our goal, practiced for years, is for me to get in and out of the hygiene room in under 5 minutes. Therefore, our total goal together is to encourage the patient to schedule another appointment for a more thorough evaluation of any changes/discoveries.

The hygienist then supports and reassures the patient about the need for a more thorough understanding to protect their teeth and eating for a lifetime. They confirm the uniqueness of a full understanding of teeth, harmonizing bite forces, and oral-systemic health and well-being.

“This is what sets our office apart. Together we strive for the best in your total oral health prevention.”

A well-thought-out and choreographed hygiene appointment can truly establish you in the relationship-based sector of dental care.

As a maximizer, I’m always tweaking processes to try to make things a little better. A few years back on the advice of a wise mentor, I made a small change to the last question I ask of patients in my Pre-Clinical Conversation. This change required a dramatic difference in how I view my “job” for patients.  

A Powerful Pre-Clinical Conversation Question

For years, I thought I was so unique to finish my time in the consult room with the question: “Is there anything else I should know about you to take good care of you?” Patients genuinely seemed to appreciate that question. I felt great about the responses I got, almost always along the lines of, “Nobody has ever asked me these types of questions!”  

A few years back, I was diving deeper on Locus of Control of Oral Health with my small growth group, The Sinking Stones. I was hoping to help my patients increase ownership of their condition and shift the “locus of control” from the doctor/expert (tell me what to do, when, and how) toward a true partnership (I can be the expert of the technical pieces, but you are the expert of you).  

The elegance of this transfer relies on our ability to do so without the patient feeling abandoned and unguided. I was gently reminded by Dr. Rich Green that a small change to that question could help frame the relationship differently right off the bat.

My new question is: “Is there anything I should know about you to work well with you?” Rather than facilitating a dependent/top-down/expert doctor relationship, I now have a much better chance of a patient understanding how important it is for me to be in partnership with them.

I can look them in the eye and tell them my healthiest patients are those that view me as their partner. This is better than looking for “experts” to tell them when it is appropriate to take on a particular procedure or make a decision for them without knowing their temperament, circumstances, and objectives.  

Though I love taking care of people, a change in those four words has allowed me to do so in a partnership according to the context of the patient’s life.

Dentistry is rapidly segmenting into two distinct professions.

One will be what most patients think of as traditional dentistry. The tooth fixer and cleaner. The technician. These dental offices will focus on bits and pieces of treatment to get full insurance dollars from each patient each year. The staff will likely also be fragmented by tasks.

The other profession will be the doctor of the oral-health system. The valued family advisor on health and wellness. As Pankey-trained dental offices, we are well positioned to become the relationship-based advocates for our patients’ health.

Training Your Team to Advocate for Patient Health

How about your team? Have you put in the time to train and behaviorally change your most valued support?

A most important person in that team approach is the hygienist. Are they having conversations about total health? Social conversations don’t lead to behavior change that improves the health awareness of our valued patients.

Again, as Pankey-trained dentists, our hygienists can have a huge impact on our patients’ perception of our unique thoroughness. Occlusal awareness should be part of hygiene discovery about their health.

Bringing Up Occlusion in the Hygiene Appointment

This can involve simple questions: What have you been noticing about your bite? Chewing? Jaw? Headaches? “What have you been noticing about [fill in the blank]…?” can begin a discussion.

Depending on the conversation, one can follow with: “We are noticing that, as people live longer (keep their teeth longer), we see things slowly develop that can lead to big concerns. In our office, our purpose is unique – we want you to be able to enjoy eating all the foods you love the remainder of your life. I will look at potentially traumatic bite forces for you.”

How do you introduce occlusion in your hygiene exams? Let us know in the comments! 

Our good intentions and true thoughts surrounding a difficult situation with a patient can get lost in the communication process. When we fail to meet patient expectations, we can almost become a different person.

Our patient interprets what we say and do as demonstrations of our character. This is why, if we want to resolve conflicts and make patients feel understood, we need to pay special attention to showing that we care.

How to Show You Care About Patient Concerns

There are many ways to show you care that can be beneficial on both sides. It also helps to take criticism not as a personal affront, but as an opportunity for improving our communication skills. It may seem counterintuitive, but the best way to soothe or diffuse heightened emotions is to let people experience them. Allow patients to fully express their upset, instead of trying to shoot them down or make light of the situation.

Then, truly embrace empathy. Don’t just listen and nod without truly empathizing with their upset. Let them know that you understand how hard the situation is for them. Next, acknowledge the challenge of revealing their true feelings by thanking them for their honesty and for telling you what they think.

And then there’s the hardest part: apologize. You don’t need to admit you’re guilty and beg their forgiveness. You simply need to express how sorry you are that they are experiencing upset. Also, don’t assume that you can guess how to fix the problem.

Ask your patient how they want to be helped and be honest about whether you can make it work. By patiently listening and acknowledging their feelings, you may have already given them exactly what they wanted.

How do you show your patients that you care? Let us know in the comments! 

Throughout my dental hygiene, dental school, and residency programs, I was blessed to have exceptional instructors and role models. All of them encouraged me, believed in me, and most importantly, impressed upon me the importance of lifelong learning. Many of them recommended Pankey, telling me to go there as soon as I could.

A Journey to Deeper Patient Relationships

That journey began in 1994. I will never forget sitting in Dr. Irwin Becker’s philosophy class as he talked about the Crosses of Dentistry. He discussed “Knowing Your Patient” and I remember becoming very emotional.

As a young hygienist, it would bother me when I would see a re-care patient and not remember what we talked about the previous time. I started jotting things down on index cards about each patient and keeping them in a private file. Not the things you would typically see in chart notes, but personal things they felt comfortable sharing.

Each time they came in, I would refer to the personal card file and refresh my memory as to where we left off. There was no way I would have been able to remember all those special discussions, so I had to write them down. Each time they came in, the next chapter began.

I also started sharing more information about myself. I found the more I shared, the deeper the conversations went. I really wanted to know my patients on a much deeper level and that is what happened over time.  

When I came back to the Pankey Institute for the second continuum, I was pleasantly surprised to be greeted by name by Dr. Ernie Anderson, one of the course instructors, as I stepped into the elevator of the condos. Obviously, he had taken time to look at the roster to see who was in the class and that was very impactful. The kindness, thoughtfulness, and encouragement shown to me at the Institute were instrumental in demonstrating how I wanted to make my patients feel during my care.

Time spent getting to know my patients has resulted in lifelong relationships. Of all the things I’ve learned, this is one of the most important keys to a meaningful and enjoyable career.

Buyers are actively seeking dental practice opportunities all over the country. With the influx of doctors to desirable areas, sellers must have a strategy for how to identify the right buyer for their legacy practice.

Navigating the Best Transition For Your Dental Practice Legacy

Complementary technical skills to properly care for a patient base are essential. Behavioral considerations like interpersonal skills and communication are part of the success of a relationship-based practice. Timing and financial considerations play a large role in buyers identifying their opportunity as well. Working with a seasoned transition consultant allows for the vetting of these necessary components.

Some practice brokers seek a transactional experience for a changing of the guard with a processing of documents and a single strategy for its completion. This is driven strictly by financial and legal considerations. That transactional mindset is what you have been working to avoid in your practice for a career. So why would you consider growing your practice or ending your career with a philosophy that goes against the grain of what your practice has become?

Curiosity Driven Dental Practice Transition Strategies

Why not become curious about practice transition strategies? You could explore a co-discovery experience of what best fits your practice model and philosophy. Asking more questions and learning more about what makes your practice a successful legacy is the first step.

Transition consultants offer a complete approach to evaluate your relationship-based practice. The approach seeks all the financial and legal considerations plus works to transfer the technical, behavioral, and business culture. The purpose of this is for continuity in your practice and security for your future built on strategic solutions. Finding a transition consultant with successful business experiences helps make them uniquely qualified to collaborate with you to develop your strategic transition or expansion solution.

Whether you are a specialist or a general dentist, seek a consultant that will perform a comprehensive exam on your practice. They should report their findings with a thorough and professional strategy to meet your wants and needs. Developing a legacy plan for your relationship-based practice model that creates opportunity and security for your next phase must be intentional.

Are you ready to discover the best strategies for you and your practice future?

When a dental partnership fails, it’s natural to want to keep the truth quiet. The dissolution of relationships, especially business relationships, is often seen as shameful. In Part 1 of this series, I decided to openly discuss a partnership that ended. Here, I continue that story.

When Dental Partnerships Go Awry

After negotiation and mediation failed, our contract stated we would have our case settled by the American Arbitration Association. When the dust settled three-and-a-half years later and the final appeal ruling of the Arbitrator’s decision came down in my favor, it ended up on the front page of our local Daily Law Bulletin.  

I had multiple texts come in that morning from attorney friends and patients congratulating me on the victory. Even an arbitration victory can feel like a loss with the stomach lining and energy that it takes to go through the process.  

I know that some lessons will never be learned out of a book and need to be experienced, but please add this one phrase to your existing or upcoming contract: The loser of any appeal of binding arbitration shall pay the other party’s attorney fees. That alone would have prevented many years of stress, a whole lot of money spent on attorneys, and some gray hairs to boot.  

Creating a Partnership Charter

Recently, I was introduced to a book entitled ‘The Partnership Charter’ that has energized me around new possibilities for a partnership with my current associate. A partnership charter is a cooperative document meant to instill a spirit of collaboration into an agreement between parties.  

While not legally binding, it provides a framework for the partnership that is highly individualized and contains no boiler plate standard clauses. The process is the most important outcome and the document is secondary. It is meant to be reviewed and revised throughout the partnership, becoming a true living document that creates continued conversation over synergy and fairness.  

Though not every scenario can be planned for, I am confident that getting in and out of my next partnership will be spelled out much more clearly than my last. The charter will provide a process of collaboration that will guide us toward fairness for all concerned.

In part 1 and 2 of this candid blog series, Dr. Brad Weiss discusses the dissolution of his partnership with an associate and how he believes others can avoid falling into similar situations.

In July, I finished my term as president of my rotary club. I termed it a “planned hardship,” much like a camping trip where you know you will be better for having experienced it.

Each week for the rotary club meetings, I ended them with Rotary’s Four Way Test: First, is it the truth? Second, is it fair to all concerned? Third, will it build goodwill and better friendships? Fourth, will it be beneficial to all concerned?  

My vision of what defines a successful partnership aligns with the rotary club mindset. I believe a partnership in the dental practice is where each of the four above criteria can be met. My patients are the ultimate beneficiaries of a well-functioning agreement.  

A Broken Dental Partnership

I am not a practice transitions expert, nor did I stay at a Holiday Inn last night, but I did go to the school of hard knocks. I have been an associate, worked as an employee for a corporate entity, shared space as my own S Corp, and eventually merged my small practice with a much larger one to become a 50-50 partner with an associate as our employee.  

There is shame attached to the failure of any relationship. As my partnership split after six-and-a-half years, mine is no exception. The more I tell my story, the more I hear such similar stories from other dentists. It is eerie and disappointing to know that more is not done to improve the odds of partnership success.  

My belief is that the shame attached keeps others from knowing how to avoid potential strife between two otherwise reasonable people.

To be continued…