Clarifying and fine-tuning a new patient system can be more challenging than you might think.

Five years ago, my partner Charlie and I bought a ‘Pankey practice.’ Soon after the transition, we started to recognize that our new patient system would need a little adjusting. The prior owners, who happened to also be my parents, had almost every new patient go through the same protocol.

Charlie and I noticed that the young adult patients who were drawn to our practice had two things in common. (1) They wanted cleanings at the first appointment and (2) they often had less dental needs. We concluded they may not need all the diagnostic records that someone with a lot of restorative needs would have to have.

Defining an Efficient Patient System

I am very systems oriented, and having worked with my parents for a few years, it wasn’t easy for me at first to switch up the new patient system. I liked having all patients funnel through the same protocol, but I began to realize that to get the younger generation into our practice we needed to cater to their desires and gain their trust.

When a patient calls our office, we have a great team that asks questions to understand what the patients’ needs are. I would say that because our referral is mostly word of mouth, we still have many new patients looking for comprehensive treatment. This means we have the traditional new patient appointment, which includes the new patient interview comprehensive exam and full diagnostic records.

But if a patient calls and says they want a cleaning and that there are no concerns, we flex and allow them to meet with the doctor first for a new patient interview, then they have their comprehensive exam and we finish with a cleaning with the hygienist.

If I find that diagnostic records are necessary, I will then have them come back for the records. Sometimes if I really think it would be in the patient’s best interest to not have the cleaning the same day, I will try and talk to the patient to help them understand why I think diagnostic records would be a better option that same day. Most times, if the patient understands the benefits, they are comfortable coming back for the cleaning with the hygienist on another day.

No matter whether the patient has the full new patient exam and diagnostic workup or has the exam and cleaning, the most important part to me is the first 30 minutes where I sit down with the patient and get to know them. I love this time because it allows me to learn about my patient. It also allows the patient to learn about me and my practice and ask any questions.

I believe those first minutes with my patients set our practice apart. It is the beginning of building trust so that whether they have a healthy mouth or need extensive treatment, they are confident that my practice will work with them to maintain optimal oral health.

Dr. Crete discusses an anterior esthetic case from the initial conversation to finished treatment plan for a patient who lacked smile confidence.

Patient Profile

Drew became a new patient at my practice as a 20-year-old junior in college. His reasoning was: “Just to get my teeth cleaned.” During his initial hygiene appointment, he mentioned the “spot” on his front tooth (#9 – small pit filled with composite 10 years prior).  

He asked: “Can you put some new bond on there and make it match better? Even when my dentist did it the first time, it was always obvious.”

I heard his question as a window to ask further questions and find out a little bit more about him. At Pankey, we call this, ‘knowing your patient.’ It can start with an introduction to a new patient during a hygiene examination.  

Asking the Right Questions for Case Acceptance

I began by asking, “Do you know why you had the bonding done?” and “Did you have a cavity?”  

His answer was, “No, I have been playing hockey since I was really little. I was not always good about wearing my mouth guard and I chipped my teeth a lot.”   

Further questioning revealed he was referring to the enhanced mamelons and pitted enamel areas of his anterior teeth as “chips.”

His parents had elected not to have the chips repaired because they were told it was cosmetic treatment and their insurance would likely not pay anything.  

The Value of Open Dialogue

I then asked a few more open-ended questions like, “Is there anything about your smile you would change?”  

His answer: “Well, I always feel like I have little teeth and it makes me look like a little kid. I wanted braces when I was in junior high but my dentist told me I had a good bite and braces wouldn’t fix all the spaces I have.”  

Further dialogue with Drew revealed a significant concern he had about graduating from business school in a year and having to go through interviews looking like a little kid. He said, ”I worry no one will want to hire me because I look so young.”

To be continued…

Customer equity in the dental practice is the retention of existing patients and attraction of new ones. This ensures patients can have more of the dentistry they don’t realize they need. So how do you find and retain new patients?

Asking for New Patient Referrals

New patients come from a combination of invitations, referrals, and marketing. You can have much more control over internal marketing than external. This is the environment you create in your practice that incites patients to refer you to their personal networks.

You must create a safe, non-judgmental system for asking for referrals and having those important conversations in your practice. Most importantly, you must choose the right patients to ask, because some will be too difficult or unreceptive to the question. Some may also be patients that you don’t want extensive relationships with. In that case, you may thank them for offering, but make it clear you aren’t looking for new patients with a soft statement.

Asking for new patient referrals is made easy by the fact that you usually know immediately which patients will be receptive. These are the model patients who pay bills in a timely fashion, care about your suggestions, and are just generally amazing for whatever reason.

Identify potential patient ‘marketers’ in your morning huddle on a regular basis. Then pose the question to these patients in a casual, non-aggressive manner. You can be joking, vulnerable, honest, reserved … whatever tone you think will work best with that particular patient. The request should flatter them or feel good to them.

This is how you create and seize opportunities. It can also occur naturally if they compliment you, but there is no shame in being upfront about asking for referrals.

How do you handle patient referrals in your dental practice? Leave your thoughts in the comments! 

Dr. MacDonald continues Know Your Patient

What is always attractive to quality individuals is the same thing that is attractive to quality patients and the rest of the people in your life. Building strong relationships with your team will have a direct influence on developing good relationships with patients, but first you have to demonstrate attractive leadership qualities.

Delivering Relationship-Based Leadership

To me, the following statements are a safe place to start for attracting and sustaining talented team members:

1. You, the leader, believe they are important and their role is important and valuable to you.
2. You view each person as unique, valuable, and worthy of your respect.
3. They perceive the opportunity for growth and development (both skills and income).
4. They are given the authority to make decisions and have responsibility for their part of the practice.
5. They are on a team that can count on one another because they trust each other.

There are many more important aspects, but you get the idea. Your team is an extension of you. A caring high trust relationship between the dentist and their team that is observed and experienced by the patient will help the patient build trust with both. In fact, it is probably the key to the patient trusting you.

Belief & Trust

When we refer a patient to one of the specialists or technicians on our interdisciplinary team, it is made with confidence and conviction. That is possible because we know the doctor or technician and their team very well. We believe in their clinical skills, their integrity, and how they manage our patients.

This is the result of intentionally selecting each specialist and developing a relationship with them and their team. In that process, we have developed a protocol that outlines what we can expect from one another and what each of us is responsible for. We spend time together individually and as teams. They know how much we respect and value what they do. They express the same in return.

Knowing your patient is a model for the nature of your work and how to approach all of the key relationships in living out your WHY. Practicing this way makes dentistry much more rewarding and enjoyable. Enjoying all of the people in my practice world is what I want and how I want to experience my career. Thank you Dr. Pankey and all who have brought this to life for me and for many!

Knowing your patient beyond their surface structure is essential. It is a process of discovery that is fueled by curiosity. In my view, the critical elements include:

1. Building trust
2. Understanding the value and uniqueness of each person
3. Uncovering the patient’s emotions about their dental health
4. Facilitating the development of heath, function, and esthetic goals
5. Exploring what is possible for them

Leadership Through Understanding

Why is this leadership? It is leadership because the practice leader is responsible for defining reality. The reality of what is important and how we act on those foundational beliefs. Those foundational beliefs that we call ‘values’ are the building blocks of our practice culture. That culture is defined by:

1. What is our WHY? Is our WHY what we reference to make our decisions and manage our practice?
2. What are the unique rules of behavior in this culture?
3. How do we spend our time and resources?
4. What defines success?

Knowing Your Patient

If practicing in a high trust relationship-based culture is what you desire, then knowing your patient is a cornerstone of your practice structure. It can act as a model for the rest of the critical relationships in and around your practice. If this is your culture, then all aspects of your practice are built around relationships.

Next are the relationships with and within your team. I was recently doing a presentation at a major dental meeting in which I was highlighting team roles and responsibilities. From the back of the room a dentist asked me how I attracted quality team members. My answer was simple:

“You have to be attractive to them.”

What I meant was that you have to study the marketplace and understand what the best candidates are seeking. Then, you actually have to deliver it.

To continue reading Part Two..…

How do you get to know your patient? 

Part of knowing yourself is knowing what you want. Is what you want crystal clear to you? Does it inspire you to action? Is it a powerful enough motivator that it can survive the resistance you will encounter in your pursuit of it? Do the people around you know what you want and why it is important to you?

These questions are just the beginning. They are also essential if you are going to move in the direction of your dreams.

Envisioning Your Dream

If you are not moving and seem stuck, then a powerful vision of your dream is both a requirement and a determinant. It is the spark to start your engine. Most of us struggle to gain a distinct understanding of what we truly want at any level, but especially at the deepest level.

A blind person wants to see. A lame person wants to walk. A person in pain wants comfort. There are no competing agendas nor is there any confusion about what is most important to them. That is what I mean by clarity and passion for the cause.

Leadership & Influence

Leadership is about influence. The most important person you will ever lead is yourself. You are influencing yourself 24/7/365. Knowing yourself and taking every thought captive toward becoming what you were meant to become is the most powerful weapon that you have. Use it.

The journey of a thousand miles begins with the first step. Here are several:

1. Reflect on what you would be doing with your life and career, if you knew that you couldn’t fail. Do whatever it takes to get into the mindset to let go and believe.

2. Secure the best expertise that you can find. Build a relationship of trust and intimacy with mentors. Begin a very detailed and guided examination of yourself. Listen, observe, and experience what happens to you in this process.

3. Trust yourself. Act on what you discover. Do it again.

4. Contact me and we will celebrate your successes!

This post is a continuation of the leadership conversation I started in my previous blog. Check it out here.

When we ask patients what they really want, we can drastically improve our case acceptance. 

In my last blog, I talked about the path that led me to start asking patients: “Is there anything about the way your teeth look that you would like to change?”

Surprisingly, this one sentence has transformed my practice. The answers often surprise me. Countless patients with chipping, crowded, discolored teeth respond without hesitation, “Nope!” and many others with what I think are quite lovely smiles respond with a laundry list of things they would like changed.  

Transforming Your Dental Practice

Now that I wait for patients to tell me what they want, I no longer waste time on case work-ups that never turn into productive treatment. And because I found a way to zero in on the cases that I like doing the most, I have transformed my practice into one where I get to do more of the procedures that give me a higher level of satisfaction and happen to also be quite profitable.  

My message is this: First, figure out what your dream practice looks like. I think the best way to do this is to pursue high quality continuing dental education, get a great foundation in comprehensive dentistry, and find the areas you like most.  

Second, figure out how to do more of those things. Find ways to give patients permission to ask you for that treatment. If you love treating TMD, allow patients to uncover problems that will get them excited about the treatment you can provide to alleviate their pain. If you love seeing infants with tongue-ties, include questions on your new patient paperwork about breastfeeding. If you love placing implants, make sure your patients know you can provide them with long-term solutions for missing or hopeless teeth.  

Now that’s not to say that all I do all day is esthetic dentistry. I do plenty of posterior composites and single-unit crowns. However, having some challenging esthetic cases in progress, the ones that give me a lot of gratification and really do change lives make dentistry so much more enjoyable.  

Define your dream practice and eventually you may find yourself living it.  

Helping patients move past denial over their dental health is no easy feat. In your dental practice, you have likely encountered this situation many times.

The truth is, patients who won’t or can’t accept the treatment they need for improved oral health can be put on a more positive path. The hard part is that they often require a significant amount of patience.

In a previous blog, I discussed the mechanism of denial and how it functions to constrain our patients despite our best intentions. There is no ‘forcing it’ because the psychological weight is too heavy. Facing a loss of a measure of health is extremely difficult, despite whether we ourselves believe the issue isn’t significant.

Characteristics That Support Change For Patients in Denial

One way to help our patients in these situations is to avoid frustration. Acceptance of other people’s emotional struggles can come from checking in with our own personal response to stress.

How do you create lasting change? Exploration of this question can give you a clearer perspective about similar answers for others. It can also reinforce the sense that our reactions to stimuli or upset can be quite different.

Once you (or a patient) have accepted change, you will still need to rely on your own resilience to parry the unexpected difficulties or days where your resolve is less strong. Some of the qualities that help in this situation include courage, commitment, awareness, curiosity, confidence, support, and skill.

The foundation of change is the first of these qualities: courage. Making changes in spite of fear is reliant on our willingness to see the potential risks and move ahead anyways. A big piece of this is recognition. If you can recognize what is holding you back from change, you can externalize the fear, make it more manageable, and talk about it rationally with others.

How do you help patients accept and appreciate change? 

Why is it sooo difficult to manage people? Probably because we spend time trying to “manage” people.

I’ve come to the conclusion that people aren’t meant to be managed. Scary words from a CEO, right? The truth is, I’m not very good at managing people, so instead I strive for creating clear expectations, responsibility, and accountability.

I believe that everyone has unique gifts and we should position people to utilize their strengths. When someone isn’t performing up to my expectations, communication is the key to affecting change. I have learned that the ultimate outcome is completely in the hands of the team member.

So how do we hold people accountable and what happens when they repeatedly fail to live up to their responsibility? The key is effectively communicating the expectation for their performance and developing ownership around the outcome. I find it most effective to do this during face-to-face meetings with a system called the 3 Fs: Fair, Firm, Frank.

3 F’s of Effective Communication

Fair

When a team member underperforms, I schedule a short meeting with them to discuss the situation. During the discussion, I begin with questions about their behavior or performance to determine what led to it and how to correct it.

The objective: To make certain the team member understands the expectation of the level of performance, acknowledges where they fell short, and creates a commitment and a plan of action which results in achieving the expected level of performance.

In this meeting, you want to be FAIR – listen to the team member while creating clarity around what happened and what the preferred action would be to avoid repeating the situation in the future.

Firm

Sometimes the “fair” conversation doesn’t have the desired results or the team member improves for a period of time but then slides back into old habits. In the event that this happens, you will have to schedule another meeting. During this second meeting you have to be FIRM.

The objective: To have the team member, immediately, bring their performance up to the expected level.

Briefly review the area of underperformance and remind the team member of the commitment and plan of action they made during the first meeting. Be clear that if the team member chooses not to immediately bring their performance up to the expected level, that will indicate to you that they are not a willing, contributing member of the team.

Frank

Despite having the “Fair” and “Firm” conversations in an attempt to correct performance, there are times when a team member simply does not upgrade their performance to a consistent and acceptable level. If that occurs then it is time to be FRANK.

The objective: To clearly explain that the consequence of a failure to immediately perform at the acceptable level will be termination.

As with all leadership, you should find your own style, language, and habits. I tend to try to be encouraging and remind the team member of why I believe in them, while emphasizing the need for the team member to perform up to expectations.

I also like to email a team member after the meetings recapping what they committed to. This confirms I heard what they intended and that we are working off of the same expectations.

Regardless of your leadership style, the 3 F’s provide a solid guide for how to address underperformance in the unfortunate instance when it is progressive.

Note of thanks: Dr. Rachel Pullsen shared “the 3 F’s” with me and the other women who came together this past July for the first annual Pankey Women’s Retreat. Thanks so much, Rachel, and give a big thanks to your sister-in-law who I believe is the originator of the 3 F’s. We all grew as a result of your sharing!

Ever since I started my AEGD residency following dental school, I have loved continuing education. I’ve always sought new courses, new educators, new techniques. But for me, the most impactful educational experience was taking The Essentials courses at The Pankey Institute.

Not only did I learn about the complex temporomandibular and masticatory system, perhaps more importantly, I gained the skill and confidence I needed to tackle complex esthetic cases and truly found my sweet spot in dentistry.

Finding My Way in Dentistry

I am a bread and butter general dentist. However, my favorite cases are the ones that have the capacity to change someone’s smile, to make them not only healthier and more beautiful, but most importantly, improve their confidence. Once I gained these skills I wanted to implement them into my practice as soon as possible, but unfortunately I tripped over a few stumbling blocks before I found the right way to do that.

I remember one particular patient I had who really could have benefitted from some esthetic dentistry. I spent hours mounting the case, cropping and organizing photos, even waxing up anterior teeth on a model to show him the dramatic esthetic improvement I could make to his smile. That patient was engaged and listened to everything I had to say.

He came back for his second consult, asked questions, but at the end of the day never pursued treatment. I learned a valuable lesson in that case and numerous others. When I stopped presenting the treatment I thought patients needed and instead let them tell me what they wanted, I started closing cases.

As a part of my comprehensive exam, after the radiographs, the periodontal probings, the hard and soft tissue exam, and often clinical photography, I simply ask the patient, “Is there anything about the way your teeth look that you would like to change?”

To be continued…