What Patients REALLY Value
True story #1
Brad works for a huge dental implant company that you all know very well. He has an implant in the # 30 spot that is over 10 years old and he loves it. He completely gets implants and their true value. His big poodle dog is named LuLu. Last year, LuLu had a problem. A problem that required immediate lifesaving surgery in the middle of the night. The emergency vet says it can’t wait until tomorrow. Either surgery or euthanasia. Right here, right now, no other choices. Surgery costs $3,500. Decisions, decisions. LuLu got the surgery and is doing well today.
True Story # 2
Kecia is a long term (chronic?) patient that kinda sorta comes in for recall appointments, but really deals with problems only when she has to. She says she wants beautiful cosmetic dentistry, but balks when she realizes she actually has to pay for it. Today she needs a crown to restore a badly fractured tooth #12. Kecia has to make special financial arrangements and split up her P.P.O. insurance co-payment for the treatment needed so she can begin the crown today. During the appointment, Kecia talks on and on about her many trips to Las Vegas to shop, eat, and gamble. She wants to make sure her temporary will stay on because she leaves tomorrow for her 4th trip to Vegas this year.
True Story # 3
Sandra is a new patient that is missing most of her posterior teeth. Her chief complaint is “I can’t chew”. After the initial consultation, she chooses upper and lower flexible partials over implants due to insurance coverage, finances and immediate esthetic wants.
Fast forward 4 weeks. Sandra has been in several times for adjustments and is completely fed up with both partials despite the fact that they fit well and look great. With an extremely accusatory attitude, she demands a full refund, including her insurance payment, saying that she is going to see a dentist that “knows how to make good fitting partials.”
True Story #4
Shane is a nice patient that has a good job with good insurance. He drives a newer Ford F-250 that probably costs around $50,000. He has a highly active decay rate that is promoted by his constant soft drink intake. He really needs 5 implants and crowns to restore his mouth correctly and to avoid something removable. His dental insurance policy has implant benefits, but he must spread out the treatment over time due to financial issues. The treatment plan progress is delayed by annual insurance maximums and must be spread out over several years. Shane is getting the implants, slowly but surely. Oh, as long as nothing else breaks tomorrow.
True story #5
Clint is a 59 year old, long term patient that has been missing several posterior teeth for many years. Over time, his occlusion has totally collapsed due to the missing teeth and esthetically he is a mess. He came in one day specifically to find out what his options were, what insurance covered, and to find out what it would take to “make things look better”. After a 45 minute consultation and in depth conversation explaining his options, he was presented with a $5,000 staged treatment plan, including insurance coverage, that would not completely fixed his problems, yet make dramatic improvements esthetically and functionally. When he looked at the treatment plan, he exclaimed “That’s way too much! I just retired, I can’t afford this.” He has yet to begin any treatment. Obviously, Clint values retirement much more that a healthy smile.
All of the people in these stories had to make choices and these choices were based on their perceived knowledge, finances, emotions, and lifestyle values. Some made choices based on sound information and understanding while others made emotional decisions based on a lack of knowledge or just plain ignorance. Obviously, all parties felt very confident that they were making decisions in their best interests, even though it often wasn’t the case. In many cases, the culprit is a lack of accountability or responsibility by the patient. Patient education only goes so far when someone is only focused on fun things and not willing to consider the ramifications of truly important decisions.
Many times the patient expects the dentist to restore them to full natural function but operate within the limitations of finances, insurance benefits, and patchwork dentistry. Unfortunately for a good number of these patients, healthy teeth take a backseat to many of the other luxuries life has to offer. Expensive trips, cars, houses, and other frills often come way before financing excellent dental treatments. Many patients just do not understand the complexities and required costs associated with providing cutting edge dental restoration and these perceptions can lead to compromised outcomes. Even worse, these irrational perceptions can lead to adversarial conversations between the doctor and patient.
There are many wonderful patients that truly value what modern dentistry has to offer and are accountable to their personal decisions. They understand that exquisite dentistry can solve their problems, it doesn’t just happen by chance or with outdated dental options. They also understand that there is a cost involved with the process and you get what you pay for. These patients are the ones that we will go the extra mile for to insure that they get the dentistry they need.
If we only had a schedule full of these wonderful patients, the world would be a better place. Unfortunately, we only remember the few bad apples, those patients that blame us for their problems or get downright angry because we can’t solve their problems in the way that suits them.
Focused Patient Education
We in the dental profession often wear our hearts on our sleeves. Our feelings get hurt when patients don’t completely accept our treatment suggestions and write big fat checks before treatment is even started. This is the reality of our society and things aren’t going to change in the foreseeable future. The question is, “What can be done to minimize the problems that come from patients’ perceived values and expectations?”
The patient MUST understand and own their problems.
Ultimately, this is the issue that has to be resolved for any dentist-patient relationship to succeed. Dentists do not spend enough time or use the correct phrases to make sure that patients completely understand that the dentist did not cause the problem. By addressing and discussing the problem in depth or even to the point of sympathy, patients should be able to completely comprehend that their problem requires cutting edge dentistry and technology to correct it. They also must comprehend that there are no easy fixes in dentistry and that patience is a must. Dentitions do not fall apart overnight nor can they be reconstructed properly in a single day. Additionally, patients have to understand that biological factors can add another layer of complexity to any implant case. Continued discussions of the initial problems and progress of treatment is also beneficial to remind the patient of where they came from initially.
Ugly pictures are invaluable.
Dentists love to show off beautiful pictures of their best veneer cases, but how often do we show decayed teeth, gaping holes, or aggressive gum disease? By only showing finished cases that turned out well, we may be doing a disservice to our patients by sugar coating the problems they have. It is important that dentists not only focus on the beautiful end results but also the realities of failing teeth. So often patients expect perfect, natural looking results but never take into account how bad their oral condition is.
Dentists can often head off troubles caused by patients’ irrational thoughts and perceptions by taking lots of before and after pictures. In the end, patients never remember how bad they looked before, only that they are not 100% satisfied with the final product. Ugly before pictures can be invaluable when a patient is complaining about the final cosmetic results.
Physically hand them a partial or denture.
Seriously, hand them some false teeth. Make them pick it up and actually handle these acrylic monstrosities. Ask them what they think. How they will eat, smile, and kiss with these things in their mouth?
This one exercise tends to really wake patients up to the realities of old school dentistry vs. modern cutting edge dentistry. Patients think they understand what dentures and partials are and how they feel, but in actuality, they really have no concept. They think “false teeth” are somehow like natural teeth, not big chunks of acrylic or Valplast.
By physically handing a patient a denture or partial, it opens up a world of questions and quite often opens their eyes to the true issues that they have never even considered.
Many patients have great insurance benefits, but they don’t have a clue as to what it covers or what their best options are. By taking 5 minutes and doing a complete investigation of a patient’s insurance policy, we as providers often open up a world of Class A treatments that patients never knew they could have access to.
Signed Informed Consent.
Not just for surgery. Informed consent for any major restorative treatments can be a real benefit later on, especially when the patient chooses removable over fixed options. Spell out the possible problems on the front end and the patient may consider different options or at the very least, they can’t come back and rail you about a good fitting partial.
Marketing to patients today can be an extremely difficult or even a precarious undertaking due to the fact that people sometimes want things that dentists cannot possibly deliver. The reality is, things are always going to be like this no matter how much we want them to go away.
By being aware that patients value different things at different times in their lives, we in the dental field must always be prepared to work around these perceptions and desires. By taking extra time when educating patients while also considering their true values and desires, dentists can often overcome difficult situations and produce better outcomes for patients and better results for their overall oral health.