9.26.14 Issue #655 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Nancy Caudill
Senior Consultant
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What is YOUR Philosophy Regarding Treatment Planning?
By Nancy Caudill, Senior Consultant

The question presented to me was: What is the industry standard for treatment acceptance and why would it vary from practice to practice? Let’s take a look at the following scenarios:

The Age of the Practice
If you have purchased an older practice with older patients, typically there is a lot of restorative work to be done. An exception to this rule would be an older practice that was owned by a doctor who was more direct with patients and may have completed most of the treatment that was needed, or at least what the patients were willing to accept. In this case you just have to wait until something breaks!

On the other hand, an older practice where the doctor has been very conservative with the treatment recommendations may tend to say, “Someday you will need a crown/filling”. This approach is beneficial, assuming that the doctor still owns the practice when these “acorns turn into oak trees”. However, the downfall of this approach is that when a doctor has been very conservative in his or her approach to dentistry and sells the practice, the dentist coming in reaps the benefits of all those “acorns” that were planted.

The Number of New Patients
The more new patients, the more obvious treatment there is to recommend and the easier it is for patients to accept. As a result, there is a higher number of treatment recommendations and higher acceptance percentage. The fewer new patients you have, the less treatment there is to easily recommend and the lower the treatment recommendations. This is not to say that the acceptance would be any lower. This would depend on the skills of the dentist and his/her support staff, right?

The Philosophy of the Dentist
Some dentists are very black and white: I see a cavity, you need a filling/crown. I see a crack, you need a filling/crown. I see leaky margins, you need a filling/crown. The old silver fillings are past their usefulness, you need new fillings. Others are more shades of grey: You might need a crown in the future if this tooth starts bothering you. You might need a crown in the future if more of the cusp breaks off. This old silver filling has passed its usefulness, but if nothing hurts, let’s just wait.
Is the Practice Insurance Driven?
For offices that have always allowed insurance to play a large part in the decision-making process of the patient, once that patient has used up their annual benefits they don’t accept any more treatment until next year, unless something hurts. For those offices that are more “want based”, patients are much more accepting of the recommended treatment by their dentist and have a much higher acceptance rate.

How Busy is the Practice?
Too many times, I see hygienists and doctors not taking the time with patients to educate them about their needs, and more importantly, their wants. Patients buy what they want. Doctors and staff, in general, are not good at offering patients options when there are no symptoms and it is not as easy to “sell” the patient on treatment.

The Dentist’s Ability to Present Treatment
Let‘s say that you have a patient with a fracture or craze line but the tooth is still intact, asymptomatic, etc. The patient has the following options:

1. Do nothing and wait until it breaks (could be tomorrow or years from now)
2. Repair the fracture with a large filling which doesn’t have a good long-term prognosis
3. Remove the fracture and restore the tooth with a crown to protect it from more damage in the future, with much longer-lasting results

Patients will respond to these 3 scenarios differently, depending on whether they are proactive or reactive. You don’t really know what the patient is going to choose unless you know your patient very well, and you may. It is like the scenario of buying new tires for your car – do you wait until you have a flat tire or do you replace them when the tread is wearing?

I also observe dentists using words like, “I think, maybe, could be, small, little, etc. This does not exude confidence in the diagnosis and can affect the patient’s willingness to accept treatment being recommended. Would you want your medical doctor to tell you that he/she “thinks” you need your appendix removed?

I see many dentists who “under-diagnose” or delay telling the patient what they see because it is the path of least resistance. A diagnosis may require more time to educate the patient and/or listening to patients ask questions or lament that they can’t afford treatment. I tell my clients all the time, it is not your fault that stuff happens to your patients’ teeth. You should feel good that you can help them save what was damaged so they don’t lose the tooth.

There is no right or wrong. You have to do what you are most comfortable with in your approach with patients. But at the same time, it is not fair to expect your schedule coordinator to keep you busy if there is no treatment being presented. If I had a magic wand, I would encourage my clients to give all the options to the patient and let them decide what direction they want to take. Your financial coordinator will help them to afford it.

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