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  04.07.05 Issue #161


Treatment Presentations Like Taking a Walk down the Long Green Mile?

Sally Mckenzie, CEO
The McKenzie Company

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There you stand, saying your goodbyes to the patient, certain that you will be seeing her again very soon. You are absolutely confident that you have just provided one of the most exceptional treatment presentations of your career. The patient was positively transfixed. Nodding in affirmation, smiling in agreement, without a doubt she will proceed with your recommendations. It’s positively incomprehensible that as the patient makes her way to the appointment desk, that perfect plan for ideal dentistry might just as well be making its way down the long green mile.

Why is it that patients who are eager, willing, and ready to proceed with recommended treatment as it is presented by the doctor, quietly send the best of plans to the worst of fates with little more than a preliminary hearing?

Where confidence and conviction prevailed just moments ago as the patient gushed over the oral health opportunities spread before them, concern, ambivalence, and/or fear sweep in and suddenly that ideal treatment plan that was all but signed, sealed, and delivered is now simply under review.

It can be agonizing for dentists who are eager to provide comprehensive dentistry to find that they are wasting precious time presenting treatment plans that are relegated to the “maybe someday” list. While there are many factors in securing treatment acceptance, rethinking some basic patient communication strategies can yield significant improvements.

Number one: Are you the right person for this particular job? Before you gasp in horror at the notion that anyone but you can detail specifics of recommended treatment plans, consider this: Patients are often much more comfortable discussing their treatment plans with an auxiliary than with the dentist.

It is quite common for patients to feel uncomfortable asking detailed questions of the dentist. Some are concerned that they may unintentionally imply that they do not trust the doctor’s recommendation. Others are worried that they are taking up too much of the doctor’s valuable time. Still others find that if they do ask questions, the answers are too clinically detailed to truly understand.

In addition, patients often feel awkward discussing fees with dentists. Many patients see dentists as being in a very high-income bracket, and they perceive that the dentist may not understand their financial limitations. Conversely, dentists who get into the habit of discussing fees and financial arrangements with patients can feel unnecessarily pressured to make concessions or provide credit options that are well beyond what is reasonable for a small business to offer.

What’s more, dentists typically don’t see any problem with presenting treatment plans in the operatory. However, patients feel they are at the mercy of the doctor in this space; it is not conducive to a relaxed, detailed discussion. Treatment plans should be delivered in a separate area of the office designated as a “no interruption zone” where plans can be spelled out and patients are encouraged to ask questions.

If treatment acceptance in your practice is not within striking distance of the recommended 85%, it may be time to consider if your practice could benefit from a treatment coordinator.

Next week, just what could a treatment coordinator do for your practice?

If you have any questions or comments, please email Sally McKenzie at

Interested in having Sally speak to your dental society or study club? Click here.

Are you winning in the race to beat the clock?

Dr. Nancy Haller
Executive Coach
The McKenzie Company

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Despite my love of longer days, I hate the beginning of Daylight Saving Time. Advancing the clocks at home and work reminds me of how precious time is. The thing about time is that it can only be spent, it cannot be saved. And there are only two ways to spend time: wisely or not so wisely.

I may not be a financial wizard, but I know the basics - if you want to build a nest egg later on, you can’t spend everything you earn now. This same principle applies to our most valuable and undervalued resource – time. In fact, time is more precious resource than money. After all, money comes to us as a direct result of how we spend our time. If you want more productivity out of your time in the future, you have to shift the ratio from "expense" to "investment".

1. Waste Disposal
The first step is a critical appraisal of how you spend your time. Question your habits. How much of your time are you spending foolishly? For simplicity sake, let’s say you earn $100,000 per year and work an average of 40 hours per week for 48 weeks. That amounts to 86 cents a minute. Rounding that up to an even dollar, that’s $5.00 for 5 minutes. Now, ask yourself, how many 5 minute sections of your daily activities are worth that kind of investment?

Keep a time log for one week. In your time log, look at each work activity and decide objectively how much time each was worth to you, and compare that with the time you actually spent on it. An afternoon spent polishing an internal memo into a Pulitzer prize winning piece of provocative prose is waste; an hour spent debating the goodbye gift for a colleague is waste; a minute spent sorting out the paper-clips is a waste (unless relaxation). Don’t’ allocate time to the trivial. More importantly, if you have a task to do, decide before hand how long it should take and work to that deadline, then move on to the next task.

2. Stop Doing Your Staff’s Work
Having considered what is complete waste, turn your attention to what is merely inappropriate. You say it’s often easier to do the job yourself. You think that putting postage on outgoing mail ensures that bills will be sent that day. Writing the progress report that your dental assistant missed is more pleasant than sending it back. Nonsense!

Large gains can be made by assigning duties to your team. Invest time in clarifying job responsibilities. Give feedback when they do not meet agreed-upon expectations. If you have a task that could be done by an employee, use the next occasion to start training him/her to do it instead of doing it yourself. You will need to spend some time monitoring the task thereafter, but far less that in doing it yourself.

3. Prioritize
Use the 80-20 Rule originally stated by the Italian economist Vilfredo Pareto who noted that 80 percent of the reward comes from 20 percent of the effort. The trick to prioritizing is to isolate and identify that valuable 20 percent. Once identified, prioritize time to concentrate your work on those items with the greatest reward.

4. Eliminate the Urgent
Urgent tasks have short-term consequences while important tasks are those with long-term, goal-related implications. Work towards reducing the urgent things you must do so you'll have time for your important priorities. Flagging or highlighting items on your To Do list or attaching a deadline to each item may help keep important items from becoming urgent emergencies.

5. Consider Your Biological Clock
Our bodies have more than 100 circadian rhythms. Each unique 24-hour cycle influences an aspect of functioning, including body temperature, hormone levels, heart rate, blood pressure-- even pain threshold. Understanding how these cycles interplay is fascinating. Pay attention to what time of day are you at your best. Are you a "morning person," a "night owl," or a late afternoon "whiz?" Knowing when your best time is and planning to use that time of day for your greatest priorities is effective time management.

Over the next week, we will all have 168 hours. How much of your time will you allocate toward the investment side?

If you want to get a higher rate of return on your future, contact Dr. Haller at She will help you to make more productive use of your time.

What Are Your Real Practice Boundaries?

Scott McDonald

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Doctors are throwing thousands of dollars in marketing money down a gutter each year because they have not figured out their REAL practice boundaries.

After twenty years researching thousands of practices, we find that most solo practices get 80% of their patients from only three Zip Codes. Often practices will draw more than 50% of their patients from only one Zip Code area. So does it make sense to “cover the bases” by buying an ad in a yellow page directory in a neighboring city? NO!

People need to understand the physical and psychological boundaries to their practice. In rural Kansas, a dentist 45 minutes away may be perceived as “conveniently located.” On the other hand, a practice two blocks away in the wrong direction in Manhattan is “out of someone’s way” and not frequented. Still, if a patient is tied to a dental plan with few providers, many of these rules go out the window.

Physical Boundaries
We define physical boundaries as any geographic feature that affects the shopping patterns in a population.

  • Large Physical Boundaries
    Where there is a river, mountain, grade, construction site, or monument, it will affect how people move throughout the area.
  • Time Boundaries
    Many physical barriers are noted for their impact on the length of time it takes to travel to a given practice. Some of these may be the layout of roads and highways.
  • Smaller Physical Boundaries
    The most obvious examples of physical boundaries may be big, but smaller local boundaries may also affect your practice boundaries such as City Hall, a landfill, or community dump.
  • Seasonal Boundaries
    Some physical barriers are permanent while others are seasonal and can include:
    -drawbridges, a major issue during voting season
    rivers or flooding, a major issue in Phoenix for years with the Salt River
    roads closed for snow
    tourist seasons, spring break in Florida for instance

Psychological Boundaries
In some ways, psychological boundaries represent a more difficult area to view. They are less obvious, and change over time. Still, with careful examination you can begin to see how these affect your practice as well.

  • A Bad Name
    Can anyone really say that the upscale Colorado suburb of Columbine has not struggled with its name recognition after the school shooting tragedy of the past? The community is actually upscale, growing, and pleasantly residential but the events associated with the site are not easily shaken..
  • Interstate Freeways and Bridges
    Even if an overpass, underpass, bridge or railroad crossing is porous (allows traffic to flow normally from one part of an area to another) people can see them as psychological barriers. Literally, the “other-side-of-the-tracks” is the “other-side-of-the-tracks” for some people.
  • Old Perceived Barriers
    The classic case is when railroad lines become inoperative. Even when there are no more trains, even when they take away the tracks, the thought that there was a physical barrier tends to influence behavior. It takes remarkably long for a traffic pattern to change when a new right-of-way is completed. After all, humans are creatures of habit.
  • Demographic Group Identity
    While it may sound odd to some, many parts of a community gain their identity from a dominant group. San Francisco has its Chinatown, North Shore (Italian District), and Tender Loin (we are not talking cuts of meat). But most communities have their Skid Rows, Red Light, and Bar Districts along with a Catholic, Baptist, and SDAs part of town
Over time images change. Traffic patterns change. Nevertheless, it takes years in most cases to erase a psychological boundary in a patient’s mind.

Boundary Formation
So, how can you rationally describe or define your practice boundaries? Some dentists rely upon artificially imposed boundaries to represent a practice area. They choose, for example, a City or County boundary. Unfortunately, this is rarely appropriate.

Perhaps the best standard unit is the Zip Code. Still, smaller units can be used to more accurately define the area that a practice wants to reach or already serves. These are called “carrier routes.” A carrier route is defined as the route that a single postman covers. They are created by the local Post Office and can be obtained free from the central post office in the city (usually the one that handles bulk mail).

Census data can also be used and is assembled by Census Tracts (units roughly comparable in size but using different geography to carrier routes). It is possible to do very exact demographic analysis on this more localized information because “better” households can be targeted while “less desirable” households can be eliminated. Still, if any marketing is to be done, we believe the Census Tracts will be more practical.

Once the practice boundaries are defined, you will be able to target your market dollars in a place where they will really do the most good.

Scott McDonald is the former Marketing Manager for the California Dental Association, national lecturer and author and provides demographic marketing and site analysis recommendations for The McKenzie Company. For more information email or visit our website at

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