03.20.09 Issue #367 Forward This Newsletter To A Colleague
Dealing With Staff Drama
Consultant Case Study
Phasing Treatment

Energy Vampire Bleeding You Dry?
by Sally McKenzie CEO
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Here she comes. You’re thinking, “Oh no. Not again.” All you want to do is turn and run. In five minutes or less, with just one conversation, it will seem as though the life has been sucked out of you. You will soon begin to feel the blood draining from your head and pressure on your chest. No, this isn’t a heart attack! Rather, it’s a close encounter with an energy vampire. No one can siphon the enthusiasm from the team faster than she can.

These spirit carnivores come in all shapes and sizes, but one characteristic dominates: they are unrelentingly negative. There are no silver linings, only dark clouds, and they cannot wait to send a downpour to wash your personal parade away. Saying they like to vent is like saying the Titanic had a leak. These people cannot stop talking about their misfortunes and oh, those misfortunes are many.

Countess Drama Queen can turn a little fender bender on the way into work into a multi-car pileup in which dozens were lucky to escape with their lives and bodies fully intact. There are no small events in this energy vampire’s life, only major calamities that require everyone to stop what they are doing and give their full attention to her.

Stopping System Collapse

Virtually every performance starts with a dramatic entrance, “You will NOT believe what just happened to me…,” or, “Oh, you have GOT to hear this!” She feeds on the drama—any drama—and instinctively incorporates it into her own life. The hygienist’s mom suffers a stroke? Countess Drama Queen is certain her recent headaches are an impending aneurism. If you’re lucky, after a few encounters you’ll realize that you’d better make your exit stage left immediately. Otherwise, you’re going to have to request a lunch break in the middle of today’s show. She’ll have you trapped as her captive audience; every scene and every possible scenario will be replayed in excruciating detail.

Then there’s Count Misery. He is convinced that because he’s miserable, you want to be. After all, he lives by the adage that misery loves company, and he certainly does. It’s him against the world. He’s never had a fair shake. Someone else is always to blame—his college professors, his coworkers, his staff, his wife, his mother, his father, his brother. He complains continually about work, family, stress, life in general, and he will tell you the same sob stories over and over and over again ad nauseam. You do your part by controlling your urge to tell him to just get over it already. You offer suggestions and helpful hints so that this person can get off this troubled train and onto the road to happiness. Forget it. All your caring suggestions are simply kindling for his gloom generator, which burns away at your expense.

One of the worst of the energy vampires is Count Spite. He is quick to blame others when things go wrong or don’t go his way. He is often cutting and insulting. His idea of positive feedback might be, “Well, you didn’t do as poorly today as you did yesterday.” He reduces a staff member to tears and his attitude is, “Oh well, she deserved it. She’s lucky I didn’t fire her.” He doesn’t take responsibility. He can do no wrong. He is equal parts extremely insecure and intensely competitive. He enjoys putting others in their place and making them look foolish and incompetent. Anger seems to percolate just beneath the surface, and will burst forth in an explosive geyser bordering on rage. This vampire can be downright scary.

Countess Constant Chatter isn’t necessarily negative all the time; she just needs to be the center of attention, much like Countess Drama Queen. She is only concerned about drawing attention to herself. She likes to talk incessantly about her family, her friends, her dog, her shopping, her cooking, her hobbies, and her advice. She’ll tell you how she plucks her eyebrows, what products she buys to clean her bathroom, as if you were actually interested in knowing such information. She simply cannot shut up. No matter what the direction of the conversation, she will take control and redirect it toward her. And, just like all the other vampires, she’s a master at draining the energy out of a room full of people before they ever realize it.

Next week, managing these vampires will require more than a string of garlic.

Interested in speaking to Sally about your practice concerns? Email her at sallymck@mckenziemgmt.com.

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

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Nancy Caudill
Senior Consultant
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Survive These Times….Give Your Patients What They Want

Dr. Marvin Black – Case Study #423

Dr. Black has prospered well over the last ten years but now things are changing rapidly and he was at a loss as to what to do.  Calling McKenzie Management for consulting services helped him get clear direction as to what to do to stay profitable.

Dr. Black’s practice statistics:

  • 22 New Comprehensive Patients per month
  • 5 New Emergency Patients per month
  • Service Mix (his would be considered very healthy in financially stable times):
    • 30% Diagnostic, Perio and Preventive
    • 10% Basic Restorative (composites, extractions)
    • 60% Major Restorative (C&B, onlays, veneers)

His primary concern is that his patients aren’t keeping their hygiene appointments and his new comprehensive patients aren’t accepting treatment.  It appears that the only guarantees of treatment acceptance are those patients with “emergency” needs – a crown to replace a fractured amalgam, a root canal for the abscessed tooth or an extraction for those patients that are not in a financial situation to accept the first two options.

Unfortunately, what Dr. Black didn’t realize was that his patients’ needs were the same but their wants were changing.

The Dental Menu
Have you noticed that when you frequent your favorite restaurant the menu changes from time to time?  Why?  Because the customers weren’t ordering that menu item anymore. This concept also applies to Dr. Black’s practice. He has the same patients but they aren’t “ordering” what is on his dental menu.

Change the Menu
It was obvious that in order to stay busy during a changing market, Dr. Black was going to need to adjust his approach. This change doesn’t need to be a permanent change, as Dr. Black is not excited about performing root canals and extractions. Over the years he has convinced himself that the “best” service for his patients was anything except extractions.  He is discovering now, after his practice income is 20% less than it was last year that he should take a different approach to his practice service mix. His patients are tightening their pocket books and are not as inclined to say “yes” to his “best” options.

Stopping System Collapse

What About Those Emergency Patients?
Historically, Dr. Black shied away from the potential new patient with a toothache. They were a “necessary evil” and interrupted his “perfect” schedule.  They weren’t inclined to accept his optimum treatment plan.  It was recommended to Dr. Black that he redefine what an emergency patient brings to the practice:

  • They will come whenever you give them an appointment and happy just to be seen
  • They can be “cash” patients since they aren’t a “patient of record” yet (assuming you don’t participate with their PPO plan)
  • They offer the practice an opportunity to invite them back to join the practice with a comprehensive exam and hygiene visit

Diagnosing and recommending treatment can be a source of stress because emergency patients are interested in getting out of pain, not your comprehensive treatment plan, so you have different expectations.  Dr. Black wants them to accept the “best” and they don’t want the “best” – they don’t want to hurt.  Why not respect their wants so it becomes a “slam dunk” treatment plan with 100% case acceptance?

What is Gained?
Why does Dr. Black want to invite emergency patients into his practice now?

  • To provide a “wanted” service to a patient in distress
  • Improve cash flow
  • Stay busy
  • Promote the practice

 Six months later, his production had increased and his overhead was reduced because the 11% lab overhead as a percentage of collections was now 7%.  Dr. Black was making more money!  As an added bonus, his “over-the-counter” collections increased from 38% to 42%

 When financial times are good, everything is good and patients say “yes” to the best possible dental options.  When times are more financially challenging, patients are much more selective.  Dr. Black was a smart business owner.  He recognized that his “menu” wasn’t working, so he changed it.  He put services on the menu that his patients would “order” instead of saying, “Sorry Mrs. Jones, I don’t offer that here.  I only provide the “best” dental options to my patients!”  Who is to say that what the patient wants is not the “best” for that patient?  Feel good about providing the best service, and give your patients want they want….everyone wins!

If you would like more information on how McKenzie's Practice Enrichment Programs can help you IMPLEMENT proven strategies, email info@mckenziemgmt.com.

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Belle DuCharme CDPMA
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Are Your Patients Going Through A “Phase”?

When presenting treatment diagnosis to patients, it is best to reinforce to your patients that your concern is for their overall health and total well being—after all, these are the main concerns of healthcare providers. Dentistry is important to achieving total well being and should not be downplayed to “watch it, and when it gets worse we will treat it.” So how do we translate evidence into billable, buyable services?

Often dentists are reluctant to think beyond the laundry list of procedures based on the diagnoses of evidence before them, but presenting the total treatment plan will absolve the dentist from not delivering all the information to achieve informed consent. Dentists often say that they feel responsible for giving a patient all treatment options during the initial visit or they will be liable for non-disclosure of important information. Yes, it is important for the dentist to comprehensively evaluate a patient prior to treatment and to report the findings in an accurate diagnosis explaining the appropriate course of treatment. However, if the patient chooses not to return to the practice, the dentist has little to do with the outcome.

When I look over many paper treatment plans and computerized treatment plans, I observe that the immediate treatment is blocked into appointments with everything that is to be done on the right side in the same appointment and everything happening on the left side in one appointment, whether it is scaling and root planning or crowns. Maybe the thought is to meet an hourly goal for production by doing as much dentistry at one time as possible. Sometimes this works but the patient doesn’t always understand the reasoning behind it. Plus, patients don’t care if you meet your daily goals.

By phasing treatment and explaining the system to the patient, a new understanding of where the patient is with a personal treatment plan will come about. Phasing of treatment is not a new idea but, because it involves monitoring the patient, it is often not implemented into the practice. For instance, all patients that have come in for emergency care are in Phase 1 and do not move out of this phase until no longer in pain and the immediate concern is under control. This phase includes necessary radiographs and may involve removal of infected teeth and antibiotic treatment. If this patient never returns to the practice after that visit, he/she remains in Phase 1. Actively marketing this patient for further treatment is often not pursued.

When the patient is free of pain, diagnosis is the next step in Phase 1. The remainder of the series of radiographs is taken along with diagnostic casts and intra-oral photos. The dentist may determine that the patient can go on to the hygiene department for assessment of their periodontal condition and preventive care. The dentist should monitor them through any periodontal care including scaling and root planing, the use of anti-microbials, desensitizers and topical fluoride treatments. That means coming into the operatory during hygiene visits to see the patient.

A satisfactory degree of periodontal maintenance must be achieved before a patient can move on to Phase 2 of treatment. The patient is educated to understand that the outcome of Phase 2 is dependent on the success of Phase 1.

Phase 2 starts when the hygienist and doctor determine that the patient has achieved an infection-free level of periodontal maintenance and is compliant with home care. This phase includes single- and multi-surface restorative on individual teeth. Endodontic treatment is performed in Phase 2.

Phase 3 includes single unit crowns, inlays and onlays. Teeth bleaching, if indicated, would be completed before the insertion of tooth-colored prosthetics. For children, space maintainers and orthodontic care is delivered while monitoring home hygiene care. Regular check-ups are required to warranty cast restorations and orthodontic outcome in this phase.

Phase 4 is the time for replacing removable prosthetics and the placement of implants. Fixed partials or overdentures are processed and delivered. Any additional periodontal surgery and other advanced treatment that is dependent upon the success of Phases 1 through 3 are performed. Phase 4 will also include further orthodontic care for children or adults. Compliance in maintenance and follow-up in the recall/hygiene department is again enforced to warranty all prosthetics, whether fixed or removable.

Phase 5 is achieved when the patient is placed into the recall system following the completed phases of treatment. The careful monitoring and follow-up of patients placed in recall is vitally important to ensure patient retention. Generally, patients appreciate letter reminders and calls in regard to scheduling their recall appointments; studies show that about 20–30% of patients that are overdue will schedule when called.

If treatment is phased, the patient should come to understand the necessity for continuing until treatment is complete and they can be maintained at a healthy level.

For more information about McKenzie Management’s Advanced Training courses, email training@mckenziemgmt.com, call 1-877-777-6151 or visit our website at www.mckenziemgmt.com.

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

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