10.26.12 Issue #555 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Signs of a “Sick” Practice - Part 1
By Sally McKenzie, CEO

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A friend of mine recently asked me to recommend a dentist for her. I was somewhat surprised because I knew she had been with her dentist for some years, and she isn’t the type of patient to shop around for a “dental deal.” So I asked if she was unhappy with her dentist’s care. Her response was, “No, but I don’t really think he wants to be doing dentistry.” I was intrigued. As the conversation continued, it became abundantly clear that this is a very “sick” practice. Let me explain.

For starters, I learned that the office is open only three days a week, making appointment scheduling inconvenient for patients - and that spells trouble for retention and disaster for growth. The doctor is in his 60s and remains a sole practitioner, which is a waving red flag that the practice is most assuredly losing more patients than it is retaining. The office manager, who has been with the doctor since day one, insists on six-month pre-scheduling for hygiene patients. If patients have to cancel, they are placed on the “cancellation call list,” meaning the patient will be contacted when an opening occurs. The phone calls from the practice trying to reschedule the patient usually begin the next day and continue every day the practice is open. What does that mean? Cancellations and no-shows are an issue, and not a small one.

Scheduling patients months out will not ensure a full schedule; it is a myth that has been disproven again and again and again. Yet, offices refuse to let go of this fallacy even though it’s costing them a fortune in time, inefficiency, and patients. If ever there were a perfect example of an office that, at a minimum, needs to try another approach, this is it. Clearly, many of the patients in this practice would respond better to receiving a professional notice via email or USPS two weeks in advance of their due date notifying them that it is time to schedule their professional dental hygiene appointment. An appointment that is made within a couple of weeks has a far higher compliance rate than one made six months ago.

But there’s more to this situation than merely the six-month scheduling issue. As the conversation continued, I learned that the office manager is friendly enough as long as you don’t have to reschedule an appointment. If an emergency arises and you have to cancel at the last minute, it will result in an “uncomfortable” conversation with her. She will remind the patient that the cancellation policy is clear: “The office requires two days notice for all cancellations.” If patients cannot or will not follow the manager’s “rules,” over time they will come to feel very unwelcome in the practice.

Unfortunately, the troubles don’t stop at the front desk. If the patient needs treatment, the good news is they can get an appointment to see the doctor within days. The bad news - for the practice, not the patient - there are multiple appointment openings to choose from. What’s happening here? It’s obvious. The doctor does not have enough new patients to support his schedule - even three days a week are difficult to fill.

Moreover, I learned that my friend had to practically beg the doctor to address the cosmetic issues that she wanted taken care of. During an appointment for a filling, he finally recommended six anterior crowns. They also briefly discussed the possibility of whitening as well as adult ortho. It went something like this: “You probably should consider crowns on those six front teeth. You might want to think about some adult ortho as well as whitening.”

This was a breakthrough. Finally, there was hope that she could get the cosmetic treatment she wanted. However, she realized this would be no small investment, and she wanted more information. The doctor completed the filling, left the room, and naturally, the patient began quizzing the assistant. “How much time would the treatment take? How much are the crowns? Does the doctor offer Invisalign or will I have to see an orthodontist?” As is so often the case, this unprepared staff member was thrown into “treatment presentation” mode. The assistant hastily dodged the questions and told the patient that she would share them with the doctor. The office would call her to schedule a treatment consultation visit soon, so that the doctor can further explain his recommendations.

Four weeks have passed and the patient has heard nothing from the practice. Next week, more signs of a “sick practice.”

For more information on this topic, visit my blog: The Lighter Side.

Interested in speaking to me about your practice concerns? Email sallymck@mckenziemgmt.com
Interested in having Sally McKenzie Seminars speak to your dental society or study club? Click here.
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Belle DuCharme, CDPMA
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Are You Updating Patient Health History Forms?
Belle DuCharme, CDPMA

Dear Belle,

“My husband was up all night bleeding from his mouth from an appointment to prepare two teeth for crowns. He is a heart patient with an artificial valve and is on Coumadin.   His tongue and cheek were cut by dental instruments and they could not stop the bleeding but sent him home anyway. He said they never asked if he was taking the Coumadin but asked if he was taking aspirin. He is seeing his physician today. Is this right?”

Worried Wife

Of course this scenario is not right, and sadly it happens too often in dental practices. Carelessness in updating patient medical histories leads to incomplete record taking and possible injury to patients. An accurate and current medical history is an essential tool in providing excellent dental treatment. Protecting both the patient and the dentist from unnecessary risks requires a written medical history to provide information to accomplish the following:

• Identify medications to prevent drug interactions and possible side effects
• Identify any oral manifestations of systemic disease or pharmacotherapy
• Identify and manage patients with compromised medical conditions such as heart disease, high blood pressure and diabetes
• Identify patients using substances that interfere with healing such as tobacco and alcohol
• Identify patients that may have eating disorders or other behaviors affecting dental health
• Identify patients that have had implants such as knee and hip replacements
• Identify patients undergoing chemotherapy
• Identify patients with back or neck problems so that they can be made more comfortable
• Identify any new allergies such as latex
• Identify patients that are developing symptoms of a disease
• Identify and verify the need for pre-medication

Failure to obtain, update and investigate each patient’s medical history is a basis of negligence and has been the root in alleged professional liability claims against dentists. The following steps should be taken at every patient dental visit:

• Review in private the written history
• Ask the patient if there has been any changes in their health or medications since the last visit to the dental office
• Have they suffered any injuries or illnesses since the last dental visit
• Confirm the current medications and dosages including dietary supplements
• Note any changes in the patient’s computer chart and paper chart (both must match if you are maintaining both types of records)
• Visually assess the patient for any remarkable changes since the last visit such as loss of weight/weight gain or psychological stress such as loss of job or death in family
• Have the patient sign and date the update or a new health history if there are several changes or if you have a new health history form
• Staff member taking the information must sign and date also

All staff should be trained in checking medical alerts for patients in both computer and paper chart records. The information should be displayed clearly so that all providers are aware of the patient’s conditions. Using paper charts? Do not write history on the front of the chart. Put a red medical alert tag on the patient’s record which will warn the viewer.

During the morning business meeting the clinical staff must review each and every patient for medical alerts and possible complications to treating each patient. Who is responsible for the task of updating medical records? The dentist is ultimately responsible for the diligence in protecting patients from risks of harm, but other staff members are not immune from discipline. In many offices this task is considered a clerical or administrative task. It is when asking the patient for the information, but it is the clinical provider’s duty to investigate and understand the ramifications of the history in relationship to the dentistry that will be delivered to the patient that day. 

Presenting treatment plans to patients is also a good opportunity to check medical histories. The patient will be required to sign informed consent forms that let the patient know what to expect before, during and after treatment. Medical histories, drugs and supplements are verified to make sure there will be no unfavorable interactions during treatment.

The American Dental Association has the latest information on what questions should be asked on health history forms. The uniformity and consistency of this system is paramount to the protection of the patient and the dental providers. Make it a priority in your practice, not an afterthought.

Take your practice to a higher level of professionalism by enrolling today in a McKenzie Management Dental Business Training Program.

If you would like more information on McKenzie Management’sTraining Programs  to improve the performance of your team, email training@mckenziemgmt.com

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Gene St. Louis
VP Practice Solutions
McKenzie Management
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Goals of Case Presentation and Treatment Acceptance
By Gene St. Louis

Case presentations are based largely on communicating specialized health care information to patients who are nearly always laypeople - therefore, they shouldn’t be long or drawn out. Time requirements are determined by how long it takes the presenter to achieve the necessary communication, i.e., 10-20 minutes. Case presentations should be thought about in advance so information is clear and concise. The most effective presenters are often those who take the least time - however, the presentation must never seem hurried.

It is impossible, of course, to compose a case presentation that will be appropriate for all dental professionals and all patients. It is essential for the presenter to use his/her own words and own manners of speech. Presenter confidence and enthusiasm can only come from experience and the desire to succeed. When dental professionals are convinced their treatment plans are the “right thing” for the patients, they soon develop an aura of confidence that is unmistakable and readily communicated. All patients need to feel a sense of concern from their health care professionals. 

When patients have been sufficiently involved in the diagnostic process, case acceptance is almost guaranteed. If the patient detects that you are trying to “talk them into it” they will resist. The thing that turns people off the most is when they perceive that they might be talked into something. It is human nature to resist being told what you must do.

You Must Establish the BLT
When someone likes you, they want to believe you. When they Believe you and Like you, they will Trust you. When BLT is established correctly, with the right type of patient, there are few patient objections to treatment. BLT does not mean you’re everyone’s buddy. This is the foundation for having happy patients who complete treatment and maintain recall as well as making referrals. Make them feel important. Give them your undivided attention and communication. Be sensitive to the patient’s anxieties.

Use the SWOT Rule
Strengths - Find out what good dental experience that patient has had (their likes). “What is it you are looking for/expect from a dental office?” “Tell me about your good experience at dental offices?”

Weakness - Find out what bad experience that patient has had (their dislikes). “Is there anything you don’t like about coming to the dentist?”

 Opportunities - What is the patient interested in for themselves from a dental perspective, i.e. what do they perceive their interest to be? This will clue you into their dominant buying motive. “If you had a magic wand, tell me what your teeth would be like?”

Threats - What are the patient’s concerns (objections) to having the treatment done, i.e., fear of pain, money or time. These threats must be addressed. “Is there anything that has kept you from getting your teeth fixed?”

When treatment planning your next case, consider this flow:

1. New Opportunity or Research (prior to arriving)
New Patients - ask for referral source; Existing Patients - make sure you know what they came in for at their last visit for and if any treatment is outstanding; Lost Patients - ask how the patient has been treated and if everything is ok.

2. Pre-Approach or Pre-Heat (prior to arriving)
Find out what the patient knows about you and the practice prior to the appointment

3. Initial Communication/Interview/Introduction
Combined with New Opportunity and Pre-Approach, it creates the ultimate in chair-side manner and rapport. The combination of the three utilizes the principle that 85% of successes come from the ability to deal with people effectively and 15% is from technical skills. Prior to the meeting, patient information must be shared (preferably in the morning huddle) about what was gathered from the New Opportunity and the Pre-Approach.

4. Opportunity Analysis and Discovery
The art of finding out what the patient really wants and how to present it in a manner they want - determining whether the patient has immediate or future needs. Identify and develop solutions to the patient’s primary interest or buying criteria, use presentation tools like patient education systems, etc. Don’t run off patients due to an overload of clinical information. No one likes to be “sold” something they do not want or do not understand. Understanding each patient’s concerns/needs is critical for having successful case presentations. All patients are unique and will respond most positively to presentations that are developed specifically for them.

5. Solution Development and Presentation
This is the consultation phase of the complete exam where you pattern your presentation to satisfy the buying motive of the patient. Consider phrases to help open the patient’s mind. “Would it be important to you…?” “Am I safe in assuming…?” “If there were a way…?” “Would you have an interest in…?” Also consider questions used after a statement to maximize the impact and the retention level of the patient. “Is that correct?” “Is that important?” “Do you agree?” “Am I right?” “Is that accurate”?

6. Patient Evaluation/Objections
Listen - don’t interrupt. Cushion - use a neutral acknowledgement: “I appreciate your concern and hear you.” Question - reshape the objection into a question to be sure you understand what their objection is.

7. Commitment to Buy or “The Close
Get a commitment from the patient. Examples: “Do you see any good reason that we shouldn’t start today?” “Would you like to begin treatment on Monday or Wednesday?”

8. Service or Follow- Up
The job of the dental team is not only to “close a case” but to create and maintain a happy, paying patient for life who will refer other happy, paying patients to the practice.

McKenzie Management offers professional training to yield significant improvements in securing patient commitment. View the Treatment Acceptance Training Program details HERE.

Interested in speaking to Gene about your practice concerns? Email gene@mckenziemgmt.com

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