Improving Case Acceptance for Comprehensive Interdisciplinary Cases

Patient education that facilitates the visualization of problems and potential outcomes is essential to success

Karla Soto, DDS

Comprehensive interdisciplinary cases, which are arguably the Holy Grail of being a "Super GP," are life-changing cases that transform patients into better versions of themselves—physically, emotionally, and mentally. Knowing how to properly execute these complex cases is one thing, but getting the patients to understand the value of the investment for the treatment that you're proposing is another issue entirely.

The Path to Acceptance

OK, so you've invested in acquiring the training and skills needed to work up these kinds of cases. You see a patient who could benefit from this approach, you gather all of your records, and you develop a treatment plan. You're ready to take this on. When the time comes to sit down with the patient to go over all of his or her treatment options, you may present your list of recommendations and find that the patient automatically agrees to everything. However, if you're like me and you have normal patients with wishes, fears, expectations, and financial, geographic, and time limitations, then the path to treatment acceptance for comprehensive cases is usually not so simple and requires patient education.

Due to these and other factors affecting patients' decisions, clinicians should try to remove as many potential barriers to treatment as possible before they even get to the point of presenting. The first step to understanding the goals is being able to visualize the possibilities—not unlike seeing the blueprint of your dream house. And because people are largely visual learners, this can help to communicate the plan in a way that resonates better. It is important to note that conveying the possibilities without any bias is key to achieving patient buy-in during this process. Regardless of the predispositions that we as clinicians may have developed over time, such as having an insurance-based mindset or making financial assumptions based on a patient's socioeconomic status, or how the industry may have misinformed the patient population, it's our responsibility to educate patients regarding the ideal goals of treatment.

Seeing Is Believing

Thankfully, the idea of "seeing is believing" holds true in any case—big or small—whether it entails patients seeing the problems or seeing the solutions. However, when focusing on the presentation of complex, potentially life-changing cases, there is even more of a reason to pull out all the available resources from your tool belt to enable the magic to happen.

Digital dentistry has opened up a whole new world of amazing possibilities that has not only elevated the way that we communicate with patients but also raised the bar regarding how we diagnose conditions and plan and perform treatments. For the treatment planning stage of the patient journey, there are currently many ways of going about helping patients visualize their problems as well as the possible outcomes of treatment, including the following:

• Traditional methods. The presentation of digital photography and radiographs, including the use of photoshop or drawings to convey outcomes.

• Two-dimensional facial visualizations/simulations. There are a variety of standalone applications and modules within digital design software programs (eg, Smile Creator, exocad [Figure 1]; SmileFy, SmileFy [Figure 2]; Evident Kois Hub, Kois Center [Figure 3]; Invisalign Smile Architect, Align Technology) that can be used to show patients what they might look like at the completion of treatment.

• Intraoral scanner simulations. The software applications of many intraoral scanners (eg, Invisalign^® Outcome Simulator Pro, Align Technology [Figure 4]; TRIOS^® Treatment Simulator, 3Shape) offer tools that use artificial intelligence to simulate outcomes for patients.

• Smile test drives. Motivational mock-ups with the aid of before and after pictures and video can be designed by a technician or by the dentist and delivered to patients so that they can visualize the final result in their own mouths (Digital Smile Design [Figure 5 and Figure 6]).

General Guidelines

Regardless of your approach and whether or not you're taking advantage of all the platforms available out there or not, it's fair to say that there are certain fundamental principles for improving acceptance that apply any time that you're presenting a treatment plan but especially during complex treatment plan presentations, including the following:

• Begin with the end in mind. Focus on the "why" then explain the "what" and "how."

• Be well prepared. Do your homework, study the case, and have in mind all possible options.

• Sequence when necessary. When possible, the patient's chief concern should take precedent, but you may have to break up big treatment plans into smaller parts to make them financially feasible. This may take weeks, months, or years, but at least the patient is moving in the right direction toward an optimal outcome.

• Be ready to compromise. Sometimes, the ideal treatment plan is just not realistic to the patient. You can provide guidance regarding what is ideal, but in the end, you are there to provide the best solution that is acceptable to the patient.

• Be present. To really connect with your patients, don't be in a rush and don't double-book appointments when presenting.

• Be a care manager. If you aren't doing all of the interdisciplinary work yourself and use a team of specialists, make sure your patients know that you're managing all of their care from a big-picture perspective and that you are their point of contact.

• Meet each patient at his or her level. Patients' personalities are all different, which can require different approaches. Read their body language and adapt to it while remaining authentic.

• Align your team's efforts. Patients' experiences start way before they meet you. This is an important life decision, and the way that they feel about the energy of your team and practice is a key element.

The process of considering complex treatment is an emotional journey for patients, and there are key moments for decision-making throughout. I recommend explaining costs and making financial arrangements during the same appointment that patients become emotionally invested after seeing their possible results. When you or your treatment coordinator are discussing financials, you must have a variety of options available, whether they involve partial insurance coverage, payment plans, third-party financing options, or even cash discounts for prepayment. Providing plenty of alternatives will increase your chances of closing on the needed treatment because most of the time, the financial investment in interdisciplinary cases is significant.

A Shift in Mindset

Sometimes, giving a full case presentation can be intimidating; however, this experience is priceless for both the clinician and the patient. The worst-case scenario is that patients say "no," but at least you provided them with a complete experience, developed trust, and potentially gave them the most information about their oral health that any provider has ever given them. If they can't do the full workup, then the chances are that they will either stay to do some minimal work or they will come back to you when they are ready, but either way, they will recommend you to other friends and family.

The moment that you fully value yourself, your time, and your skills, your confidence in presenting these cases will improve. That shift in mindset is essential to improving interdisciplinary case acceptance and achieving success, not only for us but also for our team members. The beauty of maximizing the available resources out there is that it allows us to focus on what really matters, which is that human connection. At the end of the day, the most important thing is delivering the most appropriate care while treating people with kindness and empathy, but success starts with you.