Selling the Treatment Plan
Listening to patients to determine their values is essential in motivating them to accept treatment
Richard P. Gangwisch, DDS
I hate the word "sell" when it is used in the context of trying to persuade patients to accept treatment plans. When I went to dental school, we were taught that we were the doctors and that we would be the ones who would decide what was in our patients' best interest. Then, I entered into private practice, and cold hard reality hit me smack in the face. It didn't take too long for me to realize that the patients would be the ones who were deciding what was in their own best interest. This is where the word "sell" comes into play. Merriam-Webster offers many definitions of the word "sell," but the most appropriate in this context is probably, "to persuade or influence to a course of action or to the acceptance of something." Several of the other definitions carry highly negative connotations, reflecting why the word is often perceived as more mercenary than altruistic. We aren't "selling" treatment plans aimlessly just to make money; we're recommending them because they are in the best interest of our patients' health. Therefore, as dentists, it becomes our job to help our patients see that we have their best interests at heart and motivate them to accept treatment.
Be a Good Listener
The heart of a treatment plan boils down to three things: needs, values, and resources. The needs portion is fairly easy. You determine those from your clinical examination and questions. The values part is the next hurdle. As dentists, we love to educate our patients to the max. But before we go about expounding on the intricate details of the wonderful treatment plans that we can offer, we need to take a step back and listen. Patients are only going to decide in favor of things that they perceive will benefit them based on their values, so we need to take the time to determine what their values are so that we can incorporate them into our treatment presentations.
An example of a great starting question to ask patients is "What is most important to you about your teeth?" One of the primary goals here is to determine whether patients are more concerned with the functional aspect of their teeth or lean more toward being concerned about the cosmetic aspect. Once that has been determined, it allows you to proceed with open-ended questions to get patients thinking in your direction. For those who are more concerned about the functional aspect, you could say something like, "I see that you have some missing teeth. Are you happy with your ability to chew your food, or would you like to enhance it so that you can better enjoy eating and improve your digestion?" For patients on the cosmetic side, you could ask, "Are you happy with your smile, or are there things that you would like to improve?"
At this point, we must turn into listeners. Take the time to listen to what your patients value and don't interrupt. This will allow you to formulate treatment plans and presentations that take patients' concerns into account. In his classic text, How to Win Friends and Influence People, Dale Carnegie notes that the Roman poet Publilius Syrus once remarked, "We are interested in others when they are interested in us," which led to Carnegie's famous advice: "To be interesting, be interested." We may have a lot of detailed information that we think will be most likely to persuade patients to accept treatment; however, the best way for us to get them interested in our information is to show our interest in them.
When you develop your treatment plans, don't prejudge patients. Devise an ideal treatment plan for each and then some alternatives. Use patients' values to guide you to a workable treatment solution that prioritizes their concerns.
It's All in the Presentation
When presenting treatment plans, treat the interaction as more of a discussion than a presentation. Treatment plan presentations should be all about the benefits for patients. Highlight the advantages and disadvantages of each treatment option. It is also very important to explain the implications of not having the recommended treatment performed. Moreover, it is good to point out how much money that patients could save by proceeding with the needed treatment now versus waiting and allowing conditions to worsen.
If patients become resistant to your suggestions, try using the "motivational interviewing" approach. You start by asking patients open-ended questions. Then, as philosopher Blaise Pascal suggested more than 350 years ago, before disagreeing with their answers, first point out the ways in which they're correct. Offer empathy for their concerns. President Theodore Roosevelt once said that "People don't care how much you know until they know how much you care." Guide patients in a way that allows them to generate their own solutions. Generally, people are better persuaded by reasons that they themselves have discovered.
Images of patients' current oral conditions acquired with a digital camera or an intraoral scanner can be helpful aids in enlightening them. Then, following up with PowerPoint slides or a portfolio book of your work that shows the beautiful results that you can achieve for their issues can be a great way to persuade an indecisive patient.
Don't expect every patient to accept your recommended treatment the first time it is presented, especially if it involves teeth that have been missing for years. Patients may be very resistant at first but then soften once they have returned to your office for a few visits. If a case will involve complicated, comprehensive dentistry, it may be better to have patients return at a future date to discuss treatment options after you have had more time to analyze the information. This will also give you time to prepare a treatment plan that is written in a way that is more understandable instead of one with a bunch of lines of codes and itemized prices.
For big cases, type out the treatment plan using word processing software. List the basic options and include the fee range. Don't itemize. It can be overwhelming to laypeople to try to understand a whole sheet of technical dental jargon. And listing separate fees for each line item is reminiscent of hospital bills that list the price for each aspirin tablet, which can make patients feel like they are being nickel-and-dimed.
When presenting treatment to married patients whose spouses are not present, arm them with intraoral images, digital radiographs, and patient education materials to take home. It can be a good idea to suggest having the spouse access your website to look at before and after pictures of similar cases. You can also offer to have another consultation that includes the spouse.
Closing the Deal
If patients accept your treatment recommendations, then it is time to close the deal with the financial details. This is where the resources part comes in. When possible, it is best to pass this portion off to a staff member who is trained in handling these matters. If patients leave with a printed treatment plan but do not schedule an appointment, make sure that the office follows up in a few days. That way, you can catch such patients while your recommendations are fresh in their minds.
By asking questions and then listening to patients in order to determine what their values are, clinicians can achieve significantly greater success in case acceptance. Patients' perceptions of what will benefit them are critical in their decisions to embrace or reject your proposals.
About the Author
Richard P. Gangwisch, DDS, a master of the Academy of General Dentistry and a diplomate of the American Board of General Dentistry, is a clinical assistant professor at the Dental College of Georgia at Augusta University and practices in a Heartland Dental-supported office in Lilburn, Georgia.
