Treatment Confusion- Clinical or Financial?

Do your patients understand what you’ve presented to them?

Within the first minute or two of a phone call, I can usually determine what that patient’s experience was in an office, where the treatment discussion comes into play. Most patients will find some way to identify their barriers to moving forward with treatment, if you give them a chance. “I Miss You” can be written by a sky-writer, sent in a post-card, or said in a phone call, but your patients do want their absence noticed most of the time. “Why don’t they call us?” is a question I hear alot from Team Members. ”It’s their mouth!” is another staement. Well yes it is, but if we’d been more effective in the beginning, there would be no need to reactivate a patient would there? Let’s consider this-

Consider what happened the last time you saw that patient. When treatment was presented, who presented it? Where did they present it? How did they present it?

When? Was it presented at the Comprehensive Evaluation, Emergency Evaluation, Consult or recall? Record that in my New Patient monitor (found in my “Free Download” page).
Who? Was it presented by you, the Doctor? Your Assistant, Hygienist, or Treatment Coordinator?
Where? Was it presented in the chair, in a consult room, or standing at the front desk?
How? Did you use visual aids (models, intraoral images, before/after pictures), clearly understandable treatment plan?

If you taped your discussion, would you primarily hear your voice, or the voices of your team? Is the conversation structured in a way that encourages patient participation? Do you take the opportunity to get the patient to say back to you what they understand are the issues, and the path you recommend taking? Is the financial agreement section of your treatment plan larger than the tratment plan itself? We’re all (myself included!) so focused on presenting that we may forget to listen.

Utilize your Team as another set of ears and eyes

How welcome is your team to contribute to the conversation? Sometimes we get in the middle of our conversations and miss the little things. The body language and the unsaid objections that someone else in the room might notice. Just because a patient is nodding their head does not mean they are agreeing with you. He may just be trying to keep up and doesn’t want to sound foolish by asking a question. You’re already focused on the end-goal, but your patient doesn’t see what you do. Allow your Team to help your patients by politely saying out loud what they believe the patient may be confused about. You will see the relief in your patients eyes. If you are uncomfortable doing this, then make a point of addressing the questions patients usually have.

What happens if I don’t do anything?
How long is this going to take?
Is this going to hurt?
Can you show me a picture of what this looks like?
Is this serious or maintenance?
Will someone help me navigate the financial part of this?
Do I have to do this now? Do I have to do this soon?
Is there another way to address this? How? Why did you choose this way?

If your patient is talking at least half as much as you are, they are engaged in the process, and you will be able to correct any misunderstandings they might have. If your patient is silent, there is a strong chance your Treatment Coordinator will tell you at the end of the day “He needed to go home and look at his calendar and then call back to schedule. I think he’s going to do it.” He is also more likely to be on the unscheduled treatment list 6 months from that day as well. These are the patients I am contacting. They are the patients who either were confused about the treatment, or they were frozen in the financial aspects of their treatment. They were trying to figure it out on their own, and were not succeeding. Watch them, listen to them, ask them questions, and utilize visual aids for your patients- it absolutely makes a difference.

Financial Confusion?

Just because your patient walks out with a handful of paperwork, including a few pamphlets for 3rd party financing, doesn’t mean they have had an effective financial conversation. Whoever discusses financials needs to think of this as a conversation rather than a conference. They do not know what their patient’s financial situation is, and shouldn’t make judgements or assumptions going into that conversation. Just because your patient has a booming business, doesn’t mean they are not privately struggling with 2 college tuitions. Begin the discussion the same way with each and every one of your patients. They will be making a financial investment in their health, and you are going to break down the process for them. Invite them to weigh in with their choices as well. Their choices? By that, I mean review the doctor’s recommendations, but always make certain you ask the patient if they wanted to address their treatment in another order. What should you be looking for to determine financial confusion?

“Can I just do one?” This question should always be seen as an indicator of possible financial stress. The answer to that question can almost always be “Absolutely!” Of course the patient can do just one- they can also do none. It is the rare case that must be done “All or nothing”.
“Maybe I should just pull it!” This is a statement that also usually indicates a financial decision in the works. Your patient is trying to put a value on that tooth because the cost of restoring it is overwhelming at that moment. Yes, your patient can pull that tooth. I’ll bet you can just feel that frown of disapproval, disappointment, and judgement appear on your face when you read those words. I’ll also bet your patient will notice that as well. It is not our job to make them feel bad about their choices. Acknowledge openly that it can be costly to restore teeth after they have demonstrated a problem-decay, crack, abcess, etc. Assume that your patient doesn’t really want to lose their teeth. Let your patient know that you will try to help them find a way to restore their teeth without having to resort to extraction.
“I’m just going to pull it!” That is a more definitive statement, and usually indicates a decision made. It is fair to ask the patient if they would be comfortable with the compromises that they will have to live with due to missing teeth. Don’t argue with your patient- it is their mouth, after all. Listen as much as you talk, and you might be surprised what your patient has to say.
“I have 2 kids in college. I just can’t do this right now” This is a true statement for your patient. Step back, and let your patient see that you respect their situation and are approaching it as their advocate not someone who is judging their decision. This patient could have chosen to stay home, rather than come into your office in the first place. Honor their financial situation and find out what they think is possible. Then work backwards. If they need to do one tooth at a time, absolutely! Do that. If they say they can do it in 2 months, schedule them 3 months out, and invite them to contact the office if they think they can come in earlier. You will see the relief on their faces, and they will frequently call to move that appointment up. Don’t force them to spend more than their family can afford, because they will cancel that appointment, feel bad about it, and will not call back-frequently because they are simply embarrassed.

What do I hear when I talk to patients?

The patients I speak to because they have ended up in a Practices unscheduled treatment pile, have similar things to say. This is what I hear on a daily basis that is keeping your patients from scheduling:

“I can’t do it all!” They thought it was all or nothing.
“I have to go to a participating dentist” They did not see the value of their practice over one in the book. I have a tool that might help with this conversation, particularily if you feel you may be losing this patient.
“I can’t even remember what they talked about!” This patient was talked to- it was a conference, not a conversation, and the patient wasn’t hearing you.
“I know I still owe $_______ and don’t know if I can afford to go there anymore.” That patient got a surprise statement because copayment wasn’t accurately estimated, participation status was not clear, or financial arrangements weren’t clear.
“I just can’t do 5 or 6 appointments”. Discussion about scheduling should have included a question about the patients schedule- many just can’t take off work in this environment, and scheduling needs to be more creative with them. Arrange to do most, if not all, of their treatment on a day they are off- or at least offer it to them.
“What do I need again?” This, by and large, is the most common question. They don’t know, and there was no follow-up, or the follow-up wasn’t effective.
“I wish I could just be knocked out.” This is of course the fearful patient who needs to hear from you how they are going to be made more comfortable. They need to hear that your doctor is gentle, and that if they are uncomfortable, you want to know it immediately. They need to hear what services you might offer to address anxiety, discomfort. Do not laugh at this statement, even if they are laughing themselves. These patients are serious about this statement however they present it. Listen and respect their concern.

Patients sometimes need a little time. They need to catch up. We know dentistry, and they do not. Make sure to listen to what they are saying, watch their body language, and follow up with all of your patients. When you don’t, you end up with a pile of unscheduled treatment that is much more difficult to pursue. A patient who hasn’t proceeded with treatment is not a patient that will refer their friends to you either. A patient who has even begun with that one tooth, with your support and encouragement will.

Bringing patients back into a practice is one of the most rewarding things I do with my day. Patients appreciate being welcomed back, and even if they do not schedule, appreciate the contact. It may just not be their time yet, but you will be more likely to be the one who treats them when it is. This is the fun stuff folks! It’s so much better when it is done well in the beginning, but you do sometimes have a second chance.