Commentary

Creating Value: Partner With Your Patient

William A. Blatchford, DDS

Much of dentistry is no longer a needed service. Shocking as that may sound, it is a truth in the marketplace. Dentistry has moved from crisis-care, urgent services to optional choices by the patient. As the marketplace has shifted, the missing skill in dentistry is learning to create value for optional dental care.

Presentation skills must change as the marketplace has already changed. In former years, a dentist could diagnose treatment and have it accepted because it truly was urgent and necessary care for the well-being of the patient. Today, most dentistry is a choice in the marketplace, on par with other discretionary purchases such as a cruise, a tandem bicycle, or new kitchen countertops. As an example, big-screen televisions are a $70 billion industry in America. Dentistry amounts to a $52 billion industry. The change from being a needed service to a choice requires a dentist to develop new skills so that dentistry is one of the top priorities for a consumer’s money.

Customers today prefer to spend their hard-earned money on products and services that improve their emotional well-being. Dentistry is still offering products instead of helping patients shape their dreams of what might be possible for their health, smiles, and longevity. Dentistry needs to move into the skill of building of emotions, rather then just presenting a product.

Every generation creates it own dreams. Model railroads and Model Ts are diminishing in value as the WWII generation ages. Muscle cars, looking young, lasting forever is the dream of the Baby Boomers. People are tired of the basics. Dentistry must leap from satisfying patients’ needs to fulfilling their dreams. The mandate of dentistry is to be a part of the Baby Boomer’s dream of looking good, feeling good, and lasting a long time.

Patients and potential patients know dentistry is a choice. Patients drive the marketplace with their values and desires. Before, dentistry justified the need for treatment with pathology. Today, dentistry is in a wants-based marketplace, and the patient drives the conversation to their dreams. They know dentistry is a choice. They don’t even need teeth but they want them and they want them to look good.

In today’s marketplace, the immediacy of need is missing. Because patients know they can choose "yes," "no" or "not now," dentists no longer have validity when speaking in terms of "Mrs. Jones, you really need to have that missing tooth replaced." Dentists must learn the same value-creating skills as other service professions. The marketplace is demanding that dentists become partners with their patients in developing their dental dreams.

Our current presentation skills rely mainly on education, with dentists or dental staffs talking the majority of time. The mandate was to educate the patient about needed dentistry. Education worked in an era in which patients had little knowledge and few choices. In today’s more sophisticated marketplace, patients will discover their own greater values if we create a partnership of asking questions and letting the patient speak the majority of time. In the right atmosphere of trust, if the right questions are asked, patients will voice their desires and dreams for their own dental health. They will share their values of health, longevity, and looks. This, then, is the direction of skill-building needed to place dentistry on the priority list of options available to patients.

Today’s dental patients are much more sophisticated. If they want technical information about crowns, use of amalgam, etc., they use the Internet. Education is an important part of dental treatment but not a part of the sales process. A sale takes place emotionally, from the right side of the brain. When we place the patient in the technical arena (the left side of the brain), it is not possible to make a decision and the response will be, "Let me think about it," or "I don’t think so."

A situation is occurring in dentistry that places urgency in learning the new method of partnering with patients. Dentistry has become a commodity. This is an economic situation created by us, as organized dentistry has made a great effort to make every dentist equal. We agree to keep dental fees within boundaries, to avoid marketing any special skills, to keep our diagnostic skills equal by submitting to insurance for approval, and even try to pass legislation requesting no special designation be given for further study and accomplishment like being accredited by the American Academy of Cosmetic Dentistry, being a fellow of Academy of General Dentistry. This means to patients that dentists and dental "products" look more and more alike. In dentistry, the consumer believes teeth are teeth. Therefore, when one office offers "caps" at $299, what is a patient to choose?

Thirty years of dental insurance has helped create a marketplace where our excellence, skill, and judgment are not differentiators in the eyes of the patient. Dentists submit their diagnosis to insurance companies for "preauthorization," which sends a message to patients that insurance rules. Dentists then hope their treatment will be accepted as "usual and customary." We have also have stopped offering treatment or are reluctant to prescribe treatment that is not covered by insurance. Insurance has helped create dentistry as a commodity, and we have been willing participants on that path.

Creating value for treatment is not easy for a heavily insurance-dependent practice, a practice in which more than 50 percent of income is derived from insurance. To create value and interest for results with patients, dentists must become mentally free of insurance. This requires a thorough self-examination of the dentist’s values, motivation, skills, and desired reputation. The dentist must see value for his patients beyond insurance dictates.

James Bryant said, "If you truly expect to realize your dreams, abandon the need to be liked by all. If conforming to everyone else’s expectations is the No. 1 goal, you have sacrificed your uniqueness and, therefore, your excellence."¹

The dentist must not only realize but also be passionate about the fact that his patients deserve to choose from all the dental treatments available, not just what insurance determines to be the most economic. Creating value for patients by being mentally free of insurance means putting the practice in a position of risk and reward. The risk is that some patients will say no; they would rather have insurance dictate their treatment. Is the freedom to diagnose to your standards and pleasing the patients worth the risk? It is your choice. The path to creating value is clear.

Because the public now views dentistry as a commodity, how each office provides that service can become a differentiator. Learning new skills in asking questions and becoming a partner with patients in developing their dreams will make an office different. Relationship is never a commodity; and when a level of partnership is reached with a patient, a distinction is made. Turning a waiting room into an inspiration room of beautiful smiles where your patients can see your excellence is one way to set a practice apart.

Creating value for dental patients in today’s marketplace of choices also requires positioning a practice so that the larger community of patients knows of these skills, qualities, and relationships. This positioning or marketing helps shape the patient’s dream even before people participate with your office.

Creating value for patients is also being skilled in the modern dental techniques and materials. The irony is that G.V. Black is revered as the father of modern dentistry. His preparations were invented in the late1880s, and he died before Henry Ford invented the assembly plant. Dentistry is very slow to accept change. The dental world is changing. To differentiate yourself in the dental field, become clinically excellent.

Dentistry does not embrace change quickly nor easily. Our dental paradigms (filters through which we view our world) are very strong. Practicing in small individual offices, dentistry has traditional methods and thinking. Taking comfort in what has always been accepted, dentistry continues to find strength in what has always been. A strong dental paradigm is "We don’t sell dentistry." Or, "Our patients will only accept what their insurance will cover." Or, "We do only necessary services in our office."

Dental paradigms are strong in the area of sales. Paradigms can keep us stuck in an old way of thinking. Dentists perceive sales skills as having no place in the dental office. A dentist would never want to be caught "selling." This dental paradigm is based on the old model of selling where pressure is placed on the client to purchase. Yet, what we don’t realize is that without skills and the mindset of asking questions, we do put pressure on our dental patients by acting as the all-knowing speaking to the undereducated and telling them what they need. This is akin to the parent-child relationship and makes discovering dreams difficult.

The world is reinventing itself almost every 10 years through new technologies. For a technology to be relevant, it must improve the life of people other than just millionaires. Are we not part of the greatest technical changes in dentistry? What are the possibilities for patients today? "Not in your wildest dreams" is even passé. Dreams enunciate our latent desires; they create a mood in which everything is possible.

Why is dentistry clinging to the old presentation model of telling patients what they need when the marketplace is demonstrating more sophistication? Change requires being uncomfortable, learning new skills. It is easier to work harder with known methods. Shifting to a new presentation method requires an awareness of the need to change and then the desire to change.

Dentists are the messengers of looking good, feeling good, and lasting a long time. Dentists can help people achieve their long-held desire to be more attractive, to keep their smile more youthful, to have their own strong teeth as they grow old, and to avoid dental emergencies. These are the dreams of patients, and it is the dentist’s obligation to uncover those dreams and to fulfill them.

Dentists can help shape their patient’s dreams by being an inspiration themselves. By having their own mouth restored to tomorrow’s standards, they are helping to shape a reachable dream with the patient. Staff dentistry must also be excellent, not just adequate.

In the old sales model (Figure 1), customers needed sales people and products. Relationship was not important to the sale. Sales people spent more time on the pressure close, thus giving sales people a poor reputation. Doctors and staffs perceive they already ask questions and develop relationship. Let’s review the usual questions asked and evaluate if this set of questions really helps develop a dream.

After the health history form is completed in the waiting room, the conversation follows, "How are you? How’s the family? How’s the summer going? Everything pretty good since last time? What is your main concern today? Let’s take a look. Here’s what is wrong and here is how to fix it. You do want to fix it, don’t you? You really need to have that taken care of. You understand, don’t you?"

These kinds of questions are a routine script repeated many times a day. How deep is this relationship? How big are the questions? How involved is the patient? What is the result of these questions? When small, routine questions are asked, we narrow our possibilities for results. Small questions will yield small results.

The new model of sales (Figure 2) is used when we have more sophisticated consumer who knows he or she has choices. The salesperson must establish relationship and rapport and ask questions to help shape the customer’s values and dreams. Clearly 70 percent of the time is spent on developing relationships and asking questions. It does not require a heavy close because the sale is really driven by the patient. This method fits dentistry beautifully because dentists can deliver on patient dreams.

Developing rapport is a very important part of relationship-building. The traditional questions above are too rapid-fire to build true rapport. Really listening is not happening because we have our own agenda. We have our own mental tapes we play, rationalizing our present mindset and skills. "I have no time to ask questions." "I have been in dentistry for 15 years, and I know the answers." These mental tapes get in our way. Dentists fear the patients may say no to suggested treatment, so small questions are asked and the resulting diagnosis is small. If we ask small questions, we will get small answers that are close to the insurance maximums.

One of the mistakes made in dentistry is that the dentist does not ask the important questions nor really listen to patients. Our need to tell, educate, and explain is so great that it is like only being on "send" in the e-mail mode. Dentistry is not accustomed to being on "receive" (as in listening), yet this is when rapport, integrity, and values are created. When we try to sell our product based on what we think the patient needs, there is a hard close.

Creating dental dreams with our patients requires developing an atmosphere for patients to talk about their values and what is important to them. Dentists and dental staff shift from being the educator and "telling" to becoming a resource. This creates an opportunity to actually learn from our patients.

Stop thinking in terms of educating patients. Think more about educating yourself about your patients, not their teeth. Think in terms of learning with them. Think about helping them. Learning and listening are the key skills.

An important educational truism is "The mediocre teacher tells; the good teacher explains; the superior teacher demonstrates; the great teacher inspires."² Education is an important part of dentistry, not the dental sales process. Patients actually stay away from regular dental care to avoid the "dental flossing lecture." How can we be the superior teacher who inspires the students? Asking questions and listening creates the inspiration rather then the traditionally scripted lecture of education.

When big questions (Table 1) are not asked of patients, we educate and sell the product that has value for us. We try to talk them into something that is important to us. This creates heavy pressure on the patient because he or she is not treated as a partner. This is like a newly thin person trying to convince others to exercise and love vegetables. The message falls on deaf ears and can actually create a point of rebellion in the listener. The inner voice is saying, "Don’t push your values on me."

 

Table 1 Big, Important Questions

· When you think 20 years ahead, how would you like your smile to be?

· You said keeping your own teeth is an important goal.

· What would you like them to look like? To feel like?

· What benefits can you see by keeping your own teeth? Tell me about that.

· You said you would like your teeth to be whiter, younger looking. How would that help you in your job?

· What value would a nice smile add to your career?

· What advantage do you see in having as few dental treatment visits as possible?

· What benefits can you see in preventing future dental emergencies?

Shifting from telling to listening has been referred to as a "secret weapon."¹ It is the opportunity to stop thinking in terms of educating the patients and think more about educating ourselves about our patients. We need to learn WITH them about what is important to them. Think about helping them. Listening is the most important skill. Many people in dentistry are driven by feeling they must have the answer.

Before meeting a new patient or visiting a recare patient, stop to think, "What is my purpose?" And most importantly, "What is in it for the patient? What are they interested in?" If you find yourself talking about teeth and solutions before you help them discover their values and dreams, you are in the danger zone. This is the non-emotional area, and there is no dialogue with the patient.

Questions are your tool for understanding patient concerns. Questions help put you in the role of the problem-solver. As your patients speak to you, listen, listen, and listen. Listen in a new way. Listen in order to question, not to answer. Listen for key words that are meaningful to the patient. Take notes, show empathy, ask questions, and then ask more questions.

Creating value for beautiful smiles, which fulfill dreams of looking good, feeling good, and lasting a long time is the desired skill and mindset needed in the changing marketplace of options. Creating relationships and rapport and asking big questions will help shape patient’s values and dreams for their dental health and appearance. Education does not sell dentistry but is an important part of the treatment process. Building confidence in asking questions and listening to learn about your patients are the skills that will make your office the practice of choice.

Author

William A. Blatchford, DDS, is the founder and director of Blatchford Seminars.

References

1. Davis W, The Best of Success: A Treasury of Success Ideas. Successories, Aurora, Ill, 1989.

2. William Arthur Ward.

3. Richardson, L. Stop Telling, Start Selling. McGraw-Hill, New York, 1997.

To request a printed copy of this article, please contact/ William A. Blatchford, DDS, Blatchford Seminars, P.O. Box 9070, Bend, OR 97708-9070.

Figure 1. Old Selling Model

Figure 2. New Selling Model

Figure 3. Big, Important Questions

* When you think 20 years ahead, how would you like your smile to be?

* You said keeping your own teeth is an important goal. Why?

* What would you like them to look like? To feel like?

* What benefits can you see by keeping your own teeth? Tell me about that.

* You said you would like your teeth to be whiter, younger looking. How would that help you in your job?

* What value would a nice smile add to your career?

* What advantage do you see in having as few dental treatment visits as possible?

* What benefits can you see in preventing future dental emergencies?