David Schwab, Ph.D.

To gain insight into specialty referrals and the need for clear communication, it is instructive to consider a famous story from the aviation industry.  Some years ago a foreign airliner that was approaching a major airport in the United States crashed short of the runway. The pilots had advised Air Traffic Control that they were low on fuel. The controllers were giving the pilots instructions for a priority landing when the crash occurred. However, an investigation revealed that the pilots had only said that fuel was “low”; they did not declare “a fuel emergency.” The controllers later said that they would have cleared the plane to land immediately if they had known that the fuel situation was critical.

In dental offices, urgent referrals to specialists are sometimes made using ambiguous language. If the referring office asks, “How soon can you get this patient in?” the response may be, “Tomorrow.” In this case, the office manager at the specialty office may have every reason to believe that she is doing a great job. However, if the caller really meant to say, “Can you get this patient in today?” then we have a failure to communicate.

There are three parts to an urgent referral:

1. The referring office should ask if the patient can be seen in the specialist’s office today, as soon as possible. No ambiguity.
2. The reason for the urgency should be stated. “Dr. Smile would like Dr. Specialist to see the patient today because she is experiencing discomfort,” for example.
3. If it is an urgent matter, then the referring office should always make the call to the specialist’s office for the patient. Allowing the patient to make the call is not a good idea. It is courteous and efficient for the two offices to communicate with each other and secure the same-day appointment.

Communication between referring and specialty offices can be a challenge, but plain speaking can avoid misunderstandings and get an urgent case to the specialist’s office as soon as possible.

When a patient presents with a mouthful of major dental problems but is reluctant to accept treatment, what can you do to encourage case acceptance?   You can co-diagnose and cajole. You can soft-pedal and sugarcoat and offer to phase and stage. You can empathize and sympathize. While you try to educate, the patient chooses to ruminate and procrastinate. Your team can trot out a low cost loan and still be met with a moan. When the patient leaves with no appointment, you can shake your head, roll your eyes, and throw up your hands, but you cannot foist a choice on a patient.

Here’s a solution that many young dentists are timid about using but that most experienced dentists have learned to employ: speak plainly; tell it like it is. Patients come to your office because you are a licensed professional, an expert in dentistry. They may not like what you have to say, but at some level they want what they are paying for—your professional opinion. Just as you have an ethical obligation to diagnose, you also have an duty to provide patients with the unvarnished truth.

When the diagnosis is alarmingly clear and serious, the consequences of no treatment are that a bad situation will only get worse. Informed consent means that patients must be made aware ahead of time of the risks of treatment, but they also need to know—and you should document your discussion in their chart—the consequences to their health of their decision to ignore your advice.

It is of course important that dentists continue the tradition of speaking to patients in a calm, professional, and respectful tone and showing compassion for the patient’s dental issues. However, part of the trust that develops between doctor and patient is an underlying foundation of honesty.

You can begin a difficult conversation by using these introductory phrases:

In my professional opinion . . .

 I have an obligation to tell you that delaying treatment is not advisable because . . .

 I know this is not what you want to hear, but as your dentist I feel that it is important to be completely honest with you . . .

 I wish I had better news, but your treatment needs are urgent because . . .

These comments can be tempered by telling patients that with proper professional care (and the patient’s cooperation by demonstrating conscientious home care), dental problems can be significantly alleviated.

The bottom line is that you have the ability to improve case acceptance and greatly help patients with major dental needs, but the patient must first face the reality of those needs if case acceptance is going to happen.

It all starts with telling it like it is.

Why do millennials matter?  They are the largest demographic group in the U.S. (84 million). Born between 1980 and1999 the millennials are now, in 2016, 17-36 years old. According to Marketing to Millennials by Jeff Fromm and Christie Garton, for millennials, it’s all about the experience, and they are already talking about you on social media. Not only are the millennials digital natives who are avid users of social media, they are also influencing other groups such as the baby boomers who often emulate their behavior.

I recently did a search on amazon.com for an SD card for computer memory storage. One card had a list price of $8.47 and over 10,000 reviews. Think about that. Over 10,000 people have taken the time to give their opinion of an item that costs less then ten dollars. Using reviews to check out products or services prior to making a purchase has become part of our culture, and the millennials are leading the way on social media.

Millennials want to know what their friends think and they also want to know what groups of people are thinking so they can make an informed decision. They are likely to review your dental practice to add to the database and help others.

Because millennials value the experience, it is important that you use that word in your marketing. “Our goal is to give you a great experience!” Once you make good on your promise, offer to take a photo of the patient who has just completed a cosmetic procedure. The photo should be of the smiling, happy patient and the doctor. Immediately e-mail or text that photo to the patient and say, “We are so happy that you are pleased with your new smile. Feel free to share this photo.” Millennials will often oblige—and presto—the photo goes out through a millennial network.

The photo says it all because it shows a happy patient, great dentistry, and the doctor who made it all possible. It’s free publicity for your dental practice because you have a good relationship with a millennial who is inclined to share experiences with friends.  You set the stage by providing a great experience and value.  (For a discussion 10 Value Propositions, click here.)  Your patient has just become your greatest spokesperson.

Millennials matter.

As a way of increasing case acceptance by making a great first impression, the doctor should call the patient prior to the first appointment. This phone call impresses the patient and sets the stage for the patient to trust the doctor and be amenable to treatment.

Savvy dentists have found that this “pre-appointment phone call” is very effective, because patients do not expect it but they certainly appreciate the gesture.

It’s easier to do than you might think. Here are the steps.

1. New patient calls and makes an appointment.
2. Team member notes why the patient is calling, including any concerns the patient may have.
3. Doctor calls the patient a day or two in advance.
4. The script is simple: “Hello, Mrs. Jones. This is Doctor Smile calling. I see that we have an appointment on Wednesday at 10:00 a.m. I just wanted to call and personally welcome you and let you know that I am looking forward to meeting you. I will do a thorough examination and answer all your questions when I see you.” The patient will be pleasantly surprised and thank you for calling.
5. If you get voicemail, just use the same script as your message.

The patient will be impressed that you called. When is the last time a doctor called a patient in advance to welcome them to the practice? For most patients, this is the first time they have received such a call.

The new patient now has a first impression of you. Instead of anxiety about meeting a new dentist, the patient thinks of you as courteous and caring.

When you meet the patient, the ice has already been broken, so to speak. You have set the stage for a trusting relationship and the patient will be more likely to listen carefully to your treatment recommendations and accept treatment. When you increase case acceptance, you not only generate more production but you also create another happy patient who can offer a testimonial.

One of the reasons that this simply courtesy call works is that so few doctors do it. Get on board now before everyone does it.