How Dentists Are Judged by Patients

In the 18 years I managed a dental practice, I never once heard a patient who walked back into the reception room after his or her appointment say to a waiting friend, “Can you believe the anatomy of this crown?” or “Wow, look at the carving of this filling!”


When I ask dentists in my audiences what they perceive patients are buying from a dentist, the majority of dentists say dentistry, treatment, healthy mouth, saving teeth, etc. While this is certainly true, it is not the No. 1 thing patients are buying.

Unfortunately (or fortunately as the case may be), a dentist is judged by everything but his or her quality of care. Let us explore 20 key areas in which you are judged by patients and their perceptions.

1. A PAINLESS INJECTION
What words does a patient use to inform you that your injection is painless? When I ask this question of dentists in my seminar, I usually receive the following answers: “Doctor, I did not feel a thing,” “That didn’t hurt,” or “That was much better than my last dentist!” My problem with these answers is that it shows me that the patient knew they were receiving the injection. The answer I am looking for—and I am always thrilled when I hear it—is “Doctor, when are you going to give me the injection?” or “Doctor, I am ready now, let’s get the injection over with!” The doctor’s answer to both of these patients is “Mrs. Patient, I have already given you the injection!”


To me, this is the No. 1 practice builder. Take a scared patient (according to my audiences, usually a macho male), give him or her a painless injection, and that patient will refer half the town to you. You can double your fees. Patients will drive miles and refer strongly to the dentist who provides painless injections in the practice.

2. DOES NOT HURT
This item covers all services provided at the chair. From the assistant placing the bib to the hygienist providing a cleaning, “does not hurt” denotes a practice where the patients have no fear of pain. You may ask why this would not cover the injection, and my answer would be that there are many dentists who provide painless dentistry but a less-than-painless injection.

3. STAFF WHO ARE…
Kind, professional, caring, warm, helpful. The list goes on and on. In the mid 1990s in the United Kingdom, a national newspaper did an in-depth survey of the British dental consumer to find what causes them to remain with, leave, or choose a dentist. The role of the staff was the No. 1 reason, far ahead of No. 2. Nothing gives your patients more comfort than to return to your office on an ongoing basis and see the same smiling faces greeting them in the reception room and in the clinical area. Staff retention tells the patients everything about the dentist.

4. RUNS ON TIME
Today, we are a world without patience. From road rage to not wanting to queue up for a service, we want what we want when we want it. I regularly poll my audiences to find the practices where staff have gone to the reception area only to find that the next patient has walked out because the patient perceived he or she has waited too long. The ultimate happened recently when a practice told me it had sat the next patient in the treatment room, returned to the current patient next door to complete the treatment, and upon return to the “recently seated” patient, found the patient had left! A practice that regularly keeps to its planned schedule will find the undying gratitude of patients. This is such a key management concern. Let me share with you 3 quick tips from my in-depth scheduling program to give you a start on solid time management techniques.

(1) Build in weekly flexibility by blocking the last afternoon of each work week. Do not begin to schedule in this block until the Monday of that specific week
(2) Create a daily schedule with long mornings and short afternoons, allowing you to provide the majority of complicated services in the morning when physicians tell us the vast majority of us are at our best.
(3) Give the patients an appointment card with a time, which is one unit (10 minutes) prior to your schedule. This allows a buffer of time for a patient running late, getting lost, handling or updating the paperwork, visiting the bathroom, and chatting at the reception desk. Your goal is to seat the patient 5 minutes after they walked in and 5 minutes before their scheduled time. What a wonderful feeling it is to run ahead of schedule.

5. “DOCTOR, THAT WAS THE MOST THOROUGH DENTAL EXAMINATION I’VE EVER HAD.”
It is not enough to provide a thorough and comprehensive examination; the patient must understand the quality of the service provided. In training terms it is called “show and tell.” During a program I gave in London some years ago, I was stressing the importance of both showing and telling patients when the dentist is doing the oral cancer check. A dentist in the audience shot out of his chair, and in no uncertain terms, took me to task on this issue. He identified himself as the head of the clinic of the local dental school. He said, “How can you scare the patient by talking about oral cancer?” “Oh,” I said, “it is OK for patients to smoke and get oral cancer, it is just not alright to talk about it to them?” He glared at me and sat down. At the end of the program, I invited anyone in the audience to share with us something they would take home from the program and incorporate into the practice, which they never had considered before that day. To my amazement, the same dentist shot out of his seat for a second time, but this time he apologized to me and said he would be instructing his students, as of the following week, both to provide and inform the patient of the cancer screening.

6. DENTISTS WHO LISTEN, ALLOW QUESTIONS, TREAT DUMB QUESTIONS WITH DIGNITY
Today’s patient is highly informed as to what treatment might or might not be available in dentistry. Whether surfing the net or reading health magazines, patients are certainly doing their homework before coming to the practice. Every single article that I have read in the past 4 to 5 years that focuses on helping the consumer choose a physician, dentist, surgeon, or any of the wide range of specialists, always begins with one caveat. Find a health provider who will give you quality time in which you are encouraged to ask questions, and answers will be provided. To the dentist reader, I need to distinguish between quality and quantity time. I find practices where a new patient examination appointment can take 2 hours, of which as much as an hour can be with the dentist. But on further investigation, I found the quality of the one-on-one conversation time between the dentist and new patient during this hour was pretty sparse and ineffective. Communication is definitely a matter of perception and expectations and is a 2-way street.


While dental schools teach students to ask a new patient, “What is your chief complaint?,” I feel this is a clinically focused question and beyond most patients’ clinical expertise. I would suggest we substitute a different approach:

(1) How may I (we) help you? or How can I help?
(2) What caused you to pick up the phone and make an appointment?
(3) What is your No. 1 concern about your teeth (smile, mouth, dentistry)?

7. PATIENTS ARE HAPPY WITH THE RESULTS
This one always fascinates me. Patients have not been to dental school, but they are running around town telling the world what a marvelous dentist you are. However, while it might sound like a clinical endorsement, the patient as a consumer is the one who is speaking. So, what does he or she mean? The comment refers to one of 3 areas—2 of which are clinical but do not require the patient to have a dental degree to judge the quality of clinical service received.
(1) Function: The patient came into the practice with missing teeth and an inability to eat steak and French bread. Since the bridge was placed, eating has become a joy.
(2) Aesthetics: The patient hated the way he or she looked and worked hard not to smile and show the world an ugly smile or teeth. Now he or she cannot stop smiling.
(3) Feedback: Plastic surgeons in particular tell us this is a major area of referrals. Your patient leaves the practice after receiving the new bridge and finds friends and co-workers remarking on the patient’s well-being. “Susie, have you been on vacation? You look great!”

8. Prompt emergency service
One can grow or kill a practice by the way emergency patients are handled. This is such a key area of effective scheduling and excellent customer care. I spend 20 minutes on this subject alone in my scheduling program. The basis on which one schedules emergency patients must be predicated on the following core belief: there is a moral, legal, ethical, and logical need to recognize that one cannot schedule emergency patients to the detriment of your regularly scheduled patients. Today’s patient of record may have waited anywhere from 2 to 4 weeks for a long appointment during which you are going to prepare a 6-unit bridge. Helping a patient in pain who has been walking around town for 6 weeks with a tooth hurting “off and on” and 3 weeks with it “hurting constantly” is not accomplished by “pinching” time from this scheduled patient. Helping emergency patients in a caring and efficient way without compromising your quality time with scheduled patients requires a practice to take a firm and logical approach to scheduling emergencies. Space does not allow for expansion on this subject, but if I were asked to limit my tips to 3, then they would be the following:

(1) Schedule emergencies during the long mornings your daily schedule is designed around.
(2) Direct emergency patients to a specific morning time, chosen by the clinical staff in the morning meeting.
(3) Request that emergency patients arrive 30 minutes prior to doctor time. This allows for the paperwork, seating patient, examination of problem, necessary x-rays and diagnosis, informed consent, and any injection. It is essential that one never says to the patient, “Come on down early to get the paperwork done.” Rather, “Dr. Brown is very committed to being of service to patients in pain. It sounds as if you are in need of immediate attention. Our special time this morning is 9:30.” A genuine emergency patient says, “Thank you.”

9. PROMPT NEW-PATIENT EXAMINATION APPOINTMENT
On this subject I am really quite brutal. All new patients calling in for a new-patient exam need to be seen within 7 days of the call. Patients are really quite funny on this subject. They have not been to a dentist for 15 years, yet they wake up today and for whatever reason want to see a dentist. They call around, get your name, and call for an appointment. Patients want to be seen the day they call…yesterday would have been better. Your schedule is full, you are backed up, and so they are given a time 5 weeks ahead. The chances of the patient keeping the appointment are not good. Monitor your new-patient exam show rate. It should be 100%. Why would it not be? The patient called requesting help. If you are unable to schedule to this rule, then the schedule has lost its flexibility, and it will definitely compromise the quality of your life in the practice as well as getting you a name in town as “great doctor, great practice, but don’t bother calling, you have to wait weeks for an appointment.”

10. HIGH STANDARD OF STERILIZATION
Sterilization not only has to be done, it has to be seen being done. I was visiting a practice in England recently, and it was fun to see the dentist playing this little game. He puts his new glove on his left hand, has his right glove almost but not quite on, and then he waits. He does not complete putting on the second glove until the patient has been seated in the treatment room and he stands in front of the patient and completes the action. A picture is worth a thousand words. Patients’ antennas are scoping a 360º circle looking for gloves, masks, etc. Along these lines, therefore, the patients’ bathroom becomes a key part of sterilization. There is absolutely no point going through the full OSHA setup if the patient walks into a filthy bathroom.

11. WELL-EXPLAINED TREATMENT PLAN AND FINANCIAL OPTIONS
If the reader has ever heard me speak, you will know my mantra is “Inform before you perform…no surprises.” I believe in being proactive, not reactive. I do not believe patients should have to ask questions. For every patient who does, there are 20 who are too scared to ask. The practice needs to provide all the information a patient needs to make an informed decision before the patient can even think of the questions/concerns they have. I think most dentists, because of their clinical training, do a pretty good job in the clinical area of treatment explanation. If anything, they do too good a job, going into details that most patients don’t need, want, or understand (unless the patient is an engineer).


I wish the same could be said for the financial investment part of the equation. “Inform before you perform” refers as much to the money part as to the clinical part. I have spoken to dentists who have served on the peer review committee of their local dental society. They tell me that 70% to 80% of the complaints they receive from the local community about dentists revolve around money. However, the complaints are not about “it cost too much, it was too expensive.” The complaints have to do with miscommunication. “No one told me I was going to need a crown for $859 after the endo was done.” “No one told me…” etc, etc. 

One of the quickest ways to run off patients and kill a practice is to take a shortcut around explaining treatment options and how they are to be paid for. Therefore, it is mandatory that every patient have a signed FA. FA stands for “financial agreement” rather than “financial arrangement.” Agreement is the emotional buy-in, arrangement is the process.

12. FACILITY IS UP TO DATE
This ties in with the research patients are doing before they walk through the door. Patients know what an intraoral camera is; they understand high tech, and to them high tech equals high quality of care. We know this is not necessarily true; but again, it is all about perception and expectations. Please make sure that your Yellow Pages display ad, if you have one, truly does reflect the environment and standards of your practice.

13. POST-OP TELEPHONE CALLS
Even my veterinarian personally calls after my German shorthaired pointer has had surgery. Dental patients now expect their physicians and dentists to do the same. This service has to be one of the biggest practice builders of all times. When I poll my audiences I find a pretty even split between the call being made by the dentist or the administrative staff. To me, administrative staff never make post-op calls. The reason has nothing to do with having or not having clinical knowledge. It has to do with personalization. “Mrs. Patient, this is Jenny from Dr. Smith’s office. I am calling to see how you are feeling and if you have any questions about your post-op treatment I can help you with.” “Yes, Jenny. When I was in doctor told me …” “Oh, Mrs. Patient, I am so sorry, I am not sure what doctor meant. Let me run down the hall and see if I can find out what doctor meant.” How much better would it be for the dentist to make the call personally at the end of the day in the car on a cell phone from a list the staff provided? Patients absolutely love it. Should the dentist, for whatever reason, find making this call tough, then the call is made by the clinical staff member who assisted the doctor with this patient and can therefore represent the doctor in a way that the administrative staff would not be able to.

14. POST-OP INSTRUCTIONS
These are a must for every practice. Years ago, one could not find any written post-op instructions for sale. So, like other practices at the time, we had to sit down and compose and print our own. Today, one can find such instructions for sale in mail catalogs. Ideally, each procedure is printed on different colored paper, so one does not even have to think which one to give; one just reaches for the yellow sheet for the “after extraction post-op.” Be sure your name and during-hours and after-hours phone numbers are available.


We put one standard line at the end of each of our sheets that really seems to help the patients: “No question is too small to ask, we are as close as the phone if you need us.” We found that our after-hours calls were greatly reduced when the patients were given permission to call us after hours. Just knowing it was OK seemed to make it unnecessary for the majority of situations.

15. HELPFUL WITH THIRD-PARTY PROVIDERS
I could write a chapter on this, but I will limit myself to a paragraph! Whether or not a dentist and staff have negative feelings toward third-party providers is not the patients’ problem. The practice that takes a positive approach to working with insurance patients will reap the benefit. Remember this: it is harder to collect money from patients with insurance than patients without insurance. Therefore, the team needs to slow down and increase communication with insurance patients. It benefits everyone when that communication is positive rather than negative.

16. PERSONAL HYGIENE OF DENTIST AND TEAM
If we love garlic, it would be nice to love garlic on Friday and Saturday nights only.

17. DENTISTRY OF THE DENTIST AND THE TEAM
I realize that to most dentists and staff, when reading this item you are shaking your head in disbelief. However, when I look out into the audience and see someone in dentistry with missing teeth or a dentist who has not seen a hygienist for several years, it does confirm the need for all of us to walk the talk.

18. LOCATION
In retail, location, location, location is everything. If you are in the process of or have built up a strong referral practice, I don’t believe that location is an issue. Please remember that patients who come in because it is convenient will leave you when it becomes inconvenient, unless they have built a relationship with you and perceive the benefit of that relationship. If your practice attracts many patients because of its convenience, and you and the patient do not build a relationship outside that convenience, you will find these patients to be the first to complain about everything and also the first patients to walk when they do not get their way (as they perceive it).

19. HOURS
I am aware this subject is definitely a regional and cultural one. On the East Coast, it is quite normal to find practices seeing their first patient at 9 am. On the West Coast, a practice may have started their first patient at 6 am and by 9 am they are already 3 hours into a 6-hour day. Each practice needs to look at the demographics of the practice and the needs of the dentist and team to determine what hours work best for their overall needs. I just ask you to think outside the box on the matter of setting patient treatment hours.


Early morning patients are gold. Usually top management, these patients’ No. 1 concern is time. They tend to have high dental IQ, and money is usually a nonissue. Evenings can also be unbelievably productive. For years I have advised practices to stay away from offering Saturday hours, unless the Saturdays in your practice are as or more productive than any other day in the week.

20. MONEY
I have saved the least important reason a patient chooses a dentist for the last. I truly believe that a patient only quetions the fee when he or she questions the treatment or service as he or she perceives it. Are there patients who chose a dentist by the fees? Yes. But they are in the minority…..and we don’t let the minority rule the majority.

Look to the plastic surgeons. Plastic surgery is expensive and elective (thus not covered by medical insurance), can be painful, may require time off work, does not guarantee results, and in fact, patients have to sign a disclaimer acknowledging that they may be unhappy with the results. Yet, board certified plastic surgeons have their schedules fully booked for months with the antsy patient having to wait 3 to 4 months for the surgery. Oh, and by the way, these patients are required to prepay their surgery fully in advance, and if paying by check, a full 3 weeks in advance. Why are patients lined up around the block? Because they see the benefits of the surgery (as they perceive it) and therefore want the surgery.

CONCLUSION
A doctor is judged by everything but his or her quality of care. Is this fair? Is this ethical? No, it is not. But it is today’s dental marketplace. In our competitive world, where so much of dentistry delivered is elective and the patient is buying this optional dentistry with discretionary income, it has become the norm.


The dentist and team who deliver quality dentistry in a caring and professional environment should never ever have to want for patients. You will enjoy a full schedule and patients who say yes to both your treatment advice and the cost of delivery.


Ms. de St. Georges is an internationally renowned dental practice management speaker and author. She has spoken at virtually every leading dental meeting in North America and the UK. She is a contributing editor to Dentistry Today and the UK journal Independent Dentistry. Ms. de St. Georges can be reached at (800) 366-7004 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it for more information about her educational materials and workshops.

 

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