I talk teeth; my team talks money: Patients ownership and case acceptance


Before a patient decides to move forward with dental treatment, two things must be in place: ownership/understanding of one’s oral health, and finances. Dr. Stacey Gividen examines case acceptance from the perspectives of the patient and the doctor/team.

Author-Stacey L. Gividen, DDS

I’m going to be very blunt in regard to this topic because it’s a very important rodeo we all ride in time and time again: treatment planning and case acceptance. Now, before you turn the page, let’s just say we’re all hanging out at a dental conference social (remember those days?), and this question comes up, “How do you get your patients to accept so many of your cases?”

Let’s spin this a bit and seek to understand case acceptance from a different perspective. Pretend you’re the patient and that you know absolutely nothing about dentistry aside from the obvious—brushing, flossing, and oral health are important because “mom told me it was.” You go in for a checkup and are told you need periodontal care, a root canal, a couple of crowns, and several fillings. You’re already feeling quite overwhelmed because nothing hurts, and you’ve no idea what any of that dental talk means except that it’s going to cost A LOT. Initial thoughts: “Where’s the exit? How did it get this bad? Does the dentist know what they’re talking about? Is all this really necessary, because we know that dentists just want to pad their wallets? I feel inadequate. I just want all of my teeth pulled.”

Now, let’s take it from the doctor’s thought perspective. “There is a lot of work that needs to be done. Home-care habits need to change, diet could be better, patient seems motivated, but I know this treatment plan will likely scare them away. The patient needs to know what’s going on and how we can get all this work done.”

If we dissect this scenario, we come to the root of the problem (no pun intended) as to why patients have a hard time accepting and subsequently moving forward with their dental care.

Issue number one

Understanding and taking ownership of one’s oral health. I’ve had patients who come to the dentist only because “my wife told me to,” or something along those lines. When you introduce yourself, right away you know the patient really doesn’t want to be in the chair. They couldn’t care less about what’s going on in their mouth and, even more so, they don’t care about moving forward with any needed treatment. On the flip side, there are those patients who need and want to know everything. And of course, you have those patients who are in the middle.

At this point, I see things in black and white. My job as the doctor is to diagnose, educate, explain risks, benefits, and any alternatives to recommended treatment or care. Sometimes our delivery is on point; other times it’s not. The key is to connect with patients on a level that allows them to understand the benefits they will derive from receiving care and the downside of not doing anything. Essentially, we have to establish trust in the patient-provider relationship. This imperative piece of criteria must be met and is a prerequisite for us to do our job. Patients’ ownership of their oral health status happens when we instill the relevance of care and the long-term benefits (or consequences) of their decision. Some patients will jump on the bandwagon; others won’t. This discussion is a must, regardless of the size of the treatment plan. Once we discuss and connect with patients about the treatment goals for their oral health, more often than not, they will bring up any pressing concerns from their perspective.

Issue number two

Finances. Again, let me be blunt. We can’t (and shouldn’t) perform dental treatment without being compensated for it. It just doesn’t happen that way. Businesses don’t just “happen.” We can talk to patients until we’re blue in the face, but if they can’t (or won’t) pay for the dental work we provide, then to some degree, the point is moot.

Let me be clear on this next point: This doesn’t in any way negate the importance of what needs to be done clinically or dull the compassion we have for our patients’ needs. It is essential that we have a system in place to help further the momentum of our patients as they decide to move forward with their dental care. This is where, ladies and gentlemen, yours truly bows out and passes the baton to my front office team.

I don’t like talking about money with patients. I abhor it. As such, I have competent staff who can speak about the ins and outs of insurance benefits and offer financing options as fluidly as I can talk about what I do during a root canal. We are dentists. We are not financial coordinators. Let’s play to the strengths of our team and maximize our staff to their potential. Yes, it’s that simple.

Essentially, in the process flow, our staff’s role is to support and validate our recommended treatment plan and enhance our case acceptance rates. But we must educate, trust, and encourage our staff in this way. For many of us, letting go of this control can be challenging; however, the balance of teamwork is quite lucrative because while we focus on the clinical aspects of the treatment plan, our staff is able to break it down to fit the individual patient’s financial needs, priorities, and situation. Lest we forget, patients actually have better, more frank conversations with our staff than they do with us, because they (our staff) aren’t “the doctor.”

If you don’t believe me on that, just ask your staff. The dynamics are real. Once your financial coordinator has made the magic happen, more often than not, the patient will be ready to move forward. A plan is in place. An understanding has been made. A relationship built on trust is established and a budget is set. This is teamwork at its finest, with the biggest winner being your patients and their next question being, “When is the next appointment available?”

STACEY L. GIVIDEN, DDS, a graduate of Marquette University School of Dentistry, is in private practice in Hamilton, Montana. She is a guest lecturer at the University of Montana in the anatomy and physiology department. Dr. Gividen is the editorial codirector of Through the Loupes and a contributing author for DentistryIQPerio-Implant Advisory, and Dental Economics. She serves on the Dental Economics editorial advisory board. You may contact her at sgividendds@gmail.com.

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