I have often heard dentists decry the lack of appreciation expressed by their patients. After they have worked very hard, often going well out of their way to provide excellent care with an exceptional level of service, they are disappointed when their patients don’t openly express appreciation at a level parallel to the effort perceived by the dentist. For many dentists, this issue of appreciation is important; so, I’d like to address what is reasonable to ask of patients. Appreciation is not one of those things.

 

I believe it makes sense to ask just four things of your patients but equally important that you actually ask these things. Virtually all of the patient relationship problems you may experience come from these four sources.

 

 

The least you can expect from your patients is that they tell you the truth. This begins with correct and complete information about their medical history, medications and reasons for a physician’s care. It extends to previous dental experiences and history. The truth also requires patients to be up front and honest with you about their expectations, wants, fears, limitations, issues, preferences and the like. It is axiomatic that the more you know and understand about patients the more likely you will be to provide them with care that will meet their expectations and address their concerns. Without this information, it is significantly more likely that you could, even inadvertently, make a mistake that would harm the relationship or the person.

 

How do you ask them to tell you the truth? Not with forms which are often disregarded as necessary evils. If you want to learn the truth, you must engage in a conversation that has as its goal learning the fullness of the truth rather than simply getting an answer to a question on your checklist. This takes time, but it is time that is well worth the effort when properly incorporated into either your new patient process or annual review with existing patients. What you don’t know can hurt you and behaviorally skilled team members must be given the time, space and resources to learn these important things about each patient.

Once you and the patient agree on an appointment date and time, whether it is with the dentist, the hygienist or any other member of the team, it is reasonable to expect that both you and the patient will be present and on time. In essence, your agreement on an appointment date and time is a contract between you and the patient and you must have an agreement about what that contract means and how it can be altered. If you wish to be free to make changes at the last minute, you can reasonably expect the patient will want that freedom as well.

 

In order to hold your patient accountable to that contract, you must uphold your end of the bargain. If, for example, you aren’t able to reliably be on time for patients, you will not be able to ask that patients, in turn, arrive on time. Thus, the first thing you must do as a team is insist that your systems and mindsets ensure that you are reliable and on time with regularity. Not just when you can or when it is convenient, but regularly.

 

You must also plan your calendar with sufficient advance notice to avoid last minute schedule changes. While an occasional illness or unavoidable event (such as a death in the family) might be excused by a patient, you must be prepared to reciprocate without judgment or complaint when they are plagued with a similar situation. The less you alter your schedule capriciously or without consideration of those patients who have made plans with you, the better it will be all around. Without realizing it, many dentists have insisted on systems and policies that violate this implied contract with patients. In an effort to keep their schedules full, dentists may ask employees to call patients to fill openings when they occur. Because this can be a time- consuming task, staff members may often call a patient who already has an appointment a day or week or two later and ask if the patient is willing to be seen earlier. If the patient says “yes,” that person could easily think that it is now acceptable for them to call and shift an appointment with little notice. But even if the patient declines to change their plans, the same implication is apparent: they get a free ticket to expect you to change at their request. This strategy of filling holes is a devil in disguise and I regularly urge my clients to steer clear.

Without question, the most problematic and damaging situations occur when patients fail to handle their accounts satisfactorily. It is almost impossible for the relationship to recover when the patient fails to know his or her obligations or fails to honor those obligations.

 

For this reason it is imperative that you and your staff never allow a patient to make an appointment until the fees have been discussed and specific financial arrangements have been made. I believe that financial understandings must be put in writing so there will be no confusion. If you had to rely on your memory for these types of details, you would likely get them confused or forget the specifics; so, don’t ask your patients to rely on theirs.

 

Sometimes patients treat financial arrangements off-handedly, but you cannot allow that to deter you. When someone protests that “money is not a problem” you must boldly insist on reviewing the fees and financial arrangement anyway – so you will be clear.

 

When one spouse tells you that the other will be handling the bill, or a young person insists that a parent will be handling the account or an ex-spouse informs you that a former husband or wife is obligated to pay the bill, do NOT allow yourself to assume that those arrangements are agreeable to the absentee.

 

Once you get into the habit of incorporating a discussion of fees and financial arrangements into your format with all patients – new or existing – you will find your receivables diminishing and your patient relationships improving.

Ah, this may be the toughest Ask to actually ask. Without question, pleasant people are more enjoyable to work with and crabby, cynical or perpetually angry people are a drain. The work of dentistry is too hard and challenging to add the additional burden of negativity or gretziness. If you don’t enjoy the patients with whom you work, it will be hard to generate the enthusiasm to work hard on their behalf.

 

Is it reasonable to ask patients to be cooperative, positive and of good humor in their interactions with you and your staff? Yes. Is it easy? No. The challenge is to let people know when their attitude is getting in the way or causing you distress in a way that will get their attention without aggravating their frame of mind. The trick is to comment descriptively on what you are observing and why that concerns you without expressing judgment. “You seem to be upset when you are in our office, Mrs. Jones,” is more likely to convey your concern than “Why are you always so negative with us?”

Most of you know how seriously I take the role of Facilitator in a relationship-based practice, and that I encourage the Facilitator to have no additional responsibilities or tasks. When dentists have given themselves, their practices and the rest of their team members (as well as patients) the gift of a full-time dedicated Facilitator, they will find that these Four Asks can be routinely addressed and patient relationships will be healthier and more likely to survive other blips. Sure Facilitators are an additional expense not found in most practice models. But can you afford not to have this member of your team?