10 Worst Mistakes When Presenting a Treatment Plan

Do you get frustrated during a consultation?  We can get so focused on figuring out the dentistry that we forget a whole human being is attached to those teeth.

It’s not an easy job.  We diagnose disease, craft a treatment plan, and then must perform the procedures to the best of our abilities.  But on top of all that, we are also responsible for presenting the plan to the patient for their approval.  The art of the consultation takes years to master and along the way we can make a lot of mistakes.  Here are the 10 worst offenses that can derail your case presentation and delay necessary care.

(1) List treatments.

Example: “You need three root canals, four crowns, and three fillings.”

We are health care providers, not tooth carpenters.  It demeans our profession to talk about our services like they’re common commodities.  But even worse it can give the patient the impression that they are just consumers shopping at a store.

Discuss the patient’s problems first, such as decay, infection, fracture, and so on.  Then present your treatment as solutions to those problems.  But when presenting treatment, make sure you don’t commit the next mistake which is…

(2) Speak in dental terms.

Example: : “We’ll do a PFM here but only after some crown lengthening to avoid violating biologic width.”

I don’t know much about cars, so it can be overwhelming when I go to the auto mechanic.

As you can see here, your piston inducer has reversed polarity, so now I have to calibrate a whole new rotary spank converter."

We have been given a wonderful dental education.  Part of our responsibility as health care providers is to help patients understand their problems and potential solutions.  One of the best ways we can do that is by taking the technical details of our education and distilling it into patient-friendly terms.  Find your favorite euphemisms for procedures such as crown lengthening and immediate dentures.

(3) Make elective treatment sound necessary.

Example: “I can make your smile so much better with veneers!”

This one really offends me.  It is our duty to inform patients of treatment when it can remove disease from their body and restore function.  But it is completely inappropriate to tell patients that they require treatment that is entirely cosmetic or elective.

I will ask patients if they have any cosmetic concerns and await their answer.  If they say no, I leave it alone.  Offering cosmetic appraisals when they aren’t wanted is a sure fire way to make people feel bad.  It’s just not nice.

(4) Present complex care in a hurry.

Example: “You can get a four unit bridge or two implants.  Well it was nice meeting you, Mrs. Jones.  We’ll submit to your insurance company and we can figure it all out.”

You run into the hygiene room to meet a patient who needs a lot of work.  You race through the treatment options but all you can think about is getting back to the next operatory to finish that root canal.  What’s the rush?

When I encounter a patient who has a few treatment options, I re-appoint for a half hour consultation visit.  It gives me and my team time to do our homework and plan the case correctly.  Then I have dedicated time to walk the patient through their problems and our solutions.

(5) Talk for a really long time.

Example: “Blah, blah, porcelain, blah, blah, payment options, blah, blah…”

I once spoke to a patient for something like 40 minutes explaining the entire range of treatment options and the history of dentistry.

"And that's how Branemark discovered dental implants. Excuse me, are you paying attention?"

I almost bored myself to sleep.  Really.  My eyes got heavy and I almost fell asleep while talking.

Yes, we have a lot of information to convey, but break it up into little bits.  Raise a concern and ask for feedback.  Mention a treatment option and ask for their thoughts.  Turn the consultation into a conversation, not a presentation.  Reduce the amount of time you’re talking so you reduce the chances of overwhelming your patient.  While we’re on the subject, another way to talk for too long is to…

(6) Go into unnecessary detail.

Example: “Feldspathic porcelain isn’t as strong as zirconia, but I’ll still use some to veneer over the zirconia core.”

This is not the same as #2: “Speak in dental terms.”  The difference is that some concepts need to be grasped by a patient, such as what a root canal is, but other concepts are just technical details.  Discussing dental material science is rarely necessary.  We’re just contributing to information overload.

(7) Introduce a barrier to treatment that doesn’t exist.

Example: ” Don’t worry, the implant surgery is easy so I don’t want you to freak out.  We can always to put you to sleep if you want.”

Two of the most common barriers to accepting treatment are limited finances and dental phobia, among others.  If a patient has concerns about the treatment process, let them raise them during your conversation.  Don’t assume that they are going to be afraid of the procedures or have an issue paying your fees.

(8) Use condescending words.

Example: “Your gums are awful.  Here’s what I can do to fix them…”

Obviously avoid adjectives that can be hurtful, like “awful.”  But we should also try to avoid the words “you” and “I” in our consultations.  “You” can sound like we’re pointing a finger at someone; it can be a little harsh-sounding.  “I” puts distance between you and the patient; it can be a little smug-sounding.

Introduce the word “we” into your routine.  “We” takes the nasty edge off of “you” and “I” by uniting you on a team.  “Our gums aren’t very healthy right now.  But here’s what we can do to get them feeling better…”

(9) Meet in an unfriendly room.

Example: “Let me move that stack of bills from your chair.  It’s the maid’s day off.  Ha!  Seriously though, don’t sit on that.”

Patients aren’t thrilled to be in the dental chair.  No surprise there.  So presenting complex care in that environment may be too distracting and/or uncomfortable.  Consultations in a private office may also be a bad idea if your desk looks anything like my pile of papers that I call a desk.  It gives the appearance of being disorganized and dirty.

It’s ideal to have a dedicated consultation room.  Comfortable chairs, a computer, table space to show models, etc.  Most importantly, it’s a private and comfortable setting that allows you to chat about personal matters.

(10) Charge a consultation fee.

Example: “I’d like to bring you back for a consultation.  My fee is $100, but I promise it’ll be worth it!”

I think it is perfectly reasonable to have a fee for diagnostic procedures, such as radiographs, study models, diagnostic wax ups, and the like.  It takes time and effort to correctly diagnose and treatment plan.

However I don’t like the idea of charging a patient for the consultation visit.  It places financial pressure on someone to quickly ask their questions and make a decision.  It will also preclude patients from setting up a consultation appointment in the first place.

 

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Please note that I can no longer answer questions from the public regarding their personal dental care. I am unable to properly diagnose or recommend treatment over the Internet. If you are looking for a dentist, please visit the "Find A Dentist" feature on healthysmiles.org