1 step to increase your case acceptance

“Wisdom consists of the anticipation of consequences.” – Norman Cousins

Growing up in Western Canada, I experienced very severe winters. Driving in those cold and icy conditions was something we were told to do our best to avoid. However, this didn’t stop most Canadians from braving the elements.

One frigid December day I wanted to travel with my cousin to Edmonton, approximately a 90-minute drive, to see a significant cultural event—a hockey game. I pleaded with my father to give me permission; after all, I was almost 17 years old! After I pretended to listen to his concerns about the weather and road conditions, he reluctantly handed me the keys to the car. My cousin and I giddily got in and set off on our journey.

We were no less than 10 minutes from home and not even on the freeway yet when we rear-ended another vehicle at a red light. The roads were so icy that even at low speed the brakes were useless and we skidded into the car ahead of us. With our teenage cockiness shaken and the car’s crushed front end to match our spirits, we hung our heads and returned home. I silently handed the keys back to my father as an “I told you so” grin spread across his face.

What does this story have to do with case acceptance? It has to do with the consequences of our decisions. Would I have decided to travel in those conditions if I truly knew the consequences? Every day we recommend treatment to our patients. However, if we inform them of the consequences of their dental condition as part of our personalized case presentation, they can make the decision that is right for them.

The benefits of introducing consequences

When we identify dental pathology, because of our training and experience we know what can happen if something is left untreated. Far too often that knowledge is not shared with patients when discussing their treatment. We identify a dental problem and immediately provide a solution to a patient. We make the fallacious assumption that the patient has the knowledge to connect the dots between condition and treatment.

Rather than saying, “Mr. Smith, you have a large broken filling on your molar, so you will need a crown,” a more effective communication technique is to introduce consequences, and then follow with a question: “Mr. Smith, you have a large broken filling on your molar. In my experience, if this condition is left untreated, your tooth may fracture and cause pain and swelling, which will result in additional costs and complications. What would you like to do?”

Properly informing our patients and involving them in the decision-making process has its advantages. It honors patients’ autonomy and respects their rights to have a say in their health. It also positions you as a trusted partner in patients’ health as opposed to a stern and judgmental figure.

Personalizing the experience

Let’s briefly discuss the patient experience. We all recognize the importance of a warm, friendly, and professional rapport with our patients. We can all appreciate how creating and cultivating an outstanding patient experience can benefit patients as well as the office. Rolling out the red carpet for all patients, new or returning, has to be done intentionally and not left to chance. We can have great case presentation and case acceptance skills, but if our team is treating patients like numbers, it’s going to be a challenge for them to accept our treatment recommendations.

An important component of understanding our patients is having some awareness of their goals. Here are some things to consider:

• What do we know about their health goals? Are they trying to lose weight, lower their A1C levels, or quit smoking?



• What are their oral health goals? Do they feel doomed to be edentulous like their parents? Are they embarrassed about their smile?



• What are some personal details of their life? Are they looking for a job or a mate? What’s holding them back from taking care of their smile?

Imagine if a patient handed you a 3x5 card that listed their goals, desires, values, budget, life events, and more, and from this card you were tasked with creating a treatment plan for the patient. With the knowledge from the card, wouldn’t you assemble a treatment plan that checked off the items on the card? You would be doing a disservice to the patient if you did anything less. The exception, of course, is a situation where there is something going on in the patient’s mouth that directly affects their wishes. Then we’re duty bound to inform the patient.

Far too often we create treatment plans by checking off our own boxes. We need to start seeing our patients’ teeth and lives from their perspectives. If our patients feel treatment plans are meeting their needs and not their dentist’s, this will go a long way to building trust, and ultimately, they will say “yes” to the necessary treatment.

Far too often we create treatment plans by checking off our own boxes. We need to start seeing our patients’ teeth and lives from their perspectives.

An important facet of making patients aware of the consequences of their untreated conditions is to personalize it based on what we learn about their goals. For example, you might say, “Mrs. Jones, having a large cavity like that could result in an unwanted infection and interfere with your planned trip to Cancun.” This approach will likely cause Mrs. Jones to visualize the impact on that event and provide her with the impetus to make a choice.

Providing consequences is even more effective if it’s followed by a commitment question. Asking patients what they would like to do about their dental condition forces them to become cognitively involved. Having patients engage their brains to solve a solution is better than doing it for them. When asked a question, our brains answer even if we don’t verbalize it. If the dentist is skilled at asking effective commitment questions, most patients will answer in some way and then dialogue can continue.

Providing honest consequences, not scare tactics, can help patients gain control of their dental care. Fostering active participation in decision making will increase compliance, reduce lawsuits and grievances, and result in patients keeping their appointments and having better outcomes. Patients identify what’s most important to them, and this personalized approach will help improve their perceptions about the dental care they’re receiving. They will likely remain loyal to our practices, refer others, and develop genuine and trusting mutually favorable long-term relationships with us. We can help our patients drive a clear and safe path to optimize their oral health. Think of the consequences!

Sonny Chokka, DDS, graduated from the Loma Linda University School of Dentistry in 1993. He is a graduate of Sirona Speakers Academy and is a multiple-office owner dentist supported by Pacific Dental Services. In his 20-plus years of practice experience, Dr. Chokka has been recognized as a subject matter expert in patient experience for enhancing case acceptance, and is a faculty member of the PDS Institute.