CDEN0310

I 07 special _ practice management I cosmeticdentistry 3_2010 CareCredit and credit cards usually sooth the sting offeesforUS$3,500orless.Feesatthislevelarenot insurmountable and usually do not anger or em- barrass patients out of your office. But what if you presentcomplexdentistryformorethanUS$3,500? Let’s suppose your fee is US$10,000 and it involves multiple, long appointments and your patient would lose time from work? Do outside- the-mouth issues get in the way of case accep- tance now? Yes, they do. Does patient education make the unaffordable affordable? No, it does not. How do I know? You have proven it, have you not? It is with the patient whose fee is greater than US$3,500 that I recommend an outside-in ap- proach.Employinganoutside-inapproachinvolves initiatingyournewpatientprocedureswithconver- sations―telephone and the in-office new patient interview―that focus on understanding what is happeningoutsidethepatient’smouth,suchassig- nificant life issues, budget and work obligations. Later in this article, I’ll show you how. After we have an understanding of outside-the- mouth issues, we do our examination. Then, during the post-examination conversation and case pres- entation, we link our treatment recommendations to the realities of their outside-the-mouth issues. Let me show you how. The flow of conversation starts with outside- the-mouth issues and ends with inside-the-mouth treatmentrecommendations.Ilabelthisanoutside- in process (Fig. 2). An excellent example of an out- side-in process is the purchase of a home. Imagine you and your spouse decide to buy a new house. Yougotoarealestateagentand,justafewminutes into the conversation, you talk about price range, neighbourhood,schools,proximitytowork,financ- ing and down payment. These are all big picture, outside-the-home issues. Once you settled on the broadoutside-the-homeissuesthen,andonlythen, does it make sense to begin discussing the detailed inside-the-home issues, such as room size, carpet and tile selection, lighting, etc. Good estate agents discoverwhatthesuitabilityfactorsofhomebuying are(price,downpayment,monthlypayments,loca- tion, etc.) before they get into the inside details. In other words, the flow of conversation is outside-in. Now imagine you and your spouse go to the estateagent,butthistimesheisaformerdentistand uses the traditional inside-out process she used as a dentist. As soon as you sit down she begins edu- catingyouontheinside-the-houseissues―thedif- ference between cement slabs versus crawl space foundations and vinyl siding versus brick exteriors. Shegoesasfartorecommendanotherappointment with her so she can show you how to keep your house clean before you buy one. She does all this before she has any idea of what you can afford and where you want to live. What would you think? Youwouldthinkaboutfindinganotherestateagent, would you not? How many of your complex-care patients, after experiencing your inside-out process, find another dentist for the most likely reason that you spent a bunch of time educating them on inside-the- mouth details before you had any idea what was suitable for them? You educated them right out your door. An outside-in process works best for complex- care patients. Here patient education is not the driver of case acceptance. This is why: first, patients with complex needs often come into your office with a specific complaint―embarrassment about their appearance, aggravation by their dentures or fear of losing their teeth. They do not need to be educatedabouttheirchiefcomplaint.Theymaynot be aware of all their conditions, but it is most likely thattheyhavelivedwiththecomplaintthatbrought them into your office for a long time. Next, many complex-care patients have heard thepatienteducationlectureaboutplaque,pockets and sugar many times before. It’s old news and thus not a subject that distinguishes you. For many patients, patient education efforts bounce off like BB’s fired at icebergs. Expecting to influence them into a US$10,000 treatment plan that does not fit intotheirbudgetbyshowingthemhowtoflosswell is naïveté. Fig. 1