CDEN0310

08 I I special _ practice management Let me be clear at this point: we are going to spend some time on the patient education process with complex-care patients, it is just not one of the first conversations we will have. The first conversations we will have with com- plex-care patients are about discovering outside- the-mouthissues—justlikethesuitabilityconversa- tion with the estate agent. The outside-the-mouth issues of budget, time, work schedule, health issues are what I call fit issues. These are the issues into whichyourtreatmentplanmustfit.Becomegoodat discussing fit issues and you will save an incredible amount of time, you will sell much more dentistry and you will no longer blow patients out of the water—and out of your practice. _Fit versus change The earlier influencers in my dental career em- phasised that a significant part of being a good dentististogetpatientstochange.Changetheway they clean their teeth, change what they eat and change the priorities in their life and put dental healthatthetop.Ittookmetenyearsandthousands of patients to realise that patients change when they are ready, not when I tell them to. I learned to replace the concept of change with the concept of fit. Instead of telling patients they need to change to accommodate my treatment plan, I learned to accommodate my treatment plan tofittheirlifesituation.Patients,especiallythemore mature, complex-care patients, have complex fit issues. These include finances, family hassles, work schedules, special current events, travel, stressors, health factors, significant emotional issues; in short, any issues dominating the patient’s energy and attention. When you present complex-care dentistry, it has to fit into the patient’s life. Think about it. If you offer most patients a US$10,000 treatment plan, something in their life has to happen. People need to wait to receive their tax refund, wait for a child to graduate from col- lege, become more settled in their new job, or take a much-needed vacation. Knowing the manner in which your complex-care treatment plans fit into the current or foreseeable circumstances of your patient’s life is a mandatory skill for practising complex-caredentistry.Withoutfit,thereisnocase acceptance, regardless of the level of dental IQ or your zeal for patient education. _Discovering fit issues Your team often knows what is going on in the patient’s life. How do they know? They talk―they chit-chat with the patients and they make friends. Another purpose of chit-chat is to learn about those fit issues in your patient’s life impacting their treatment decision. When chit-chat is intentional, I call it fit-chat—an indirect way of discovering patient fit issues. When you fit-chat, be curious and listen more than talk. Listen to the manner in which patients spend their time and what’s creating stress in their life―health, money and/or family issues. If they mention something you believe may influence a treatment decision, be curious, listen attentively and encourage them to talk more about it. Through indirect fit-chat, you’re going to discover what’s going on in patients’ lives. Some patients do not fit-chat well. They are simplynottalkers.Iamthatway.WhenIgetmyhair cut, the last thing I want is a chatty experience. When you have a complex-care patient who will not fit-chat, you can try a more direct approach to discovering fit issues. Here is an example of a direct approach: “Kevin, I know from the line of work you are in that you are busy and travel quite a bit. I also know you are ag- gravatedbyfoodtrappingaroundyourlowerpartial denture. Let’s talk about your choices and how we can best fit your dentistry into what is going on in your life. Is now a good time to talk about this?” Here is another example of a direct approach: “Kevin,mostpeoplelikeyouarebusy,on-the-goand have lots of irons in the fire. I need to know if any of these irons are affecting the amount of stress you are under, the amount of time you can spend cosmeticdentistry 3_2010 Fig. 2