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06 I I special _ practice management _I enjoy seeing the articles in CAD/CAM in which clinicians recount their creation of magni- ficent works of art through digital restorative dentistry. In most of the case studies I’ve read, I am sure the patient fees reach well over US$15,000 or more. Let me ask you this: what percentage of your patients whose fee is US$15,000 or more are ready to start care immediately after you present their treatment plan? I have directed this ques- tion to thousands of my dentist audience mem- bers over the last decade and the overwhelming response is “fewer than 5 per cent”. Is this because patients do not understand dentists’ treatment recommendations? Or is it that the fee does not fit into their budgets? Chances are that both these apply. Asdentistsweareprettygoodathelpingpatients understand us and our treatment recommenda- tions.Whatwearenotgoodatisunderstandingour patients and the manner in which our treatment recommendations must fit into their lives. If you have heard it once, you have heard it a thousand times: the key to case acceptance is patient edu- cation. Go to dental seminars, read journals, listen to consultants; most of it sounds the same― educate, educate, educate. Now let me ask you this: is it true? Is patient education the solution to case acceptance? Ifitis,thenwhydomanynewpatientswhohave been thoroughly examined, educated and offered comprehensive treatment plans leave your practice and never return for care? Is it that you did not educate them sufficiently? Or is it that in the chal- lenge of case acceptance, patient education is not the only answer? Let’s consider the new patient process and case presentation and learn when patient education works for us and when it chases patients out the door. _Inside-out versus outside-in Howdowegetpatienteducationtoworkforus? Let’s first make the distinction between an inside- out versus outside-in new patient process. The tra- ditional new patient process is inside-out. It begins by studying the inside of the patient’s mouth― the examination, diagnosis and treatment plan. It is after this inside look that we educate the patient withregardtoallhis/herproblems―howhe/shegot them and what we can do about them, for example case presentation. After case presentation, we quote our fees and discuss financial arrangements. It is only once we have gone through our inside processthatwediscoverwhatishappeningoutside the patient’s mouth―his/her budget, work sched- ule, time and significant life issues. The flow of conversation starts with inside- the-mouth conditions and ends with outside-the- mouth issues. I label this traditional way of manag- ing the new patient the inside-out process (Fig. 1). For patients with uncomplicated dental needs ―fees of US$3,500 or less―the inside-out ap- proach with appropriate patient education works well. Here’s why: First, patients with minimal clinical needs are often unaware of them. Patients with conditions such as periodontal disease, asymptomatic peri- apical abscesses and incipient carious lesions must be made aware of them and educated regarding their consequences. Patient education is the driver of case acceptance when patients are unaware of their conditions. Next, the inside-out process works well for patients with fees of US$3,500 or less because the outside-the-mouthissues―fees,timeintreatment and life issues―are such that most patients can proceed with your treatment without undue hardships or inconvenience. Dental insurance re- imbursements, patient payment plans such as CAD/CAM 2_2010 Case acceptance in complex-care dentistry Author_ Dr Paul Homoly, USA