Tuesday, May 6, 2008

Pride and Trust

Monday we were talking about Pride and what it means to you.

First, I saw the movie 21 and it was not very good. I read the book Bringing Down the House and it was much better. I give it a 4 out of 10.
I am a big Netflix guy and I watched one of the worst movies I have ever seen this weekend. It was called "Shoot'em up" with Clive Owen. I give it a -2 on a 0-10 scale.

Back to teeth.
On Monday I was saying that when I do a work that is better than average then I have no problems charging a fee that is more than average.

Only one problem, the patient doesn't know what is better than average work is.

If I do a filling and Joe Smoe does a filling. How does the patient know that mine is better?
They don't.

I, for instance, start this filling 10 years ago by taking tons of continuing education to know how to do this filling properly.
I have the best x-ray system to diagnose the decay better.
I have researched the best materials.
Then I buy and use the best materials.
I have a facility that is comfortable.
I have a staff that is trained to do this procedure better.
I use all the best tools.
I try to do the best filling I know how to.
Then I make myself available to them if there is ever a problem.

So what does the patient perceive as a good filling?

They may perceive a friendly staff. The may perceive a nice facility. They definitely perceive a good injection. They perceive comfort during the procedure and then they perceive comfort after.
And they perceive THE PRICE.
They don't understand materials. They don't understand technique. They don't recognize if someone takes off too much tooth structure. They don't understand why something would last longer by doing it better.
Did I mention they do understand price.

How many calls do we get.... How much do you charge for a crown? How much do you charge for a cleaning?
Cleaning that is a whole different blog. The patient doesn't know what a cleaning is. (I know you are not suppose to end a sentence with "is" but if the AGD wanted a Pulitzer Prize author, this dude would not be considered) So many of my patients come from a clinic setting practice that they were getting a free 20 minute cleanings.
This stuff drives me crazy. I work my ass off trying to be the best dentist I can be hiring the best people I can (hygienists) and they are getting away with this.
Then they tell the patient that they need a "deep cleaning" and they are going to have to pay for that.
So I ask if the dentist did a perio exam.
They say, "What do you mean?"
Did they take this probe and measure the depth of your gum pockets?
"Doc, I have no idea what you are talking about"
YEAH RIGHT, they NEED a deep cleaning. Don't get me started.

This is an idea of another blog. What clinics offer guys like and you? I think they have benefit to us and I will explain this soon.

Anyway, back to perception.
I think of ourselves a little like auto mechanics. Its a cash business and people have no idea what they are spending their money on. And, oh yeah it has to be done. This lends to huge trust factor.
It is funny when I bring my car in to the shop. The guy will tell me you have some carbon build up in your something and we need to do something with a something and then you a problem with the blah blah blah blah blah and blah blah blah $750. (See what I mean about the price.)
I say, "Well, Mike you have been my mechanic for years, I have no idea what you are talking about, no I don't want to see a picture of the carbon build up, so go ahead and do it. "
One time he actually showed me a photo of the carbon build up. I had no idea what I was looking at and if that was even my car. He was trying to inform me and educate me but...

I know, I know we are not like auto mechanics but it really comes down to trust.
Back to the perio thing a minute. In all my New Patient Exams I put my patients in our consultation room and we just talk. We start a relationship (as much as you can get in 15 minutes) and one of the things I talk about is gum disease. I explain to them that I am going to be doing a thorough gum exam. I explain this is what the gum disease looks like and this is how I examine for it.
It is like taking a intraoral photo of decay. This is taking the trust out of it (not that having trust in your care giver is bad) but you are involving them in the decision about them.
Then they know that if they have a bunch of 6mm pockets, they now know what that means. They understand what it means if they don't do anything and they understand why they need "deep cleanings". Then they know that after their deep cleanings they want those 6mm to become 3mm or less.

Back to fillings.
I suppose explaining is again key. But I am not going to spend half my day talking to people about what a filling is and how we do it. I am not going to go over what a good one looks like and what it means to use the best materials.
So it is going to have to come down to trust.

So if they come with a little trust in the office we all are a little better off. You know what I am saying...If they are referred to our office by someone the trust has started.
Imagine the conversation over some beers at your patients house. "If you are having that much trouble with your dentist, you should try mine. They are the best. All the stuff they have done for me has been great. And he is good looking to boot."
So they come in with some pre-conceived trust.
So we try at our office to have an internal marketing strategy. We do a terrible job at it but...
We try to send thank you letters to referrers. We try to send movie tickets. Dinner gift certificates, T-shirts...stuff like this (I have been try to get everyone on board to just send a $20 bill in the mail. I would love to get $20 in the mail, it would make me pay attention).

Have I answered my own question? Have we figured out what is going to make someone pay $50 more for my filling?

Well, why would someone pay $450 for a room at the Ritz when the Hilton down the road is $200 a night.
Why would someone pay $40 for a steak at Ruth's Chris when the Outback has a $18 Outback special (and it comes with a salad)?
Are the beds that much better at the Ritz? Is the meat that much better at Ruth's Chris?

Lets stop here.

Well, today I have been all over the board.
I am talking about fillings, then perio, then auto mechanics. Then I talk about internal marketing, then hotels.
Needless to say I don't have all the answers, so I babble.
I am going to take some of these and talk about them individually and maybe we can come up with something together.
If you have some clarity, please comment.

Talk to you Friday,

PS. Are you still reading?
Are you enjoying this stuff?
Have any ideas on topics?
Let me know by commenting or emailing me. Jgammichia@aol.com


Anonymous said...

Hey John,
Of course we are still reading! Nearly stop what I am doing each time I see the post hit my email to read what tales you have to tell.

You are right, trust is huge, but some patient education does help in reinforcing that trust. Some people want to understand why thier car is acting funny. Asking WHY is what makes us humans the smarter ones, RIGHT??

Thanks again!

Anonymous said...

I'm here 'till the end buddy.

Anonymous said...


My FIL told me two things before I started out on my own, starting my own office. He said "You'll hurt 'em in the mouth and you'll hurt 'em in the wallet"

That has always, always stuck with me. People have choices. Dentistry is not a "factory" and hence the human touch is key. Patients will come and go, but having the one come back from another office to praise your glory is the ultimate.

Keep motoring!



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