Never Say Never

When I graduated from dental school, I made two promises to myself: never establish a home office or specialize in orthodontics. But never say never. As a general dentist, I’ve enjoyed incorporating orthodontics into my practice, which is—you guessed it—in my home.

After commuting 40 minutes to an hour and a half, depending on traffic, to my high-rent suburban D.C. office, my home practice has been a delight; the coffee pot is my only distraction on the way to work. I thought there might be a problem with drop-in patients, especially on weekends, but I live in a rural area, which is not conducive to folks just sauntering over unannounced.

My wife manages the office, and the worst drawback for her has been people giving her payments when she’s not at work. They might call three months later, upset that the payment was never recorded. Later, she would find the crumpled check buried in her purse along with her two wallets, numerous loose bills, assorted change, expired credit cards, a coin purse (containing more change), lipstick, eyeliner, emery boards, nail clippers, wadded facial tissue, ancient MasterCard receipts, scraps of paper containing historical grocery lists, and—well, you get the picture. She no longer accepts payments at the grocery store or on the alley on bowling night.

I’ve loved incorporating orthodontics, which I once condescendingly referred to as “wire-bending.” It has allowed me to more closely track my ortho patients’ oral hygiene and diagnose caries development early. And the meticulous treatment planning, which predicts a two or more year regime, has spilled over into other aspects of my general practice. The treatment plan contains a list of dos and don’ts that the kids and parents are supposed to follow. Those instructions, however, seem to be forgotten at Halloween.

And incorporating this aspect of dentistry does add to the mix.

I’ve spent a lot of time performing dentistry overseas with different charitable organizations. One time when I was far away, a mother, who didn’t want to use our on-call dentist, phoned my wife, who told her to bring her son right over. The boy was in braces, and a wire was poking him. He arrived at the house with blood and muck all over his face, more than just a wire poking his cheek. With the mom looking on, horrified, my wife took him into our kitchen—practicing dentistry without a license is not on the table, but being a good neighbor is—and proceeded to wipe him off with peroxide. There was a minor cut on his lip and straw caught in his braces, which, it turned out, were not loose. He had fallen face-first out of a hayloft and into a horse stall. The muck my wife had just wiped off was not just dirt.

On another occasion, when I was in town, a school nurse phoned our office. She sounded frantic. A young orthodontic patient needed to be seen right away. I’d once been told by an orthodontist that there was no such thing as an orthodontic emergency (which was the main reason he’d chosen his specialty), but this particular call sounded like one, although the nurse wasn’t very clear about the problem. When the young man entered the waiting room, I heard my wife crack up laughing. She was almost in hysterics as she came back to announce his arrival.

I couldn’t imagine what could be that funny about a patient in distress—until he was seated. When the boy turned toward me I saw a ballpoint pen clipped to his upper wire. It was firmly pressed against his lips and chin, while the “clicky” end was wedged far up his nose. A telltale bulge revealed that it was pressing hard against the inside of his nostril. The school nurse had attempted to dislodge it, to no avail. I tried to be nonchalant and asked him how his day was going. He just shrugged.

As I took the wire off, the pen fell to the floor. I should’ve taken the time to snap a picture of it jammed up his nose. I asked if I could have his pen as a souvenir, after my assistant had wiped it clean, but the kid said he needed it for school.

There some are days when I just love my job!

Orthodontics and a home office have been a great way to expand my general dentistry practice.

Best thing I ever did.

Jim Rhea, DMD

RE: Exit Interviews

This blog entry is inspired by Larry Stanleigh’s great post on patient exit interviews. One of the rewards of reading and writing for this blog is that we are constantly learning from one another.  Sometimes, when I read one of my fellow blogger’s entries, it inspires me to write. Thank you, Larry. 

I look at the problem of learning why patients leave a practice from a different angle. Instead of asking patients why they left my office, I ask them why they left their previous office. Patients (and dentists) often are more comfortable with this approach. I find that patients are more forthcoming because they don’t feel that they will hurt your feelings. You’ll get a greater number of honest answers. Believe me, you’ll learn what NOT to do in your practice. They’ll tell you things they would never tell their previous dentist.

I usually say something benign like, “What brings you here?” or “Tell me about your last dental visit.” or “Who was your last dentist?” I’m not a big fan of scripts. Just ask in a manner that seems natural for you.

Sure, you’ll get the usual responses, like how the patient just moved to your area. Some responses, however, have surprised me. My favorite is when patients tell me that they just absolutely loved their previous dentist. They tell me about how great he or she was, how their kids loved that office, and how caring the staff was. They brag about how the dentist just about walked on water. My question naturally is, “Then why are you here?”

Are you ready for the response? C’mon, you can see it coming. You’ve heard it many times before! “We had to change offices because my dentist no longer accepted my insurance.” Man, I could write a whole blog on this one alone!

Sometimes the patient responds that the dentist became very involved in the local dental society, or that he or she became a busy lecturer. The biggest complaint from the patient, then, is that the dentist was never in the office.  Let’s face it: Patients want you to be available when they need you. Sure, they are happy for you when you move up the political ladder, but they’ll soon be looking for a new dentist. Lecturing across the country? Patients think that’s cool—and they’ll be happy to brag about you to their new dentist.

Another reason I’ve heard is that the practice was sold because the dentist retired. I get new patients from that, too. Believe me, I make absolutely no effort to bring those patients into my practice. Ideally, patients will stay with the new dentist. However, I usually hear the same concern: The dentist who bought the practice is just too young. I can really relate to this since I, too, was once a young dentist. But the good news is that, over time, that problem corrects itself. If you observe most practices, the average patient age tends to be close to that of the dentist. If an older dentist sells to a much younger dentist, there will be some patient loss.
  

Some of the above reasons are not ones that patients may want to tell you. How many times have you told someone they are too young or too old to treat you? Not many, I bet. You just quietly move on. 

I agree with Larry that exit interviews can prove valuable in the rare cases in which people actually will be honest with you. I have found that learning why people are now in your office can prove to be just as informative.

Andy Alas, DDS

Wow, Your Office Is So Cool

Recently I went on a daddy/daughter weekend with my 13-year-old daughter. We were originally going to go to NYC, because she always wanted to go there. Then we started looking into flights and hotels and found that a four-day weekend was going to cost us too much money. 

I broke the news to her and told her that I wanted to take her to Savannah, Ga. I had never been there. I always see it in Southern Living and it looks like so much fun, and all our friends tell us it is so nice. My daughter was disappointed but she thought Savannah would be fine. 

I told my wife, “Since we are not going to NYC, please book us something nice.” 

So our trip was on. I took Friday off and we left at 8 a.m. We rented a car (I don’t trust my vehicle to go more than 100 from the house) and my daughter thought that was pretty cool.

We rolled up to our hotel in Savannah at about 2 p.m. We stayed at a place called the Andaz.

Wow, was this place nice. We had the door opened for us and we were greeted by a staff member in the atrium. 

Yeah, this place didn't have a front desk. It had young people standing around with iPads in their hands greeting the guests. They had a key card-maker on a small table, but that was about it. This was the hotel version of the Apple store.

I was a little taken aback. I thought to myself, “Where's the front desk?”

Then I calmed down and thought, “This is how cool places look nowadays. I am cool, so I can handle this.”

Of course, I start thinking of my practice. And, since I am cool, I started wondering if this kind of concept could work at my office. But just because it is cool and I am cool, it doesn’t mean that all cool ideas are going to work for my office. 

I looked at my demographics and it turns out that 40 percent of my patient pool is over age 55. Great demographics for a productive dental office, but not so great for rationalizing why we need new computer gizmos.

I think that the older generation might be starting to feel pushed out, or maybe even left out. You know the Gen X attitude: “Figure it out quick, because the next generation of gizmo is coming out and it’s just going to build on this one.” It’s like math. If you sucked at Algebra 1, you were in real trouble for Algebra 2.

And, for the older generation, it’s being shoved down their throats and they don’t like it. I don’t want my office to treat my older generation this way.

Then I started to think about what the staff does at the Andaz when no one is walking in the door. Do they just stand around or do they play Candy Crush on those fancy iPads?

The desk at our office also is a work station. And when no one is walking in the door, my staff deals with the hundreds of other things they have to do. It just doesn’t make sense to me to have someone there just to greet patients.

But really the issue is…how should we greet patients?

I mean, you can get the same welcome from a warm smile and a “We have been waiting for you and we are excited that you are here"; you don’t need someone just standing around.

So let’s look at our offices. Do our patients actually get greeted?  

Are your front desk people looking up from their computers and smiling at the people coming in? Do you have photos of all of your patients? We take photos of all of our patients (with a camera that hooks to the computer; about $29 at Staples), so we know who is walking in the door and we can greet them by name. 

Have you thought about, when a patient needs help filling out paperwork, having a staff member come around the front desk and sit with the patient and offer assistance?

When we see another company doing something that we think is cool, we don’t necessarily have to change. But we should think about our office and how we do things. 

Maybe my office can’t be the Andaz, but just because we don’t have a staff member in the reception area just waiting to greet patients doesn’t mean we can’t do something for our patients to make them feel welcome. 

Tell me your thoughts. 

How do you greet your patients? Have you implemented something you saw being done at another company? 

Have a great day, 

John 

Too Many Choices

In school, choosing dental materials was an easy choice. You used whatever the professor told you to use. But as a new dentist, I’ve been overwhelmed with the choice overload and information overload. Is it really necessary to have 5 or 10 different types of bonding or cement material?

Don’t get me wrong: I feel thankful that I’m in a practice where I get to choose what products I use and have control over the type of treatment I provide. I know several of my classmates who are working in large clinics who would love to have my dilemma. But, at the same time, can too many options be a bad thing? 

Most people think that there is no such thing as too many choices, but as new research comes out, psychologists and economists are saying that an overload of options may actually paralyze people or push them into decisions that are against their own best interests. As dentists, that means that our patients may not receive the best care.

From dental materials to types of restorations to which treatment plan is best for a patient—as dentists, we have several important choices we must make on a daily basis. Know that what works well for your colleague may not work well for you. And, despite the pitches from some sales reps, you are not committing malpractice if you don’t use their products. So how do we choose which products to use? I have come to the conclusion that less is more. 

The first thing I did was create systems and flow charts, which has helped me to take the guesswork out of the procedure. Second, I’ve referenced places like Dentaltown or the Clinicians Report for more information. Then, if I’m still not sure, I just resort to what I used in dental school.

I would love to hear from our readers. Which are your tried-and-true, go-to items? What things can you not practice without? 

Thanks in advance for the feedback.

Grant Glauser, DDS

Seekers

I learned a ton of valuable information in dental school, but something I didn’t pick up on was how many drug seekers I’d see in my practice. Holy moly!

We know that prescription drug abuse is the fastest growing and most prevalent drug problem in the US, and many seekers use dentists as a resource for the drugs. This has to stop—most importantly for the benefit of the abusers, but nearly equally as beneficial for us as practitioners. It’s a waste of my chair time and staff effort for someone to come into my office, who’s clearly not interested in treatment and only wants something “to hold them over until they come up with the money.” The only way we can combat this issue is as a team. I’m here to give you a few resources for your arsenal the next time you’re presented with such a case.

You know these patients. They’re smart individuals, for the most part. Their medical histories are dead giveaways:

Allergic to: Codeine, Hydrocodone, Tramadol

There’s often an infection, broken tooth, half treated root canal with a temporary filling or, on occasion, no visible issue. Their pain level is through the roof and they often jump out of the chair the second you touch their lip with a mirror. And they usually have the same spiel:

“Doc, I can only have that one that starts with a ‘O’… Ox… Oxy… Oxycontin I believe is what it’s called.” or “P… Per… Perco something or another.”

Please tell me you’re not fooled by this. If so, I have news for you: there are state prescription monitoring programs! Most states have some variation, and 25 states share their information through a program titled PMP Interconnect, sponsored by the National Association of Boards of Pharmacy (NABP). In Virginia, it’s linked through the Dept of Health Professions. Are you wondering how this is useful to you?

My staff is so well versed in this program. With a single red flag, even during the initial phone conversation, they log in, enter the patient’s information, and out comes their prescription history. It takes 2 minutes, is available 24/7 and is all done online. Sometimes the list of prescriptions is upwards of 10 pages long! THIS patient is getting no prescriptions from me beyond Ibuprofen or an antibiotic. I even bring the print out into the operatory with me when I have pushback from patients about my unwillingness to prescribe. Some have gotten right out of the chair and walked out. So be it.

The problem is that these individuals “doctor shop.” They leave my office after an unsuccessful attempt at gaining a pain medication and drive right down the road to the next office. My hope is that with education and more practitioners paying notice to the issue, we can help combat this major problem.

If you’re looking for more information, there a few great resources that offer free CE on the subject. Check out the FDA, NIDA and Boston University School of Medicine.

Thanks for listening.

Donald Murry, DMD

Exit Interviews

One of the most common measures for the success of a dental practice is the number of new patients we see. There almost seems to be a competition amongst us to see who can bring in more new patients. I have always had a problem with that; I hear about practices seeing 50, 100 or more new patients in one month. How is that possible? That kind of growth would mean you would need a new dentist provider in the practice every six to 12 months, as one dentist cannot properly care for that many people. What I suspected is that as fast as some of these practices are filling up the front door, there may be an equal number leaving out the back door. Is anyone measuring that? I think we should.

Why do people leave a dental practice? Patients leave because they have died, they have moved far enough away that seeing you for regular care is too much of a burden, or for some other reason. The first two are completely understandable. When I am informed that a patient has left the practice for one of these reasons, I don’t question it. However, when someone leaves my practice to see another dentist within the same city, I do wonder what happened. In these cases, we always conduct an exit interview.

Most people do not like conflict, and when a patient leaves a dental practice, they don’t want to be confronted. Asking someone why they have left the practice puts the recipient of the question on the defensive, so we never ask why.

First, we figure out who the best person is to call the patient who has left the practice. We try to determine which member of the team had the best, most amicable, relationship with that patient, and sometimes that person is me. That team member then calls the patient. “Mr. Jones, we have received a request to transfer your dental records to another dental office. I want to let you know that we have complied with this request and would like to ask if you could help us with something.”

At this point the patient almost always agrees. Then we ask if there was something we did, or did not do, that lead to their decision to seek dental care elsewhere.

No longer are we asking why. We are asking what did we do, or not do. This has been very illuminating. Sometimes we learn it is the behavior of a specific member of the team, or a way a financial transaction was handled. When it is something that is tangible, and not just emotional, we collect this information and share it with the team at the next team meeting. We use this information not to point fingers at team members for being bad, but rather to discuss how this can help us be a better team and slow the leak of patients leaving.

It has been a powerful learning tool. As we have employed this over the years, the number of people who leave is now one third the number of new patients. So we see three new patients for every one that leaves.

One last thing we do when we are on the phone with the newly departed patient is that we thank them for giving us the opportunity to care for their oral health. We tell them that if there is anything we can do to assist them with their health care at any time in the future, our door is always open. We have had these patients say, “Wow,” and a remarkable number have returned to our practice, as they don’t get the caring service that we had provided them in our office.

Try this and let me know what kinds of responses you get as well. It’s not just about how many new patients you get each month, it is the number of net new patients that is a real measure of growth.

Back to the grind…

Warm regards,
Larry Stanleigh, DDS

Back to School

Here in Michigan, the day after Labor Day marks the beginning of the year for the majority of schools. The first week of school has traditionally been tough on the practice.

We see parents who didn’t realize it was the first week when they set up their children for restorative care, or they themselves not realizing that they can’t come after work because their son or daughter needs to be picked up from practice. Everyone’s routine shifts a bit that first week back to school. We have learned from that experience and equally shifted.

We don’t schedule any children during that first week of school. How? Simple. When setting the appointment, we conveniently and thoughtfully avoid giving that time to kiddos that are of school age. We also make a significant point to inform parents of school-aged kids when they are setting their own appointments that this time is going to fall on the first day of school, and ask if that will still work. We would rather have a slow (and markedly less stressful) scheduled week with possibly less production than a day full of cancellations and no-shows.

We are, of course, available to children for urgent needs. But as a rule, we try to keep the kiddos at school this week and out of the office. This protocol is not only for scheduling reasons but for patient management. Many children struggle getting back into the routine of school and often their behavior in the dental setting isn’t what we normally would see. We have been opting out, if you will, for a few years now and I feel it is one of the better scheduling procedures we have come up with.

Between our two practice locations, there are at least six different school districts close by. Our team marks in the schedule any known days where school is off so that we can inform parents. This makes it much easier to schedule appointments for school-aged children and parents love that we know when their kids have a scheduled break. It’s a win-win situation.

Do you see a change in your practice when school resumes?

Colleen B. DeLacy, DDS, FAGD