Fwad1 Rdh1207

Treatment Presentations / Case Acceptance

July 1, 2012
Research shows that people decide who to purchase health-care services, support, and personal items from based on their perception of the health-care professional's attentiveness and truthfulness during the first minute of communication.
Skills and techniques for getting to YES


Research shows that people decide who to purchase health-care services, support, and personal items from based on their perception of the health-care professional's attentiveness and truthfulness during the first minute of communication.

The old adage "There is never a second chance for a first impression" is true for case presentation and subsequent acceptance. "Selling" seems to be a dirty word in our profession, yet whether we acknowledge our ability to influence others or not, we are engaged in treatment acceptance or denial every day.

Patients can move from acceptance to withdrawal in the blink of an eye, leaving us bewildered and disappointed. What motivates a patient to follow our suggestions seamlessly or question us to the point of distraction?

Three key components compile the decision-making process -- the patient's personal triggers, our ability to quell concerns, and our skill at creating tangible value for the treatment plan.

As hygienists, our job is no longer to focus solely on the treatment and maintenance of periodontal conditions. The days of the "tooth scratcher" (as my father lovingly called me) are gone. The moment we pick up a mouth mirror, we begin the significant role of assessing the restorative needs of our patients.

Hygienists who work as bonafide cotherapists with their dentists hold a position of influence that is noticed and rewarded. Aspiring to a higher professional standard of care, we create an avenue to health and quality of life for the patients we serve.

Step up to treatment discussions

Treatment presentations involve the entire team and rely on all team members delivering a consistent message. First, understand what motivates your dentist to recommend different treatment modalities. Plan time for clinical conversations with your dentist to discuss topics such as implants, cosmetic procedures, timing for replacing failing restorations, and the limits of the cosmetic procedures offered in your practice.

If you don't know the answers to these questions, find out. Patients ask questions. How well you answer them will greatly influence the level of confidence they have in you and the team.

Do not undermine your chance to be a cotherapist

Educating patients on restorative dentistry requires us to educate ourselves in two areas -- technical treatment options and communications skills. It will take some planning and studying in order to provide these services and increase your value. However, the payoff for becoming a well-informed team member and controlling the patient's educational process is well worth the time and effort.

Treatment presentation hierarchy

Patients count on our experience to decipher their treatment. However, fear, funds, or failure to understand our objectives can block smooth enrollment into a restorative treatment plan.

As a respected confidant, what counts is our ability to access and present treatment that resonates with the patient's emotional needs. Delivering specific clinical information during the presentation is usually contraindicated. Treatment presentations should not contain detailed explanations of the clinical steps we will perform. Achieving the ultimate clinical outcome is expected for the clinician; however, explaining the entire process to the patient may cause undue concern.

If you feel compelled to explain your restorative presentation in detail, ask the patient for permission. The underlying triggers and concerns of a patient must be included in a successful case presentation.

How do we determine triggers and concerns specific to each patient? Two important skills are "active listening" and "asking open-ended questions."

Active listening:

Active listening is the engaged process of paying attention. The rules are simple -- pay complete attention to the patient, sit or stand facing the patient (same height), make full eye contact, and have no distractions from outside the operatory, ever.

The art of "active listening" will provide clues about the mindset of patients, and what drives their buy-in to our suggestions. Active listening is your time to commit total attention to the patient, and what you glean from listening to your patient will provide the information for a presentation that will validate the importance of your patient's perspective, and ultimately their compliance. Armed with this information, you can repeat back to the patients what they have shared with you. In so doing, you create value for what has influenced their decision-making process. More than any other skill, active listening provides opportunities for you to help your patients accept difficult choices. Remember, purchasing decisions come from deep reactions to spoken words and images. Patients move to action based on what they feel from the head, heart, or gut.

Open-ended questions:

Open-ended questions are questions constructed to illicit more than a yes or no response. Posing a question that forces someone to feed you information is not pushy or nosy. It is our professional way of gaining insight into what will encourage patients to accept treatment that we know will help them.

Constructing open-ended questions could be the focus of an entire team meeting. Challenge yourself to ask questions of team members that will not allow them to give a yes or no answer. It will seem awkward at first, but the sooner you master this skill, the farther down the path to case acceptance you will be.


1. What are your concerns about treatment

This question will help patients begin a dialogue with you. If you simply ask, "Does anything bother you?" the patient can easily shut you down with a yes or no.

2. How can we make your visit more comfortable

We usually ask, "Are you comfortable?" Out of fear or guilt patients may say yes, when actually something may really be bothering them. I challenge you to commit to writing down 10 open-ended questions and share them with your team.

Present options

Knowing the parameters of restorative materials and your dentist's approach to restorative care will allow you to present multiple treatment options to your patients. This will expedite a quick case acceptance. Remember, presenting treatment options is not diagnosing! Provide more than one option for handling any situation. It is your duty to field questions. The time you spend preparing patients to hear treatment choices recommended by the dentist will provide solid ground for a successful case closure.

Emotional triggers and concerns

You may be asking, "What am I listening for?"

Emotional triggers:

Triggers to act -- Emotional triggers are beliefs that naturally move patients to accept treatment. Examples of triggers are esthetics, function, avoiding pain, peer pressure, and, let's not forget, guilt!

Triggers are easily dealt with because they move patients to act/accept. Your case presentation does not have to be creative. Presentations should always be truthful, however, dealing with patients who are motivated to start is easier than dealing with patients filled with concern.

Emotional concerns:

Concerns to stop -- Concerns or thought processes that stop or slow down case acceptance are pain, fear, or frustration.

Pain -- This is often a true roadblock. Patients may give you all kinds of reasons for not continuing treatment. Keep asking questions and make sure that fear of pain is not the true concern. Never promise that a procedure will be pain free! You will lose credibility.

Fear -- Fear and pain are closely linked. Give enough information to quell patients' imaginations, but do not explain the procedure in graphic detail.

Anger -- Patients may be angry that treatment is needed. Some may feel that the recommended treatment will not be successful and they will continue to have the same problem.

Frustration -- Often this hurdle will lead to denial that treatment is needed.

Many times there will be several triggers or concerns that will drive patients to postpone treatment. As health-care providers, it is our ethical responsibility to listen and learn what drives each patient.

What are our takeaways?

  • Build a solid cotherapist relationship with your dentist
  • Learn to listen for what will drive your patients to say yes
  • Practice active listening
  • Rehearse open-ended questions
  • Study triggers and concerns

Go on and enjoy exploring and practicing the skills of a true communicator. Our goal as health-care providers is to communicate our way into a deep, trusting connection with our patients.

LISA C. WADSWORTH, RDH, is a lecturer, certified professional/personal development coach, and president of Lisa C. Wadsworth Inc., a company focused on the integration of implant dentistry into your practice, communication skills that lead to the acceptance of technical treatment plans, and ergonomics. Lisa can be reached at (215) 262- 6168 or [email protected].

More RDH Articles
Past RDH Issues