Effective communication with patients should be clear, concise, and consistent. Clear means that the message is easily grasped, intuitively understandable, and unambiguous. Concise means that the maximum amount of information is communicated in the fewest possible words. Speaking in pithy sound bites that patients will remember is preferable to providing a rambling discourse that circles the point without ever landing on it. Consistent means that all members of the team are providing the same message. Certain words and phrases should become a mantra in the practice. These key points are repeated the same way because they are effective, and the very fact that the practice is consistent is in itself an important element of the communication success. The following are seven frequently heard comments or objections from patients, and recommended responses:  

1. If this is not covered by my insurance, then I don’t want it. Patients should be told that dental insurance has only three purposes: a) payment for preventive services within a calendar year, b) limited payment for single tooth or single quadrant dentistry within a calendar year (but if patients need a root canal and a crown, they will most likely exceed their annual insurance limits), and c) some plans have a special orthodontic benefit. With this background in mind, the patient should be told, "In our practice, we base treatment recommendations on the needs of the patient, not the limitations of the benefits." Notice that the word "benefits" is used in place of "insurance." Patients often fail to make a distinction between medical and dental insurance. The former is designed to provide a financial safety net to protect the patient in the event of an expensive illness or disability, while the later is a benefit from an employer in the form of additional compensation (usually tax free to the employee) to partially offset the employee’s expenses for basic dental care. Footnote: try not to say to a patient, "I am sorry, but this procedure is not covered by your insurance." A much better response is, "The proposed treatment is beyond the scope of dental benefits."  

2. So, am I going to be paying for the doctor’s new office? For some patients, this question is in the context of friendly banter with the team. There are some patients, however, who are not smiling when they raise this objection. Broadly speaking, there are two types of questions that patients ask: those that are legitimate, inbounds questions and those that are inappropriate and out-of-bounds. Patients have every right, for example, to ask questions about fees. They should understand in advance what they are getting for their money. When patients start questioning how you spend your money, however, they have crossed the line and are out of bounds. To bring the conversation back in bounds, focus on the underlying issue. "Mrs. Hickenlooper, I think you are really asking about our fees." The patent would not care about the cost of the new office if she thought that your fees would remain the same. Her fear is that your additional overhead will be passed on to her. The fee question should then be handled directly: "In our practice, the fees we charge reflect the quality of the care you receive." Some patients will not be satisfied with this answer or any other: the virtue of this response is that it is positive, confident, and true. 

3. Why don’t you accept my insurance plan? Resist the temptation to discuss the inadequacies of the plan in detail. A more general response is preferred: "In our practice, we evaluate many plans, and we have concluded that we cannot work directly with this plan and still maintain our high standards." The key word is "directly." Use it also when a patient calls the office for the first time and asks whether you accept a certain plan. "We do not work directly with that plan, and we ask that you pay in full at the time of service. However, we will be happy to submit the claim form for you. Whether you receive reimbursement will depend on the details of the particular plan." Patients want to know whether they can get reimbursed from their insurance company if they come to your office. Even if you are an out-of-network provider, you can file the insurance claim form for the patient and some benefits may be forthcoming. Avoid the following phrases: "I’m sorry, but we do not accept that plan." "We are not on that plan." "We are not a preferred provider with that plan." One very good positive message is, "Although we do not work directly with that plan, we will file the claim of you and we will do everything possible to help you maximize your benefits." 

4. Can I wait and do this later? There are some patients who make a decision to go forward with treatment and just cannot wait to get started. There are others who are forever waiting for just the right moment to schedule treatment, an elusive moment that for them is always slipping into the future. The wrong way to answer this question is to plunge into a discussion of fees: "Right now it’s expensive, but if you wait and do this later, it’s just going to be that much more expensive." A much better way of handling this objection is to go back to the principles of clear, concise, and consistent: "The proposed treatment will never be more conservative, more cost-effective, or less invasive than it is today." Each part of this answer is designed to resonate: everyone wants "conservative" dentistry; no one wants "radical" dentistry. "Cost-effective" implies good value for the dollar and avoids the use of the words "expensive" or "inexpensive," which are in any case subjective. "Less invasive" implies that problems that are ignored only get worse and require more extensive treatment in the future. 

5. I’ll think about it. This comment can be a conversation killer. Some doctors assert that if the patient wants to think about it, well, then, there is nothing more to say. The patient will go home and think about it until other priorities intrude and the ultimate decision is to do nothing, or at least to defer a decision. There is, however, an alternative scenario. When the patient wants to think about it, you have two objectives: first, not to fall into a verbal trap and two, to regain a measure of control over the situation. The verbal trap snaps shut with the use of the following ill-advised questions: "Do you have any further questions?" "Is there any additional information I can provide?" Are you ready to schedule?" There is a clear and present danger that the patient who wants to think about it will answer "no" to these questions. The door to conversation is now not only closed, but locked. A better approach is to ask a strategic open-ended question, one that acknowledges the patient’s right to go home and ponder, but also gives the patient’s thought process some direction. "If you want to take some time to think about it, then that’s fine. I have one question though, that I would like you to ask yourself. How do you think this treatment will benefit you?" The patient will no doubt go home and think about the fee. You are asking the patient to consider what you are offering in exchange for the fee. If a patient starts listing benefits, such as improved appearance, freedom from discomfort, the ability to go into a restaurant and order any item on the menu without fear of embarrassment, improved self confidence—and the list goes on—then the patient is visualizing quality of life benefits and therefore buying in to the treatment. (continued on page

6. You charge a lot more than some other dentists. This is a moment of truth, a point where the patient is either going to yield to their instincts to shop for the lowest price (as we are all conditioned to do by Wal-Mart and eBay), or take a leap of faith and assume that their trust in you is well placed. If you handle this objection deftly, patients are likely to conclude that although you are not the cheapest dentist, you will take good care of them and give them their money’s worth. The first response is to separate yourself from all those other dentists. "I don’t know what goes on in other offices, but I do know what goes on in my office." If other dentists are charging more or less than you, then you really are not concerned, because your focus is on your practice and your patients. You can then continue: "In my practice, you always get your money’s worth." That statement, expressed with confidence, is a winner. Now it is time to drive the point home. "Mrs. Hickenlooper, over the years we have lost some patients due to fees. (Pause). "But we have never lost a patient due to quality." So the Mercedes does cost more than the Ford, but no one ever said that the Mercedes was anything less than a well made vehicle. Finally, a comment that leaves little room for argument. "In my practice, I believe that we should do it once and do it right. It is never cheaper to do something twice." 

7. I can’t afford it. You are not usually in a position to know whether the patient can afford treatment at this time or not. Your treatment coordinator should present financial options with great confidence, including a courtesy for payment up front, payment by credit card over three months, and for those patients who need longer term financing, CareCredit. In fact, I recommend that practices stay in close touch with their CareCredit representative and avail themselves of in-office training opportunities. When dealing with financial issues, tell patients, "We want to make dentistry affordable so that it fits your budget. We have various payment options." The word "options" is used because it empowers the patient and asks them to choose a way to pay, rather than choose to defer treatment. While these verbal skills are vitally important, one should realize that each comment needs to be put into a kind and gentle context. The phrases listed above should be carefully woven into a conversation with patients and used judiciously as appropriate to answer questions and to build trust. It is not a question of having a verbal riposte to answer each objection, but being prepared with consistent phrases that promote the practice’s philosophy and help build value for the dollar. By speaking in sound bites, you eliminate confusion, make it easier to train the team, and enhance communication with patients. 

Quite a few doctors have taken their teams to a Ritz-Carlton hotel to give them an observational training program in customer service. Service at the Ritz is legendary, so a visit to one of their properties makes a perfect field trip/case study for learning how to promote consistently excellent service, especially if one has a demanding clientele. Dental teams often comment on the attitude of the Ritz-Carlton staff—caring and competent people who seem to glide down hallways, make eye contact with each and every guest, smile so sweetly, and offer a chipper greeting. One notices instantly that Ritz-Carlton employees, with their smart-looking uniforms and good grooming, are ubiquitous. When the need for reinforcements arises, more smiling faces appear out of nowhere to be of service. A thank you from a guest for this level of service is met with a demure, "it’s a pleasure." In fact, one of the innumerable pleasures of attending a Seattle Study Club Symposium is the chance to experience such a high level of service first-hand at a Ritz-Carlton or Four Seasons hotel. Attempting to emulate the Ritz-Carlton’s superior level of customer service in dental offices is of course admirable, but there is an underlying assumption in all of this that does not hold up to scrutiny. The assumption is that, when it comes to customer service, more in better; that customer service should always be improved; and that, indeed, perfect customer service is a lofty goal, always to be chased, never to be achieved. The contrarian’s idea—that there are theoretical and practical limits to customer service—is rarely discussed. After all, everything has limits. For example, in a fascinating piece of scholarship on astrophysics, Professors Lawrence Krauss and Glenn Starkman describe how the universe’s constantly accelerating rate of expansion places an absolute limit on the amount of information that any civilization can store and process. Moreover, even without other limits on information processing, the authors state in their paper entitled "Universal Limits on Computation" that we will reach this absolute limit in about 600 years. You can forget about a larger disk drive or offsite date storage, because the Big Bang will be nothing compared to the Big Crash, the day of the ultimate "system error," when the human species does not compute. The good news is that we have six centuries to bend the laws of physics and fix this problem (which by then could be a non-issue, much like Y2K). In our own time, however, the limits of customer service should be understood in dental offices. While excellent customer service should of course be de rigueur in dental offices, doctors risk confusing their team members if they do not distinguish between customer service that works to the advantage of the patient and the practice; and well-intentioned behavior that masquerades as customer service but ultimately works against the interest of both the patient and the practice. The first type is "true" excellent customer service, while the latter is "faux" excellent customer service. Here are some examples of "faux customer service": 

1. Assuming that the customer is always right. This old saw has been repeated so often that some people think that it is literally true. In a dental office, the customers are the patients, and patients are often wrong. They may be wrong about their appointment time, wrong about how much they owe, or wrong about what they say the doctor told them. If a practice persists in allowing patients to create an alternative reality in the dental practice, then the practice loses control and starts reacting to the whims of patients who may not know best. A practice moves from faux to true customer service when team members gently remind the patient that, in fact, the appointment is scheduled on Wednesday of next week, not today, but then they offer the patient the choice of being seen today (if they are willing to wait) or returning next week at the originally scheduled time. This is all done in a positive, non-argumentative fashion that in no way embarrasses or demeans the patient. It is faux service to tell the patient (falsely) that they were right along; it is true service to react to and handle a problem in a way that satisfies the patient.  

2. Apologizing for office policies. Apologies do have their place in customer service. If a service provider makes a mistake, even a minor one, then an immediate and sincere apology is the right thing to do. However, some practices apologize for the wrong things. For example, when patients complain that they do not want to update their health history forms, there are team members who apologize for asking. The much better alternative is to say, "We need this information so we can treat you safely." If you apologize for the very existence of your policies, then you send the message that your protocols are arbitrary, changeable, or not important. True customer service always finds a way to respect the patient but also educate them. 

4. Threatening the integrity of brand. One reason that the Ritz-Carlton distinguishes itself is that it has a consistent and distinct image in the minds of consumers. If you check into a discount hotel, you may be treated courteously by the staff, but mere good manners on the part of the hotel employees will not catapult the budget hotel into the sphere of a Ritz-Carlton. The Ritz attends to hundreds of little details, which together form picture-perfect customer service. This slavish attention to detail is not cheap, and the Ritz makes no apologies for its room rates and other charges, because this high-end hotel chain fiercely protects its brand identity. When dental offices engage in faux customer service, they risk losing their own brand identity. The following story illustrates the point. A patient refused dental treatment because, she said, she could go to another dentist and pay a much lower gee. At first, the doctor and staff held their ground and talked about value for the dollar. Several days later, however, a team member called the patient and said the following. "I know you were upset about the fee, Mrs. Jones, and we don’t like it when our patients are unhappy. I have talked to Dr. Smile and he has agreed to reduce his fee to match what the other practice charges." This capitulation makes about as much sense as the Ritz lowering their rates to match those charged by Holiday Inn Express based on a customer complaint. It turns out that the patient still chose the other dentist, so this so-called quality practice not only lost a patient, but also some of the luster from its brand.

5. Allowing patients to escape personal responsibility. There are times when patients need to be told things that they do not want to hear. What some patients want to hear is that everything is fine, or the treatment can wait, or the treatment really will not be that involved, or the fee is less than they expected. When the patient’s wishes fail to meet the reality of a diagnosis and treatment plan, the patient may be surprised, confused, defensive, and even agitated. It is true customer service to explain treatment options (which empower patients by giving them choices), empathize with the patient who is trying to take in all this information and make a good decision, and offer to be there as a resource over time while the patient ponders what to do. It is faux customer service, however, to avoid reality by consciously or unconsciously tailoring what should be the ideal treatment plan to the patient’s budget. Patients deserve to know the unvarnished truth so they can decide whether to accept the recommended treatment plan, a less costly alternative, or forgo treatment in spite of the doctor’s recommendations. 

6. Lack of team conflict resolution. True customer service requires that any team conflicts remain hidden from patients. Behind the scenes there may be serious interpersonal conflicts, but when the curtain goes up, the team performs with the precision of a Broadway troupe, and the audience— in this case, the patients—are well pleased with the performance. Although team conflicts should always remain off stage, this does not mean that they can remain unresolved. One of the purposes of staff meetings is to confront issues that would otherwise threaten to manifest themselves in front of patients. In the world of patient, the team is always smiling and happy, the epitome of true customer service. Behind the scenes, however, the masks need to be dropped to give reality its due. It is faux customer service to pretend in staff meetings that there are no problems, because eventually these issues will begin to manifest themselves in front of patients. 

7. Assuming that nice guys finish first. There was a dry cleaners where all the employees were exceptionally friendly and personable. Customer service was terrific by any standards. The problem with the dry cleaners was that the business was very disorganized. Articles of clothing were misplaced, it took a long time for each transaction, and customers frequently did not understand charges. These problems were handled deftly by the employees, who always managed to make customers happy. Ultimately, however, great customer service is not a substitute for protocols and systems. The dental team that says, "We provide the best customer service," should be commended; but it is faux customer service to think that good service can substitute for structure and efficiency. Some doctors say that their teams are still working to copy the Ritz-Carlton service model, so their practices are in no danger of hitting the limits of customer service. In fact, customer service takes many forms. While dental practices should always be dedicated to true customer service, the examples listed above illustrate that some actions taken in the name of customer service are actually false friends, helpful to neither the patient nor the practice. 

Alas, everything, including customer service, has its limits. David Schwab, Ph.D., provides lively and entertaining practice management seminars and be offers in-office consultations to help practices reach the next level. He has an audio series available for doctors and team members. Dr. Schwab works extensively with Seattle Study Club and its affiliates. He may be contacted at (888) 324-1933 or via e-mail at dschwabphd@cfl.rr.com. His website is www.davidschwab.com. On the Sideline continued 33   

David Schwab, Ph.D., provides lively and entertaining practice management seminars and he offers in-office consultations to help practices reach the next level. He has an audio series available for doctors and team members. Dr. Schwab works extensively with the Seattle Study Club and its affiliates. He may be contacted at (888) 324-1933 or via e-mail at dschwabphd@cfl.rr.com. His website is www.davidschwab.com