HOW TO NOT FAIL AS A DENTIST - Chapter 3

CHAPTER 3

“BUILD FROM THE TOP DOWN, NOT FROM THE GROUND UP”

by Dr. BAK NGUYEN

It’s a matter of perspective, not only to you but to your audience. Unlike going to the theater and to watch movie trailers, your audience hates to be kept holding their breath in waiting for what is coming next.

This is about feelings, remember? So cut the chase. It will hurt, and it won’t be pretty. The sooner, the better, so they can start healing, both physically and mentally.

In dental terms, don’t build up slowly your treatment plan a tooth at a time in front of them. Do that in silence in your head as you are examining them. But then, start with the big picture. Give it to them upfront.

You are a doctor, not a salesman, on that, we can all agree. So do not follow the sale technic of those squeezed page on the internet and sale funnel where you tease your patient and talk and talk to have them push on a button at the end to close the sale.

Yes, you have to close but remember your liabilities. You are on the hook. Once you close the “SALE” your work begins, while most sale people have done their part already. We are not sale people. We have to be genuine, kind and upfront. I think that this starts with the diagnosis, from the first moment.

To me, it is always simpler to have a big picture first. I like to make my diagnosis from a PANORAMIC x-ray. Lately, I have the privilege to work with 3D dental scan, which has eased by much my job of communicating and diagnosis with the patient.

With the touch screen technology, we, the patient and I, are literally touching their teeth and moving them around with ease and without any discomfort to them, neither physically (since we are working from a computer screen) and mentally (since they now feel safe and in a state of mind to listen).

I do not go quadrant by quadrant, but I see the whole first. If there are teeth missing, we count them together and they know right away that those will have to be replaced. At the average of $3500 a tooth for an implant, the math is drafting up as we count. Involve them, that the only way to share and connect with them.

Them, you can move forward and go quadrant by quadrant, looking at the x-rays and the buccal examination. Actually, once we are introduced, I used to start in the mouth first. It made sense to me to see everything first, and then discuss after.

Over time, I put myself in their shoes and realized how intrusive that was. They gave me consent, but was that the best way? Just imagine to strip down a person naked first, to touch them before sitting down, get the conversation going and to build a relationship? In the dating scene, that will never be accepted. So why are we doing it in the dental field? We are professional, should it be even more delicate and thoughtful? To care about how our patients are feeling?

So now, when I do an exam, I try to break that habit of mind to start by looking in their mouth first. I start with the scan when it is available. If not, I start with the closest thing to it, a panoramic x-ray. Then, I move to the intra-orals x-rays to finish in the mouth once we have established trust.

Don’t feel bad, we were all trained to start with the mouth first. This in a paradigm that will change slowly as we have a better understanding of the position we are putting our patients in and the sensitivity of the emotional intelligence on the field, not just the efficiency of the line of production.

Yes, I said it, too often, we are guided the efficiency, and since we wear a white coat, we have been given some privilege and authority It does not mean that we should jump on those right away.

While we are on the matter, the white coat or scrub that we all proudly wear in now part of our identity. In the hall, it is a sign of our function. But have you ever stop and wonder how it is perceived by the patients? With our mask, glass, gloves and white coat, we are sending the message that it will get messy… with their blood!

This is not really reassuring. Get rid of the filter for as long as possible. Be human, be exposed, be there with them. When it is the time to go in their mouth, ask for permission and go in gently. Once you are there, try to get out as quickly as possible to cut to the bare minimum the invasion of privacy… even if they gave you permission.

The same logic goes with the white coat and all the protection. Use them as the standard of our profession required, but not a single minute more. Yes, I take out my white coat as often as possible.

“I am not a doctor, my function when I serve is as a doctor. I am human, just like them.”

Dr. Bak Nguyen

Try that, this will help the connection, almost instant connection. You are as efficient as your trust goes with the patient. Never forget that. Just like a massage therapist is never leaving her/his touch from your body once the contact is made for the duration of the massage, do not leave the connection of trust you have established with your patient. Your cares are both emotional and physical.

Now, let go back at the diagnosis. Start from the big pieces first, even on the financial point of view. Burst the bubble as soon as possible. Then, the smaller pieces will be adding up, but the perspective won’t change much after the initial burst.

Too often, when we started from the mouth, we go tooth by tooth and are building our treatment plan and diagnosis a tooth at a time. We are looking inside their mouth and are saying out loud to our assistant or hygienist the needed work in their mouth.

They do not understand everything that we say, but they hear everything adding up, one after the next. By the third thing, we are saying, they feel exhausted already… until we raise the chair and tell them the facts, one at a time, often starting with the little things first and then, FINISHING THEM will the big issues and the billing coming with it!

Does it have to be as hashed and as hard? To both parties? We have spent the 10-15 minutes together stretching the intrigue and the pain to FINISHING THEM with a fatal blow. Even if we are kind and gentle, this must be a better way to establish trust and connection, don’t you agree?

I start with the worst and try to give my patient the big picture first. Usually, that’s is also what is the most costly financial too. I do not try to shy from it. If there are three teeth missing in the mouth, they see it, and I start with those. That’s 3x $3500.

I ripped the bandaid as quickly as possible. Even if in their mouth, there is more to come, the worst is done. Since we just started the examination, I still have their attention. Then I move to the second major issues. I know the rule of three, that after three facts, I am exhausting them, so I try to regroup my diagnosis into categories.

For example:

• missing teeth (implants)

• cavities (filling)

• gumps

If there are no missing teeth, but cavities that required a root canal, those go on top of my list of priorities. I do not regroup from the treatment point of view, but from their perspective.

What I meant is that if a tooth requires a root canal, the post and crown are one single treatment (done in three phases). To them, it is one fact, remember the rule of three to avoid exhausting their emotions and attention.

The rule of three is not an absolute, but a handy guide to keep in mind, always. So strike one, the big pieces. Strike two, the minor pieces. Strike three, the treatment time.

I do not necessarily giving the exact among as I provide them with the diagnosis, but I know that it is the next question in their mind. To cut the intrigue short, I will give them a big picture, even in term of fees.

If I have to round them up, I always go higher in the approximation and being upfront and saying that out loud to them. My staff will make the exact calculation afterwards, this just to have a good idea.

I know that I have to add up, but as quickly as possible, I want to stop adding up. As you reach strike three, you have stopped adding up. Now it is the time to start breaking down. Just that will be a relieve in the emotional process.

As you are breaking down the process into appointments, once again, try to condense your appointment so your patient can is a light at the end of the tunnel as soon as possible.

Usual, doing so, I reverse my line of logic. I will start by taking care of the small things first. As much as possible within the first appointment. Let say that they had 2 missing teeth and 5 cavities.

The first appointment will be to fix the cavities. On the list, that was the cheapest, but in the same, we took care of 5 of the 7 problems on the list. If that can be done within the first appointment, image the release! If not one, then two appointment, one for the right side and one for the left side.

At least, with this in mind, you will be able to get rid of the major part of the problem right away. The work wasn’t too hard, the bill not too high.

From their perspective, you have taken care of more than half their problem, you have gained their trust, they had time to prepare mentally for the inevitable (more exhaustive treatments and expensive treatments). Now they are ready since you both have committed in a relationship.

Even within the initial diagnosis, it is possible to keep that mind frame. When you started giving them the big picture of their treatment, you ripped the bandaid quickly. Strike one, then you show them the other treatments regrouped. Strike two.

As soon as you start breaking down the process, you relieve the pressure and starting the healing process. They don’t know it, but already, you have started giving them hope and healing them, at least emotionally.

After the diagnosis and the treatment plan, my staff usually will take care of the insurances, the tax credits and the means of payment (financing). All of those aren’t about adding up, they are about subtracting and dividing from the initial strikes.

I won’t say that it was pleasant, but I try to keep the unpleasant part, at least the worst part, as brief as possible. Always be being honest, kind and upfront.

That’s phase I. The next phase will be to be as such or better in the operation room: kind, smooth and fast! This is not an opinion. We all have our own pace and do not like to be hurried.

But think of it from the patient’s perspective: they are finally there, after having swallowed the needed treatments and the means to afford them, now they are scared of the pain…

Can we do something about? Of course, we can! We have anaesthetics. That is good for the physical, but not the emotional. That will be expressed in terms of how annoying are the noises and smell of our operating rooms. They are not complaining, they are trying to communicate their emotional stress.

That put us in a hard spot. We cannot change either the noises or the smell… But what we can do is to keep to the minimum their exposure to those. Keep the patient as much as possible outside of the operation room.

From the diagnosis to the discussion, all of that should happen in an office where there are sitting at the same level, not in a dental chair looking up to you.

Then, in the operation room, be kind and smooth, and work on your speed to release them as soon as possible. Of course, while performing the best dental surgery at the highest level of excellence! Trust me, with practice the right mindset and the right training, it is within reach, way closer than you think.

Be good, be kind, be fast, not for your pride, but for the wellbeing of your patients. Keep this in mind, and no matter how many years of experience you have or how you look, your patients will never let you go. On that, you have my word!

This is MILLION DOLLAR MINDSET applied to dentistry. This is HOW TO NOT FAIL AS A DENTIST.

This book is not about understanding THE DIFFERENT FACETS of what it means to become a DOCTOR IN DENTAL MEDICINE

Dr. BAK NGUYEN