How people behave is based on the quality of the relationship.

Basic interpersonal interactions, including business relationships, always begin as utilitarian in nature. We don’t join together because we want to, but because we need something we believe the other has at the price we are willing to pay.

My desire to go hang out with my buddy Ruben who happens to own a car repair shop is not just because I really like the guy (which I do) but because I have a problem with my car. The fact I get to see Ruben is icing on the cake, but if I didn’t have the car problem chances are we wouldn’t get together very often. The reason is he doesn’t know me that well and vice versa. We probably fall into being in the top 500 really close friends to each other.

When my car stopped running in the middle of the highway one day a while back, I was glad I could call my friend. He got a tow truck for my car and then picked me up on the side of the road and took me to breakfast. He even paid for it, which was nice.

To me this is an example of friendship in business. He and I both knew a bill would come due for the work he provided and I would gladly pay it because he does good work at a reasonable price and I would be getting my car back. I’m happy to give money to support a friend rather than some disinterested and possibly rude stranger, but if there was no one else to fix my car, that’s what would have happened. I didn’t go to Ruben because I like him. I went to Ruben because I needed him, even though it’s nice I like him as well. Now, let’s apply this to dentistry.

Of late I have really had a problem with patients and schedules. Knowing that the primary reason people come to see me is because they have a concern having to do with their own mouths, and not because they necessarily want to hang out with me, I have encountered, more than I like to admit or experience, people who don’t show for scheduled appointments. Some even cancel when my employee calls to give a courtesy reminder the day before. Cancellations the day before appointments are difficult to fill.

Now the standard recommendations consultants give are to review and refine our systems. Also they might listen to the employee’s phone voice or coach him or her on ways to put out fires and keep the schedule full. They might advise over-booking a little, but this can result in bone-tired dentists and employees and frustrated patients who had to sit for an hour or more in the waiting room. Frustrated patients tend not to recommend us to their friends and family members. In my experience, the anticipated improvements for all this internal effort is negligible. In fact when it comes to human relationships when the obvious objective of the dentist’s receptionist is to talk people into what they have already decided they don’t want to do, it comes off poorly.

To add insult to injury we dentists, when our schedules fall apart, seem to automatically blame the receptionist. Now I know what many of you are thinking because I have thought it often myself — if only I had a better receptionist. In no way am I trying here to justify the possibly weak work of an employee, but it is to say we are fools to base performance on outcomes they have little to no control over. When patients decide they don’t feel like coming, there is not a lot we can do after the fact. Sure it’s cold to know that patients really don’t care about my schedule, but that’s just the way it is. No sense hitting my head against the wall.

And the answer to my problem is not to blame myself either – except to the extent that I enable patients to take advantage of my time and money. Getting angry is counterproductive and eats at the heart I want to have for people who come to me for care.

So here is my answer to myself and anyone else who finds themselves frustrated with the full-appointment illusion. I have to re-teach patients how to treat me. This begins with reviewing my message. Oh, you didn’t think your preventive dentistry message to patients had anything to do with establishing appropriate therapeutic and financial expectations? No one told you this? Keep reading.

When I come to the part in my initial presentation on what is periodontal disease I come to a point where I explain that when the problem goes from simple gingivitis to something the patient is unable to fix or manage themselves, there must, by necessity, be a shift in responsibility.
We (meaning all dentists and hygienists) must step in and do a portion of what is needed. Our work for the patient is 20% and the patient retains 80%. This means that if the patient fails to accomplish what he or she needs to do for themselves on a daily basis, it really won’t matter what we do procedure-wise every once in awhile.

I go on to tell them that their 80% involves two jobs. The first job is effective plaque control. Whatever they are doing, or not doing, every day has more of an impact on the outcome of care when compared to what we do for them every once in awhile (and I lump smoking and diabetes management in under this concept of plaque control because it’s in their hands and they have to manage it every day).

I then tell them their second job is appointment management. They are free to drive their teeth and gums wherever they choose in order to get the care they need and want. No one is going to chase them down. It is, therefore, their responsibility. A part of appointment management also includes the responsibility to pay their bills.

Now when a patient fails to come to an appointment or cancels the day before, it indicates that the care they were going to have somehow became less important than something else. Another possibility is that it was never that important to them in the first place but they were being polite while in a dental office or at an initial consultation appointment and simply went along with someone else’s sales pitch – until they got out the door.

Now because they are adults, they should be free to do whatever it is they wish to do, even if we don’t agree. And because we also are adults, we are entitled to protect our practices from living in an illusion that people are accepting care when in fact they really are not. It really comes down to teaching patients to take their responsibilities seriously after we have clearly spelled out what these responsibilities are.

So what does this have to do with scheduling? I believe I accepted a default scheduling system that most offices employ that subtly teaches patients that appointment management is more our problem than it is theirs. They have grown accustomed to pampering phone calls and reminders, as well as a willingness on our part to permit them to play with the schedule, come when they want, and in some cases deferring payments possibly even in the hope that we will get tired chasing them and eventually decide to write the debt off.

So I’ve come up with a new policy and begin implementing it today.

If you are interested in what it is, simply send me an email (benyoungdds@gmail.com) and I will send it to you directly. In other words, I’m not ready to publish it to the world. And in return for me sending it to you, I want you to critique it. Tear it apart if you think it’s silly. In this way, if I have really blundered here, you will enlighten me. If you like what I am saying and decide to incorporate some or all of it, just let me know how it works for you. Also, if you are willing to give permission, I will put all the emails I receive together on a mailing list and send out everyone’s responses to the group.

3 Responses

  1. Hi Ben, I am intrigued by your recent post. Unlike other consultants, I look upon cancellations a bit differently. Yes, people are very busy these days and are being pulled in many directions, especially regarding financial decisions. However, ALL are subject to the emotional connection (relationship) that should have been established when the new patient first visited your office. Indeed, I coach dentists to stress the fact that their practice caters to their specific needs and reserves a block of time for their care exclusively. I reinforce this fact over and over, especially with staff members who are responsible for confirming appointments. The goal here is to have the patient understand that tyeir oral care is very important to the dentist, but responsibility must be shared with the patient.

    So, when the patient is called to confirm appointments, and the patient asks to cancel on short notice, the staff are instructed that the dentist has set this time aside specifically for the patient dental care needs. The point is to make the patient feel a little poorly that they are not keeping their commitment to shared responsibility. While this does not eliminate the problem, patients do not seem to exhibit the same behavior more than once, because they don’t want to disappoint the dentist and staff member again. BTW, I believe confirmations calls should be made two days in advance, so that the staff has more time to fill the opening.

    If you wish, I would be glad to check out your new policy. All the best, Lee

    1. Wow! this was great insight into Dentist-Patient relationship. Although people are very busy these days and are being pulled in many directions which might lead them to cancell appointments but if patients are well educated about their current dental health and the importance of preventive care during their first visit, it makes a huge difference. Patients do tend to make great relationships with the frontdesk staff & hygienists and they expect great service from them but ultimately patient loyalty depends upon the care & expertise provided by the dentist.
      Now when a patient fails to come to an appointment or cancels the day before, it indicates that the care they were going to have somehow became less important than something else and unvailing this mystery is the key to avoid this from happening more often. Ultimately it all drills down to the customer service, quality of care and affordability.

      I hope your new policy will work for the best of both patients & the practice. All the best, Lee

  2. People canceling appointments has always been an issue with the practices I work with.

    For the most part, its people who are just starting to work with us. I notice they are the type who just feel like they have a duty in going to the dentist, and are not that worried about the teeth’s appearance and dental health. They are a hard group to befriend- but general dental care is the bread and butter of most practices.

    The friendships that do occur seem to be between the hygienists and dental assistance and the patients, rather then the Dentist. Others have noticed that as well, at one of the practices I work with its the hygienist who writes the letters and becomes the contact point.

    Its not uncommon for dentists to seemingly constantly be getting new hygienists, and losing old ones. It also makes a weird balance for dentists- as men seem to more attach and remember the visually appealing ones, though the dentist wants only the most talented and OSHA corresponding hygienists.

    Worse yet- personally, I MUCH prefer male hygienists over female hygienists. You never know where people are going to feel the most comfortable and the most relaxed. This includes odd racial biases and etc. These things pull strong to people with these preferences, as the dentist I went to for the longest was almost entirely because of the male hygienists.

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