How to make your practice the ‘Go To’ surgery for ‘Simple’ Orthodontics for adults?
It will be obvious, or should be, that if you have gone to the trouble of learning something about orthodontics in order to assist your patients and your professional practice, you have to promote the service or else it will be a waste of time and effort.
Now, the old saying is that if you build a better mousetrap the world will beat a path to your door.
I can’t be sure that this adage is true but, I can be absolutely certain that this will only happen if the world knows that this superb instrument of capture is actually available. Without this knowledge the track to your portal will remain completely unsullied.
Making it Public:
Broadcast to the world
It becomes obvious that we have to get the information of what we provide out there so that patients who might be interested can raise the topic when they visit. It has been my experience that unless the patient knows that your practice provides a service they will assume that you don’t and so they will go elsewhere for that service because they know that Dr Snoddy down the road does provide this service.
How do they know?
Usually because there are adverts in the local press or on the practice walls or because a patient of his has told them that he/she had the procedure done and was delighted with the outcome. That happy patient then becomes an ambassador for the practice and will refer like-minded individuals to you for similar treatment.
I well remember a young lady coming to see me and asking if I could place a veneer on her upper lateral incisor which was instanding to a small degree to make it level with the rest of her arch. In today’s world, I should probably create an aligner and achieve the necessary effect with some minor orthodontics. But, when the incident occurred veneers were the treatment of choice. I carried out the treatment to her satisfaction and as she was about to leave the nurse asked if she would like a recall for a check-up in due time. She declined stating that her ‘normal’ dentist did this. After some 8 months I noticed her name in the appointment list. Fearing that the veneer had come off or fractured I sent the nurse to find the models of her teeth so that I could have a replacement made without disturbing the existing veneer. In fact, when she arrived the veneer was in place and sound. But, a very small amalgam at LR4 MO had fractured which she wished to have replaced with a composite filling. I arranged to do this but as she was leaving I asked her why she came to me for this treatment (not that she wasn’t welcome). She replied that her ‘normal’ dentist did not do these things but her friend had had similar treatment from me so she came to get this done at my practice. This is a prime example of a satisfied patient acting as an ambassador for the practice! Of course, anyone bringing money into the practice is always welcome. I don’t know who her ‘normal’ practitioner was nor whether he did this kind of treatment but, my guess is that he did, (it was nothing out of the ordinary) but he had not made her aware of this so she made an assumption. This is an illustration of why you should let your patients know if you provide services which are outside the ‘routine’; and always offer a cosmetic option where appropriate.
We, as dental professionals are very used to looking at mouths and teeth and we develop the ability to visualise what the effects of a proposed treatment will look like. But, our patients do not, in general, spend most of their waking hours peering at teeth and they have not acquired the ability to visualise what a proposed outcome might be of any suggested treatment—assuming they really can understand the proposed treatment.
So, no matter how good you can make your description of the desired result remember that most, if not all, of our patients will not be able to imagine the results. Therefore, it would seem sensible to have some illustrations of befores and afters together with illustrations of the types of appliances which will be used and, perhaps most importantly, some models with the types of treatment appliances on them so that the patient can get a clear grasp of what the appliances are like and can actually put their hands on the models. There is no substitute for visual and tactile illustration of something which is difficult to describe and difficult for a patient to envisage.
Difficult to describe adequately
You will require some photos of pre and post treatment showing some results which have been achieved. (they do not have to have been done by you!) Also required, are leaflets for the patient to take away and browse at leisure. This gives them time to consider the treatment and time to generate some questions in order that they make the decision to go ahead without any pressure from you or your staff. This is very important because when the decision is made of their own volition the patient is less likely to be hypercritical if the treatment takes a little longer than predicted or is shorter. I would have thought that if treatment time was reduced the patient would be extremely pleased but, no; I was asked for a discount because the reduced treatment time meant that I did not have to spend as long with her as I had predicted. Some people cannot be satisfied!
When I start to talk about money to a group of dentists there are usually some who look acutely embarrassed. Occasionally, I have been told that they don’t discuss money – it’s unprofessional! Codswallop!
Money is an important part of the treatment. You promise to deliver a result in return for a specific sum. It is a part of the contract between practitioner and patient in exactly the same way as in your dealings with the NHS you agree to provide some specified services to the NHS in return for a defined total sum. If you default on your side by not delivering the agreed target they will ask for some money to be returned – we call this clawback.
So, it is essential that you talk about the costs of the treatment you are offering and this should be done by the dentist him/ herself. The payment details and schedule should be defined but these details can be discussed and written down by the Practice Manager. They should be written so that there is no confusion and the patient has a copy to take away as an aide memoir.
It is an extremely good idea to have an interest free finance scheme available to assist patients to achieve their goal. There are quite a number of such schemes which will pay the practice the whole amount once the patient has been financially approved. The finance house will collect the payments from the patient so your risk is minimised but, there will be a percentage payable by you which will be charged by the finance company. You must set your charges to account for this. But do remember that you cannot inflate the charge for a patient who is using the finance scheme to compensate for any charges levied as that is not allowed by law. A patient who chooses to pay without using the finance scheme has to be charged the same amount as one who uses the scheme.
We use the term ‘Simple’ meaning orthodontics which requires relatively little movements just to address the aesthetic issues but which does not attempt to deal with any malocclusions in the non- visible areas of the mouth. But one of the major problems we, at Oralign, encounter is that whilst many of the cases we deal with appear to be simple, in reality there are many which are far more complex than they first appear. So, be aware that sometimes we, as GDPs, may not recognise the complexities of a case but an orthodontist may spot the difficulties inherent in the treatment. One particular problem may well be that the treatment of just a single arch may create problems with the occlusion. One such incident occurred when a patient requested that her upper teeth be treated to improve her appearance but our orthodontist recognised that in straightening her upper teeth the overjet would be increased. The overjet was not pronounced due to the retroclined central incisors but moving the upper teeth into line meant proclining the teeth from their starting position which would inevitably increase the overjet. The GDP was informed and advised the patient of the problem recommending that both upper and lower arches be treated in order to control the overjet.
The patient declined to have the lower jaw treated and a note to this effect was made on our system that the probability of an increased overjet might result and the patient had been informed.
The upper teeth were satisfactorily treated with which the patient was delighted but she complained that the overjet was greater than it had been previously. The dentist advised her that this had been explained prior to treatment being commenced but, the patient had decided not to undertake treatment to both arches. In order to assist the dentist, we were able to demonstrate from our comprehensive records that this had all been explained before the active treatment had started and the patient had signed the consent form indicating that all was understood. An offer was made to treat the lower arch at a reasonable and reduced charge. But once the patient realised that our records were wholly comprehensive she withdrew the complaint, declined further treatment and signed a satisfaction note indicating contentment with the result. Had teeth been extracted the uppers could have been brought back closer to the lowers but tooth removal would have meant the loss of unrestored premolars – rather a waste; because once removed they cannot be put back.
It’s apparent that moving these uppers into line will result in increased overjet -advice given to treat lower arch to prevent excessive overjet
Interestingly, the GDPs Indemnity provider reviewed the case and advised that they could not defend the GDP but when we produced the evidence that all had been explained to the patient and she had signed the consent form in that knowledge, a different light was cast on the situation.
The lesson we have all learned from this minor dispute is that it is imperative where a patient declines some of the advised treatment, which they are entitled to do, that full, extensive, contemporaneous notes of the discussions and advice must be noted on the record and must be written up on the consent form which the patient signs. This negates the claim that they did not get told or that they did not understand.
In today’s litigious world this is imperative!
Learning From the Past:
Our experience at Oralign, and my own practice experience, is that patients who pay relatively substantial amounts of money for treatment usually make certain that they fully comprehend what they are paying for and seek clarification where they have doubts. However, there are always the exceptions; some patients are too shy to ask for a full explanation – afraid to admit they don’t understand. Because of this, we must make huge efforts to ensure that we use simple, non-jargon language and we must be as certain as we can be that the patient has understood all the aspects both pros and cons.
It has been my experience that most of the dental disputes arise due to inadequate communications either by the dentist or by the patient failing to express themselves fully and the dentist not pursuing full clarification. The maxim of when in doubt explore further must be our watchword. Don’t solve a problem the patient did not actually present with but do ensure you solve their problem by being absolutely certain you are clear about what is troubling them.
Most dentists, myself included, make the error of not really listening to the patient but assuming we know what the problem is after just a few words are spoken. We may; but quite often patients tell us the full story in less than succinct terms so that the vital bits may emerge when we have stopped really listening. I have done this many times and I have arbitrated at dispute resolution hearings the same things on many occasions. We really need to learn the lessons of these experiences.
‘Simple’ orthodontics may well turn out to be a lot more complex than at first thought – that’s why you need to be sure you understand the patient’s concerns and you need to communicate them in full to your expert Oralign orthodontist which will make sure you get the desired results.
A successful Outcome
The desired result is a successful outcome with minimal unanticipated side effects or complications and, above all, keeping well clear of both the GDC and the courts of Law.
Expert diagnosis and planning enables the GDP to undertake adult orthodontics safely which gives an uplift to practice enjoyment and to practice income – only Oralign offers such a service.
Further information: firstname.lastname@example.org Mob 07519647425
Lester Ellman July 2017