Home Practice Management Why Case Presentations Fail

Why Case Presentations Fail

by Steven Anderson

There’s an insidious pathological condition in dentistry’s midst. It reaches epidemic levels in every dental practice. Left unchecked and untreated, it does serious and ultimately very costly damage. But the symptoms are not at all obvious to those affected. Most reflexively deny there’s anything wrong, even in the face of incontrovertible evidence and an expert diagnosis.

Adamant denial is, indeed, the immediate reaction of those who initially have the condition diagnosed. Those who refuse to recognize it will never solve it.

The above rings some bells, doesn’t it? It sounds a lot like periodontal disease with proven links to such grave issues as coronary artery disease, stroke, diabetes, and arthritis.

But we’re not talking about perio here. The problem in question lies in the minds and hearts of dentists and their team members, and the ways they interact with patients.

We call it Approval Addiction. Borne out of a fear of rejection, it builds rejection into communication between you and your practice team and patients. Meanwhile, it damages the performance of the practice and the professional self-esteem and fulfillment of the dentist and team. And it hurts patients, who don’t get stateof-the-art dentistry for lifetime oral and general health.

There is some good news about Approval Addiction, however. You can cure it and reap the personal, professional, and financial rewards and spare yourself the pain of rejection – which hits dentistry especially hard.

Just as there is a system for treating periodontal disease, there is a system for communicating with patients at every stage of the professional/patient relationship, from the first “Welcome to the practice” to accepting and implementing treatment plans that is the antidote for Approval Addiction.*

This system is grounded in the science and psychology of how patients make treatment decisions. First, though, you’ve got to recognize that there is an Approval Addiction problem, which YOU probably have!


I’ll never forget the first time I looked this beast in the eye. It happened about 30 years ago, at the very beginning of our work with dentists.

At the time, we consulted with businesses of all kinds and did seminars to teach principles of marketing and communication. Word-of-mouth brought a few area dentists to our seminars, which went viral in dentistry. We naturally got curious about the attractiveness of what we were doing in the dental world and arranged to do some onsite observation at some dental practices.

At the end of the first day we were flabbergasted, floored! We asked each other how in the world anyone could communicate with their clientele as they did and expect to get any kind of positive results. The dentist and team were doing more to dissuade the patient than persuade. It all flew in the face of everything we knew about how consumers come to make positive buying decisions.

We knew right off where the problem lay: Fear of rejection. In an effort to spare themselves the risk of hearing “no” from the patient, accurate diagnosis and treatment planning was being sacrificed by the dentist and the patient was walking out the door with little or no idea of what was really going in his or her mouth. The entire experience seemed to hang in limbo where the dentist wouldn’t hear “No” but wouldn’t get a “Yes” either, not to a treatment plan or the next appointment or pretty much anything. We’d seen the problem in business, but never at such an extreme level. Approval Addiction continues to be the number-one obstacle to success in dentistry.


What we heard during our first dental practice visit – and still hear – was Limiting Language. In perio cases, it can go something like…

• Well, we have a little infection here.

• We might want to take a look at this sometime.

• We can watch it, and wait to see what happens.

Wrong, wrong, wrong. Hello! There is no we involved. The patient has the infection. There’s nothing little about it, either. This is bad news for oral health, and ultimately health in general, no maybe involved. Watch and wait for what? Unless you do something, there’s nothing to see but things getting worse.

Patients need to know the whole truth so dentists can treat their problems and keep them healthy. But the practitioner shies away from telling the truth in clear ways that call for action. Why? Because patients don’t like hearing it, and dentists want to be liked.

The feelings here cut very deep. Even when we know it shouldn’t, “No” hurts because it feels like rejection, exclusion. We are, after all, deeply social creatures. In primeval times acceptance by others meant survival. It’s still key in emotional well-being.

Heard repeatedly, “No” takes a toll, and a dentist is the Mayor of Noville. Just think about the value proposition dentistry offers from the patients’ point of view: You’re asking them to pay you money to find problems they didn’t know they had, which can cost much more money to correct. This is why people come in saying, “I just want get want my teeth cleaned.” They don’t want to hear about new problems. To you, this is a big “No” to clinical skill and expert care which you’ve spent a lifetime to perfect.

Then there are the words dentistry uses to describe treatment. Take, for instance, “scaling and root planing,” things only done to fish and wooden boards. Or – a favorite of mine – “probing.” There isn’t a man or woman that hears that word and thinks about teeth! Many times, the words dentistry uses to describe treatment make it sound worse than the condition.


Good communication goes to the heart of Approval Addiction – literally the heart, where “No” hurts. It hurts less when you hear “Yes” more. A system of good communication makes treatment planning and presentation much easier and more comfortable because you know what you plan to say, and responses to listen for, and why. Practice team members have their own clean verbal protocols, too.

Use a good system of communication and success, however you measure it, goes up with comfort level. The power of a few words can dramatically change outcomes.

One example involves making a patient’s next appointment. Using the old, ineffective way, a team member asks the patient as he or she is checking out, something like, “Well Mike, when do you want to want to come back. Would you like to schedule your next appointment?” And, 9 out of 10 times, the patient won’t make the appointment.

If on the other hand, the team member asks, “I see the doctor has recommended you come back in three months.

Will this same day and time work, in 90 days?” The easy, natural answer is “Yes,” isn’t it? When you get it, you’re doing both the patient and the practice a favor, getting treatment scheduled.

Like the above, all effective communication in the practice has a built-in presumptive response. In more consequential, higher-level exchanges – like presenting diagnoses and treatment plans – this involves preparation that begins before you do an exam, even before you say “Open.”

Ask questions, and listen carefully, you will find out why the patient is in your chair and what he or she truly wants. Grasp that, and you have a receptive patient – to the whole truth about oral health and your great dentistry.

Use a proven system for communicating with your patients so you can circumvent Approval Addiction, get better case acceptance, and have more healthy patients who repeat and refer. That’s a result to which everyone can say “Yes!”

*For a comprehensive look at how you and your team can combat “Approval Addiction” through a proven system of communication, download the free e-book: (Why Case Presentations Fail: The Treatment Acceptance Solution) by going to www.TotalPatientService.com/ ApprovalAddiction

Steve Anderson is the founder of Total Patient Service Institute (TOPS), which provides seminars and coating to raise treatment acceptance. He is also a presenter, author and entrepreneur, having founded over a dozen businesses. You can contact Steve at: 1-877-399-8677 or www.TotalPatientService.com.

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