Person-Centered Dentistry

2 DISTINCT DENTAL VISITS

A SHORT STORY by MIKE ROBICHAUX, D.D.S.

INTRODUCTION

Mary is a 50 y/o housewife married to an engineer and together they have two children, both in high school with one getting ready for college.  She has been considering changing dentists for a while because her present dentist just doesn’t seem to be keeping up.  She is not happy with the way her mouth feels and looks and wants a fresh start with someone new.  Her friends keep mentioning 2 dentists so she thought she’d try one and go from there.

CHAPTER 1

She calls Dr. A’s office and hears a recorded message giving her 5 options, so she chooses the one for new patients.  A lady answers and begins the conversation with multiple questions about Mary’s insurance.  She follows this with a full explanation of their policy regarding insurance, missed appointments, and financial arrangements.  At the end of the conversation, she gets Mary’s full name, address, etc.  Mary is then transferred to the appointment secretary and she makes an appointment with the hygienist, since this is what she has always done.

Upon her arrival at the new office on the day of her appointment, she notices that the office is new, fresh, and quite impressive.  The parking lot is full.  When she enters the reception room, she is impressed by the beauty and décor of the office.  However, she is a bit taken back by how many people are waiting and by the disheveled look on the front office staff.  She feels tension in the air.

The hygienist is very pleasant but seemed to be in a hurry.  X-rays are taken by her assistant as well as blood pressure and a review of the medical history.  The hygienist efficiently cleans her teeth and does a cursory exam.  Dr. A walks in and introduces himself.  He seems like a very nice person.  He examines her mouth, looks at the digital x-rays on the monitor next to the chair, and speaks in dental terms to his hygienist about his findings.   He sits her up and says that she has some problems and that the treatment coordinator will discuss how he is going to help her.  She is taken to a private room where she is told what the doctor is recommending, how much it will cost, and how she can have her work done so that she maximizes her insurance benefits.  Politely Mary tells her that she will have to discuss this with her husband.  She notices a frustrated look on the Treatment Coordinator’s face as she gets up to leave.  You see, the purpose of Dr. A’s practice is maximum profits and the Treatment Coordinator’s charge (which is tied to her bonus) is to not let anyone leave without an appointment.

CHAPTER 2

Not sure what to think about her first visit to Dr. A’s office, (something didn’t feel right), she decides to call Dr. B’s office.  She has her x-rays and records sent to his office (no one from Dr. A’s office asked her why she was requesting her records).  On the second ring, a lady with a very pleasant voice answers the phone.  After welcoming Mary, the lady engages in a conversation with her, filled with questions about how long she had been in town, where she was from, her family, how did she hear about the office, etc?   It was as though Mary had just met a person who was truly interested in her (actually she was) and it made her feel relaxed. 

The lady then moved to the purpose of her call and described to Mary several different ways she could enter the office.  Dr. B prefers to begin the relationship with a new patient through an interview whereby he learns exactly what it is this person wants relative to their oral health and to learn as much about this person as he can.  This is followed by a Co-Discovery exam where the patient learns about his/her mouth at the same time the dentist does.  Finally, after studying all the records taken, he prefers to sit with the patient and share what he learned and together they create a long term strategy, based on the goals of the patient.    Mary thought it was best to come in for a cursory exam and consult with the doctor.  The lady asked Mary if she would like to go on line, complete the forms for the office, and email them or download and fax them, or if she would like the forms mailed.  Finally, out of courtesy, the lady quoted an estimated fee for the visit.  She ended the conversation with a sincere thank you for contacting the office and when Mary hung up…she said WOW!

Upon her arrival at this office, she notices that the building has been there a while, but that it appears to be well maintained.  She notices only two other cars in the parking lot and when she enters the reception room, there is only one other person there.  The decor is pleasant and comfortable and the sole front office person actually comes out into the reception room to greet her, indicating that she was the person with whom Mary had spoken when she called the office. This made her more relaxed, since she felt she had already bonded with this lady.   She is well groomed, pleasant, and is noticeably poised.  There is something unique about the office but she just can’t put her finger on it yet.

 

CHAPTER 3

She is escorted back into a small conference room and her medical and dental histories are reviewed.  Based on her phone conversation when she made the appointment, the receptionist confirms the purpose of her visit.  She also asks Mary if she was free to share why she had left Dr. A’s office.  Dr. B comes in and sits with her, choosing not to sit behind the desk in the room.  After a brief conversation relative to the referral source, Dr. B is informed by the receptionist about why Mary is there today.  Dr. B confirms that what he heard was correct and asks her to tell them him more about her concerns and she does.  Dr. B is curious, so he asks Mary to just keep talking about her mouth and what things are most important to her.  Then he asks some very simple, but powerful, questions.  With these questions, Mary begins to sense that this is a unique place and that these people truly care about her.  She realizes that it is about her.  There seems to be no pressure on her to do anything but share what is important to her.  She feels it is safe to trust these people.

He begins with:  “I can sense that you want your teeth, have you given any thought as to why?”  At first she says that she wants to be able to chew and she wants to be healthy.  Dr. B says that’s good but can you think a little deeper (sometimes this is awkward for Dr. B but he is absolutely convinced that he should go there)?  He notices her face begins to change and her body language indicates she is processing something in her right brain.  Finally, it becomes extremely clear that she has accessed something that has an emotional content and she says that she used to watch her grandmother take her teeth out and put them in a glass on the window in the kitchen and that at a very young age she knew that she never wanted to do that.  Dr. B is inwardly pleased, because he now knows that any decision she makes regarding her dental health will be connected to that emotionYou see, the purpose of Dr. B’s practice is to help his patients make decisions that are in their best interests, based on their goals and values, and this moment is paramount for that to happen.

CHAPTER 4

They move to a treatment room and he very carefully examines Mary’s mouth.  He does it in a way that she is intimately involved, feeling a strong sense of being in control throughout the process.  The dentist and his assistant are speaking in a way that she can understand.  He checks the soft tissues of her head and neck, the health of her gums, the teeth, and then he checks her bite.  He is asking her questions the whole time.  At the end of this part of the visit, he sits Mary up and asks her three more profound questions.  First, he asks Mary how she wants her mouth to be when she is 80 years old and she shares her thoughts.  Secondly, after she tells him what it is that she wants, he asks her how she would like him to approach her mouth, meaning does she want to take care of things when something breaks or if there is a problem or does she want to be more proactive relative to her dental health.  Finally, because she indicated that she would like to be more proactive, he asks her if this would be a good time in her life to step back and determine at a deeper level, the actual state of her dental health and to discuss the options that are available to her. 

 

She said this may be a good time in her life but she is concerned about the upcoming expenses of her child entering college and that she has some concern about the stability of her husband’s job.  When she was told that after more detailed records were taken at another visit, she would have the opportunity to go over the findings of the exam with the doctor, work with him to co-create a path for her to reach her desired goals (with fees quoted in advance), and that she would control how fast she moved down that path while the doctor and his team would control the quality, she felt relieved.  In addition, she was told that the first step of this journey would be directed at stopping her mouth from deteriorating and establishing health and treatment designed to restore her mouth, should she need any, would follow later.  She felt even more relieved and made the appointment for a more comprehensive exam.

CHAPTER 5

Looking behind the scenes at these two doctors, it is interesting to note that Dr. A is heavily in debt.  He has a huge practice with 12 employees (all paid hourly with no benefits; turnover is high).  He sees 75 new patients per month.  He does 2 hygiene checks every 45 minutes and sees over 20 patients a day on his schedule.  His debt is not only at the office but is also in his personal life.  He has not yet begun saving for his retirement nor does he have any money set aside either corporately or personally for emergencies.  He is taking multiple medications for HBP, diabetes, and anxiety.  He is working over 200 days a year and rarely takes a vacation.  He hates Sunday evenings and Monday mornings.  He is deeply frustrated because he has been highly trained but cannot seem to get his patients to say yes to the treatment he recommends.  He rarely receives gifts and is continually putting out fires with disgruntled patients as well as between staff members. 

Dr. B on the other hand, has very little debt. He has one front office person, a hygienist, and two dental assistants that share time at the front desk and in the lab.  They are all paid a salary, a 401k plan is in effect, and they get sick leave and a uniform allowance.  Turnover is rare.  His office is fully paid for and he is working toward his retirement goals.  He has set aside within his corporation enough money to handle expenses for 6 months and has done the same in his personal environment.  His only debt is a new, state of the art digital pan x-ray that he hopes to have paid off in 3 years or less.  He too is highly trained and rarely do his new patients say no to his treatment recommendations, although many have to do their treatment over time.  He sees just 6 patients a day on his schedule with 1 hygiene check per hour and works fewer days than Dr. A.  He sees 12 new patients per month.  He is physically fit, takes no medications, and just loves to enter his practice on Monday mornings.  From time to time during his day, he feels a gentle hum in his office and he gets the sense that he has created something that is spiritually right for his patients, his team, and yes, for himself.  He routinely receives gifts, cards, hugs, etc. from his patients.  His staff admires him and feels honored to be part of such a special office.  He is content.

 CONCLUSION

If we look a little closer at Dr. B and what he did to achieve these results, we may be enlightened.  From the very beginning, Dr. B made a very remarkable decision.  He identified his most closely held values, things like honesty, integrity, a strong work ethic, empathy, a deep love of his neighbor, his commitment to excellence, among others.  Then he put these values into the very fabric of his practice.  He decided that it would be wise to hire individuals who shared those values, hence the great working relationships and minimal turnover.  Since he was committed to doing above average dentistry, UCR and the insurance game did not enter into the picture.

Relative to the financial aspect of his practice, he realized that he could not provide above average quality care with average fees, so he set his fees at levels that allowed him to do his finest.  (Knowing that this would exclude the disadvantaged in his area, he developed a plan to donate a certain amount of dentistry per year).  He also believed that it wasn’t how much care he provided but rather how much he kept, so he created a budget and kept to it, and kept his debt structure under control.  He didn’t like the idea of mass marketing so he developed a relationship-based, person-centered practice, where virtually all of his patients come by way of referrals. His patients have become true missionaries for this approach to dentistry.

Early on it became clear to him that his technical skills had to be elevated so he pushed hard with his C.E.  Soon his competency zoomed but then he saw how far behind he was with his behavioral skills and how difficult it was to present complex treatment plans to his patients.   So he went out and developed his Emotional Intelligence or EQ.  At the same time he began a journey to discover what his beliefs about life were, from where did they come, whether they were tied to the truth, and how much they were inhibiting his growth as a dentist and as a spiritual being.  This three pronged approach has paid huge dividends.

So we can see that it was no accident that Dr. B ended up with this special dental practice.  We can learn a great deal from Dr. B and his journey.

 

Rev: 5/21/2014