Episode 171: Prioritizing the Why, Instead of the What

“If they want to increase case acceptance, dentists need to do a better job explaining to patients the why behind things happening with their mouth, not the what.”

When you look at the freedom productivity allows, it all comes down to great case acceptance. Unfortunately, because so many dentists are tied to insurance companies, they have a tendency to limit their diagnosis depending on what insurance will cover and what patients will agree to.

What we teach and talk about at Productive Dentist Academy is improving case acceptance with comprehensive treatment plans. By only diagnosing what we think a patient wants to hear, we are making assumptions about their needs. And we’re not really giving them our best and highest care. So today, I want to talk about some of the secrets I’ve learned about communicating well with patients including:

  • “Need” vs. “relationship”
  • Why diagnosing risk factors helps educate patients
  • Determining what is your responsibility as the doctor and what is the patients’


This is Dr. Bruce Baird with the Productive Dentist Podcast, coming to you from the mountains and the cliffs of Big Sur staying here post ranch and I’ve had an absolutely amazing three weeks. Summer is here I guess but spent time with all my grandkids in Mexico, down in Cancun and we have 24 of us we had an absolute blast. The week before that, we went with friends to Vegas and spent a few days, a few days longer than I should have spent probably but we spent a few days and now we came to Napa Valley for three days, then drove down to Pebble Beach, played in the Clay Walker tournament, it’s it’s an Invitational charity for MS. We got got the opportunity with some friends to play Pebble Spyglass Spanish and Spanish Bay and that’s been 12 years we’ve done that, and it’s just been an absolute blast.

I got to play with John Barnes, my best friend from dental school we actually played in the tournament this year together and just had a, again just had a blast and now after four days at Pebble, we came down to Big Sur to stay at Post Ranch where my wife and I stayed on our honeymoon and kind of a special place for us.

But why am I sharing all this with you? Well, it’s it’s the opportunity to, to go places because of being productive and, you know, when you look at treatment plans and you look at, you know, look at the things that we do, you know, it all comes down to having great case acceptance but what is case acceptance? Well, you know, his case acceptance telling a patient, they need a crown, and I’m saying yes, well, yeah, that’s that’s case acceptance but what I’ve seen happen over the years that has been kind of a sad, sad state of affairs is dentists, you know, are so tied to the insurance model, that, you know, they and we’ve talked about it in the past, but they, they have a tendency to just tell the patient they need the one crown because the patients are too often saying, “Oh, can’t we just do one?”

And so you get into this, you get into this mode, where you’re constantly just going, “Well, you need one crown, you know, you this is your worst tooth, let’s get that done. Let’s keep an eye on the others.” Well, I’ve never in my career watched keeping an eye on something actually have that tooth get better and so really what what we teach them when we talk about a Productive Dentist Academy, and we’ve got a live event coming up in mid-September, that is in Dallas or in Irving actually and over the next few podcasts, I’m going to be going through some of the topics that we’re covering, and improving case acceptance with comprehensive treatment planning and it really helps you communicate that treatment plan that patients will accept. You know, nothing’s more frustrating to me than seeing the condition of a patient and struggling to communicate a treatment plan.

I think probably some of the most difficult things that I’ve watched in my career are dentists who have gone to Spear or Kois or LVI, or you name that Panky, and they learned all the tricks, all the techniques, all the new technology, but yet, they still are not doing the comprehensive treatment plan because they don’t feel comfortable communicating that and, you know, it’s, it’s, it’s something that we talk about often and, you know, what we’ll be talking about is effective patient and team communication, how to elevate our standard of care, you know, building rapport, that drives trust and loyalty, and then talking about some advanced clinical hygiene.

So what what I’d love to see happen is every dentist, look in the mouth and tell patients, what would you do, if it was your mouth. I mean, just straight up without a worry, whether they’re going to accept the treatment or not and I’m going to share with you one of the things that I think, is a secret to that, which is taking away the thought process of, well, “Bob, you need this, and you need that and you need to have this done, and you need to have that done.” To me, that doesn’t communicate well, you know, patients perceived need, is probably going to be different than your perception of their need and so what I want to do is go through a process that we educate the patient, and we do it in a different way and I’ve always talked about building, building great communication with the patient, which in my opinion, you have to get to know the patient. You can’t tell somebody what they need, if you don’t know them, you can’t tell them, “Oh, you need this.” I would say, “Screw you, you don’t know what I need, you know, I need a new car. I need I need a job that pays more. Don’t tell me what I need.”

And, you know, so when I step back, I want to get to know the patient. You know, “Bob, how long have you lived in Granberry?” “Oh, I’ve lived here a little while.” I see you live at Pebble Beach drive, hey, do you play at Harbor Lakes? Yeah, I do, what kind of clubs you play with. In other words, I’m going to build rapport and link with that patient and I’m going to do that in a way that we become friends before I start telling people what they need and that’s what we’re going to be talking about in the first session in September. But it is, you know, I can hammer this over and over and over again and it’s critical to getting patients to say yes. The second thing that I do is I go into that process of, of looking at that patient’s risk factors and those risk factors, you know, John Coiste, has done an amazing job talking about risk factors, periodontal risk, you know, functional risk, biomechanical risk, aesthetic risk, I added physiologic risk, which throws in sleep apnea, and psycho risk, “Are they crazy, you know?”

And so I look at these risk factors, and I go through those with the patient and as I’m going through these risk factors, well, let me let me put it to you this way. As I went through the risk factors. Listening to John Kois years ago, what hit my hit me right between the eyes was, “Oh, my gosh, I’ve been redoing dentistry for people that it wasn’t my fault. It’s not my fault that their dentistry failed. Their dentistry failed because they’re drinking Dr. Pepper all day long. Their dentistry failed because they don’t know which end of a toothbrush to use. You know, their dentistry failed because I told him to wear a night guard and they’re not wearing it, that’s why the dentistry failed.”

Now, I’m not saying that my dentistry is perfect, but I do believe that dentistry should have a great chance of lasting a lifetime if the patient follows our recommendations, and those recommendations fall into those risk factors and we’re going to get into that deep in September. I’ve got multiple podcasts on risk factors and what we do so I welcome you to go back and listen to those but as a kind of as a highlight, I’d like to talk to you a little bit about, “Okay, let’s talk periodontal risk.” You know, Bob, have you ever been told that that you’ve had periodontal disease, and this is I’m saying, Bob, because now Bob and I are friends, because I know where he plays golf, we have friends in common. We’re, you know, we’re on the same page and now I’m talking to Bob, and I’m saying, “Does anybody ever say anything about that?” And he said, “Well, they did one of those deep cleaning things one time, I think they charged me like $400 or 500, or whatever it was for a deep cleaning.”

And I said, “Well, I totally understand bisque. Let me explain something about periodontal disease that, you know, we just learned, you know, over the over the last four or five, six years, is the bacteria that can cause gum disease also can kill you. It can also cause cause Alzheimer’s. I noticed you have a history of some heart issues. I noticed If you have diabetes, you know, these are things that affect those health situations,” and the patients go, “Oh, wow, you know, I guess I didn’t realize that,” and as I go through these risk factors with patients, what I’m doing is I’m building information for them, so that they can make the decision, then go in and talk about a biomechanical risk and I see erosion in the mouth and I go, “Bob, are you on any,any medications?” While I’m on set approval? I’m on this. I’m on that, you know, if you look at the labels on that, it says talks about dry mouth and have you noticed that? “Oh, yeah, my mouth is so dry go exactly.” “Well, what happens is, you know, these medications will dry the mouth but saliva is a natural cavity protector, it helps neutralize acid and when you don’t have the saliva. Now, I’m not telling you not to take your medicine but what I’m telling you is we have to be extra careful with sugar and with antibodies and being on antibiotics and certain things, we have to be very careful on that,” and the patient goes, “Wow, gosh, I didn’t know that and then functional risk, I will always throw it out that says, you know, but the average person bites at 125 pounds per square inch. That’s how tight their bite is and I say mine is over 1000 when I had my measure, that’s why I break teeth. Now, I don’t break them anymore because I wear what’s called an occlusal guard. It’s a piece of plastic that goes in and it helps me protect my teeth,” and they go, “Wow, I didn’t know that, you know? Well, that makes sense.”

Anyway, go through these risk factors and as I’ve gone through these risk factors, almost always something comes up at the end that they say, or why has no one else ever gone over this stuff with me? I don’t understand why haven’t they told me this and I do believe dentistry and dentists need to do a better job of educating patients about why it’s happening, not what’s happened because I can educate you about why it happened and we’ve got a great chance of preventing it from happening again and let me, let me tell you something, your patients will start doing the dentistry that you recommend because the way you’re going to recommend it is very different. You’re going to say, you know, “Bob, we’ve, we’ve got multiple ways that we can handle this but, you know, let me just share with what I would do if it was me. Well, that’s why I go to docs, I went to the elbow surgeon, what would you do if it was you? shoulder? What would you do if it was you?

Any kind of medical problem? I want to ask that question. Well, what would you do if it was you? Why? Because they’re the expert. I don’t know elbow? I don’t know, shoulder? I know teeth, I know function. I know the, all the risk factors and I know why things happen and so patients will always ask that question. They’ll say, “Well, why is no one else ever done this? Why is they never told me?” And my response is not because most dentists don’t know it or, you know, they’re just dropping the ball or whatever I, whatever I want to say, I’m gonna say, “You know what, because we’re learning so much new technology, new ideas, new thoughts, new things in science are showing up but for the first time in my life, Bob, I think we can do some dentistry on you that should last the rest of your life if you just follow those recommendations.”

So anyway, that, you know, that is, that’s my topic for today is improving your case acceptance by doing comprehensive treatment planning, explaining to the patient, not what’s happened, but why it’s happening. You know, it’s not about, it’s not about the what it’s really about the why because once they realize the why is their fault, they’ll stop doing it or they’ll, they’ll, they’ll start following your recommendations and truth is, some will follow them and some won’t, but at least you’re not, you’re not finding yourself redoing dentistry that you have no reason to redo because it’s not your fault and I redid so much dentistry over my career that really wasn’t my fault. Now I’ve redone stuff that probably was, but I’ve read done a whole lot more that wasn’t. So anyway, I hope you enjoyed this. We will be back next week.

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