Recently we stopped at a local upholstery shop to have a seat cushion repaired. The owner, who is a patient, said “Doc, I have a bone to pick with you.” She then described coming to our office for her semi-annual exam and prophylaxis that included a doctor exam and cavity detection films. She was very upset about the fees. She said,“ I have no issues with the quality of care. But I can’t understand why I have to have a doctor exam. You spend about five minutes looking around, never find anything and charge me fifty dollars! No offense intended, but can’t I skip the exam and save the money? Remember, Doc, I pay cash and don’t have insurance.”
How would you respond to this situation? What is our patient really saying? Is her complaint about the money or the fact she sees no value in the service we have delivered? The first thing we did was thank her for being open about her frustration. She could have just left the practice. Next we asked whether she understood what we were doing when we were looking around inside her mouth. She said, “I know you have told me, but isn’t the hygienist doing the same thing?” So, we took a moment to explain the difference between the hygienist doing an examination and the doctor reviewing the exam findings, diagnosing, and potentially proposing treatment. Finally, we asked whether it would be better for her if at each appointment the hygienist told her ahead of time what the fees would be for her next appointment. Also, we promised that we would only do doctor exams as necessary or as mandated by the dental practice law in our state. That seemed to be a good idea to her.
We clearly have missed the mark with this patient. Although we have reviewed the reasons for a doctor exam and the value of a healthy mouth she sees our care as similar to a “Jiffy Lube” oil change. In our office we do have verbal protocols for each phase of our procedures so the message should have been getting through about what we are doing and why. We reviewed her record when back at the office and determined that she has some minor periodontal issues that she has chosen not to address. Whatever we are doing we are not getting her to take ownership of her problems. We wrote her a short note reviewing our findings and promised that her hygienist would show her the areas of concern at her next visit. The words we have been using up to now have not been working it is time for all parties to get involved in facilitating behavioral change. Maybe this patient is not listening. Maybe she is a visual not verbal person. Maybe it is just about the money. We need to keep asking and listening and teaching. Words do matter.