Wait Watchers

Comprehensive treatment presentations that result in overwhelm can cause dental practitioners to fear being labeled “aggressive” or “expensive.” This fear can be so strong that many dentists become “Wait Watchers.” They postpone complete dental diagnosis and treatment planning, opting instead to observe, to “wait and watch” things, to attempt to maintain the patient’s dental status quo. Thus, thorough restorative and preventive treatment is stalled because Wait Watcher practitioners understandably fear patient overwhelm.

My friend, Debbie, waited at the suggestion of her Wait Watcher dentist. Here is her true story. “My dentist had no trouble selling me a program of ‘watchful waiting’ for two troublesome molars that had large, old fillings. Like most people, I dread having dental work done and was more than happy putting off the inevitable reconstruction. Every six months my dentist reminded me I’d need those crowns EVENTUALLY … but not until they started giving me “problems.”

In the end, ‘watchful waiting’ cost me an extra $2,500 and months of unnecessary pain. ”Debbie eventually experienced excruciating pain simultaneously in both teeth, resulting in the need for full crowns and root canals. Debbie continued —
“I have a fairly generous dental insurance policy, but I had used up my annual benefit paying for the two crowns, so I bore the cost of the two root canals myself. That extra $2,500, nearly three months of constant pain, and the stress of all that dental work was completely unnecessary! If I had had those teeth crowned when they first showed signs of deterioration, I would have saved myself a bundle.

Well, you can wait for agony to set in and then watch your bank account grow smaller, but not me. Dr. Watch-n-Wait is no longer my dentist. Never again will I let my teeth deteriorate just because they don’t yet hurt. With my new doctor, we have designed a pretty aggressive reconstruction and maintenance plan that maximizes my dental benefit and seeks to avoid any permanent damage to my teeth. It may cost me a little more up front, but I now know from experience that I’ll save in the long run.”

Does the Wait Watcher program preside in your office? Wait Watchers is for losers! Patients lose money, comfort, and valuable tooth structure. Practitioners lose patients and credibility. In some cases, doctors lose in malpractice court cases.

So, why do it? Why wait and watch? The most common answer is that doctors (and hygienists) do not want their patients to be overwhelmed with the costs of comprehensive treatment. Somehow they think they will get reputations as money-hungry wallet chasers. This is a legitimate concern. Most dentists are not Wait Watchers from deliberate neglect. Rather, an attitude of misplaced patient compassion causes Dr. Wait Watcher to observe needed treatment instead of treating it. Dr. Wait Watcher’s compassion compels him or her to diagnose the patient’s pocketbook rather than the dental condition. Dr. Wait Watcher reasons that waiting for the patient to return in pain justifies the treatment. Wouldn’t it be better to take that mis-focused compassion and redirect it toward total comprehensive care in a way that won’t scare away your patients? How do you do that? Take your strength (compassion), which has become your weakness (waiting and watching), and transform it into a higher strength (action).

Let me be clear here. I am not a dentist and don’t mean to be telling a doctor how to diagnose or when to treat. I understand that sometimes it may be prudent to observe a condition carefully. However, it has been my experience that if there are a lot of “watches” in a practice, this usually points to a lack of diagnostic clarity on the part of the doctor. Look at this as an opportunity to re-define your diagnostic procedures, and share with your team so they can all support you. I suspect you will then see your “watches” decrease.

A great transformational wait-watcher conversation might sound something like this. “Shirley, I’d love to watch that big old metal filling, however, you’d risk the possibility of infection, abscess, or fracture. Because I am absolutely committed to conserving as much of your tooth structure as possible, I’d like to protect that tooth with a crown now.”

As a Dr. Wait Watcher you are probably wonderfully compliant, non-confrontational, and have great patient rapport. Continue to be who you are, and enhance your compassion in order to become more effective. Build on your compassion by adding a new dimension that compels patients to take action.

Here are five strategies for effective treatment presentation:
1. Ask your patients’ permission to share with them ALL your findings during their examination.
2. Utilize The Treatment Triad℠ format. Translate all treatment into one of three levels of service:
• “911” Emergency treatment gets patient out of pain NOW.
• Preventive treatment designed to keep patient out of future pain; may be prioritized over time and coordinated with patient’s budget.
• Cosmetic is totally elective and fun to explore.
3. Prioritize treatment plan in order of urgency. Creating long-term, prioritized treatment plans gives patients time to plan their financial commitment as they move toward comprehensive oral health.
4. Give your patients the full menu of services you provide and guide them to the best options. How would you feel if your waiter never told you about the lobster special because he thought you looked like you couldn’t afford it? It’s always a mistake to pre-judge what you think someone can afford. People in this country have the money for what they want, whether they need it or not. Our job in dentistry is to help them to want what they need.
5. Use words and phrases that improve patient perceived value, such as:
• absolutely
• added value
• comprehensive care
• affordable financial plan
• now

Share with your patients their complete diagnosis and comprehensive treatment plan in a manner that does not overwhelm. Following the five guidelines above will enable you to do this.

Finally, an effective script to follow up on your treatment presentation is this: “Shirley, I want to give you enough information to make a well-informed decision.”

This message is not just for dentists but for hygienists as well. While regulations typically prohibit hygienists from diagnosing, hygienists can indeed be a huge support to the doctor in their pro-active assessments and restorative observations, informing the patient in preparation for the final doctor diagnosis. Dentists and hygienists should meet regularly over case reviews to ensure that they deliver the same congruent message to their mutual patients. Indeed, these strategies could serve as a topic for the entire team at your next staff meeting.

Waiting and watching is not only detrimental to you and your health professional team, it can be a legal liability. Being a Wait Watcher is a dangerous and destructive habit that wreaks havoc on your patients’ oral health, as well as their loyalty to you and your practice.

Are you losing on the Wait Watcher program? Stop watching. Offer your full menu of services. Prioritize your treatment plan using the The Treatment Triad℠  to present comprehensive treatment. Watch patient overwhelm disappear!