We are 2.5m years old as a species (unless you are a Christian fundamentalist – in which case, soz).
For 2.49m years we were hunter/gatherers (to read Robert Winston’s excellent book Human Instinct – CLICK HERE)
10,000 years ago, somebody decided to plant a seed and wait for it to grow – its the waiting around that turned God into a man – because the crops had to be protected. Before then, the agreed view was that God must have been a woman (what with lunar cycles, menstruation and all that).
Most of how we react and respond is based on the first 2.49m years – we haven’t had the time to change (on the evolutionary time-scale).
So when you tell a patient that their £2,000 dental implant is going to cost £3,500 because there have been complications, they will choose one of two predictable reactions:
Fight or flight.
Fight – “you must be effing joking, I’m calling the Dental Law Partnership, BBC Watchdog and the GDC” (any idea which would be worse nowadays?).
Flight – “see ya then – I’m off” (and I’ll fight when I get home).
Why do we fight or fly?
Because, just like a bloody great lion jumping out of the bushes just when I was settling down for a drink – you scared the shit out of me and my evolutionary sub-conscious mind took over from my 21st Century conscious mind.
There is a golden rule in the patient experience.
That starts with a dentist wimping out on the financial conversation and sending the patient to reception to be told what they have to pay in front of all the other wildebeest.
The more sinister and dangerous version is telling the patient that their implant and restoration will require an investment of £2,500 – and then hoping to God that there are no remakes and the patient is happy with the aesthetics.
I get the feeling that this is becoming more of a dance with the devil over time.
Patients are getting savvy and some dentists are getting just a little bit too hasty to see that “up-front payment with a 5% discount” in the bank.
Now – before you start – any self-respecting lion who erects an A-board by a watering hole that reads (in wildebeest speak, of course) “beware of the lions” can expect a period of loneliness.
The difference in dentistry is that you aren’t actually trying to frighten them – but the unfortunate fact is that dentistry is an art as well as a science and that the patients are unpredictable – after all they are homo-sapiens (literally wise after the event) and not homo-praedictio.
So the opposite of surprise is expectation.
Managing that expectation is a mission critical part of your patient experience and treatment planning.
I was chatting to a dentist the other day who told me that 20% of his implant cases required extra work as a result of functional or aesthetic problems.
At the moment he is basing his cost-estimating on the 80% of cases that go through without a hitch.
The 20% that “go wrong” create a fight or flight mentality and the loss of profits and potential problems are eating away at his time and his profit margins. His quote of the conversation:
“when a case goes “complicated” like that, I know before I start working on the solution that my next patient will generate no profit for the practice because the profit on the next case will cover the impending losses on the patient in my chair”
Bonkers and disheartening.
“Mr Patient, I need to explain to you that dentistry at this level is an art as well as a science. There is an element of unpredictability because you are a human being and not a machine. On average, 80% of our patients sail through the treatment with no problems. Equally we notice that 20% of our patients require more attention than normal either because of functional or aesthetic problems with the treatment. I have no way of knowing at this stage which of these you might be.
What I would like to say is that 80% of the time you would be looking at an investment of £2,500 for this implant and the restoration but I have to inform you that, in 20% of cases, that investment could rise in order to keep you safe and happy with the outcome – in the past, the investment has risen to as high as £3,500 so the best we can do right now is be honest and promise to keep you informed at every step of the way.
If you can accept that 80/20 rule and the consequences of falling into the higher risk category then there will, at least be no surprises – how does that sound?”
That’s my first stab at a solution to this problem that, if successful, could avoid future problems, both financial and legal.
I’d be interested in any further ideas on this subject.
In the meantime, whether there is a God, whether or not she is male or female and whether you wake in the night feeling the primeval urge to chase small animals and shit in the woods – do at least avoid the more obvious problems in patient communication.