Why Patients Say "No"

How to Handle the Two Most Important Patient Objections

by Tyson Steele

Have you ever wondered why the keys on a typewriter keyboard are laid out their current order? Many people assume that the format is designed to improve typing speed.

As you've probably guessed, it is not.

The early typewriters had levers that were activated by pressing the keys. When a key was pressed, a lever with the appropriate letter would fly up and strike an inked ribbon placed just in front of a piece of paper, transferring ink to the paper. If the lever didn't have enough time to fall back into place before another key was struck, the two levers would crash into each other and jam the typewriter.

This, of course, didn't look so good when a salesman was demonstrating the typewriter to a potential customer. To solve this, the creators of the first typewriters moved the keys out of alphabetical order in order to keep people from typing too fast. (They even put all the letters for the word "typewriter" on the top row to make them easy for the salesman to find!)

In other words, the typewriter keyboard is actually designed to help you type slowly! The funny thing is that we keep creating ergonomic keyboards, extra sensitive keyboards, data entry shortcuts and all sorts of improvements without ever going back to the drawing board to fix the foundation.

It's often the same thing with how we handle case presentations. We try all sorts of methods to overcome patient objections without ever going back to fix the foundation. In other words, we need to know "why" patients say "no" in order to better know how to present treatment.

THE WRONG REASONS

Ask most dentists and staff members why patients say "no" and you will hear a litany of responses. However, the most common ones tend to fall into several categories:

1. Money & Insurance -- Many people assume that patients fail to get treatment due to a lack of money or insurance. (Of course, this is what patients say. But keep in mind that the real objection is often hidden behind what patients tell you.) Although it is true that patients will sometimes reject or delay treatment due to money and insurance issues, this objection is actually more rare than you would first guess.

2. Lack of time -- Commonly cited by patients as a reason to put off treatment, this objection is often held in high esteem by dentists and staff alike. However, it is rarely a real objection.

3. Lack of understanding -- Another theory is that patients avoid treatment because they don't understand the procedure or why it is necessary. Of course, like the money issue, this can sometimes be true, but it's not as common as you think.

4. Fear of dentistry -- This is the one that leads dentists to write, "we cater to cowards" in their yellow page ads. Of course, this can also sometimes be a real objection, but you don't overcome it the way you might think.

At most case presentation seminars, you are taught to "overcome" these misleading objections. The problem, of course is that by assuming these objections are real, you are misled from the beginning. Ultimately, this causes you to address something that may not even be an issue but ultimately becomes an issue as the patient considers it. In other words, by trying to address the wrong objection, you can actually help your patient discover new reasons NOT to receive treatment.

THE REAL REASONS

The funny thing about the two most important REAL objections in dentistry is that, most of the time, you overcome them without even knowing it. You see, you MUST overcome these objections in order to get the patient to accept treatment. So, if you are getting any case acceptance at all, you are already addressing these two issues indirectly.

But don't start thinking you've got it all figured out and you can stop reading now. The better you understand this, the better you will become at helping your patients get healthy.

So, what are the REAL primary reasons that patients fail to get treatment? Well, here is the first one for your consideration...

LACK OF URGENCY

Ultimately, many patients fail to get treatment because of a perceived lack of urgency. Of course, patients don't tell you this, but their subliminal reason for rejecting treatment is that the treatment can wait.

This is a huge objection. In fact, it's the most common objection in dentistry.

Ultimately, many things contribute to a perceived lack of urgency, but the most important are:

1.Lack of pain. -- "It doesn't hurt, so it must be okay for a little while longer."

2.The problem has existed for some time. -- "Why get treatment now? It's held up this long. I'll just wait it out."

3.In the process of explaining treatment, the doctor tells the patient that the treatment "could" wait. -- There's nothing wrong with this except that it is often the only part of the conversation that the patient remembers. "Doctor said it would probably hold up another year. I'll just wait."

4. The perceived benefit of getting treatment now is outweighed by other concerns. -- "I'll just do it later when I have the money (or insurance.)"

Of course, in many of these cases the patient will tell you that they don't have the money or they don't have the time. However, you can be assured that a lack of urgency is often the real objection.

In fact, you know this already. You treatment plan a crown based on the fact that the patient has a failing amalgam restoration. The patient doesn't get the treatment and tells your staff they are "really busy, don't have insurance, need to wait for the money," or some other objection. Several weeks later, the tooth fractures, causing a great amount of discomfort for the patient. Ultimately, the same patient who "didn't have the time, didn't have insurance, didn't have the money" suddenly finds the time and money for treatment and has decided that it's not necessary to have insurance.

You see, pain creates a real strong sense of urgency. And, once urgency is established, all of the other objections are overcome. If the patient "really" had a money objection, they would still have the money objection even when it's urgent!

Now it's time for the second REAL objection. If a lack of urgency is the most common objection in dentistry, then this one is the most IMPORTANT...

LACK OF TRUST

The most important reason patients fail to accept treatment is broadly defined as a lack of trust.

Many years ago, dentistry was considered by the public to be one of the most trustworthy professions. Unfortunately, recent surveys of public opinion have indicated that this attitude has largely shifted. Whatever the reasons for this change, it has left dentists fighting an uphill battle when it comes to case acceptance.

You see, if patients trust you, then almost all of their other objections can be overcome. Trust is the foundation of the dentist/patient relationship, and when it's there, case acceptance is a given.

Again, you already know this. You have patients who hold you in high regard. When you discuss treatment with them, they hardly need to listen. They make decisions regarding their care based completely on your judgment and recommendation. "Gee Doc, just do whatever you think would be best."

Think about it. If a patient really trusts you, they will prioritize the treatment. If they trust you, they will usually find the money. If they trust you, they will believe they need the treatment. If they trust you, their fear of dentistry is overcome.

Trust is the foundation. Without it, you will fail.

BUILDING TRUST & URGENCY

Ultimately, there is a foundational problem with the manipulative case presentation strategies taught at many seminars today. For, while they attempt to overcome some of the less important objections, they diminish patient trust in the process. In addition, they fail to address the patient's lack of urgency in a way that simultaneously builds trust.

Each and every case presentation should be structured in a way that will build trust and urgency in the patient. The trick, of course, is to discover how to do that. If you say, "Every single one of these amalgams needs to be replaced with composite this week or you might drop dead from mercury poisoning!" you may build urgency, but you're diminishing trust.

In next month's issue we'll discuss how to build trust and urgency. And the great thing is that you can do this even if you're not a great salesman. For that matter, you're already doing it. Every patient who currently accepts treatment from you is already displaying a level of trust and urgency. (Now, just imagine if you could improve that by 10%.) See you next month!