Embrace Progress: ‘What They Want’ Isn’t Always Best by Daniel Grob, DDS, MS, Editorial Director

"Give them what they want!"

This seems like the key to success, if you pay attention to the blogs and consultants out there. I've even written about the topic in past columns as a concept necessary to success in the consumer-driven, "put the patient or client in charge" atmosphere that we're now living in. But is just responding to patient desires enough?

By responding only to the obvious wants of the patients, might we be guilty of leaving some treatment (necessary or suggested) off the table, delaying all the progress that research and clinical experience has given us?

Sales experience needed
Marketer, blogger and consultant Dan Kennedy confirms in a post what I've been saying to my kids and many others for most of my later adult life (after I discovered the hard way): Almost everything is selling.

Kennedy says that if you study the habits of highly successful people, you'll find at their core an ability to "sell themselves, their ideas, their philosophies and dreams." One would think that because we work in health care we're insulated from this type of business practice, which some people find distasteful, but think about how most of your day is organized: From the initial phone call and new patient check-in, to almost every visit and then through wearing retainers, we're selling concepts, ideas and enrolling cooperation. And that's only at the office!

Just this morning, I had an exam appointment to provide a second opinion. The parent said they thought their child was too young for braces … which means they had called at least two orthodontic practices, taken the time to visit two practitioners and spent a couple of hours with each one.

The chief problem identified by the family dentist was a cross-bite, but there was much more.

More than they'd bargained for
After welcoming the family to the office, the mandatory tour and validating the medical history, we gathered records and uploaded them to our cloud-based data system. With high-speed internet, the digital X-rays and photos are available in the conference room, cropped and traced, within minutes. The parent watched the introductory video and then we went to work.

• The photos showed the expected asymmetry from the cross-bite.
• Pan was unremarkable, but what followed was significant.
• The lateral cephalometric exam showed enlarged adenoids.
• The patient has a history of snoring.
• Nail-biting was admitted.
• Ear problems have been present since early on.
• The tongue was barely movable because of a tight lingual frenum, and speech therapy had been attempted.
• By the way, this finding is present in most of the siblings by history.

I was on the hot seat: How should I communicate that what the family came for was just one symptom of so much more? My discussion of all the above was welcome but unexpected, and not usually in a typical dental setting. It was the first time anyone ever mentioned these findings to the mother. My treatment coordinator and I were not able to schedule care during that first appointment.

• Price? It's important that your marketing and office protocols and appearance reflect your price point. Quite honestly, if you're not the highest-priced orthodontist in the area, that's usually not the problem.
• Lack of need? As mentioned earlier, I had numerous facts and findings supported by the dentists, and obvious in the photos.
• "I need to speak to ..." This objection arises when the decision-maker isn't present. Clarifying this point during the initial phone conference is extremely beneficial.
• "It won't work for me ..." Perhaps they don't trust themselves, based on previous bad decisions. As much as I try to practice at a level that encourages the best in discussion and complete treatment plans, the tendency to succumb to the pressures of modern practice is everywhere.
• I did my best to work through the triage of treatment that I believed was warranted in this situation:
• Airway evaluation by an ENT physician.
• Evaluation and possible removal of the lingual frenum.
• A program to eliminate the oral facial habits.
• And, lastly, correction of the cross-bite, alignment of the incisor teeth and a period of monitoring to await most likely Phase 2 treatment.

Faster isn't always better— for them or for us
Proposing orthodontic treatment be done in six months—whether with acceleration techniques, fewer and fewer aligners, or the latest and greatest appliance—may be leaving care, treatment and potential practice growth on the table.

Have you been to an auto dealership for an oil change lately? You're greeted by the driveway attendant and a concierge, then assigned a service advisor who evaluates your key fob and mentions that you're due for your 10,000-mile checkup.

Many hours or even a loaner later, you're handed a bill and a report that tells you all the things that you had done that weren't on the list of what you wanted. At least take a walk inside for a free donut and cup of coffee. (I must admit, the barista was very pleasant!)

Sound familiar? "Giving them what they want" may keep the bills paid temporarily, but long-term our profession advances with skill sets that constantly change.

• Study clubs are numerous that espouse the benefits of orthodontic care for restorative purposes.
• Manufacturers are rolling out CE courses to highlight the advantages of advanced diagnosis and treatment techniques, ranging from airway evaluations and treatment to soft-tissue management.

As we continue to advertise shorter and shorter treatment times and fewer and fewer aligners that can be changed faster than the blink of an eye, it's important to not deny our patients the advances that modern orthodontic research, experience and care can offer our patients.

By the way, the patient discussed earlier just called to schedule the initiation of care. Whew!