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The Ideal Dental Practice - Patients
We all have patients we love to treat. The dentist
likes them, the staff like them, and they like us. They might not
like having dentistry done TO them, but they would prefer not to
have anyone else doing it. They are a pleasure to treat.
Now on the other side of the coin, we have patients we don't like
to treat. These people cover a wide spectrum, and the reason we
don't like them is down to a host of factors. This is not the same
as those patients that are difficult to treat (the ones with the
uncontrollable tongue and the pronounced gag reflex for example).
No, we are talking about those that are:
· Rude
· Aggressive
· Bad attenders
· Thieves
· Litigious
· Late payers
· Unappreciative
I think you know the ones I mean. You do them an
examination on the NHS, and they complain about the price. You refurbish
you practice and they complain about the new colour. You book them
for a 2 hour appointment, and they don't turn up. They are as nice
as pie to the dentist, but rude as hell to the receptionist. And
most practices have them. And you know what; there is no reason
that these people should be part of your practice. You should remove
them from your practice.
"That's easy for you to say"
Well yes it is, because it's been done before. One of the pillars
of a successful practice is to have a patient base of people you
actually like. That way you still have difficult patients, but at
least you know they appreciate what you are doing, and at least
they are, in your mind, worthy of your care. Why treat patients
that you don't like? This to me does not make sense. Remember, you
are not the only dentist in the world. If you eject them from your
practice, they may well find a dentist who is more suited to their
personality type.
"But I can't just ask them to leave"
Why not? You've done it before. There will have been patients that
you asked to leave your practice for one reason or another. Be they
private or NHS, you control who you see, and have an absolute right
to refuse to treat anybody you don't want. A social conscience is
well and good, but not when YOU end up suffering by dealing with
people that you find unpleasant.
So what should you do? If you are an associate you should let your
principle know that, from this moment, you refuse to treat these
patients. Some associates work in a practice where the WORST patients
are fobbed off onto them. As an associate, you have a right to refuse
to treat patients you don't want, even under the NHS, because you
are a principle in your own right. So if you don't want to see Mr
Faceache, you don't have to. Remember that.
If you are a principle, you get rid. Ask you receptionist, your
nurses and your associates who are the bad patients. They will know.
Remember, a lot of the bad ones don't show the signs when they are
in the surgery. It's a bit like Jekyll and Hyde. Hyde only comes
out at reception. Get rid of them. Write to the PCT and give them
3 months notice. If you are private, write to the patient and ask
them to go elsewhere. As long as you are polite, careful and your
work is of a high quality, you have nothing to worry about. Of course
if you've done a dodgy RCT on them and they go elsewhere, you might
hear from them again, via a less than friendly solicitor. This is
why you have to be good at what you do. But we get into this in
another section.
"But I'll lose capitation if I get rid of
patients. My numbers will suffer"
Well if you think treating Mrs Nightmare are worth a pound a month,
then fine keep them. If you think that Mr Awkward is worth the monthly
Denplan payment then fine, keep them. But remember this; you no
longer have the right to complain about them. You choose your patients.
You choose who you treat and who you don't treat. They may well
walk through your door, but you are the one that ACCEPTS them into
your practice.
"I can't just tell someone to go because
I don't like them. There might be an argument."
You know there are dentists out there that do a patient interview?
If the patient meets the criterion of the dentist (i.e. isn't an
obnoxious idiot) then they are invited to join the practice. Admittedly,
this takes some balls to do this. But there are other ways, probably
the easiest for most people being a standard letter which is sent
out after the initial appointment. And yes you may get a phone call
or a visit from the patient, and occasionally they will rant and
rave at you, but doesn't that sort of prove that you were right
about them? And surely a slight disruption is better than having
to deal with someone that could easily turn into a heart sink patient.
Because once you START treating them, it's harder to get rid of
them until that treatment is complete. You have to be smart here.
You have to use that thing between your ears.
Grade your patients
If you have a present patient base that you are
thinking of doing a cull on, then you will need to grade them. And
this will take many months. But it is well worth it. You grade your
patient A,B,C,D.
A)
Patients love you and you love them. They also have the financial
resources to afford top quality dentistry
B) Patients love you and you love them.
However, their finances are limited, and will unlikely be able to
fund extensive treatment
C) These patients are borderline. They
cancel appointments, miss appointments, and say things like "I
hate dentists" to your face. You aren't sure about them, and
they aren't sure about you.
D) Rude, ignorant, abusive and will
complain that you don't give out free toothbrushes. You know who
I mean.
You get
rid of the C/D's and keep the A/B's. There are
many ways of getting rid of the C/D's. The D's
are best just got rid of. No messing, just do a mass mailing and
delete them from your practice. But what about the C's?
Well, the first thing to do is have tight systems in place for the
appointments. If appointments are cancelled with late notice, or
missed, you have a system to deal with this. Some practices
charge for missed appointments, other have a three strikes and you're
out policy. The decision on this is yours. You also need a
strict account systems to follow up delinquent debts, which also
takes into account the problems some people often have paying for
treatment. C's soon realise that they are at a
practice where C behaviour is not acceptable. And
they either convert to A/B or they leave to go
elsewhere. If you are a private practice, you can also incorporate
the following system. Every time the C patient
breaks one of your rules, you put the cost of any future treatment
up by 10%. The idea is, the more the patient misbehaves, the more
it costs them to have their treatment done at your practice.
This is not my idea, but I include it for your consideration.
However, as we know, it's not that simple. There is still the problem
of new patients.
New
Patients
It's all very well asking people you don't like not
to come back, but surely there must be an easier way. Well there
is. It doesn't prevent the D patient from walking through your door,
but it greatly limits the risk of this. This is what you need to
do:
·
Get rid of your D's - People talk to people, and hang out with people
that are similar to themselves. So when you ask your D's to leave
(politely of course) they will no doubt talk about this fact to
their friends. "You'll never guess what my bloody dentist did………."
The word will get out amongst the D's that your practice is not
the practice for them. This is how word of mouth works. They
will then be more likely to find a practice and a dentist who is
more suited to their personality type.
· Have strict written terms and conditions
for your patients - these should be fair but strict. "If
you do not turn up for your appointment we will do X…"
This should be in your welcome pack which is given to all new patients
BEFORE their first appointment. Once they have received it, and
digested it, they are then invited to join your practice. Some of
them won't ring. You have already filtered out some of the undesirables.
· Use your existing A/B patient base as
a referral network. You should ask your existing patients to refer
you patients of SIMILAR QUALITY to themselves.
Remember, people hang around with people of similar personality.
So the likelihood is, if A/B patients refer you people, they will
be more A/B. You can go even further, and give your existing patient
base referral cards. A new patient can only get onto your books
with one of these cards.
Now isn't that better than putting an ad in the
yellow pages and keeping your fingers crossed.
But what about patients in pain?
This is
something that has always troubled me about the average dental practice.
Is it right to inconvenience your existing patients for that day,
by squeezing in a patient you have never seen before? I will ask
that again. Is it fair to keep Mr A and Mrs B waiting for half an
hour whilst you deal with someone that could well be Mr D? This
is the social conscience thing again. When this happens, a lot of
dentists suddenly think "Oh, I am the only dentist in the world;
I must see this patient immediately". I would disagree with
this statement. You have no duty of care for these patients. Unless
you are having a problem building up your patient numbers, then
I would suggest referring them to NHS direct where their problems
can be dealt with quickly and effectively. That is what NHS
Direct is for. If they then still wish to join your practice, then
send them out a welcome pack and wait for them to call. Many of
you will disagree with me on this, as well as other things I have
written. But that's fine. I am after all not telling you what to
do. I am simply offering you what may be a better way to deal with
your patients. You get to choose what you do with the information.
This is simply my philosophy. I could well be wrong.
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