The practicing dentist works diligently to accumulate assets and income. He or she has little time or inclination to consider that someone may attempt to take those assets or income by starting litigation. Maybe the thought of a potential lawsuit has not entered the dentist’s mind. Why should it? The dentist may think “What could I possibly do to cause someone to sue me?”

While spending money with accountants, attorneys and financial planners developing strategies for tax deferral, estate and retirement planning and general business concepts, there is rarely time spent for the initiation of a plan to protect the dentist against something that may never happen. Anyone experienced with litigation knows that preparing for litigation and arranging one’s financial affairs properly will be much cheaper doing so in advance rather than after a lawsuit has begun.

What is available to a successful litigant?

After developing plans and spending time and money for the preservation of assets and income, why leave anything exposed to potential claims in court? In the event a lawsuit begins, what can the dentist lose? The answer depends on many factors but the short response is: Whatever amount has been filed as a claim by the plaintiff in the complaint plus the legal and expert fees and costs needed to defend against the complaint.

After the lawsuit begins and after hours of litigation discovery, interrogatories and depositions and assuming there is no settlement, the case will eventually come to trial before a judge or jury. A verdict will be entered by the court and the dentist may lose. If the decision is lost, it will cause the court to enter a judgment in favor of the plaintiff and against the dentist. As expensive as the litigation and its defense may be, the defense against a judgment is even more time consuming and costly. The fact is that there may be no defense. All of the preparation in planning a defense is to prevent the judgment from occurring. Once the judgment is entered, it is almost too late to prevail in overturning the judgment.

The plaintiff and his or her attorney will now attempt to collect the judgment and convert it into cash. Those assets not protected by specifically exempted laws such as those governing approved qualified retirement accounts and certain properly drafted trusts are at risk of attachment because of the judgment. Unencumbered real estate, bank accounts, personal property and business interests are all exposed to collection actions and levies. Salaries are subject to wage garnishment. Of course, some assets are much easier to attach than others. A bank account is available to be taken almost instantly. The bank where the funds are held in the name of the losing side of the litigation will receive a notice of attachment and must freeze the account unless the defendant owes money to that bank. In that instance, a bank has set off rights by which they are entitled to take the funds and apply those funds to any outstanding debt owed by the defendant to that particular bank. This is really a good thing because it pays down a personal liability and keeps the plaintiff from attaching the bank account. One may think that they have friends at the bank and the friends will inform them of any attempt to attach the account. That thinking is incorrect. No one at the bank wants to defy an order from a court and hide the funds or allow their “friend” to have an opportunity to withdraw the funds before they are frozen. One of the only methods available to keep an attachment from being enforced is by the set off ability of the bank against debt. No “friends” are needed to apply this theory.

How are the assets converted to the plaintiff’s accounts?

Court orders are issued, liens are filed of record with the county in which the defendant resides and also at the level of the state and all of a sudden, everyone who prepares a search to discover any available asset, now has the legal right to stop financing, stop the closing of a real estate transaction and in general, prevent the losing party from proceeding to use his or her own assets without first paying the plaintiff the amount that has been won in the lawsuit. If the defendant wants to buy or lease a car, their credit is impaired and it becomes very difficult to do so. Sometimes credit is still available but at a much higher interest rate. Credit reporting agencies are informed of the liability and the credit rating of the defendant suffers. A point is reached where the defendant must contact the plaintiff and request a settlement in order for his or her life to be able to continue as it previously had.

What can prevent the plaintiff from attaching everything?

There is very little to be done after the fact of a verdict against a defendant and a judgment in favor of a plaintiff. All planning must be in process and implemented well before a judgment has been entered against the defendant. If assets are transferred to friends or relatives while the suit is in progress, they will be easily discovered and typically, sanctions will be granted against the transferor and transferee. These sanctions can cost an enormous amount of money and time. Plan for these events by protecting and preserving assets and income well before any type of litigation occurs. Do so in a manner similar to the time and money spent on financial and tax planning that takes enormous amounts of effort spent with experts who can protect and preserve your assets and income in advance of any complaint being served upon you. Be prepared for a potential lawsuit. Your life does not have to change at all while the planning is being implemented. You will have the plan in place in the event of a judgment and you will have as much protection as possible available.

Bruce Bryen is a partner in The Snyder Group and managing partner for Bryen & Bryen LLP, Certified Public Accountants. Based in New Jersey, Mr. Bryen specializes in deferred compensation such as retirement plans, income and estate tax planning, the determination of the proper organizational format, asset protection and structuring loan packages for presentation to financial institutions. Bruce is also experienced in providing litigation support services and has testified on numerous occasions as an expert witness. 

Articles

To protect and preserve

That’s what a Wisconsin-based dentist decided when one of his patients asked him out. He wasn’t sure if it was a good idea at first, but after talking with her more and realizing how much they had in common, he changed his mind.

“I thought about it for awhile before I responded to her interest in me,” he said. “I was hesitant because I was worried that if it didn’t work out, I would lose her as a patient and there could be some negative ramifications.”

They talked about what could go wrong and how they would handle it if it didn’t work out, and both decided they didn’t want to miss out on what had the potential to be a great relationship. And it seems they made the right decision; after two years, they’re still together.

Limoli, owner of the Reed Limoli Group. They’re exposed to a lot of people of the opposite sex during the work day, and it’s really not surprising that they may find themselves attracted to some of their patients.

If you’ve decided there’s a patient you’d like to ask out or if you’re thinking about responding to a patient who’s shown interest in you, there are a few things you should think about before you make that first date, from how well you know the person to what you’re going to tell your staff.


	Unfortunately, there are some people out there who want to take advantage of you. If one of your patients is starting to come on strong, you may be dealing with what Limoli describes as a “predatory patient.” These patients make a habit of dating their doctors for reasons other than finding love. If the patient showing interest is a friend of a friend or knows someone in your family, then you’re less likely to be a target and more likely to be someone that patient would like to get to know better.

But if you don’t have any connection with the patient other than the fact he or she is a patient, it doesn’t hurt to check with your state dental board to see if this person has ever brought a case or complaint before the board, Limoli said. This may seem a bit extreme, but protecting yourself and your practice should be a priority.

“Just like Glenn Close in Fatal Attraction, there are people out there who don’t have your best interest at heart,” Limoli said. “Dentists are targets for people looking for somebody to take care of them. You have to be very careful with the doctor/patient relationship from this standpoint.”

What if a staff member wants to date a patient?

It’s a good idea to have an office policy on this that says it’s inappropriate to date a patient and could be grounds for termination, said Penny Reed Limoli, owner of the Reed Limoli Group. But if there is a patient a staff member wants to go out with, it needs to be an open situation.

“The doctor is liable for everything that happens in the practice,” Limoli said. “You do have to lay that on the line when you bring staff on board. If you don’t have a policy in place, put one in place. If you date a patient as the dentist, your staff will assume the same standards apply to them. A firm, written policy can help you avoid any misconceptions with your staff and protect you and your practice."


	Secrets will only hurt your practice, and keeping something like this from your staff is no exception. Staff members at the Wisconsin practice know about the relationship and are supportive of it.

And your team likely will be supportive, as long as you don’t treat your practice as a dating service. They’ll get annoyed if you constantly ask if a patient is single or are taking a different patient out every night of the week. But if they know you’ve met someone you think you could build a life with, they likely will stand behind your decision to start a relationship.

“If the staff perceives the doctor is evaluating every person as a potential date, that is unprofessional. And I think to try to keep it a secret creates a lack of trust,” Limoli said. “They’re going to find out. So if you do begin to date a patient, let the team know. Maybe not the first time you meet for coffee, but if you’re going to see each other you should let your staff members know so they’re not suspicious. And tell your team it’s not information for water cooler gossip or something to let out of the office.”

While the Wisconsin dentist’s girlfriend is still his patient and it’s working out just fine, Limoli recommends referring any patient you have a romantic interest in to another dentist. That way you break the professional ties and you’re free to date without having to worry about the complications that come with the doctor/patient relationship.

“As quickly as possible I would refer that patient to a colleague,” Limoli said. “Say something like I enjoy having you as a patient, but I think it would be best personally and professionally if I sent you to my friend right down the street.”

When you look at state dental practice acts that talk about the doctor/patient relationship, it’s easy for something to be deemed as inappropriate, Limoli said. Limoli knows of a single client who was simply asking a new patient questions about work and her life to get to know her better. He didn’t ask her out or express any romantic interest, yet she filed a complaint to the board citing inappropriate conduct.

The complaints can also come if you break up with the patient, Limoli said. Your ex could use your professional status and wealth against you. It all comes back to the fact that you need to be careful.


	Another way to protect yourself is to make sure you never meet the patient at your practice before a date, Limoli said. Don’t tell him or her to stop by before you head out for a night on the town. Even if you’re dating, he or she should only show up to your practice as a patient who needs a cleaning or some dental work done.

If you’re wondering where to have your first date, Limoli recommends a coffee shop. When you decide you want to continue to see this person, then Limoli says it’s time to consider referring to another dentist.

And of course, if you’re married, don’t even think about going there.

“It’s common sense, but it does happen,” Limoli said. “It can be very dangerous, like swimming in a tank of piranha. The chances of you getting out of there, and dating patients, without something taking a bite out of you are probably slim.”


	The Wisconsin-based dentist doesn’t make a habit of dating his patients. But after he thought about all he had in common with his now girlfriend, he decided he’d give it a chance. But he didn’t come to the decision lightly. He weighed the pros and cons and decided the pros won.

This dentist also treats family members, business associates, staff members and friends. That says something about his comfort level when it comes to treating people who are close to him, he said, and how you feel about that may play into your decision to date or not to date.

In the end, it all comes down to finding that person you want to share your life with, and it really doesn’t matter if you happened to meet that person as a patient in your dental practice.

“The partner or the spouse you choose is the single most important decision a person can make in their life to determine whether they’re going to be happy or unhappy,” he said. “It’s a huge, monumental decision. With that in mind, you should think about it long and hard before you decide to date or go out with a patient. Realize the importance of the decision of choosing someone who’s a potential mate and weigh the pros and cons. Calculate the risk.”

Sometimes it’s worth the risk. That’s what a Wisconsin-based dentist decided when one of his patients asked him out. He wasn’t sure if it was a good idea at first, but after talking with her more and realizing how much they had in common, he changed his mind. “I thought about it for awhile before I responded to her interest in me,” he said. “I was hesitant because I was worried that if it didn’t work out, I would lose her as a patient and there could be some negative ramifications.”

I dated a patient

Recommendations from friends are still a big part of how patients find a new dentist, but in a time when the whole world is much more closely connected through the Internet those “recommendations” and “friends” are available from a much wider array of sources, all of which are easily searchable.

Gone are the days when people would flip through a massive phone book to finds the pages of ads from dentists in their area. Those books still exist, but these days prospective patients are far more likely to conduct their search via a computer at home or at work, or even from the rapidly growing number of Internet-enabled cell phones.

They might start the search with the name of a specific dentist they heard about from a friend, or they might simply be searching for a dentist in a specific city, but either way they are likely to start at an Internet search engine such as Google, Yahoo or the newest to launch, Bing.

In the not too distant past, the results of such Web searches might turn up a practice’s Web site, or possibly a listing for the practice at an online “phone book” type site that lists contact information for different business categories. However, these days the search results are likely to include the practice Web site along with additional online outlets for the practice.

These can include practice controlled social media profiles on a site such as Facebook, a practice’s micro-blogging presence on a site such as Twitter, or content the practice does not control such as user reviews on a site such as Yelp!. Practices can either test the waters, or dive head first into the world of social media, depending on their comfort level and if they feel it’s a fit for their practice. But even those who are not yet up to setting up a blog should at least be up to date on what current and former patients are saying about them on the Web.

“Searches for a dentist that include the term ‘review’ are being conducted nearly as frequently as just the name and location of the dentist, so these review sites are clearly a force to be reckoned with,” said Daniel A. Bobrow, MBA, president of American Dental Marketing.

“These alerts, while not perfect, are a convenient way to keep up to date on what is being posted…”

Bobrow recommends that his clients set up Google Alerts, a free service that sends them an e-mail whenever keywords such as the practice’s or the doctor’s name appears in news articles or recently posted online reviews. “These alerts, while not perfect, are a convenient way to keep up to date on what is being posted, which is especially important if a patient posts a negative review,” he said.

Most review sites will not remove negative reviews, but they will allow the business to post a response. Bobrow recommends reaching out to the patient who posted the negative comments to address the concerns, and then posting the results of those efforts to accommodate the patient.

Rita Zamora, a consultant who blogs about relationship-focused dental marketing at dentalrelationshipmarketing.com agrees that dentists need to be actively policing their online reputation. Part of that is responding to negative comments, but another part of that effort can involve creating a more robust Web presence so positive information outranks a negative review when someone searches for your practice.

“When you’re actively participating in social marketing on the Web and have a lot of positive information out there, it will help to drown out some of those hopefully very sparse negative comments that exist out there,” she said.

The fastest way to spread a lot of positive information online is to create practice profiles on the social media networks. However, practices will only see the full benefit of those networks if they are putting in the time to actively participate in the online communities, Zamora said. Because of this, social media marketing will not be for everyone.

For those practices that are comfortable online and willing to dedicate the minimum of an hour or so a week to social media efforts, Zamora believes these efforts can pay off by creating stronger bonds with existing patients and showing an inviting presence to new patients. A practice can use a Facebook profile to post updates and specials that only fans of the profile can receive, and the page can also be used to show off small bits about the personalities of the practice’s staff.

“I think one of the most challenging situations that’s going to come up for dentists using Facebook is that there is a fine line between being too salesy and really socializing in a community,” she said. “They do want to have that traditional type of information available, but when they’re researching who is going to be the best dentist for them, they want to see a little bit about your personality and how it’s going to feel to interact with and relate to you when they come into your office.”

Maintaining a profile on Facebook gives a practice the opportunity to interact with patients on a number of levels. Engaged patients might be more likely to post a nice online thank you after an appointment, and Bobrow said dentists should be active in asking new patients to post a review about their positive experience. However, Zamora cautions about soliciting positive reviews, as she believes savvy Web users will be able to tell if a review is not genuine. Both agree that the best approach is to be sure search engine results feature far more positive than negative reviews.

While Facebook and similar sites can provide a terrific place for patients to get a sense of both the practice and the people behind the practice, micro-blogging site Twitter can provide practices with an easy way to provide current and prospective patients with practice-related news and announcements. The site lets practices post short notes that other users who’ve signed up to follow that practice’s Twitter feed can view online or receive as text messages on their phone.

A Twitter account can be useful to dentists who want to follow the latest news from media users such as Dental Products Report, or by following the feed from a manufacturer using Twitter, a practice can stay up to date on the most recent information on products and services. However, the site can also be very useful in helping a practice grow its online presence.

“It’s just a different avenue of marketing. It’s nice to be on it because if somebody happens to be reading a post we put on it, they can communicate with us right there on Twitter,” said Melinda Baugh, office manager at Brazos Family Dentistry in Waco, Texas. “We want to have an online presence where people can find us, and just having a Web site sometimes doesn’t get you there.”

Baugh said her practice started using Twitter as a promotional tool in March and the practice’s feed (twitter.com/WacoDentist) quickly amassed more than 400 followers. She manages the practice’s posts and includes everything from specials for their patients to links to interesting dental news stories.

Thus far Baugh has used the site to communicate with people from around the world, and thinks it is a useful tool for connecting with a range of people. Still the focus of her efforts will remain on providing information for people in her community because, “local followers equal potential patients,” she said.

Keeping up with the Twitter feed and the practice’s recently created Facebook page does take a bit of time, but Baugh said it really only adds up to 15 to 30 minutes a day. A self-described, “computer person” Baugh said it is not difficult to stay current and keeping the practice feed populated with fresh posts, but she does occasionally make her posts from home after the workday is over.

It is that genuine interaction and the dedication to making sure the practice is active with their social media efforts that are going be beneficial to the practice, Zamora said. While being on the sites everyday is not necessarily a requirement, she said spending about an hour a week to manage a practice’s social media presence is probably a good idea.

Bobrow and Zamora both agree that any practice jumping into social media to expand its online presence should have one staff member as the point person for the efforts. It doesn’t need to be the doctor, but should be someone who understands how to use the systems and has the good sense to keep things on a professional level.

Baugh ended up handling it for her practice because of her role managing the office and her comfort with computers. If a practice does not have someone comfortable with personal interaction via the Internet, social media marketing may not be a good fit, Zamora said. While every practice should stay aware of reviews-both positive and negative-efforts to expand a practice’s visibility through social networking should only be undertaken by those who can be dedicated to the efforts.

“Social media amplifies a dentist and a practice’s patient relation skills,” Zamora said. “Someone who has natural people skills may find social media marketing much more enjoyable and a lot easier than someone who doesn’t really appreciate the nuances of networking.”

Noah Levine is a senior editor for DPR. Contact him at nlevine@advanstar.com.

Do you Google yourself?

	Successful case acceptance-especially among new patients-begins long before case presentation.

	When a new patient enters your office, his antenna is finely tuned for all messages-spoken and unspoken-that will help him form an impression of your practice. When that impression is positive, it increases your chances of treatment acceptance.

	So first, it is important to let your humanity show. This means letting the person know your interest in him extends beyond the basic dental appointment. After you welcome the patient, you can ask how he learned about your practice and then talk a bit about yourself and, later, your commitment to quality dentistry.
	
	

	When you do this, you’re building a bridge between your practice and what’s important to your patients-namely, their desire for a caring, thoughtful health care provider. You’re also providing an opening for the patients to talk a little about themselves, their work and more. It may seem like a digression, but it is a great way to connect with your patients-that is, show them your sincere desire to understand, respect and like them.

	Turning to dentistry, you might begin by discussing your goal to provide the best options for the patients, and to let them know their wishes will be respected. This has the positive effect of dissipating any stress the patients may feel about “being forced to make a decision.”

	Anyone experiencing that kind of pressure is typically too distracted to concentrate on what you are saying. Assure your patients that you will provide them with everything they needs to make the best choice, and that a timely decision is in their best interest.

	By this point, you’ve built positive communications with the patients and, ideally, achieved a level of trust. Your next task is to have the patients share with you what, in terms of dentistry, is important to them.

	You can start by asking if they has any questions or concerns about their oral health, if they’re happy with his smile and if there’s anything they might want to change about the appearance of their teeth.

	Then just listen. It’s important to remember that silence is your friend: When someone is silent, it usually means he is considering your point and wants the space to arrive at his own conclusion. So, when in doubt, remember: less is more.
	
	

	In all likelihood, your patients will tell you their ‘story.’ Body language, eye contact and active listening will demonstrate to the patients you understand and care about what they are is saying.

	Your reply is equally important. Depending on a patient’s response, you might say, “If I hear you correctly, you’re tired of being embarrassed about your smile, is that right?”  Concluding this question with, “is that right?” makes it a close-ended question (or closed probe).  A closed probe can only be answered by yes or no.  

	When you have the patient conclude the exchange with an unambiguous reply, he has have given you an opportunity to satisfy his need (with a treatment plan) or continue probing for more opportunities. For example, you might ask, “Is there anything else we might be able to help you with?” If the answer is yes, simply ask, “What is that?”

	After your exam, the next step in getting to case acceptance is to show your patient how your proposed treatment will help him achieve his goals.

	Continuing with the above example, let’s assume your probing determined that your patient has been interviewing, and his self-consciousness about the appearance of his teeth makes him feel anxious and lack confidence during the interview.

	You might then say, “I can appreciate exactly what you’re saying. While people should judge us on our abilities, it’s often our appearance that tips the balance. Well, I’ve got good news. We can provide you with a choice of solutions to get you to where you’ll look forward to sharing your smile with everyone-friend, stranger, and prospective employer alike-and we’ll be able to do it in time for your next interview.”

	If your patient responds with something like, “That would be great, doctor!” you’ve just confirmed a need, which is the impetus that drives someone to accept treatment.

	The next step is to summarize your treatment recommendations, being sure to relate each procedure to how it will address the stated need of your patient.  Upon successful completion of this step, the patient is ready to be handed off to your scheduling coordinator to handle the “paperwork.”

	
	Daniel A. Bobrow, MBA, is president of American Dental Marketing Company, a Chicago-Based dentistry marketing consultancy. Mr. Bobrow is available for a complimentary telephone consultation by calling 1-800-723-6523 or at Info@AmericanDentalCo.com.

 Successful case acceptance-especially among new patients-begins long before case presentation.  When a new patient enters your office, his antenna is finely tuned for all messages-spoken and unspoken-that will help him form an impression of your practice. When that impression is positive, it increases your chances of treatment acceptance.

dentalproductsreport.com-2009-08-01

To protect and preserve

I dated a patient

Do you Google yourself?

Marketing Insider: Let your humanity show