This morning, 11 dentists received a special delivery letter that changed their lives forever.

It began, “Dear Doctor: We represent your patient Jane Doe and demand that within the next 10 days, you submit your entire records and 

Week’s end, more than 50 dentists will receive a similar letter. By the end of the month hundreds more, and by the end of the year thousands will be jarred by a similarly ominous letter. In a decade, a third of all practicing dentists will receive such a letter, and their lives will never be the same.

Virtually everything that follows these letters is uncomfortable, if not unconscionable. Anxiety and sleeplessness set in. There may be costly time away from the chair, attorneys engaged and depositions taken. Negative publicity may occur: “Local Dentist Charged With Substandard Care.” Payment may be due the former patient and his or her attorney. Professional liability insurance may cost more. And a stigma may hang over the dentist’s practice.

The business adage holds true: A satisfied patient may tell some family and friends, but a dissatisfied patient will broadcast his anger far and wide.


	There is nothing pretty about this picture, and no dentist is immune. The rain of litigiousness falls on the just and the unjust alike. If a dentist believes these letters are only delivered to ‘bad’ dentists, then that dentist needs a reality check. To a lawyer, all dentists are equally culpable. It’s what lawyers do.

Ah, but you respond, “I have professional liability insurance and am protected.” In a limited sense, that’s true. But relying on liability insurance to ‘fix’ a problem that could be avoided is akin to your patient failing to engage preventive dental care hoping you can fix problems that may occur.

Each year dentists plop hundreds of millions of dollars into the coffers of professional liability insurers. And the insurers spend most of those millions defending dentists against largely preventable incidents.


	Since the late 1980s, our office has created a barrier to the most precipitant cause of litigation: unrealized expectations. Insurers report that at least 80% of all of these legal fishing expeditions come from patients who expected heavenly results yet found they only received earthly products and services.

That misconception lies squarely on our shoulders. It’s because we get rushed and behind in our schedules. Standard of care protocol gets shortchanged. We become pressed for cash flow and we oversell. We fail to perform strict informed consent procedures.

A patient agrees to a service but is unaware that a sinus may be opened during certain extractions, a hematoma might occur, a lip may remain numb for weeks or forever, a filling may chip, a bone chip may work out, a new crown may experience root decay, a new denture may crack or lose a tooth and on and on.

The real culprit is how we obtain an informed consent. Presently, we do so in one of two ways. Either our assistants or we give the informed consent talk, or we ask our patient to read a text.

Later, when worse has come to worst, our former patient tearfully tells the jury she wasn’t given enough time to study a document containing words she did not understand. Or he claims oral warnings were never issued and the jury listens to a “No, you didn’t” vs. “Yes, I did” argument.” The patient always wins that one. After all, we are the ‘deep pockets’-and we have insurance.


	In the 1980s, recognizing that audio-visuals were the finest teaching tools, we created a series of 2- to 3-minute informed consent videos (ICV) that frankly reveal possible consequences of a root canal filling, surgical event, denture or crown and bridge procedure. Professional liability experts edited the information, which is concise, consistent and delivered in plain English.

The video relates the bad news of potential unfortunate happenings-a file may go through a root canal, a dry socket might occur, a bridge does not last forever, half the success of a new denture rests with the patient and so on.

Patients must watch the video before we perform the procedure, and then both the chairside assistant and the dentist ask if they have any questions. When their questions are answered, we ask them to sign that they saw the video, understood it and that their questions were answered. Their signature is then scanned into their computerized chart.

During the past 23 years, 17 lawyers have sent our doctors those ominous letters. After reading the script of our short ICVs, all 17 lawyers faded into the sunset. We did not even call our insurer to report the incidents.

If 17 sounds like a large number of legal inquiries, understand that our office has 34 chairs, a staff of 55, three or more doctors, 12 hygienists and 250 to 300 patient visits daily.


	There’s one more step in the dissatisfied patient scenario-defusing the situation. Dissatisfied patients, if they do not simply walk, often will settle for an admission that we were wrong. But we don’t give in easily. Our combative instincts have programmed us to roll up our sleeves for the fight. And that attitude breeds danger.

I speak from experience. In my early years of practice, when patients had problems with my services, I fought to prove them wrong. In some cases I won and felt vindicated. More often I reached a stalemate, or I lost.

In time, I realized that trying to tame an upset patient was futile, both financially and emotionally, and it was a waste of time. I had to ask myself, if I won, just what had I won?


	As my eyes opened to a smarter way to deal with patient adversaries, I invited them to sit with me and I asked: “What is the problem and what would you like me to do about it?”

Amazingly, some just said they wanted me to know about the problem. I assured them I would look into it and correct whatever was needed in a delivery system that had let them down. And I never failed to follow through on that promise.

Some dissatisfied patients wanted a refund, a remake, a different treatment option or even another doctor. We promptly gave them whatever they wanted and we bore the cost. Many felt we handled the remake situation well and remained as patients.
	That solution costs far less than paying lawyers, and we wasted no time arguing, stewing or negotiating. The methodology is to defuse the patient’s discontent by resolving the complaint.

Despite our best efforts, a few disgruntled patients still wanted a pound of flesh. We gave them a brochure we had prepared that explained their rights under the AAA program. But in the vast majority of cases, managing a patient’s expectations realistically was a wise strategy with positive results.

Articles

This morning, 11 dentists received a special delivery letter that changed their lives forever. It began, “Dear Doctor: We represent your patient Jane Doe and demand that within the next 10 days, you submit your entire records and x-rays for her treatment.”

Protect yourself

	Saving money is always important, especially in today’s economic climate, but remember, a good marketing plan can make you money in the long run.

	One obvious way to save money is to not spend it. Valid, to be sure, but also subject to what is referred to by economists as opportunity cost, that is, the forgone return from not taking advantage of some opportunity.

	And change nearly always presents opportunity. The trick is identifying how to capitalize.

	The annals of corporate success stories are replete with examples of companies that did far more than make lemonade from lemons during lean economic times: They transformed their identity, product, process, service or some other aspect of their business and forged a bold new destiny, sometimes for an entire industry.

	When do your Yellow Page ads expire? Unless your audience is elderly patients, this is not the best place to invest your precious marketing dollars. Here’s a rundown or other methods you may want to try:

		Beef up your Web site. Be sure your Web site is ‘ready for prime time.’ Think about adding video, a low-cost alternative to which is a ‘flash movie’ using high-quality photographs of the office.

		Provide information request forms. These forms can help capture ‘tire kickers,’ that is prospective patients who are not yet ready to 'pull the trigger.

		Develop calls to action. Try clickable and printable special offers. Avoid using the term ‘economic stimulus.’ It’s overused and irritates people.

		Write a blog. It’s low or no cost, and really helps your Web site’s ranking on the SERPs (search engine results pages).

		Consider a ‘drip marketing’ e-mail campaign. It’s cost-effective and a sure-fire way to convert Web visitors to patients (or at least qualified patient leads) as well as increase compliance and treatment acceptance from your patients of record.

		Volunteer. More people need help now than before, and you may be in a better position to contribute your time. In the process you build goodwill, and your practice. Even better, have a party. Just be sure you don’t keep your good works a secret, because neither you nor the charity will benefit as much.

		Remember the ‘marketing force multiplier’ (MFM). We all know one pleased patient can result in many new patients. While it’s nice to imagine there is one ‘magic bullet’ for growing your practice, the reality is there are many ways to attract a reasonable number of patients. Owing to the MFM, it only takes a few.


	Remember 2008 was a record year for many. It’s great to set your sights high, but be reasonable: with yourself, your team, your patients and your market. Striking the right balance between irrational exuberance and despair can be tricky. A worthy objective may be to simply maintain current production levels, while finding ways to reduce costs.

	Dr. William McCune of Creekside Dental, a Buffalo Grove, Illinois based general dental practice, said “I consider my marketing to be a non-discretionary investment. I’m frankly more inclined to cut staff than marketing because I know that, to keep the lights on, I need a steady stream of new patients.”

	From a cash flow standpoint, and because the benefits of marketing sometimes require time to build momentum, it’s an excellent idea to be continuously invested in an ongoing, well thought out, and integrated dentistry marketing plan. That way, the benefits of past investments are realized later, perhaps when the business cycle is in a trough.

	The only thing we have to fear is... fear itself
	Another justification for marketing in lean times is the very reason many of your colleagues will assume a ‘wait and see’ posture: fear. Anyone who practiced through the last recession in the early 1980s (and who chose to assume an aggressive stance with respect to marketing) will tell you it was a great time to promote by differentiating their practice, thus making their ‘bounce’ from the recovery that much higher.

	Remember a down economy is a measure of macroeconomic activity. To be sure, individual practices are affected, but there are so many other factors that contribute to your success.  There are always things we could do more efficiently and productively, and this may be a great time to work on them-to work on your practice rather than just in your practice.

Establish and solidify patient relationships


	During lean economic times, people are more likely to question their allegiances and habits, including behavior patterns such as where to have their hair cut, nails done, and yes, their relationship with their dentist. ‘Switch and Save’ is one of the most commonly used phrases in advertising these days. Why? Because savvy marketers know consumers are looking for bargains.

	Before I lose anyone, let me remind you the ‘bargain’ is a one-time offer. I neither ask nor suggest you commit to a permanently discounted fee structure. What I am suggesting is you recognize the potential to entice patients to see if your practice is right for them. Be as flexible and understanding of their situation as possible.


	That doesn’t mean you should alter your treatment recommendations. Let your patients decide if they can afford treatment or not. Just understand the time they take to accept treatment may be a bit longer than it would be in a more robust economy. The thing to do now is build your tribe. Then, when the inevitable recovery begins, your 'personal recovery curve' will be that much steeper, because you now have even more patients in your charts.

	Just remember this cuts both ways: do not take your current patients for granted. Invest in communications software (or beef up the content, if you’re already invested) as you can, at close to zero incremental cost, share useful information and special ‘patient only’ offers. These nearly always result in a ‘bump’ in production.


	Let’s say you’ve been doing direct mail for a while, and the return has leveled off, or even fallen a bit. Consider sweetening your offers. People are not only looking for, but expecting bargains these days. Don’t disappoint them.

	For instance, Dr. McCune’s “pre-recession offering” was a $39 exam. He dropped that to a $25 exam, and experienced shortly thereafter an increase in monthly production from $7,000 to $14,000, solely on patients responding to the $25 offer, which appears on both his Web site and his direct mail card.

	David Ogilvy, whom many consider to be the father of modern advertising, famously said “Half my advertising is wasted; I just don’t know which half.” In times like these it is even more important to put into place the means to completely, reliably and accurately track your marketing tactics.


	Marketing, communication and leadership icon Tom Peters is known for saying “Marketing is one third external and two thirds internal. He means that it’s what happens after someone becomes a patient that drives return on investment in external marketing. Here’s why.

	Say you spend $1,000 on a marketing tactic and you get five new patients as a result. Let us further assume your average annual patient value is $500 (a conservative figure, as this may not even include re-care or referral). Your return on investment is, therefore, 250% or 5:1 ($2,500 in value divided by $1,000). If another practice invests in the same tactic and receives the same result, but has an average patient value of $2,000, her ROI is four times as much.

	Maximizing patient value takes many forms-just be on the lookout for cost-effective ways to improve your patients’ experience with your practice, and cost-effectively communicate those benefits, and see your marketing ROI soar.


	Be creative in revising your copy and design to ‘speak’ more clearly to your audience’s needs and concerns.

	Help people understand that caring for their teeth now can mean greater savings, especially if their present employment situation is in question. Let them know that, as a member of the community, you want to contribute to the physical (and fiscal) health and well being of your neighbors.

	Once patients are part of your practice, demonstrate your empathy for their situation, and understand if they are not able to accept treatment as quickly or at the level they’d like. Cut them the proverbial break.* When the economy turns around, you’ll be posed to yield a handsome return on your ‘investment.’

	*By the way, we make it a tenet of our business to practice what we preach i.e. to be as accommodating and flexible as possible with our clients who need a little help. To learn more, give us a call or drop us an e-mail.

Daniel A. Bobrow, MBA, is President of American Dental Marketing, a Chicago-based Dentistry Marketing Consultancy. He is also Executive Director of Dentists’ Climb for a Cause™. He may be reached at 800-723-6523.

   Don’t ditch your marketing plan  Saving money is always important, especially in today’s economic climate, but remember, a good marketing plan can make you money in the long run.

dentalproductsreport.com-2009-06-01

Protect yourself

Marketing Insider: Don't ditch your marketing plan