Guilt: The hidden reason patients quit

Editor's note: Richard Geller's column, Marketing Madness, appears regularly on the DrBicuspid.com advice and opinion page, Second Opinion.

Patients quit for several reasons. They move out of the area, of course. Or they take a new job.

But a major reason patients quit is guilt. Dentists can easily make patients feel so guilty they never come back -- and they usually don't know they're causing this emotion.

Here's how it happens. Say a patient presents with a few blown-out amalgams, some bone loss and gum issues, and complaints of sensitivity to hot and cold. The doctor shows her all the issues, suggests a treatment plan, and the patient freaks out.

OK, I picked an extreme example. But isn't some variation of this quite common? How often have you presented everything wrong with a patient and had the patient reject part of the treatment plan?

If the patient comes back for just some of the treatments you recommended, she will probably feel guilty. She knows she "should" get that onlay to replace the leaky old amalgam. But money is tight, and a friend at a dinner party told her about a nightmare root canal she just went through.

Shame, fear, and money are the three major reasons patients quit.

I got a root canal a while back and felt pain on and off years later, so I got the tooth extracted. My general dentist told me that I must get an implant or else the teeth would move about and I would lose bone.

That worried me. But I didn't want the implant just yet. Why? I resented paying four grand, for starters. That's irrational, but that's how I felt. And I didn't want to go through the process, the surgery, and so forth. I just didn't want to do it. So I still have a gap in my teeth.

Every time I think about going to that dentist, and especially when I am in his office, I feel guilt and shame. The dentist doesn't bring it up anymore, but he doesn't have to.

For some patients, that would be reason enough to leave; the guilt would turn to resentment. It's funny how guilt and shame turn inward, then outward to what we perceive as the source.

So think carefully about which problems you present. If you feel ethically and medically bound to present all of them at once, then present them in a way that makes the patient feel OK about not taking care of them right away.

Otherwise, you risk driving away patients and not knowing why they ever quit. The solution is to prioritize what you present and ensure that the patient understands the "must dos" in your opinion from the "should dos" and the "nice to dos."

And if the patient elects not to do a "must do" or a "should do," make the patient comfortable with that decision so he or she knows you are not judging.

This is hard at first. But if you truly realize in your heart that we each make the decisions for ourselves that are right for us, and that nobody can really make those for us, you will have increasing respect for patients, even those who don't accept the "must dos."

Once you realize this, something amazing happens. Case presentations become lighter and easier. And your acceptance rate skyrockets because you truly respect your patients' decisions, whether they are yeses or nos. Patients pick up on this. They accept much more work and are not as likely to quit.

And please read my paper that talks about how and why doctors can quit advertising by building and working their own house list of prospects using e-mail at Cases4Dentists.com.

The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.

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