Dr. Dean C. Bellavia

1-716-834-5857

BioEngineering@twc.com

ONE Question That Answers ALL Other Questions


Sunday, 22 December 2019 14:59
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Do you have situations with guarantors or patients that are difficult to deal with?  Do you have situations with referring dentists that are difficult to deal with?  Do you have situations with staff or associates that are difficult to deal with?  Or do major decisions about your practice seem to take forever?  If so, maybe this pearl can help.

 

Over the past five decades my clients have asked me countless questions about how to handle perplexing situations in their practices.  After listening to their comments and questioning them to fully understand the situation, I ask them one simple question and wait for their response.  "What is Best for the Patient in this situation?"  This simple question contains the answers to all of their questions by zeroing in on what makes a practice a success or not—how you address your patient's treatment and well-being.

 

Yes, every situation is unique and must be dealt with individually, but the answer is based on how it will affect the patient—the basis of your practice and your livelihood.  Once you know how your actions might affect the patient you can address your problem by asking yourself that simple question—consider the examples noted below.

 

Situations with Guarantors:

Most questions asked of me about guarantors deal with past due patients or adjustments on their accounts.

The question asked: “I have a guarantor who has been ignoring all of our efforts to bring their account current—how do I handle it?”

The answer: “How does your decision affect that patient?” 

If the patient is not cooperating—the typical solution is to ask them to either find another orthodontist or just make them look better than when you started, put them in retention and either cancel their account or go after the balance owed you.

But some guarantors are just not very good at handling finances or the breadwinner may have lost his/her job and you end up the bad guy if you delay (very illegal) or stop the patient’s treatment, especially if it is a great patient and you feel sorry for them.  The first step is to ask the patient if he/she wants to continue with treatment—if they don’t, you have your answer.  The more difficult situation is when it is a great patient who wants to complete their treatment.  I have found that most practices finish the patient’s treatment and then go after the guarantor for payment.  It is also a good practice not to start any of that patient’s siblings.  One client’s patient was so grateful for finishing her treatment that she paid off her balance once she had a job—she constantly praised the practice for what they did for her.

No matter what the question, first consider how your action will affect the patient.

 

Situations with Patients:

Most questions I am asked about patients fall within the realm of the situations below.

The question asked: “I have an uncooperative patient who doesn’t maintain his appliances, shows up late or not at all, except for emergencies—a nightmare—I want to get rid of him, but his parents are supportive and pay on time—what do I do?”

The answer: “How does your actions affect this patient?” 

In most cases that patient wants out of treatment so just debond and retain them and settle for the amount paid thus far.  If the patient wants to complete the treatment make a pact with him/her to cooperate, stick to a realistic debonding date whether the treatment is completed (good cooperation) or not (poor cooperation).

 

The question asked: “I have a cooperative patient and family whose treatment is going way beyond the estimated time; should I charge them for the extra treatment time?

The answer: “How does that affect that patient?” 

The facts are: the patient/family is just as frustrated with the case as you are, that you might have misdiagnosed the case, and that you think that you should be paid for the extra treatment.  It is best to discuss the biological problem, give them a new estimated treatment time and ask the patient whether they want to stay in treatment or not.  If no, debond and retain them—if yes, only charge them if their treatment goes beyond that newly estimated completion date.

No matter what the question, first consider how your action will affect the patient.

 

Situations with Referring Dentists:

The most perplexing question I get about referring dentists is when a patient is unhappy with theirs and wants a referral to another.

The question asked: “My patient told me that they don’t like their dentist, will never going back, and want a referral to another one—what do I do?”

The answer: “How does this affect that patient?” 

If your patient isn’t going back then that’s what’s best for them; the best you can do is mediate between them.  If that family dentist is a poor referrer then it is best to just refer the patient to a family dentist that is a good referrer or one that is a “good fit”.  If that dentist is a good referrer it is best to notify them of the situation and ask that dentist to refer the patient to.  If you don’t like their suggestion you need to choose between a possible referral loss and the patient’s well-being.  In that case just refer the patient to a better dentist and tell the referring dentist that it was the patient’s choice.

When dealing with referring dentists the patient is always the focus of the situation, not your referral basis, and all questions can be answered by just saying to yourself “What is best for this patient”. 

 

Situations with Staff or Associates:

Most questions I am asked about staff or an associate is about their negative attitude or incompetence.  This type of person brings a practice down and typically negatively affects its growth.

The question asked: “I have a staff member who is negative and/or rude and/or incompetent—what can I do about her”

The answer: “How does she affect your patients’ care?” 

You can try to change their attitude, but that rarely works.  Any team member may be fired at any time since you are not a union shop.  If they are excellent at treatment it is difficult to get rid of them, but I’m sure that if you ask your team or patients they want her gone more than you do.  If she has been there a long time one wonders why (a relative, relative of a referring dentist, etc.), but the solution is the same—get rid of her.

 

When dealing with an associate that is not as great as you thought he/she might be it is much more difficult to resolve the problem.

The question asked: “I have an associate who is negative toward our staff—what can I do about him/her”

The answer: “How does he/she affect your patients’ care?” 

You can try to change their attitude, but if that doesn’t work you need to start looking for a new associate.  If that dentist is not very competent you need to get rid of him/her immediately to protect your patients or have your staff try to compensate for his/her incompetence until replaced.

 

Major Decisions about Your Practice:

A major decision about your practice may involve a new associate/partner, office location, change in Tx Mechanotherapy, etc.  Major changes require two questions be asked and answered: 1) how will it affect your patients (negative or positively); and, 2) how will NOT making this major change affect your patients.

 

An obvious major change is a new office, its location, cost, etc.  If the practice is growing and the present office is becoming inadequate, you need to ask yourself; "How will this affect my patients if I stay here and how will affect them if I build a new office?"  A new single office location is important for a new patient pool, but it may be inconvenient for established patients.  Staying in the inadequate location may save you money, but may make treating there intolerable for both your team and patients.  You need to choose what is best for your patients.

 

Another major change is taking on an associate/partner to share the work and give you more time off.  The first question is "Will this new partner/associate cause problems with the wrong person, lack of Tx control, etc."  The second question is "Will patient care diminish if you don't have an associate/partner sharing the load?"  You need to choose which affects the patients in the most positive manner.

 

A final major change is making major changes in your Tx Mechanotherapy.  The first question is "Will this new Tx Mechanotherapy cause more problems with patient care than it is worth?"  The second question is "Will not instituting this new Tx Mechanotherapy reduce to quality of care your patients deserve?"  You need to choose which affects the patients in the most positive manner.

 

I hope that this “question” helps you to answer your questions about dealing with the difficult aspects of running a successful practice.

 

If you have a perplexing, unique situation that is difficult for you to resolve, ask it using the “request a pearl” link:(http://www.thebioengineeringco.com/administrator/index.php?option=com_support&view=pmessages).

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