To generate extraordinary productivity from emergency patients, build immediate value. Have your best "personality" ready to greet the new patient and proceed through the new-patient process in a quick and orderly fashion.

The new-patient process should include an initial patient "interview." Review the problem that brought the patient to the office, the patient’s overall dental concerns, dental IQ, etc. It’s a chance to introduce your philosophy and to start the patient thinking about comprehensive dentistry, not single-tooth fix-ups. There is a 1-page questionnaire used by our patients that provides relevant information at a glance. It is a part of the initial patient work-up.

Spend some time formulating your interview process. Think about where in the office you would like to conduct the interview and what type of questions you would like to ask. This patients interview is critically important in turning the emergency patients into major production.

Look your best. This refers to the physical plant, the staff, and you. A warm inviting reception room, a spotlessly clean exam room, a staff and doctor that look professional and confident are paramount to success with the emergency patient.

There are numerous subliminal messages being processed by the emergency patient. Ask yourself what are your patients and staff seeing? The physical plant reflects your philosophy and personality; your patients are forming a powerful opinion at this time. It’s simply a contradiction to present holistic, "total" oral health care to the emergency patient when you display worn and soiled rugs, torn equipment, and frenetic staff.

Turning an emergency patient into a productive office visit requires building immediate value. I guarantee you’ll realize that it won’t take long to pay back your physical plant investment with the extra income.

The emergency patient already knows from the interview process that we take a full mouth radiographic series and provide a complete exam even though they have a specific tooth troubling them. If you stop and think about it, the key is to convert the patient’s posture from a single tooth problem to seeking overall oral health.

How do you find the time? If I told you I could give you a 25% increase (based on a $1 million gross) or roughly $5000 a week increase in production by leaving 1 hour blank on your schedule per day, would you consider it? The hour is your time - the interview and FMX have been previously recorded. I assume you have enough cross-trained personnel to take an unscheduled FMX.

It is this simple, you are going to allot approximately 1 hour per day in your schedule for an emergency. Have a call list. If no one calls, get caught up on your patient call list. If a new patient does call, there is enough time to interview, conduct a full-mouth radiographic series, develop a treatment plan, and initiate treatment.

What has been accomplished? Instead of treating the new patient like every other office does, you just gave that emergency patient a "new- patient experience". They not only leave without pain and with their problem solved, but very often, they leave with an informed, signed and initiated treatment plan.

Will you get every emergency patient to accept full treatment? Of course not, but my experience is that these patients often have exceptional motivation. Their attitude is one of disgust. They are tired of the emergency syndrome and often are eager to commence the "overdo" job of restoring their dental health.

This will take some time. You can’t just blurt out an ideal treatment plan. You need to first spend a few minutes introducing yourself and your philosophy of care. Explain, for example, that without understanding the patients’ entire dentition, you cannot formulate a responsible treatment plan. Educate them to the relationship between their periodontal health, occlusion, and any missing teeth. Thoroughly explain how this may have contributed to their chief complaint.

This initial presentation will make or break your success. Highly trained clinicians will present themselves with confidence and clearly have higher case acceptance than those doctors with less training. Upon completing the exam, you will formulate a treatment plan that obviously addresses the initial complaint.

(4)-   CASE IN POINT

A 32-year-old male made an initial phone call to our office at approximately 10:30 a.m. This was to be his initial office visit, having been referred by his boss, a long time patient.

His chief complaint over the telephone (this call was handled by our new patient coordinator) was a "couple" of lost fillings. It was noted from our morning meeting that the emergency time would be at 1:00 p.m. At the inception of his call, a brief review of our present status was made (Are we on time? Is this possible?). This was done by my new patient coordinator, my master assistant, and myself. It was decided that we could in fact accommodate the patient at 1:00 p.m. The patient was informed over the phone that our approach to care would necessitate a full mouth set of radiographs, a complete hard and soft tissue exam, and diagnostic models.

Upon arrival to the office, the patient was promptly greeted; it is noteworthy that a new patient experience in our office is not some random event. It begins with the new patient phone call that is structured to obtain as much information as possible, yet present our office as inviting and distinctive. A new patient coordinator is ready to engage the patient with a warm reception that most patients have never felt in a dental office. It wouldn’t be unusual for our coordinator to look for a new face to the office, extend her hand, call the patient by their first name and welcome them. It continues with the one-to-one patient interviews that are conducted in a private comfortable room. It’s only about 10 minutes in length, but we are able to open up numerous channels of communications that may have otherwise taken months to determine.

You have to remember, this patient has not "felt" my gentleness. They cannot yet judge my finished crown or filling. They could have chosen any one of two dozen other dentists in our small town. We already know that our comprehensive treatment approach is initially more costly than a watchful neglect approach. Yet most patients (9 out of 10) accept our philosophy. They accept it based on a feeling. A feeling that this place is different. This place is better. This feeling is created with a new patient experience.

By the time I had met the patient (30 minutes into his appointment), he had completed a one to one interview; a full set of radiographs, preliminary models in Centric occlusion, a full hard tissue charting and cursory soft tissue screening. I had approximately 5 - 10 minutes to review both the interview and radiographic findings before my examination of the patient. It is noteworthy that I always find a minute during the patient’s one-to-one interviews to introduce myself.

The pre-exam findings included:

1. Patient had not sought regular care in over 7 years.

2. Patient was consumed with work and a side occupation of motorcycle racing.

3. Patient had low value on aesthetics.

4. Patient had limited resources (dollars) to invest in his oral health.

5. The radiographs revealed a multitude of dental problems, including multiple  carious lesions, three unrestored teeth #12, 28, 30 with a history of endo and was missing #3.

After meeting the patient and some brief social discussion, I introduced my philosophy of care. I told the patient we would begin by looking at five basic areas of his mouth:

1.    The soft tissues; the joints and muscles

2.    The hard tooth structures.

3.    Missing, drifting, and extruded teeth.

4.    Evidence of parafunction.

5.    Aesthetics.

We would start by looking at the radiographs together. I always do this because I know I can easily communicate the patient’s needs in a way they can clearly understand. It also bonds the patient to me and shows respect and concern for their role in the treatment - It’s not all me, but rather, the two of us participating in treatment discussions.

A thirty minute exam followed that revealed the following:

1. There existed no muscle or joint pain. There was evidence of some parafunction, especially on his right cuspid (#6); little to no wear posteriorly and no significant CR/CO discrepancy.

2. Missing teeth: #1,3,16

3. Caries: #3, 6, three 12, 14, 15, 19, and 30

4. Unrestored endodontically treated teeth: #12, 28, and 30

5. Case Type I perio (gingivitis)

6. Obviously poor aesthetics.

It was clear that this patient would be treated in phase-type therapy. Phase I would include gingival scaling, restoring of teeth #7 through #11, a two surface composite restoration to the incisal of #6 (to temporarily restore cuspid guidance), as well as a night guard.

At this point, we were 40 minutes into my time, and finances were discussed and handled by the new-patient coordinator. Phase I of his therapy amounted to $4500.00 US Dollars. It is noteworthy that this patient was, at best, of average financial means, so this was a sizable investment. The basic approach was that the patient could utilize a health care financing that would allow time to make minimal payments of $135.00 over the next 11 months, as long as the balance was paid off at year’s end to avoid high interest.

The patient agreed, and #7 and #11 were prepared in 20 minutes, and provisionalized by my assistant with an additional half-hour. Depending on time necessary prior to treatment, I would have either fully prepared all teeth, or conversely taken a complete set of diagnostic records, including centric relation and a face bow without any preparations.

Remember, if you are going to convert the emergency patient to one that accepts a comprehensive treatment approach, it requires both a significant financial commitment, and some "initiation" of the treatment process through models or actual treatment.

Four years later, Chuck remains a loyal patient, having completed two phases of therapy.

Clearly, there are many situations where you can’t convert every emergency patient into immediate production. Don’t use this approach on patients swollen with acute infections, patients with intense pain and with obvious occlusal problems (TMD, Severe Wear, Extrusion, Drifting, etc.). These patients can’t think clearly enough to make a commitment to a treatment plan. Other patients will require mounted models, a thorough perio exam, and other diagnostic tests before finalizing a treatment plan.

However, there are a plethora of patients who call offices daily with bleeding gums, toothaches, sensitive teeth, fractured restorations, a sudden dissatisfaction with appearances, or obvious caries. This is the patient population you seek because they are highly motivated, enough so that if presented with a sensible, ethical treatment plan, they are often ready to commit. 

This is an obvious obstacle you will need to overcome. Your office needs to be "armed" and ready to quickly process any needed insurance information and to facilitate the use of a number of quick credit services on the market. Most successful offices are not solely "insurance based." I have found that you can reliably and expeditiously factor in coverage and obtain creditworthy patients and needed dollars literally within 20 minutes.

So, you have a choice. You can continue the pursuit of "one-tooth" dentistry, complaining about what capitation has done to your practice, or you can open your eyes, try something new, and seek these "hidden jewels."

If you take the road I advocate, do it with thorough preparation. Take inventory of what you’ll need. Do you have what it takes to build immediate value? Are your diagnostic skills sufficient to make reasonably quick decisions with laser accuracy?

If you are waiting for new patients to line up, to call seeking and needing comprehensive care, it could be a long wait. Conversely, sophisticated, high quality care is knocking on your door weekly in the disguise of the dental emergency. Prepare you office staff and schedule.

The truth is that managed care, negative press, and a host of other factors have had a deleterious impact on many practices across the country. As a clinician and businessman, you have a responsibility to prepare to react.

If you have a commitment to excellence that includes a continued education toward what Dawson refers to as a "master," then you must equally commit to a business acumen that seizes every opportunity to provide a unique "customer" experience.

Challenge yourself to develop an exceptional new-patient experience. Realize that emergency patients are new patients. Seize the opportunity to make a statement about the uniqueness of your office. It will carry your practice to success into the new millennium.

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