Case presentation has always been a mystery for many practices. The reality is that most practices feel they have mastered it because most dental treatment involves a single tooth or smaller cases. Smaller cases are generally accepted regardless of how they are presented, and we find that case acceptance drops off quickly with more complex cases.

This article will review five of the reasons why patients reject treatment and offer suggestions to improve your level of case acceptance and practice production.

1. Fees. Many patients spend more of the case presentation thinking about whether they can afford treatment than actually listening to what is being said. These patients generally decide that the case is unaffordable. Many practices have been lulled into a false sense of security and believe that, due to the COVID-19 pandemic, some people have excess money to spend on dentistry since they haven’t been able to spend it on restaurants and entertainment. Even if that is the case, patients are still very fee sensitive.

Suggestion: Make sure patients know that financial options are available. There is an adage in business that says, “It’s not how much something costs, but how you have to pay for it.” When patients know that there are multiple financial options, including patient financing, they become more confident that they can afford the recommended treatment and can have it right away. This is especially true if interest-free financing is presented.

2. Competition. Patients are no longer as averse to changing dental practices as in the past. This may be partially due to a generational difference where younger people are willing to find dentists online, through advertising or from recommendations by peers. If a patient believes that a practice is equal to another practice and the second practice offers less expensive options or other benefits such as more convenient appointments, they may decide to have the treatment done in the second office.

Suggestion: Get to know patients at a deeper level. Ask them if there are any barriers or challenges to treatment. Keep in mind that money is not the only barrier. Time, convenience of appointments, or concern over comfort and recovery are also factors for many patients. For example, most patients want to have complex treatment done on a Friday so that they can spend the weekend recovering. It may not be necessary, but it gives them a sense of comfort.

3. Past negative dental experiences. There are still many patients who are fearful of dentistry. Past experiences may keep them from moving forward even if they are fully cognizant that the recommended treatment is in their best interest. These patients often wait until they have significant debilitating oral health issues, which may not come for many years.

Suggestion: Understand that patients’ fears are real and may prevent them from having treatment. Help patients understand how the practice will keep them comfortable, break treatment up into smaller bites that they can handle or offer a level of sedation (including oral sedation) to relax them and make them feel more comfortable.

4. Time. Although there is no data, I believe that most practices significantly underestimate how many patients reject treatment simply because they don’t want to take the time. I also believe that many of these patients think they are simply putting it off until there is a more convenient time but lose their motivation and often never revisit treatment until years later — if at all. Once again, practices can take specific steps to create convenient appointment times. Talking to the patient about the best possible time, offering the longest appointments possible to do as much dentistry as possible in one sitting, and even acknowledging and knowing the patient’s favorite appointment time will go a long way toward making this happen.

We also teach a concept called “consequence-based case presentation,” wherein the patient is informed about the consequences of not having treatment. Fear may not necessarily be overcome and can actually be enhanced by consequence-based case presentation, but, if the factor is simply one of time inconvenience, consequence-based case presentation can often motivate patients to make time available for treatment in the near future.

Suggestion: Consequence-based case presentation is simply and honestly letting the patient know, without fear, the consequences of not having treatment. In most cases, these consequences include the possibility of future increased complexity, further breakdown and higher expense. Although not every patient asks, most patients would like to know if they can wait or put off treatment and what effect it would have if they did.

5. Other key decision-makers. One of the common mistakes we see in case presentation is not realizing that the patient in the chair isn’t going to decide on their own. Often, they have other key decision-makers in their lives, usually spouses, whom they want to include in the decision-making. The challenge here is that the patient hears the clear, logical and motivating explanation for treatment, and the other decision-maker, who is not present for the case presentation, does not. The patient then goes home and tries to relay the information, and their explanation is not nearly as compelling. The other key decision-maker then often suggests that the treatment can wait, isn’t needed or is too expensive.

Suggestion: Ask the patient if there’s anyone else who would like to hear about the treatment. Offer to have a second consultation with the patient and a key decision-maker so that the key decision-maker can hear it directly from the practice, ask any questions, and fully understand the logic and compelling reasons to have treatment. If the other decision-maker will not be coming to the office, be sure to give the patient three key points to share with them. Three key pieces of information are easier to digest than a long overview that can be forgotten or miscommunicated. Also, be sure to follow up with this patient by phone to ask if they have any additional questions and to schedule their treatment. It is often the follow-up call that becomes the tipping point when patients decide to have treatment and schedule.

Summary
Understanding why patients reject treatment is an important concept in increasing the average production per patient and the average complexity of cases treated. There are many patients who have needs that are greater than the most immediate and evident. By completing a comprehensive diagnosis, educating patients about additional treatment options, getting to know patients well enough to understand what barriers may be of concern and offering solutions, practices can increase their overall levels of case acceptance, production and profitability. 

Roger P. Levin, DDS, is the founder and CEO of Levin Group, a dental management consulting firm. To comment on this article, email impact@agd.org.