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The oral cancer screening examination: getting patients to say YES

Oct. 11, 2010
Dr. Jonathan Bregman offers you a three-step solution to get your patients to value and accept the critical oral cancer screening they need.

By Jonathan A. Bregman, DDS, FAGD

Why do patients accept recommended treatment? Why does anyone accept or purchase anything?


For years, businesses of all sizes (including dental practices) have tried to find out what will make a person want what they have to offer. Literally billions of dollars have been spent in research and marketing to accomplish this goal.

The three-step solution — moving from need to want

The same three-step process moving a person to want applies to everything including the cancer screening examination.

  1. Create awareness.
  2. Educate the person or help him/her to have a clear understanding.
  3. Ask for and then gain acceptance.

No step can be skipped.

  • One cannot effectively start at understanding and expect acceptance if awareness is not achieved.
  • Acceptance cannot be gained without first accomplishing awareness and understanding.
  • Understanding or education cannot be skipped, expecting a jump from awareness to acceptance.

As dental health-care providers, we know what the patient needs from our training and experience in the field. The key is to find the path that will make them want what they need!

“My patients don’t want nor do they see the value of the basic extra/intraoral cancer screening examination. How to I change that?”

Over the past two years, I have presented more than 100 programs on early oral cancer detection and the new technologies in 42 states and Puerto Rico. With every group, I have had the opportunity to listen to both their successes and greatest challenges. Let’s apply our three steps and see how they may help to move our patients to want/see the value of the cancer screening examination.

  • Success or challenge: Have you created awareness?

No one seems surprised at his/her own personal answer to this question when I routinely ask: Can you say with 100% certainty that every single patient who leaves your office — having been seen as a new patient or in your hygiene department as a preventive recare patient — knows that he or she has had a comprehensive extra/intraoral cancer screening examination?

A few say yes. Most say no.

Using our three-step model, how can we possibly expect our patients to want a cancer screening examination if they are not even aware that they are having one? ANSWER: They cannot!

  • Success or challenge: What about understanding?

All of us customize recommended care based on each patient’s specific needs. To gain and hold the patient’s attention in this educational or “understanding” process, we also must approach each patient in a manner comfortable with his or her personality style. So our goal is a customized set of recommendations presented in a manner customized to each patient’s personality. This approach will make it easy for patients not only to listen but relate to what they hear.

(If you are not aware of these four basic personality styles, you might want to look up DISC profile and learn what your personal profile is and what puts your patients in one of these four categories.)

What will “hook” a patient to enhance understanding is also about applying what we know about that person.

  • Are they all about appearance?
  • Do they have a history of cancer of other kinds in their family?
  • Are finances a real concern so minimal treatment of something caught at a very early stage would cost less overall?
  • Is the person young and thinks that “this does not apply to me”?
  • Are numbers/statistics the motivating factor?
  • Is the patient already at high risk because of alcohol or tobacco or HPV?

At this point, your patient has been primed and educated effectively.

  • Success or challenge: Do you ask for and then gain acceptance?

What do you do now when you have finished educating your patient?

Cover topics such as:

  • Home-care instructions
  • Nutrition
  • Periodontal disease
  • Implant dentistry
  • Replacement dentistry
  • Cosmetic dentistry
  • Basic extra/intraoral oral cancer screening examination

Do you stop and ask for acceptance? Do you gain some sort of commitment from the patient? Or do you not check in with the patient at all?

Here are a few simple questions you can ask at this point:

  • “Is there anything that I have not made clear to you about X topic?”
  • “Do you have any further questions or concerns that I have not addressed fully?”
  • “Do you now see and understand the value of X?
  • “Are you ready to proceed with X?

As my friend and colleague, Dr. David M. Resnik (President of The Sky’s the Limit Consulting) teaches, keep going repeatedly for the “yes” answer and final acceptance will ultimately be gained.

“I have very poor acceptance rate or meet significant resistance from my patients regarding the adjunctive screening examination (that comes with an additional fee) that I propose (VELscope, Vizilite, Microlux, Identatfi 3000). Why is that?”

  • Have you laid the groundwork?

Personally, I feel confident in saying that patients will not see the value or want the adjunctive screening with an additional fee if they do not understand its value and want the basic cancer screening examination.

So, if you are meeting patient resistance, ask yourself this question first: Have I moved the patient from needing to wanting the basic cancer screening examination through awareness to understanding to acceptance prior to presenting the adjunctive screening examination?

If the answer is no, you must back up and lay that basic foundation and then follow the three steps of awareness to understanding to acceptance for the adjunctive technology.

If the answer is yes, look carefully at how you approach gaining acceptance for this additional screening examination.

  • Do you skip any of the three critical steps?
  • How are you going about creating awareness and understanding?
  • Are you effectively asking for acceptance?
  • “My patients say, if my insurance does not cover this, I am not interested. How do I overcome this?”

Most insurance policies do NOT cover the adjunctive oral cancer screening examination. That is true. BUT ... yes, you knew that I would have a caveat ... do we:

  1. Treatment plan based on the benefits provided by a patient’s insurance policy?
  2. Treatment plan based on the true needs of the patient?

No. 2, of course!!

If a person’s tooth cannot be appropriately restored with a filling material, we recommend a build-up and a crown, right?

If a person’s periodontal condition is such that a routine ‘hygiene visit’ (1110) will not correct the problem, we recommend definitive periodontal therapy, right?

The way we move the person needing a crown or the person needing definitive periodontal therapy to wanting that care is, once again, following the steps of awareness to understanding to acceptance based on the foundation of trust that has been established. If we want to be maximally effective, we separate the “paying for the dentistry from the doing of the dentistry” with patient financing (i.e., CareCredit) or an acceptable payment plan of some sort.

In summary, greater acceptance for the adjunctive screening examination will be gained through:

  1. Laying the groundwork/foundation of the patient wanting the basic cancer screening examination
  2. Following the three steps to gain acceptance for the adjunctive screening examination
  3. Knowing that we must build high trust in our patients in order to be successful in acceptance of recommended treatment of any kind.
You can get your patients to say yes!By following the three simple steps of awareness to understanding to acceptance, we, as dental health-care providers, can and will move our patients to say “yes” when it comes to wanting the basic cancer screening examination and to say “yes” when it comes to the adjunctive cancer screening examination.Expecting our patients to move from needing to wanting without laying an effective groundwork will lead to the patient’s fall-back position of, “If my insurance does not cover it, I don’t want it.” We do not treatment plan to a patient’s insurance plan. We treatment plan to what the patient needs. And our patients need cancer screening examinations!Let us all create a patient base that will see the value of cancer screening examinations, both basic and adjunctive. Gaining this acceptance can truly mean the difference between life and death. But first YOU must say “yes” to a commitment of saving lives through effective early oral cancer detection.
Jonathan A. Bregman, DDS, FAGD, is a clinician, speaker, author, and trainer who led successful dental practices for more than 30 years. While dedicated to improving the dentist, team, and patient experience, he has a passion for educating dental professionals about early oral cancer detection and laser-assisted dentistry. You may contact Dr. Bregman by e-mail at [email protected] or visit Also be sure to check out his blog at