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CLOSING and CASE ACCEPTANCE Treatment Planning Strategies

April 1, 2006
The fulcrum of a well-managed dental practice is the comprehensive oral evaluation, complete and thorough treatment planning, and extraordinary case presentations.

by Cathy Jameson, PhD, and Jeff Gelona

The fulcrum of a well-managed dental practice is the comprehensive oral evaluation, complete and thorough treatment planning, and extraordinary case presentations. When a team has the organizational skills to orchestrate these three areas, case acceptance accelerates.

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In his article “An Integrated System for Esthetics and Function,” Dr. Ross W. Nash refers to his careful planning of the case as his treatment plan. He indicates the physical aspects of the patient’s treatment plan and also refers to the patient’s perceived needs or motivators. “The patient desired to replace the discolored direct composite veneers with porcelain laminates. She wanted the maxillary left canine to look more like a lateral incisor and the ­corresponding first premolar to resemble a canine.” Then, he describes the plan of treatment that would accomplish the best result.

Dr. Nash performed my first cosmetic dentistry - 10 direct-composite veneers: six maxillary and four mandibular anterior veneers. Even though I knew of the careful clinical diagnosis that had been done by the doctor, I was mostly aware of his willingness to listen to my perceived needs. He worked diligently to accomplish results that satisfied both entities - superb clinical results, and results that fulfilled my expectations. Both aspects of care are imperative if the word “excellence” is to be used to describe your care of patients.

Doctors and teams must remember that patients buy emotionally and justify intellectually. The two prevailing emotional motivators are fear of loss and desire for gain.

By using effective listening techniques, a doctor can probe into the emotional motivators of a patient.

“Are you worried about the time and cost of improving your smile?”

“How excited would you be to know that you have improved your look and health?”

“Are you comfortable that my team and I have the knowledge and training to complete this treatment plan?”

“How confident will you feel once we complete the recommended procedures?”

It is critical in diagnosing patients to complete the clinical and emotional evaluations. Is this patient going to be motivated by bottom-line Maslow issues such as health, safety, security, and survival? If so, these are the fear factors. Maybe the treatment plan is more cosmetic in nature and appealing to self-esteem and belonging, so ego gratification will be more effective. Whatever the motivators, the doctor and team must identify them and plan the case and its presentation accordingly.

We know one thing is sure: Patients only buy for their reasons. Every doctor has watched a patient walk out of his or her office without accepting the treatment that is desperately needed. As you prepare for your next case presentation, ask yourself, “What is going to motivate this patient to say ‘yes’ to treatment?” Are you ready to “Maslow Motivate”? Have you created a sense of urgency in this patient? Be honest in your assessment of the emotional diagnosis and you will improve your case acceptance.

We are constantly amazed by doctors who declare that they want to take their practices to the next level or they want to accelerate the cosmetic aspects of their practices, yet they don’t even do treatment plans, or treatment plans that are thorough enough to fully meet the patients’ needs and expectations. Complete, thorough treatment planning for every patient is a must.

Pre-plan, prepare, and present

Treatment planning means gathering all necessary data at the comprehensive evaluation appointment, then using that data (which includes the patient’s perceived need or motivational hot button) to design a treatment plan from top to bottom.

A treatment plan, whether it is done in the computer or manually, should include:

Date of diagnosis

Tooth number

Specific treatment to be provided (including surfaces or materials, where appropriate)

Sequence of treatment (where to start, where to go next, etc.)

Time necessary for each appointment (including doctor/assistant time)

Time between appointments (this is critical)


Appointment date and time

If you thoroughly treatment plan at the beginning of a patient’s time with you, it will save time and take you closer to a comprehensive and esthetically oriented practice.

Refinement of your management systems

You should be able to pick up any chart in your practice and see what has been diagnosed, what has been completed, and what needs to be scheduled next.

If you are not doing comprehensive treatment planning, set a goal to rework your patient-management system. Sit down with a stack of your own charts and ask yourself, “Could I or any member of this team be able to indicate the status of a patient’s treatment by the paperwork or computer entries?” If not, refinement would be in everyone’s favor.

As treatment progresses, the treatment plan must be managed to indicate progress. In other words, have a system within your treatment planning to indicate progress as it takes place.

As I said, you should be able to look at any chart in your practice and be able to see at a glance the status of that patient’s treatment. Has he or she completed treatment? Is he or she in the middle of treatment, and has his or her next appointment already been scheduled? Is he or she in the middle of treatment but has not scheduled the next appointment? Or, has he or she come for a comprehensive oral evaluation and consultation but has not scheduled an appointment to begin? In both of the latter cases, this lets your treatment coordinator know that a telephone call is necessary.

Case-acceptance rates can skyrocket when the following steps are taken consistently:

Comprehensive oral evaluation, which includes a determination of the patient’s perceived needs, as well as the diagnosis

Careful development of an ideal treatment plan

Doctor and treatment/financial ­coordinator conference before the consultation so the person making the financial arrangements can give third-party backup support and be well-prepared for the presentation of the finances.

In summary

More than ever, it is essential that you look at every management system within your practice and ask yourself, “What is going well? Let’s keep doing this. What needs improvement? What do we need to do to make the necessary improvements? How do we make that happen?”

Look at your method and system of treatment planning. Without question, this is the fulcrum of your practice. The improvement you will make in this area will come back to you in many ways: increased case acceptance, better organization, and stress control. Here’s to your dental-practice success!

Cathy Jameson, PhD
Jameson is founder, president, and CEO of Jameson Management Inc., an international dental lecture and consulting firm. The Jameson Method of Management helps dentists increase productivity and profitability, and control stress. Reach her at cathy@

Jeff Gelona
Gelona is a consultant for Jameson Management Inc. He, Jameson, and JMI’s team of consultants have lectured and consulted in 19 coountries and have offices in New York, the United Kingdom, and Oklahoma. Reach him at [email protected].