John Meis (00:02.803)
Hey everybody, welcome to this episode of The Double Your Production Podcast. I'm Dr. John Meis here with my partner, Wendy Briggs. Wendy, how you doing?
Wendy Briggs (00:10.414)
I'm doing great, how about you Dr. John?
John Meis (00:12.515)
I am doing fantastic. So this is the first of a multi-parter. And what we're going to be talking about is missing pieces in the case acceptance process. And Wendy and I, having been in hundreds of offices, have seen hundreds of exams, thousands of exams. We've seen the good, the bad, and the ugly. We followed those that have a very high percentage of case acceptance. And we know that there's some secrets of things that they do that are different than most. So that's what we're going to be talking about. And what's part one here, Wendy? What are we going to talk about today?
Wendy Briggs (00:54.09)
Yeah, today, there's so many different topics we could speak on in regards to case acceptance. Literally, we could do an entire year-long series about case acceptance alone. But I think probably in recent months, we've done a lot of lecturing, a lot of big meetings where we've talked about case acceptance. We've actually held meetings in the United States and quite a few in Canada in recent months. And I would say there's a few common themes that prevail. So that's one of the reasons we chose to do a three-part series. But part one is one thing that I see causing a lot of frustration with hygiene providers, and certainly I'm sure a lot of frustration with dentists as well. And that is not having clearly defined treatment planning standards, diagnostic standards. That's something that even early on in my career, and as I've evolved, I've got examples that we can, we'll probably dig into a few of them today, of what happens when they are identified versus what happens when they aren't. And the outcomes from both of those are really remarkable.
John Meis (01:55.403)
Yeah, it's such an important thing. Most doctors feel as though it's clear. Most teams say, oh, it's inconsistent. We don't know what they're going to do. Sometimes it's this, sometimes it's that. Doesn't seem to make a lot of sense. And if I don't know what they're going to recommend, I don't really want to put myself out there and talk to something about the patient that then the doctor is going to shoot down. So walk us through how this, you know, from a team perspective when there's inconsistency, walk through with us kind of what that feels like for those of us that are doctors and maybe haven't thought of it from that different perspective.
Wendy Briggs (02:35.85)
Yeah, you know, I've often heard dentists come to me and say, oh, I'm losing this hygienist. She's been amazing. She's been my co-partner, my co, I guess, teammate for eight to 10 years. I just think it's gonna take us forever to get back up to speed with our new hire. And when we really take a step back and figure out why that is, it's because over time, the providers become more clearly aligned as far as what the diagnostic or treatment planning standards are.
And those things just kind of naturally evolve, right? Well, the frustration comes from having, you know, someone new on our team that doesn't understand what those standards are. We haven't gotten aligned yet. We're out of sync. And from a hygiene perspective, a team perspective, especially if you don't have clarity on why the doctor's making some of the decisions that they make in the moment. You mentioned before, sometimes there's inconsistency, right? That's a very natural thing that can happen. But sometimes as hygienists, we have to, we begin to doubt our own capabilities for pre-assessing patients if what we find or what we think isn't quite in sync with what our doctors say, we become a little bit less confident, right? We don't wanna talk about things before the doctors get there because we're not sure we're on the right track. And if we aren't confident and we stop having those conversations, then the mountain becomes steeper and harder for the doctor to climb once they get in the room for the exam. And that's when we see exam times running long and we see hygienists getting more and more frustrated about that. So it becomes this downward spiral, if you will, where we feel like we're not as effective as we could be. And the frustrations build, you know, the frustrations continue to mount one on top of each other. And then that's when we usually get some kind of ranting post online or a team meeting that goes haywire, you know, because everybody's complaining and airing all those frustrations all at one time.
John Meis (05:01.523)
Anytime our teams, anytime we put our team in a position where they feel less confident, it has an effect on patient care. Because remember, patients really can't judge our competence very well. And often for in a shortcut way or heuristic for patients to assess our competence is to assess our confidence. And if our teams we're doing things that are reducing our team's competence, we're actually interfering with patient trust because they start to question competence. So yeah, and so, you know, kind of what's an example of places where you've seen, you know, this kind of inconsistency?
Wendy Briggs (05:52.694)
Well, I can start with early on in my career, right? The first practice I worked at right after I graduated from hygiene school, it was a really an uphill battle, if you will, when it came to case acceptance of patients because I was working with a doctor who had several years of experience but he had just bought the practice from his dad. And so the patient base that we had, you know, had been, often these patients have been patients of the practice for more than 30 years. And so they had a mouthful of somewhat failing dentition. And the main reason for that was the complete diagnostic gap between the old doctor and the new doctor, right? So the old doctor was what one would call conservative, almost to the point of being complacent, right? So we had a lot of patch it up, fix it up, heroic amalgams in there. We had a lot of teeth that were completely worn.
We had a lot of patients that had pretty significant problems that were probably outside the skillset of the doctor. And so they just were somewhat ignored. Right. And so then we came in, both of us bright eyed, bushy tailed, young providers. And we were faced with all of these very complex problems. And the most challenging part of that was the patient saying, well, why hadn't doctor, you know, the older doctor done anything about it? I've been coming every six months for 30 years. Why now? And for some of these patients, sadly, the only option that they really had because of their financial circumstances were to lose all of their teeth, right? And so very early on, that's part of, I guess, what really drove me to look into how to be more effective in some of these conversations and influencing patients to choose a higher level of care. And we had to get really good at explaining not only why they needed to move now, but why nothing had been done in the past. And those were really difficult to explain, right? So I think look now where I am now looking back, I see that those experiences, although painful for many patients and difficult for us to handle, really taught me a lot about the importance of having clearly identified diagnostic standards, because then I looked later on in my career and I joined a practice that the doctor was very, very confident in their own skills.
Wendy Briggs (08:06.418)
and we picked up on their standards really fast and it became so much easier to drive a high level of care. In fact, in this practice, I actually had a period of time where I wasn't scheduled with any hygiene patients at all. Every day started with not one hygiene patient on my schedule and that was a really rare and unique opportunity. And really my role in that practice was to be a diagnostic partner of my doctor.
He really needed an associate, couldn't find one, was drowning. So I gave all the anesthesia and did a lot of the, I guess, triage for patients that were coming in with emergencies, as well as hygiene patients, handled all the new patients. So at that time I was serving in a way as a new patient coordinator, right? And so even patients, when I go give anesthetic, my conversation was often an attempt to move us from one tooth at a time dentistry to expanding our viewpoint to the entire quadrant or what else could we handle for them today while they were here in NUM that would save them time and energy in the future. So both of those experiences taught me a lot about the importance of having some of these things clearly identified, as well as talking with doctors, the same doctors that are worried about losing a long-time provider. Once they understand that we can facilitate that alignment with a few systematic changes. And seeing their excitement about that also really illustrates to me the importance of some of these things and clarifying some of those standards.
John Meis (09:39.007)
Yeah. So if you have that person who really understands your diagnostic philosophy, understands how you talk to patients about it, and can talk easily, you know, a lot of doctors have that person, but then they're terrified that person is going to leave because it took so long to get it there. It took so long to help that person get to that level of knowledge because you never really thought it all the way through, never wrote it down, never created a system to train people.
And so then they just get training by experience. But that trial and error experience to learn to get to that level takes a long time, takes years, really. So part of having diagnostic standards is making sure that we have them documented, making sure that we have documented how we communicate those as well so that we're all using the same language. So in my own practice…
We had one of those really great person who really understood. We lost that person. Our case acceptance dropped pretty rapidly. And so we dug in. And so we found, we were multi-doctor practice. We found that one of the challenges was that doctors were not diagnosing similarly to each other. So there was pretty big variations in treatment philosophy between the five doctors. So that's a problem too, isn't it, Wendy?
Wendy Briggs (11:01.898)
Yeah, it really is, especially because with many multi-doctor practices, especially if they're following some of the systems we teach, focusing on patient convenience, focusing on same-day dentistry, you may not know which doctor you're going to get to come in for that exam. Now, some practices identify that ahead of time. Maybe they identify who's going to be doing the exam in the morning huddle, but we all know the best practices remain flexible because if it ends up that one doctor is busy or in the middle of something complicated that they didn't expect to be complicated, we would like to be able to serve the patient at the highest possible level and have another doctor come in to uphold the patient experience and keep things as convenient as possible for patients. However, that does create a level of complexity for the hygiene provider because in our mind, we were preparing the patient as if Dr. X was going to be in the room and then we end up with Dr. Y. And if there are dramatic variations in their treatment planning standards, then we can sometimes have preheated the patient, I guess, a little bit down a different path than what the doctor that we end up doing the exam would be able to identify. So that causes frustration amongst hygiene providers as well, because we want to absolutely our job is not to judge the doctor's level of assertiveness when it comes to diagnostic criteria, but we just want to support that. We can't always support it if we don't have clarity on who's going to be making what recommendations. And it's very, very challenging to support it if we have multiple doctors that are all over the map in regards to their diagnostic standards.
John Meis (12:39.095)
So you can imagine the complexity. The more doctors you have, if they don't have similar treatment philosophies, then now teams have to learn two different ones. They're never really sure who's going to show up for the exam. So now they're, again, they're not confident. When they're not confident, that gets seen by patients as not being competent, which is a huge problem. The other thing is, you know, if you have... You know, you want to have a very consistent patient experience. And if we have different philosophies in the office, the experience is not going to be the same. It's going to be different depending on which doc you see, which is one of the reasons why you teach. You know, all our visits should be very systematically, very similar. So the hygiene experience shouldn't really change much from hygienist to hygienist other than that little bit of personality that everybody injects into their patient relationships.
Wendy Briggs (13:32.466)
I would say another common frustration that we hear from hygienists is the amount of time. Hygienists and doctors both, right? Doctor, you know how it is, Dr. John. You can just get started with a really complicated procedure and all of a sudden you're informed you have three hygiene checks to do. And so doctors hate getting that message. Hygienists hate having to sit there and wait. The messages get more urgent, more direct, more nasty. The longer we're kept waiting because then our whole schedule gets derailed, right? And then when the doctor finally does step in, we're hoping for like a wham, bam, thank you and out the doctor goes and then we can move on with our day. And in those types of scenarios, sadly the ones who suffer are the patients because something that may have been addressed in a different timeframe or a different scenario get pushed off until the next visit if we don't have clarity on those standards.
John Meis (14:26.067)
Yeah, often doctors can, if doctors get behind in their schedule, they often can catch up, right? Because there's a lot of variation in procedures from this patient to the next. So it's often they can catch up. But hygiene, not so much, right? When it's highly systematized, not so much. So if hygiene gets behind, then the next patient's experience is going to be less because hygiene is going to drop. First of all, they're going to drop any same day hygiene preventive procedures. And the second thing that will drop is they'll stop talking about potential treatment to be done, both of which destructive to the patient and practice both, right?
Wendy Briggs (15:03.526)
And that's when we see, like I said, the rants on social media. When we present this stuff live, we always have lots of fun little screenshots of examples of how damaging this can be to the relationship when these things aren't identified. Even things like when a practice is sold, the differences in diagnostic assertiveness between the previous owner and the new owner can create all kinds of problems. In fact, we've seen practices literally tank because of this.
John Meis (15:15.264)
Yeah.
Wendy Briggs (15:30.754)
And so these are things that are very, very critical to long-term practice success. People often think, well, gosh, what's the harm if it takes me a little bit longer, if it takes a few years to get our new hygiene providers up to sync? Well, there actually can be a considerable amount of harm that people don't realize. And we can see that. We see that from the outside looking in because we do have the data on so many practices. So there is harm if we aren't clearly identifying this. And certainly there's so many benefits. I would say the benefits far outweigh.. I'm not having it done, right? The time investment it takes to clearly identify these things is one thing, but the harm that can come or the results that you're missing out on, right? We always say lost opportunity has a very high cost. So there's a lot of reasons why we love to see practices move forward and clarify some of these things.
John Meis (16:21.151)
Yeah. So we've been teaching this principle the entire time that we've been partners, Wendy. And probably about five or six years ago, I asked one of our, at one of our practice growth retreats, I asked, you know, there's probably, I don't know, 120 people in the room. And I asked, which practices had all this done? Had it documented? Had it nailed? Because we've been teaching it over and over, right? And, and not as...
Wendy Briggs (16:46.87)
And some of the practices in the room had been members for several years, right? So it wasn't like you had a room full of newbies.
John Meis (16:50.707)
Yeah, right, right. Yeah. And not a single hand went up in the room. And I thought, oh, this is harder to do than I thought. And just kind of left to their own devices, practices really struggle with this. And it's part of the reasons why we created a process for practices to go through that allows them to identify their treatment planning standards over the course of a couple of hours and another couple of hours to get the language down. So when you have the right process, it doesn't take that long. And once it's done, it's done because it doesn't change much. These things are remarkably steady. And it may never change during your career. So it's really something that's worth spending the time to, investing the time in this because it has a profound impact on ramping up team members quickly, reducing the stress and strain of having that one employee who's absolutely great and the fear of losing that person. It doesn't have to be that way.
Wendy Briggs (18:03.434)
Right. So for those of you that are interested in learning about that process, we actually at the urging of our members, they asked us, they literally begged us to put this together. We do have a two day course that we do every single year. And so we'll include in the show notes, a link so that you can figure out, if the timing works for you and if you wanna bring your key leaders on your organization and actually leave after our case acceptance workshop, you leave with all of these treatment planning treatments that you do in your practice anyway, you leave with it done. And it's a really great way. It's a great investment in yourself and your practice and your team. And there are ROI on that investment. We always pride ourselves on having a good return on investment. And the ROI from this meeting is probably close to the highest of any meeting we've ever held before. It has such a profound impact in the growth of your practice.
John Meis (18:50.571)
Yes. Yeah.
John Meis (18:55.455)
Yep, it sure does. So yeah, we'll leave information in the show notes. And so this is a good job, Winnie, we covered the first part of the topic. This is going to be a multi parter. So stay tuned everybody. Thanks for being on this episode of the W Production Podcast. We'll see you next time.
Wendy Briggs (19:16.982)
Thanks everybody.
