When Patients Try Your Patience

Welcome to Million Dollar Dentistry with your host, Gary Kadey, brought to you by Next Level Practice. Next Level Practice is the leader in dental practice management. In fact, they are the best in the world at creating happy teams that implement sustainable results. Your host, Gary Katie welcomes you to this podcast as he discusses the common concerns, challenges, and shares his decades of experience in empowering dentists and dental teams to go from good to world class. Gary Katie is the visionary voice of Next Level Practice and has for the past 20 years interrupted the status quo of the dental world. He continues to bring national attention to the oral systemic connection and and believes in the complete health dentistry model. He is a powerful educator and advocate for dentistry, dentist and dental teams. He is inspired every day by the courage and personal successes of the doctors and team members he has the privilege of working with. Welcome, Gary.

It's good to be here with you again today.

You bet. Partying with you is always a joy, Amber. I always ready to party when you're around. For sure.

All right, well, I'm looking forward to hearing your wisdom about this topic is when patients try your patients and the four biggest sources of stress. So one of the complaints that I have personally heard is that there isn't anything we can do about the patients, that they just who they are, what they are, and that that's just the way it is. But you have a different opinion. What's that?

I learned that the hard way. You know, as you know, I'm 12 years sober and I know the root cause of why I drank is because people didn't do what I wanted them to do when I wanted them to do. Imagine that I am a control freak. And I realized that, like, oh my gosh, I'm trying to control people and environments and like, it's just, you know. Yeah, it's effortful. So there's. There is a way out. I had to learn it the hard way, almost losing my family and my son and my wife and my career and all of it. But what happens is pain is necessary. Suffering is optional. And when you're faced with the boogeyman, you adapt and learn new ways. And it's the gift of the sobriety that I bring into this because I learned how to not be controlling with people, but how to put controls in place, like traffic signals, like, like stop and go. And like. So how do we get a patient who just runs amok in a medical practice? And how do we get them lining up in a dental practice so they do what we want them to do when we want them to do it, how we want them to do it, and how much we want them to do it.

There you go. So previously we talked about money in our episode Cash in the Pocket right Now and team issues and several other episodes. And now we are, you know, in setting up systems to reorganize, motivate, and energize your team. So where patients, when patients are getting healthy, the practice's bottom line is getting healthy and the team members are winning. You got a triple win going on there.

Yeah.

So we've got the team taken care of. We got those systems and processes and platforms in place running the, Running the show. So now this leaves us with these patients. So let's tackle that one right now. So how do you help doctors improve their relationship with their patients? Specifically, you call. You mentioned something called an ideal patient. So tell us about that.

Yeah, well, an ideal patient is one that shows up, pays and refer, refers other people. You know, it's like they. They show up on time. They, you know, appreciate what you. What you're offering.

The.

They trust you. They respect your time. When you make a recommendation, they respond. They realize that you have your best interest in for them, that they don't cancel last minute because they have. The weather's good and they don't feel like coming in. So it's really a mutual respect that gets created with the ideal patient. And it is possible. It is possible. The thing is, they don't show up that way. And, you know, most people are like, you know, farming for this ideal person. And it's really the responsibility of the practice to train their patients to understand what they offer, how they offer, and how to participate inside of the rules of engagement of that practice.

You know, it's interesting to me because I know a lot of times, you know, patients have been trained, all right, they've been trained to realize that doctors don't respect their time. You know, you go to the office and you sit and you wait for, you know, two and a half hours for an appointment. You know, so they, you know, if they haven't been respected, then they don't feel like they have to respect. So that being said, what do you do different in, you know, when you're teaching your practices on how they should, what kind of experience should they be having?

Well, there's two. There's two strategies to approach this, and you have to do both of them simultaneously. So you have to retrain your existing patient base through your recare system. And then you have to train the new people coming in appropriately so that's going to eventually, within six months, you will have a different experience of going to work every day because you'll have people line up. Now, the root, the root cause of every upset between two human beings is every root cause. I can drill back to one of two things. Either a missing agreement between two people or a broken agreement between two people. So this concept of agreements and we actually, this is our secret sauce about how we build practices and how we get teams to implement sustainable results. AMBER and the key thing about it is it's such a simple, it's so simple. It isn't always easy, but it's so simple. It's who's going to do it, what are you going to do and by when you're going to get it done. So that simple system of management, by agreement, who, what and by when is a game changer because now we know we can locate the source of why a patient's not ideal. And then how to build trust with them is very simple. You have to demonstrate authority with them, empathy simultaneously. So authority is grateful to have you here. You become the guide, they are the hero. So if you don't establish the guide hero relationship, the Yoda to the Luke Skywalker relationship, they, you elevate the patient and they can get that experience of elevation and you're the authority who's guiding them. A lot of times we have a lot of practitioners that need to clean this up inside of their own relationship to themselves. They use wiggle words, they're wishy washy, they say, we'll take, we'll consider that. We'll think about that. There's nothing definitive in that. And that's rooted because 75% of dentists are methodical humanists. They, they want to be liked and they don't want to make a mistake. That's what's underneath there. And so that, that starts manifesting why patients have the reoccurring. They become the guide. Then we're the zeros, not the heroes. So the script gets flipped and there's no authority, no respect. No one knows what their position is of guiding hero. No authority and no empathy. Just a bunch of anger and pissed off people bumping into one another.

I agree. That's, you know, one of the things that I realized is that when you establish yourself as the authority in, in complete health, it changes the relationship to the patient as well. So they're no longer coming just to be, you know, their teeth to be cleaned. It's like they're coming there because it is a part of their Health care once you educate the patient correctly, and.

It goes back to a bigger conversation. That's why this is chapter eight. You know, a lot of people want to deal with patients, which is the symptom in chapter one. But. But we've been building on this throughout. So you want to listen to all the podcasts because each thing builds on the next. Like, you can't get to retraining patients if you don't have what your practice stands for. Like you just said something called complete health dentistry, where the mouth and the body are connected. You're educating from that perspective. You're taking that position. That's one way to do it. You could be a drill fill and PPO mill and, and still retrain your patients. But you have to know what inside of what game are you, what game are you enrolling them into and what are the boundaries and what are the agreements for the practice? Like, what are the rules of engagement? Like showing up on time, paying your bill on time, like, all those things. A lot of doctors try to fix their practice by the symptoms, putting in a system to fix that. What they miss is, and this is the blind spot, you have to build your practice from the ground up. What is the promise that the practice delivers? Like, on a good day, we save a smile, and on a great day, we save a life. If you don't have what that promise is, then you have to get your team on board. And what's the team agreements? What are the agreements around participating as a team? And then there needs to be a business model to know what the measures are for that business, to know whether you're running a successful business or not. Then now we clean up the patients because they're just running like kittens. And you're trying to hurt a bunch of kittens inside this practice. And it's a mess because they're just like running around and scraping balls and running for, you know, just jumping around and, you know, scratching things. And it just doesn't work. So, you know, this is like, you know, a couple of month overnight success. So it takes a couple. It takes two months to get to the spot. It takes about seven weeks. If you build it and follow the system we have built. It takes seven weeks. You get to the eighth week. It's about getting your patients on board and lining them up to your values and how your business runs.

Okay, that leads me right into. You took the word painter for your creation, for making this ideal patient. So the picture for pays. So it's all the pays for all the treatment before and leaves no balance. What's that?

Yeah. Well, first, let me just talk about Painter. And the reason why I chose Painter was because it was the amount of letters I needed to get the message out.

Perfect.

But the biggest reason is that our ideal patients are created. They don't just show up. You actually create them. And if you take the responsibility of creating them, first you have to define what you want. What is your ideal patient? So this is a great story. My wife, I was looking for a wife. I was 39 years old. And I'm like, I can't find a great woman. They're nowhere to be found. And this wise guy, his name is Bijan, he said, gary, he goes, do you know what your ideal wife is? And I said, no. And so he goes, write it down. I literally took out this piece of yellow paper. I remember handwriting 20 things. And I'm going, every time I wrote it down, I go, no, that's not going to happen. You know, sexy, old world, stay at home, you know, with the child and influence our values on them. Be a businesswoman like the Yankees. I'm like, this is a needle in the freaking haystack. Once I got it for myself, I went out in the world and they started showing. Like, my wife showed up and I could see her. And because I was able to paint the picture, some people just complain about people, but they don't even know what they're complaining. So painter stands for paying, appreciating insurance. Understand. Understands insurance is a benefit, not a panacea. It's a scholarship that new patients. That N stands for new ideal patients. So your marketing matches what the ideal patient. So that fits. And your patient T trusts your patient. E is educated and is willing to be educated, and R respects your time and shows up for appointments. So that's a clear. That's a clear picture. Now, once you have that clear picture and you and your team know that now, what you can do is you're going to filter through. There's this thing called a filter. A filter is an automatic and subconscious screening process, Amber, that validates your particular point of view. So it's not until you declare what an ideal patient is that you can actually see if they are or if they're not. And if they're not, what is the gap? And how do you close the gap and give them the opportunity to close the gap? That's what it is. And then you just don't. You know, here's the thing. A lot of my docs that. That's. That work with Us are non confrontational people that want to be liked.

Oh, and that's just gonna be, you know, if you're always wanting to be liked, it's like, yes, very tough.

I'm a humanist, so I want you to like me. It wasn't until I learned the difference between like and respect that I was able to be a stand for what needed to be said and I could be honest with people on the things that weren't working for me. And then here's the thing. The patient either lines up with you or they don't. And you give them an opportunity to do it. We call it our aid system. I asked you to be on time and you weren't on time. Ha, ha ha. You're light with the first response. So, like, it goes like this. So, Peter, you know, you are such an amazing patient.

You acknowledged.

Peter. Peter, I just so appreciate you for being a long term patient. Peter, do you know that, you know, one of the things that we've taken on as a practice is really seeing our patients on time and releasing them on time. We weren't always good at that and we keep getting better. So we started with us first and then I wanted you to know, like, are you aware that you often cancel or you often show up late? Are you aware that that happens? And are you aware the impact that that has on our patients who are trying to get in and really for you, like us and our ability to take care of you? Do you know the impact that that's having?

Ooh, no, actually, I didn't think. I figured you'd be running behind anyway.

Yeah, Peter, yeah.

And we trained you poorly in the past. And I just want you to know we've established a new level of responsibility with regard to. Because in today's post pandemic world, we cannot waste time at the dental office. And we have so many people that want to get in. We have to make sure that the people that want to be here show up on time and are ready to go. So, Peter and Peter, your voice as a. You know, I thought you were a male, but you actually sound good as a female Peter. And a southern female Peter. I like the name.

Exactly.

You know what? And I like the name Peter for a woman, a powerful woman like you. So, all right, we're gonna stop there.

Because you go down many bad roads.

Right now, but I won't do that. And this is one joke for the funny people, the willing team group of people out there want to laugh.

All right, that's.

You got my humor for the Day. And like my son says, dad, your dad jokes. Dads don't laugh at. So.

Oh my goodness.

You have a long way to go, dad. So anyway, we're moving back to. What the heck was I talking about? Amber, take me back to where I was.

Okay, you were. You were having a conversation with Peter. Peter, Peter. Who is, who is the. Becoming the ideal patient? Because just having a realization over here that if I'm late, it makes you late. And then that is going to cause a problem for the rest of your patients.

Yes, PETA, my lovely Peter. You got it. So thanks for. And by the way, when you share the impact, notice what I did when I confronted Peter. I didn't make him wrong and invalidate him, Peter. I could. I could have done this way. Peter, you're a piece of poo patient and you're disrupting our schedule and you don't respect us and you don't like us and you're doing it to us and not for us. And you know, you're a piece of poo, Peter, so just get on your way. That is not what we're talking about here. We're talking about re educating and realigning your patients to your new set of values or the values that you stepped over. Now, I'm a humanist, so I want people to like me. So I don't like to confront people. But I just gave you a non confrontational way to confront people. Acknowledge Peter for being there. Share with Peter what's not working for you. Then share with Peter. Peter, do you know that you're late? And then share with Peter the consequences and the impact that he's having. And you, Peter, Amber, Peter, Peter. Amber said, oh, I didn't realize that not only am I affecting myself because most people don't have self respect or self respect for their time. They take care of themselves last. So that's why they do what they do. Because they're unconscious about the impact that they're having. And when you put up the problem in a mirror, they can start seeing for themselves. If they're responsible enough to stay in the practice, they'll see the impact that they're having. Just like you said, Amber. Oh, not only am I affecting me and how I'm being served, it affects everybody downstream. Like the people notice when I said the people that want to come in, that really want to be here, that was a little bit of a guilt trip. I'm not going to lie. But guilt trips work a little bit, so. But it's true. Like it is the truth. There's people that wanted to be in and you're taking up an hour of our time, right?

Absolutely.

There's other symptomatic issues that cause this. Number one, the reason in hygiene, people break breakup appointments is because they don't understand the value. That's why moving from a drill fill and bill and profi mill to a complete health practice gets to the root cause of why people don't come to hygiene. And the reason why people break inside of a doctor schedule is they don't know, they don't. They're not certain about money, time and pain. And you haven't handled that for them. And then they make it worse when they have to make the commitment to go visit you. So that's why in the treatment planning process, we close those three things down before they leave in the diagnostics so that it doesn't show up symptomatically downstream. When you have them scheduled inside of your schedule, they have to earn the right to get in your schedule by making a commitment to those three things of money, time, and comfort to get it done.

Okay, so, you know, one of the reasons I think that people don't show up for their appointments has to do with fear. You know, people, people are afraid. They really are afraid of the dentist. It's like, you know, and if they're not educated, and that's. I love your e here, is that your ideal patient is educated. So if you're educating that patient, that's going to help alleviate that fear right there.

Well, here's the problem. In dentistry, most of the time, the patient perceives the solution worse than the problem. Here's what I mean by that. Asymptomatic care. They don't understand the value of something that doesn't hurt. Like, like an endodontist doesn't usually have to worry about getting paid and having patients show up because there's a symptom present. GPs need to get really masterful at this, and there's a systematic process to do it that we built over years called the healthy mouth baseline, called personal motivator, called highlighting the problem, consequence and solution. Excuse me, trust. Transferring it from the back to the front and then fitting the treatment into the patient's lifestyle gets agreement. And if you don't have that systematic process in place, it's very simple. It's very five simple steps, then you're going to get these consequences downstream. So what we believe is when you handle upstream responsibility and debunk where the patient goes awry, whether it's fear, whether it's time, whether it's money. And you handle that always before it becomes a problem. What you're dealing with, with timeliness and broken and canceled appointments is patients going, not going to the prac, not going to this appointment. What is it costing me? Well, nothing hurts, so it's not costing me anything there. It's costing me money, costing me time. And then they're going to drill on my tooth and nothing hurts, so why should I even go to that? So they do that balance sheet. They call it a Ben Franklin balance sheet. Pros and cons of actually going to that appointment. Then all of a sudden they go, oh, it's a nice day. I'm going to go out with the ladies or I'm going to make up an excuse. By the way, only 15% of a why a person breaks an appointment is real. The others, wow, 5% is embellished or outright lies because they don't want to tell you the truth that you haven't shown them the value as to why they should show up for that appointment. The game's over and then everybody loses.

You know, and one of the things that that was really, when I started to work with next level, that a word that I'd never heard or even or concept was this supervised neglect and that, you know, a lot of practices have practiced that way. And it's, you know, it wasn't that they were doing it on purpose, but they didn't, they didn't want to step forward and educate the patient on what was really important. And when they didn't do that, it set, I mean, it set the tone for this, the patient. And it was like, it's not that important. If we're just going to watch something, we can watch it a little longer. It doesn't matter, you know, if it's. If we're just watching, but if we're actually treating, then, then there becomes more.

Of a. I'm sorry for interrupting. Amber. I am such a bad guest on your show interrupting you. Gosh, Amber.

But no, you know, what I'm saying here is just that we don't set people up for success if we're just watching things constantly.

Yeah, well, that's called the Timex practice where we watch things. The Timex practice rooted supervised neglect and Timex practices and rooted is in my second book called is raise your healthy deserve level. And it usually has to do with self esteem and it has to do with deserving and receiving money for value delivered. And that is a blind spot for a lot of dentists. That's why? And it was a blind spot for me, and I was able to heal that and reframe receiving. And I know it might seem like woo woo, but it's a direct connection. Every single time I locate the root cause of why people can't present treatment is because they don't think they deserve to receive the value or the benefits or all the stuff that goes along with that, the conversation that surrounds that whole thing. All of it.

Absolutely. And I think that that holds true for the patients as well. Now, Gary, you talk about what I think is maybe the most powerful part of this chapter is that you mentioned that when the doctor and the team embrace and put into practice these concepts that you presented, that three transformations will happen. And let's talk about those one by one. So the first transformation is moving from doubt to certainty. And you mentioned that a new level of intention with their case presentation happens here. So can you explain that a little bit more?

Yeah. Doubt kills cause. So when a person's in doubt, it kills their ability to cause things in another person. So as a dentist, your job is to be an entrepreneur, business owner. You have to cause something in your team and you have to cause something with your patients. But if you live in doubt and uncertainty, you translate that doubt and uncertainty into your team and patients. So we really are in the business of transformation, not in the business of coaching, consulting, and training. That's the means by which we have the transformation get created. But what we do, Amber, is actually move somebody. Like the reason why people are in doubt. It depends on the personality profile of that person. So again, if there we'll talk about the two main ones. For dentistry, doubt comes from if you're a methodical, you're trying to gather data to get to be certain you'll never get there. Because all the data in the world, if you know everything that there is in the world, you'll never get to certainty. Certainty is, is knowing what you know and knowing what you don't know. And if you don't know it, go find it out and put it into knowing. Therefore, if you follow that math, you're always knowing and therefore always certain. I'll give you an example. Like, I know how to, how to transform a doubtful, doubtful person into a certain person. I know how to transform a dental practice from just barely getting by into a practice that is thriving. I am very certain now, once in a while, I'll get a curve ball, somebody will throw something at me that I haven't heard before, and then I'll do some research on it and then I'll see it's rooted in one of the areas that is, that is stopping the practice. And so I didn't know what somebody throws at me. But if I'm in doubt, I'll always live in doubt. And then if you throw something at me that I don't know, I'm dead in the water and then I go on my heels and then I just, I don't want to make a mistake and then I kind of hide out and hopefully all this shit goes away.

Well, there you go.

That's the way it usually goes. What I'm saying is it's a flip of a switch. You actually know what you know. You know what you don't know. The things you don't know, you research and discover, find out and put that into your knowing. Therefore you're always knowing. So there's things I know all day long and there's things that I don't know, but I root myself in knowing that I know I do and I know I don't. And if I don't, I find it out and therefore I am always set. And it's not about data acquisition that will change everybody's relationship to when I know more then I'm going to be certain it's. That's a dangling carrot that you'll never get to.

Exactly. I agree. So your second transformation is moving from survival to caring. This is where you explain that the operating your practice in survival mode has been setting you up for failure because your, your focus is not patient centered. And can you unpack that a little bit for us?

Yeah, it's purpose. People experience purpose as that you care for them. If you have in your head that you're in fear and scarcity, you can't pay your bills, that might be really real. And when you're living in that world, you make decisions based up. You can't have a growth mindset in the face of scarcity and fear. You just can't, you can't grow, you can't shrink your way to growth. So the thinking of fear and scarcity, what I do is I show the abundance to our doctors. And what I do is I do this equation that's game changing. I have them take a look at the value of a crown and a buildup. I have them look at retaining their patients twice through hygiene, two profis, two exams, set of bitewings. So the case if they looked at case acceptance, which is the value of a crown and a buildup, they look at their retention. Those two things in their practice. And you quantify that, multiply that number. That average annual value of an adult Amber times the number of patients. Let's just say it's 1300 for the crown and buildup. Let's say it's, you know, 300 for two profis exam instead of bite wings. $1600 times 1000 patients is 1.6 million. There's an abundance of dentistry to be done, and this practice is struggling because their mindset is there's not enough new patients. Meanwhile, there's many. So many patients that can get them to 1 6. You know what this practice is doing? We first start with it. You know, you see it over and over. Now you've been around for a long time. They're doing 5, 600,000 and they can barely pay their bills.

Exactly.

And they.

And they will tell you, which we'll talk about in the next episode, is that they have to get new patients. They just need new work. They've got to have some more new patients. They just, you know, oh, if we don't get any more new patients in here, we're just not going to be able to do this. That's where they get. They're in that, that. Well, we'll talk about it. That new patient treadmill.

Well, they're in the blind spot of how their brothers and sisters have built practices. But if you find someone who's done it 6,000 times and has increased, you know, a few billion dollars in collections and moved people from four, five and four and a half days down to three days and done it all simultaneously, you, you know, you work with a guy like that, you become the hero. And like, tomorrow we're going to record our next episode. And I'm doing it from the beach. Why? Because I put boundaries in for time and money. And that's. This is how much time I'm giving, and this is how much money I deserve to make, period. And that's how it's going to go. So that's what's available to all doctors out there.

That's perfect. So the final transformation is from blaming others to recognizing that you can cause things to go right. So no more victim mentality. What are we going to do if we can't blame, you know, if we can't play the victim here?

Well, and it's so slippery here because I used to do it, too. And I always say when you point one finger out, your thumbs going up to your. Whoever your higher power is, and three are pointing back at you. And if you take that into mind, you lose all your power. When you say the pandemic. 9 11. I still have people blaming their condition on 911 and it's 2020. Like you know, this happened, that happened, all these circumstances. The minute you take responsibility and say I'm a hundred percent responsible for my results, you'll have an opportunity to take your power back. And this is where everything lies. Because then you can control addressing what the problem is. If you blame it on the economy or the pandemic and I show you 1.6 million sitting in your practice right now, you're going, I can't do that. That's not true. It's the pandemic.

And you know, again you give your power away. The game's over.

Boo woo woo.

I think that's PAC woman. PAC Ms. PAC man. That's what it was.

Boo woo woo.

When she gets eaten by the waka waka waka. Come on. I got to keep people interested and laugh. This is my crazy mind at work. Listen, here's the bottom line. You don't have to frickin suffer over patients not doing what you want them to do. You don't have to drink like I did to excess to deal with people not doing what you want. You just need to put controls in place and structures in place and do it in a systematic step by step path. And here's the deal, amber. This works 100% of the time when you put it in. I've never not seen it work. Never. That's a never see.

And that's what really is so amazing to me is that this, it really does work. And the only time that I've ever seen any time when something wasn't working was they weren't doing it 100% of the time.

Yep.

They, you know, it's like, oh, I'm going to do it. I'm going to do this part time. It's kind of like, let me just do this part of the time. It doesn't work like that, you know, and that's the problem is sometimes people want to be in that space.

Well, I want to, I want to have a sexy Olympic body. And I, you know, I do set up some push ups like once a year.

Oh, well, that's gonna work for you really well, isn't it?

But no, like I'm on a vicious like lean down. I mean I get, I only had like 40 minutes. I jumped on my bike, did a lap around Central park, done. I got my cardio in. I just, I did sprints the whole time. And so you know, there's, there's, there's a way and there's a pathway, and it's, it's simple and easy if you surrender to it and trust the process.

All right, well, thank you, Gary. This has really been enlightening today, and I'm really looking forward to our next episode when we record and talk about getting off the new patient treadmill. Oh, so we don't have to exercise then, right? Because you said we're getting off the treadmill here.

That's right. And you'll be hearing the waves crashing in a beautiful October day at the Jersey shore tomorrow when I do that recording. So get ready for the sound effects. I'm in my studio right now, but you won't hear audio like this tomorrow. You're going to hear waves freaking crashing. And the reason why that is is because you just, like, you make your life and your work play and you don't know if you're playing or you're working. I just happen to choose to work from the beach tomorrow, and that's what I'm going to do. And so that's what's available to all of you, having a full life of one you love and one you deserve. So I look forward to seeing you on our next episode.

Thank you for listening to Million Dollar Dentistry with Gary Katie. This podcast is brought to you by Next Level Practice. Next Level Practice is the leader in dental practice management. In fact, they're the best in the world at creating happy teams that implement sustainable results. If you would like a copy of Million Dollar Dentistry, please contact Amber Keithley at Next Level Practice. You may call us at 212-388-1712, extension 119, or go to nextlevelpractice.com podcast and request a copy in our Ask a Question box. We look forward to brightening your smile.