How to Respond to a Procrastinating Patient

How many times does your scheduling coordinator hear the response, “I will schedule treatment later” after asking a patient, “Do you prefer a morning or afternoon appointment?” Probably enough times to notice. Do patients who say this when they’re checking out at the front desk actually call later to schedule follow-up treatment? I doubt it.

When a patient says, “I will schedule treatment later,” it used to mean that he or she didn’t understand the need for treatment, for the most part. But is this the only thing that “I will schedule treatment later” means? Absolutely not. It might also mean:

1. “I’m concerned about paying for treatment.”
2. “I’m not sure what my condition is or why I need treatment.”
3. “I want to do more research before I commit to treatment, and even get a second opinion.”
4. “I need to check my schedule. (And it’s difficult for me to get time away from work.)”
5. “Now’s not a good time for me to be receiving care.”
6. “I don’t want treatment.”
7. “I need to think about it.” 

Of course, the patient is not actually telling you any of these things. It would be much simpler if the true reason was provided up-front, wouldn’t it? However, for most people, it is hard to tell their truth. Maybe it’s embarrassing. Maybe they don’t want to appear foolish. Maybe they just don’t care (although I bet they do). Whatever the reason, it’s legitimate for them, whether we agree with them or not.

How can we proactively take action to ensure that patients are scheduling follow-up care and treatment? Let’s discuss how best to respond to each response a patient could give while delaying the scheduling of treatment. 

1. “I’m concerned about paying for treatment.” Rarely will a person tell you he or she has no money to spend on dental care. Consider scheduling the patient’s treatment in phases, if possible. You could ask, “Would it help to schedule just a portion of your treatment at this time?” Or, “We offer financing options.” If the patient still declines scheduling an appointment, a note should be made to contact him or her within a one- to two-week window following the date of diagnosis, reminding them of the next steps in their treatment plan.
2. “I’m not sure what my condition is or why I need treatment.” This is a failure to communicate while the patient was in the chair. What can be done when treatment is diagnosed? For one, during the appointment, the patient’s condition and treatment options should be clearly explained to them. Use educational handouts, either in the form of brochures, customized handouts, photos, radiographs, models or any number of informational aids. Don’t just give these things to them; review the materials with them each and every time to ensure understanding. Don’t assume that just because a patient has been with your practice for 20 years that he or she will just take your word at face value and schedule an appointment for the placement of those crowns. Review the problem and the solutions, and address the patient’s concerns, questions and objections. Keep the conversation going until the patient feels he or she truly understands. 
   
   Here are some questions you can ask while you are talking with the patient: “What questions do you have about the treatment needs that have been diagnosed?” “Before we proceed, what questions for you have about your condition?” Whenever asking a question, pause afterward to allow time for the patient to formulate a response.
3. “I want to do more research before I commit to treatment, even get a second opinion.” The proactive approach to this is much like in No. 2 — ensure understanding. As you are reviewing a patient’s condition and treatment needs, check in with him or her along the way to ensure understanding. Ask: “Mrs. Smith, does this make sense to you?” Again, pause after asking the question, and give the patient time to respond. Much like a person who is reading a sentence and comes across a word he or she doesn’t understand, if a patient encounters something that’s confusing and doesn’t gain clarification, they may not understand anything after that.
4. “I need to check my schedule.” It is true that most people’s lives are busy. To proactively deal with this so the patient doesn’t “slip through the cracks,” simply state, “Mr. Jones, we’ll call you in two weeks if we haven’t heard from you. What is the best number to call?” Notice I am not asking for their approval or permission. If the patient says, “Do not call me,” well, do not call! Make sure that a note is immediately made somewhere where it will not get lost, so that the patient is called as promised.
5. “Now’s not a good time for me to be receiving care.” What proactive step can you take here? Try saying: “Mrs. Jones, it sounds like now is not the right time for you to schedule necessary treatment. When would be a better time?” Remember, then be silent. Let the patient answer. Then, determine the next step.
6. “I don’t want treatment.” This is an interesting one, since the patient came to your office for care and obviously has shown interest in self-care. As we know, some patients put off care — unless they hurt — for years. Personally, I have done more endo in my practice over the past few years than ever before, for people who have simply neglected receiving care or did not follow through with receiving a simple filling. How can you get someone to move off the spot they are on? One effective way is to draw from your own life experiences when talking with a patient. What is something you knew you should do, but you procrastinated on doing? Consider talking with your patient about your own experiences with things such as exercising, dieting or servicing your vehicle, for example. As dentists, we know the risks of leaving an infection untreated, and we should even be more cognizant of the impact that it makes on our general health. Does your patient understand that, too? If not, take the time to help him or her understand.
7. “I need to think about it.” At the core of this is mostly a lack of knowledge; thus the reason the patient may seek out information on the internet, from friends or even from other dentists. You can avoid this by striving to never let the patient leave the treatment or consult room without ensuring the patient has all the information he or she needs to make an informed decision about care. You don’t want the patient feeling like a second opinion or more details are needed.

In a dental scenario, it is morally and ethically advisable to make sure the patient understands the consequences of lack of treatment. Do your part by taking all the time that is necessary to ensure patients understand the prescribed course of action and elect to follow it on their path to dental wellness.

Don Deems, DDS, FAGD, known as The Dentist’s Coach®, is a trained professional, personal and business coach, and a practicing dentist. To comment on this article, email impact@agd.org.