Treatment Plan Presentation – Big vs. Small

Over the years I’ve done my share of “big case” dentistry.  And, I’m often asked how I get the “big cases.”  Yet, I also understand many dentists have no interest in doing big cases.  For today’s installment, I’m going to skip the rather broad topic of attracting “big case dentistry” and get to the actual presentation to the patient.  Specifically, I’ll show you how I present it in written form.

All practice management software (PMS) conveniently lets you punch in a treatment plan.  Then it spits it out in an itemized format on paper.  This is fine for small treatment plans that involve basic restorative treatment for a few teeth.  But, for extensive restorative and prosthetic treatment plans, I believe it’s a huge mistake.  Why?  Read on…

A large treatment plan, when spit out by your PMS is a laundry list of codes and fees that means little to nothing to a patient.  Worse, it can be very intimidating and confusing.  “What’s this ‘P-slash-C’ for, and why does it cost $295?”  The patient will tend to look at long list of procedures (looks like a LOT of work!) and each individual fee.  Then he or she will start to question each one… if not vocally, at least in his or her mind.

What does all this mean to a patient? Does it answer all of the patient’s questions?

A large treatment plan spit out by your PMS is impersonal and doesn’t answer patients’ questions about their treatment.  Sure, you can explain it verbally to the patient face-to-face.  But, when the patient goes home, the “significant other” may want an explanation.  The patient, unable to relay all that information, will probably just hand over the PMS treatment plan printout.  And, that’s not good!  If you listen closely, you might even be able to hear the spouse yell out, “WTF!?!?” all the way across town.

You should know that what I will propose here involves more work.  Yep… work!  And a bit of time.  But, it’s WELL WORTH IT.  And, you’ll get better and faster at it as you gain more experience doing it.  If you want to do “big case dentistry,” I believe this is critical.

A good treatment plan presentation (verbal and written) is one that answers the patient’s questions.  We dentists tend to focus on the how and why instead of the BENEFITS to the patient.  Of course, we also have to cover alternative treatment options, risks vs. benefits, etc.  We can do it in a patient-friendly way, though and still cover our bases.

What is it good for?   Aaaaaabsolutely nothin’… say it again!

Answer the questions!

So, what do patients want to know?  Do they want to know about osseointegration?  Nope!  Do they want to know how you’ll be bonding materials to their teeth?  Nope!  Do they want to hear about how a post and core is placed?  Nope!  Do they want to know about crown-root ratios?  NO!  Stop thinking like a dentist.  Pretend, for a moment, that you are talking to a non-dentist… a regular person… your patient.

When it comes to treatment options, they want to know about BENEFITS.  Patients want three things from dental treatment:

  1. Look good.
  2. Feel good.
  3. Last a long time.

That’s it!!  Really!  It is!

When it comes to the actual treatment plan, patients want to know three more things:

  1. How much?
  2. How long?
  3. How many appointments?

That’s it!!  Really!  Don’t bend their ears about anything else!  You’ll just talk them out of treatment.  Ask me how I know!  With 24 years under my belt, I finally figured a few things out.  :D

The secret to your success…

Over the years, I developed a way to present treatment and answer those questions, while covering my “informed consent” bases.  I quit printing out those PMS treatment plans.  I quit itemizing the fees.  It wasn’t working for the big cases.  Not at all!  I wanted to present treatment options, informed consent, and answer the patients’ questions in one fell swoop.  Again… there’s no real automated / lazy way to do this.  But, at the end you’ll see that after a while, you can make the process more efficient.

What’s my big secret?  It’s not a secret.  It’s not rocket surgery.  I’ve put this out there on Dentaltown.com a number of times.  I am reprising it here for posterity and easy reference.  :)

I present the whole case and a single CASE FEE printed on paper created by a word processor.  Remember the patient’s questions (see lists above).

Options, options, options…

Let me back up a bit, though.  If the case has a number of options (and they usually do), I’ll present those options first, in general terms, along with pros and cons and fee ranges.  So, if you can imagine a case where the patient may have missing teeth and others in need of restoration.  Options might include:  removable, traditional crown & bridge, and implants.  Three basic options.  Start there.

Or it could be a cosmetic case that could be an orthodontic + minimally invasive restorative vs. ten or more porcelain restorations.  Also remember to include the option of no treatment (and possible consequences).

Here is an example of the Treatment Options Overview.  You can click on the image to download a .pdf version that you can see better and save on your computer for future reference.

An example of a “Treatment Options Overview.” Click on the image to download a .pdf file that will be easier to see (and save on your computer for future reference).

It helps to print it out in an easy-to-read-and-understand format.  And, again, consider a significant other at home may be looking at it (and be involved in the final decision).

Finalizing the plan

Once the patient has decided on a particular option, I write up the treatment plan, again remembering the patient questions.  I summarize the treatment.  Then I map out the number of appointments (and time between appointments).  And, I quote a CASE FEE.  I don’t break it down by the tooth.  It’s the whole case, soup to nuts.  One fee.  I also include any “informed consent” caveats that should be mentioned.

Below is an example of a final treatment plan.  Click on the image to get the .pdf version.

Treatment plan includes general description of treatment, sequencing of appointments, and informed consent info. Click on image to download .pdf for better viewing and saving.

The “heart” of my written treatment plan answers the patient questions of “how long and how many appointments?”  Here’s an example of that:

The “heart” of the Treatment Plan is the schedule.

Below is an example of an extensive treatment plan.  This case took about a year to complete.  Clicking on the image below will download the .pdf version.

This is an extensive treatment plan. Click on image to download .pdf.

Surf’s up!

This approach has worked very well for me over the years.  In this economy, I’m not doing as many of the “big cases” as I was in years past.  But, I expect once the economy turns around (whenever THAT’S going to be!), there will be a pent-up demand for these services.

The question is:  Will you be ready to surf that wave when it comes?

“You can either surf, or you can fight!…  If I say it’s safe to surf this beach, Captain, then it’s safe to surf this beach! I mean, I’m not afraid to surf this place, I’ll surf this whole ***** place!”

So, if you’re not already comfortable doing big cases (but would like to), sharpen that saw by going to as much related CE as you can.  And, then when the right patient comes in, you’ll be ready not only to do the case, but effectively present it as well.  Remember what the PATIENT wants to know.  Keep it simple!  Feel free to adopt and adapt my approach on a word processor to suit your own style.  Once you’ve got a number of these stored on your hard drive, for any given case, you can go back and modify a previous similar plan (and not have to start over from scratch.  So, it does get easier and more efficient.

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10 Responses to Treatment Plan Presentation – Big vs. Small

  1. Thanks again, Mike. I’m going to pilfer your templates. I do a lot of full mouth cases and you are right: giving the patient too much info is a bad thing. Just let them know that you’ll take good care of them, that you stand behind your work, and that they’ll be able to chew and smile with confidence.

  2. Hey Mike, what’s “rocket surgery”?

  3. Ken says:

    I too have noted less of these bigger cases in recent times. My question to you would be approximately how much time does it typically take for you to finalize the final treatment plan. Obviosuly some of that will depend on the patient but I am guessing you have a couple consultation appointments? One for the treatment options overview and then a 2nd consult for the final treatment plan?

    I realize you are probably at a point and time in your career where these big cases seek you out but I’d like to see you write sometime on how you approach people unaware of their dental problems who are big cases but don’t know they are (or at least won’t acknowledge they are).

    • The Dental Warrior says:

      Hi Ken,

      I’ve got bunches of these treatment plans “in the can” on my hard drive. So, most times, I can dig one up and just modify it. But, before that, I sit down with x-rays, models, photos, etc. and sketch out some options on a blank piece of paper.

      Sometimes we have 2 consultations (options and final). Other times, we can sort it all out at the options consult. Just depends.

      How do I approach folks that have big issues but don’t know? I just say, “Duuuuuuuude… your grill be all jacked-up!” ;) Just kidding.

      Honestly, most of them know. They just don’t know what can be done because other dentists never tried to tell them. Most dentists don’t want to do big cases. Some are afraid if they present a big case, the patient might say YES! Some are afraid of rejection (of the big fees). “$30,000??? Are you out of your mind, Doc???” Some dentists don’t like hearing that. So, they avoid the “confrontation.” Of course it’s nothing like a confrontation. But, most people don’t like rejection. So, it’s easier to never ask.

  4. Vijay Agarwal says:

    Hello Mike

    What program are you using for your larger cases. I was trying to create a basic template but had a hard time creating the boxes for the sequence. Hopefully i will see you next year at ACDRC

    • The Dental Warrior says:

      Hi Vijay! Nice to hear from you.

      How have you been? :-)

      I’m just doing this in Microsoft’s “Word.” I create a table to organize the treatment sequencing.

      Over time, I’ve saved a bunch of these on my hard drive. So, if I can, I try to find a similar case and then just modify it for the next case.

      I hope that helps! :-)

      I’m still co-chairing Farokh Jiveh’s course at ACDRC. Hope to cross paths soon!

  5. Thank you so much Mike (and Google)! I was looking for one of your letters as an example of how to present a case, and I finally stumbled across this post. Great stuff as always!

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