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Bill Blatchford, DDS

Dr. Bill Blatchford is a dentist and practice management consultant focused on strengthening private practices. He is one of the world's leaders in dental practice management success. His 19 month Coaching Program of a "Better, Not Bigger" practice model aims at providing excellent dentistry while enjoying the rewards of less stress, reduced overhead and greater net return. In addition, Dr. Blatchford is a contributing editor for Dentistry Today, Asian Pacific Dentist, and Latin American Dental News.

After graduating from Loyola School of Dentistry in Chicago in 1970, Dr. Blatchford practiced for 20 years in Corvallis, Oregon where his practice was among the top 1% of dental practices in America. With a high gross and many staff members, he came to realize there must be a more rewarding way to practice than aerobic dentistry. His "Better, Not Bigger" practice model stems from his conviction that the practice overhead must be in control first. Then the dentist is willing to look at changes to make his practice reputation one of excellence.

Dr. Blatchford currently lives in Sunriver, Oregon and can be reached on e-mail at For information on his case presentation video, "The ABCs of Presenting Ideal Treatment" or for information on the coaching program, call Blatchford Seminars at 800-722-5580, or check out

Current Speaking Schedule

July 26
La Jolla, CA
"Flourishing in Private Practice in Changing Times"
Scripps Dental Conference X
Education Division @ 800-755-7515

August 18
Montreal, Canada
"Presenting Ideal Treatment and Getting a Yes"
Canadian Dental Association
Madeleine McBrearty @ 613-523-1770

September 13
Houston, TX
"Patient-Driven Case Presentation"
Houston Academy of General Dentistry
Linda Doll @ 800-286-1918

September 30
Orlando, FL
"Better, Not Bigger"
American Dental Association
ADA @ 312-440-2500

October 18
Rochester, NY
NY State Dental Practice Administration
Blatchford Seminars @ 800-722-5580

December 7
Charlotte, NC
"Designing the Ideal Practice Model from the Bottom Line: Bigger vs. Better"
Holiday Dental Conference
HDC @ 704-364-9390

Patient-Driven Case Presentation

The dental marketplace is changing rapidly with different delivery systems being offered to patients. The practice model for success in the next decade will be one of service and quality rather than the larger insurance driven model of the 1970s and 1980s. Dentistry has moved from crisis care to optional care. Staff and doctor must become skilled at patient-driven case presentation.

Ask the patient what they want and then give it to them. This is the essence of patient driven case presentation. Because patients are becoming more and more sophisticated in their purchasing habits, patients are aware they are at choice. This new approach to offering dentistry caters to choice. It is called patient-driven case presentation and the bottom line is "find out what they want and give it to them."

Patients become involved and are more enthusiastic when they are at choice. Patient-driven case presentation is a significant shift in dentistry. Dentists have relied on the authority figure concept of telling the patients what they NEED. The former case presentation conversation might have been, Yes, Mrs. Jones, you really need to have that tooth replaced or the surrounding teeth will cave in. You'll lose them, and eventually you won't have anything to chew with ( and probably die a slow, painful death)."

These threats motivate few patients and are actually a hard sell. Using pressure to make a decision is hard sell. Imagine having a sales person at Nordstrom threaten a customer, "If you don't purchase this coat, you could freeze to death."

The old model of selling dentistry was based on crisis care, i.e., "You need to have these fillings replaced." Crisis care has passed. Almost all dental treatment today is optional, according to Dr. Omar Reed of Scottsdale, Arizona. Dr. Reed sights a US Congress health care study which determined that "dentistry is non-essential health care." (1994) To further demonstrate dentistry is now optional, a study in England in 1968-70 was reported in the ASPD Journal which studied edentulous and partially edentulous dock workers which found that "teeth were not necessary for health," according to Dr. Marvin Truin of the British Dental Association. Outside of acute pain and infection, dental treatment is a choice and patients know this. Therefore, find out what the patient wants and give it to them.

Asking questions is the heart of patient driven case presentation. By asking questions, patients open up and talk about the most important thing to them--themselves. Shift the conversation from telling them what they NEED, to asking them what they want.

Even though dentistry is usually not the highest priority on a patient's want list, the patient is in the dental office today. Teeth and smiles are something the patient is thinking of today. What is high on patient's priority list is looking good, feeling good and having quality work that lasts a long time. Allow patients to see the excellent work being produced lately. Be proud of the end product by displaying nicely framed before and after pictures. A before-and-after album of personal cases is a must in each treatment room.

Asking questions becomes a skill for both staff and doctor. The skill building for patient driven case presentation is (1) learning to ask the right questions and (2) learning to listen. The patient should be talking 80% of the time and the doctor or staff member should be speaking 20% of the time.

The questions asked are aimed at discovering the patient's needs and wants. All dental patient needs are focused in three areas:
-- look good, appearance-related
-- feel good, functional
-- last a long time, related to quality and excellence

By designing the questions to stimulate patient's thoughts on "looking good, feeling good and lasting a long time, " the staff is helping the patient develop a clearer picture of what is important to them in their smile. Though the majority of patients are motivated by "looking good," some people just want to keep their teeth and be more comfortable. Asking patients questions will verbalize those concepts.

Patient-driven case presentation requires the use of open-ended questions. These are questions which cannot be answered "yes" or "no." Try these:

1. "You have a nice smile. If you could change anything about your smile, what would it be?"
2. "What benefits would there be for you to have a whiter, brighter smile?"
3. "What would you like your teeth to be like in 20 years?"
4. "What advantages do you see in keeping your teeth forever?"
5. "When you look in the mirror at your teeth, what would you like to be different?"
6. "What advantages do you see in having as few dental treatment visits as possible?"
7. "When you look at these before and after pictures, what do you like about these smiles?"
8. "Whose smile do you admire and why?"

These questions actually create a demand for excellence. The patient starts to think about some possibilities that he wasn't thinking of before entering the dental office. Because the majority of treatment in a dental office is optional, not crisis care, dentists and staffs must create opportunities to ask open-ended questions. Staff and doctor can actually write a script of an ideal patient conversation. Practice asking questions and keeping the patients talking about their wants.

Patients make their buying decisions based on three important factors--trust, benefits of treatment and product knowledge. Trust is the most important factor in choosing to buy. How is trust created? Genuine enthusiasm about the doctor and the end result, honesty and integrity help create trust. Trust and the benefits of treatment are emotional factors and account for 95% of the buying decision, according to Ron Willingham, Integrity Selling, (Doubleday) 1986. Conversely, only 5% of the buying decision is based on product knowledge. Traditionally in dentistry, product knowledge is where the most emphasis has been placed.

Pitfalls can occur when the staff or Doctor doesn't listen well to an answer and starts talking about technical treatment and drawing tooth pictures on the bracket table. Patient- driven case presentation demands that the patient talks about dental wants and desires 80% of the time. When the doctor or staff is talking 80% of the time, patient's eyes glaze over and enthusiasm wanes. The dream is turning cold.

Patients do not want the hard sell in a dental office. Patients do not want to be educated to the point of being able to do the root canal themselves. Ultimately, more dentistry will be accepted with patient-driven case presentation because the patient feels they are making the choice rather than being told they must have a crown on that tooth and it NEEDS to be done soon.

Think of the successful Jenny Craig campaign of having a new body. The diet consultants ask clients what they want, what their needs are, and how they want the end product to look. Craig consultants do not emphasize the sweat of exercise, the elimination of deserts and sweets, the discomfort of change to smaller portions. They ask the client what they want and give it to them.

When a patient feels they have a say in the treatment direction and it is something they want, there is emotion attached to that decision. The patient sees a picture of a beautiful smile and thinks that might be a possibility. (See Figure 1) During the time of their buying decision, they are discovering reasons why they want that smile, how it will help them in their career and how they can pay for it. They are gathering data to rationalize their decision to have a new smile. "The brain can deliver whatever the heart desires," according to D. Forbes Ley, The Best Seller, (Sales Success Press, Newport Beach, CA) 1993.

Other benefits to patient driven case presentation are:
-- fewer cancellations because patients are at choice
-- patient referrals increase because of enthusiasm
-- decreased dependence on dental insurance
-- decreased demand for crisis care or emergencies

The dental marketplace is changing rapidly and patients have choices for dental care. The hard sell of threats and pressure will drive patients away. The Baby Boomers are now approaching 50 years of age. Boomers are the largest segment of the population and they want to look good, feel good and live a long time. Boomer's dental decisions are driven by emotion and they want to be at choice also.

Patient driven case presentation puts the patient in the driver's seat. Patients know they are at choice in dental care and that the majority of dental treatment is an option. By asking the right questions and listening, dentists and staffs can create an opportunity for patients to see what might be possible for a more beautiful and long-lasting smile. Just ask the patient what they want and give it to them.

With the changing dental marketplace and delivery system choices for patients, learning a new skill in the way dentistry is presented will allow the patient to feel heard and served. With the doctor and staff learning to ask questions so the patient is at choice, rather then telling the patient what they NEED, greater case acceptance will result.

Note: The before and after pictures above are examples of sharing with patients as they decide how they want their smile - an emotion driven decision rather then the current "hard sell" in dental offices.


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