As I mentioned in my previous article on using the Buyer’s Journey concept to improve case acceptance, I want to focus next on second-opinion patients. But before I take you through the different types of second-opinion patients and how to work with them, I want to make sure we all keep this in mind:

Not every dentist is for every patient, and not every patient is for every dentist.

I’ll explain this truism in more detail later in the article, but you’ll see it in play throughout.

A Detour on the Buyer’s Journey

managing second opinion patientsAs I mentioned above, in my previous article I discussed the Buyer’s Journey as a template for treatment planning and communicating with patients. There are three steps to the Buyer’s Journey: Awareness, Consideration and Decision. These steps must be navigated in that sequence in order to successfully guide the patient from noticing a problem to acting on a solution.

And that’s why I felt second-opinion patients would need an entirely separate article to discuss. You see, communication is the key to progressing through each of those steps. Unfortunately for second-opinion patients, they have most likely experienced a breakdown in communication at some point during the treatment process.

That experience makes the second-opinion patient a very particular type of buyer. He or she is coming to you already feeling a sense of doubt. In fact, the whole notion of feeling the need to look for a second opinion entails some level of uncertainty. Such uncertainty can be associated with the previous clinician's diagnostic criteria, the proposed treatment plan or the previous clinician's ability to carry on a certain procedure.

However, uncertainty leads to mindfulness, which ultimately leads to awareness. What do I mean by mindfulness? When a patient sees their primary dentist and hears something that doesn’t quite click, that triggers the desire to learn more about the condition and treatment options. It incites a desire to be more aware. As I pointed out, Awareness is the first step in both the Buyer's Journey and the treatment planning phase.

Unfortunately, some clinicians may not step back to the Awareness stage with the patient. They reach the Decision stage and become so enamored with their treatment plan that they don’t see any other option.

Losing (because of) Focus

In the book “The Power of Noticing,” Harvard professor Max Bazerman discusses three very interesting concepts:

  1. Inattentional (or Perceptual) blindness
  2. Motivational blindness
  3. Bounded awareness

focusing on dental patientsIn a nutshell, Bazerman states that people routinely overlook important information during the decision making process and many times it’s because they’ve become overly focused. It may sound counterintuitive, but focus limits awareness. This means that important information outside of one’s range of focus can be missed. Think of an airline pilot attending to the readouts on one gauge; he’s missing the information from all of the others. Or, better yet, think of people who use their cell phones while driving; they often end up in car accidents because they’re not seeing their surroundings.

In the same way, we as dentists can become so focused on an initial treatment plan that we fail to notice our patient's reaction. We may even fail to notice other viable options if the patient asks for other ideas. The latter can occur more often if we have become over-reliant on a familiar course of action. As psychologist Abraham Maslow said in 1966, "I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail.”

Over the years, I have often heard of dentists wanting to treat different conditions utilizing the same technique, which may lead to unfavorable outcomes. In fact, if we do not want our patients leaving our practices to go find a second opinion, we have to break away from that tunnel vision. We have to fill up our toolbox with more tools than just one hammer (that’s where dental continuing education comes into play). We have to be ready to admit our initial plan may not be the only – nor the best – option. While we may be more knowledgeable than our patients about dentistry, we have to realize that we are still human, and humans make mistakes. Even doctors have bad days and can miss important aspects of diagnostics.

That being said, we could have created the greatest treatment plan in history, but it won’t be accepted by a patient if you don’t present it right.

The Importance of Communication

communicating with dental patientIn the Spear Course Library lesson “Establishing Value for Your Treatment Plan with New or Existing Patients,” Dr. Frank Spear shares how a patient asked for a specific procedure and, when presented the cost of the procedure, decided to go for a second opinion. The problem, Frank noted, was not the price or the treatment plan, it was that he did not fully communicate with the patient. He assumed a quick talk about the procedure was sufficient for case acceptance as the patient had been with him for a long time.

I believe many of us do the same thing. We come up with a great treatment plan, but we fail to properly communicate that plan – its benefits, value and, yes, even its drawbacks – with our patients, especially the long-time patients.

That’s one of the main reasons I conduct a comprehensive treatment plan presentation. Utilizing Spear’s Patient Education videos, my own case presentation slides and models, I break down the patient's condition and treatment options piece by piece. In a later article I will go into this further, discussing a concept I like to call “anterior/virtual interchange,” or AVI.

As I stated in the Buyer’s Journey article, I also ensure that I’m not the only one doing the talking. Throughout the presentation, I ask the patient their thoughts and ensure they understand what they’re hearing and seeing. I’ve said it before, and I’ll say it again because it bears repeating: Two-way communication is the key to case acceptance and patient retention. We have to leave our egos at the operatory door; it’s the patient's mouth and they have every right to question us about our methods.

They Have Options

When you’re flying on a commercial aircraft, you’ll often hear the pilot say upon landing, “Thank you for flying with us. We know you have your choice of airlines.” Well, your patient has their choice of dentists. Listen to your patient and have an open mind and you just might stay their top choice.

That is not to say we as clinicians do not have options. Sometimes, no matter what we do or say, we may not come to an agreement with a patient. And that’s when you have to remember: Not every dentist is for every patient, and not every patient is for every dentist.

In my next article, I will continue this discussion of the second-opinion patient. However, I will focus on working with second-opinion patients coming from other clinicians. Until then, I encourage you to use the Comment section below to share your methods of reassuring your patients who have considered seeking a second opinion.

(Click here to read more articles from Dr. Ricardo Mitrani.)

Ricardo Mitrani, DDS., MSD, Spear Faculty and Contributing Author -


Commenter's Profile Image Abdi S.
April 20th, 2016
Dear Ricardo, Great article. You write so well and sensible. I agree with all that you say. I just want to add that sometimes suggesting a second opinion voluntarily to a patient that may have doubt could be the best way to have them see what you (their long term dentist) are suggesting is their best option. The key there is to have the patient seek a true second opinion. What I mean by that is that the patient should ask the other dentist to figure a plan on their own (by just sharing the records) instead of just asking for a validation of a (your) treatment plan.
Commenter's Profile Image Eric M.
August 8th, 2016
Exceptionally well written Ricardo. I agree that two way-communication is the key to case acceptance. It's not like "the old days" when patients seemed to be a bit more trusting of dentists and certainly had less access to information about treatment; the internet has changed the game! Our profession has advanced so that we not only need to be be better at clinical dentistry but be much more skilled at practice management and communication with patients. Thanks for reinforcing these ideas!