(For Part I of this series, click here.)

How do you feel when your dental team tells you the next appointment is a patient seeking a second opinion? Do you cringe, worried that he will be overly critical of everything you say? Or do you get excited, hoping that this could be a new long-term patient for your practice?

In this article, I am going to show you the best practices for working with a second-opinion patient. I will be utilizing ideas presented in my previous articles, so I recommend you at least check out my post on utilizing the Buyer’s Journey in the dental practice.

Why a Second Opinion?

I previously wrote about what we as dentists can do to ensure we aren’t forcing our patients into seeking a second opinion. Now I’d like to change the focus to how we can best help those patients who are coming to us for a second opinion. I’ll give you a hint: the secret word is “communication.”

Before we get to that, however, let’s look at the types of second-opinion patients you will see in your practice. The first set of variables we must consider is when the patient is seeking the second opinion:

  1. Before initiating treatment
  2. During active therapy
  3. After treatment is completed

Besides those stages, we must also discover the reason they are looking outside their primary dental office:

  1. Price – They are shopping around for a better deal.
  2. Validation – They want to ensure that the treatment being offered or that was done is the right choice.
  3. Exploration – They are not quite comfortable with the treatment being offered or that was done and are looking for alternatives.

While the reason may not be evident initially, it is important that you get the patient to articulate the why of her uncertainty. That is the only way you can move her from the awareness stage of the Buyer’s Journey to the consideration stage.

Unfortunately, in the era of scanners, the least accurate one is the one that’s sitting on top of our shoulders. This is where your team comes in. Collectively, the team should help you narrow down the reason a patient is there for the second opinion – price, validation, exploration – and set up the appointment accordingly as some may require more time for a consultation than others. That’s why it’s important to have team training sessions, such as with Spear’s Team Meetings, so that everyone on the team is on the same page.

While you and your entire team may give it your all to find out why the patient is really seeking a second opinion, sometimes the patient may not be communicative. So what do you do?

Communication Digression

Before I get to breaking down the best way to approach each second-opinion reason, I want to remind you why communication is so important.

It’s an unfortunate truth that many patients are not immediately accepting what their dentist says just because they have the letters D.D.S. or D.M.D. or even M.S.D. after their name. Second-opinion patients are usually even less trusting. When a patient is not trusting, they become reluctant or resistant to hearing other options. That’s why we cannot start lecturing the patient when we first meet them. We need to begin with asking questions. We need to verbally poke and prod to get to the deeper issues that the patient might not even realize are there.

One way to do this is to use the Question Formulation Technique. In the book “Make Just One Change,” authors Dan Rothstein and Luz Santana present a method of teaching that gets the students to ask the questions. Used in the dental office, you can encourage your patients – second-opinion patients and lifelong regulars – to think about their situation and ask questions about treatment options. As you help them with the answers and questions, they take ownership of their treatment. And that’s what we want. It is their mouth after all.

Using this communication technique will also help to break through the barrier of distrust. The patient feels they are working with you to come up with solutions. And by listening to their input you are showing you care about their opinion. As I’ve said before, patients don’t care how much you know until they see how much you care.

Now that I’ve had my say about communication, let’s return to the second-opinion patient. As I said above, they are coming to you for one of three reasons. Let’s start with price.

price patientThe Price Patient

Right up front, I want to make clear that I believe you must avoid at all costs (pun intended) “playing the price game.” At the very least, you should be fully aware of what you might be getting yourself into.

First off, if you begin playing the price game, you become focused on selling instead of on treatment. This is an exhausting exercise and is not beneficial for either party.

Secondly, more often than not you will end up regretting letting a patient “convince you” of a lower price. I put “convince you” in quotation marks because patients don’t often try to outright haggle with you; however, you may feel you have to offer them a lower price to come in under the price their primary dentist offered.

But you know what your time is worth. You know the value of the level of care you can provide. If price is the second-opinion patient’s major concern, you have to take two steps back and make sure the patient understands and values quality dental treatment. If their only concern is monetary in nature, there’s a very good chance you won’t be able to get across what it is you can do for them.

The Validation Patient

When a validation patient shows up at your office, they want to hear if the treatment their dentist recommended is the right choice or, if they are in the middle of or have completed treatment, if it was done well.

You must be careful here. Dentists can be the worse critics of their predecessors work in the patient's mouth, and often are pretty verbal about it. Unfortunately, they don’t even realize that the one person they are ultimately insulting is the patient. The patient is the one who picked the original dentist. They also may have agreed to that treatment in the first place.

But how can the patient know if what was done was OK or not? More often than not, this is dentistry that the patient may not understand or be aware of. The previous dentist could see something or have a radiographic finding of which the patient is not fully aware.

And you may also not be fully aware of the situation with that first look. That is why you have to treat the previous dentist very delicately. By being delicate about the situation – whether or not the previous treatment was bad – the patient can read between the lines and will become more comfortable as you bring solutions to the table instead of just being critical.

If you see some type of deficiency that needs to be taken care of, instead of saying, “Man, they messed you up, look at that,” offer a solution. Tell the patient, “This is what I can do for you,” rather than, “This is what someone else did wrong.”

Being overly critical of previous dentistry does not make dentists look any better. It only make us seem arrogant. And that is one of the quickest ways to create a disconnection between you and the patient.

The Exploration Patient

Of all the three reasons why a person seeks a second opinion, the most benign is exploring other solutions. They may not feel comfortable with the original treatment plan or just want to see what may be less intrusive.

While these patients may have an open mind, you still have to be careful. You have a chance to make a real difference in this person’s oral health, so you must take the time to avoid jumping in and telling them what you think. Explore the options first by hearing out what treatments the patient has been told about before. You must also ensure that you have gathered all of the diagnostic information – clinical photography, radiographic series, etc. You have to really look at their condition and then present what you feel is the best treatment plan. If you just jump right in, you can inadvertently miss so many things that can or should be done.

How do you present the new options to the patient? You should have a whole array of materials at the ready to conduct your presentation, both analog and digital. This is a method I like to call “analog/virtual interchange,” or AVI, but I will cover that in full in my next article.

The other thing to consider when working with an exploration patient is that you may have to think outside the box. In my last article, I talked about how we as dentists can get tunnel vision when it comes to treatment plans. We can become so sure that our plan will work that we’ll continue on with it even when it’s obviously not working. For example, I recently saw a patient who was missing a couple of teeth. This patient went to a world-famous surgeon who tried doing a graft procedure that, lo and behold, got infected. It now became a nastier site to be grafted. However, this surgeon again wanted to go back and regraft. The patient came to me for a second opinion and, just by looking at her, I thought, “She doesn’t seem like she’s willing to put up with another graft, so I will look for an outside-the-box solution.” We figured out we could give her a graftless solution and give her a fixed partial denture on her teeth as opposed to trying another overly invasive surgery. She was ecstatic at this solution.

exploration patientI tell you this story to illustrate that by really listening to the patient – by accepting her concerns and starting my treatment planning from there – I was able to provide a plan that would both help her and meet her preferences. You can do this, too.

This leads me to one more point about exploration patients. We have to carefully gauge their comfort level when it comes to interdisciplinary care and the price that can come with it. At Spear, we try to foster a mentality of interdisciplinary care. However, some dentists coming from a different environment are not used to interdisciplinary care. Just as they are not used to it, their patients might never have heard of interdisciplinary care. That means you must be willing to invest the right amount of time educating patients as to what is available and what is possible with interdisciplinary care. If you do not make that investment, then the patient may not be willing to invest in the treatment.

From Second-Opinion Patient to Practice Advocate

Ultimately, when a patient comes looking for a second opinion, he is inherently comparing and contrasting a previous experience, previous criteria. Instead of letting that scrutiny make you nervous, look at it as an opportunity to excel. This isn’t a patient looking for a new dentist who has been referred by a friend or family member. No, they’re coming into your practice ready to read into everything you say. These patients are looking for variables that may be beyond our scope of understanding at a given point.

That’s why we need to have our bag of tricks at the ready. Thankfully, Spear provides many of these tools, such as Patient Education videos and training on interdisciplinary care. If you are ready, prepared and can help them answer questions confidently and competently, then you just might win over the second-opinion patient and convert them to a regular visitor to your dental practice.

In my next article, I will discuss further the concept of analog/virtual interchange in treatment presentations. For now, I encourage you to use the Comment section below to share your methods for working with second-opinion patients. Or, if you’re a Spear member, you can share your tips on Spear Talk.

(Click here to ready more articles by Dr. Ricardo Mitrani.)

Ricardo Mitrani, D.D.S., M.S.D., Spear Faculty and Contributing Author - www.facebook.com/RicardoMitraniOfficial/