Editor’s Note:

Want to hear more “Frank phrases” from Dr. Frank Spear himself?

To hear him talk more about presenting a “report of findings”—as well as more about the Spear research study discussed in this article—check out the online course, Case Acceptance in Modern Dental Practice, Part 1. He also talks about having the “What is possible?” discussion in the course, What Does a Comprehensive Approach to Treatment Planning Look Like?” And to get a hands-on immersive experience that fully expands on the Spear philosophy of treatment planning, be sure to check out our popular campus workshop, Facially Generated Treatment Planning. 


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Show Them Everything —

Spear teaches dentists to use a consistent method to record exam findings. The clinician looks at Airway, Esthetics, Function, Structure and Biology (AEFSB) to ensure a full picture of the client's overall oral health is obtained during the exam. Notes are recorded and a complete report of findings should be presented to the patient at the exam's conclusion.

Presenting all of the findings is crucial because it ensures there will be no surprises for the patient. But why is eliminating surprises so important?

To answer this question, let's look at some research Spear did in 2018 when we analyzed dental office Yelp reviews from across the country. Through sentiment analysis, we categorized reviews to better understand what makes patients happy or unhappy. We found that 63% of negative reviews alluded to some sort of communication error. As we scrutinized, a common theme among negative reviews became apparent. Most negative communication reviews had a tendency to begin with the patient being surprised by something. This then led to some sort of conversation that left the patient feeling displeased. While you can't make everyone happy, the more you can do to set expectations helps sidestep huge communication landmines.

This finding aligns with what we saw in Spear's initial research for our Patient Education platform. As part of the platform's creation, we worked with a medical research firm that brought focus groups together so we could learn how patients would react to the video animations we created.

During focus group sessions, we heard several conversations about patients changing clinicians within the previous two years. They described how during their prophy appointment the clinician found several issues to be addressed but questioned why those same issues were never mentioned at previous appointments.

While this was a small sample size, the patients were consistent when sharing their feelings and their desire to get a second opinion. In each case, the patient ultimately went to the clinician who gave the second opinion even when the same dental issues were identified.

The insight gained from these two research experiences is to give a patient a complete list of findings. Discussing treatment and moving forward are separate actions, but what we know now is that holding back findings or showing them what you think they can manage (or pay for) will ultimately be harmful to the practice. The key is not to surprise them later, but to build trust by being upfront from the outset regardless of how long they have been with the practice.

Moving From a Report of Findings Into “What is Possible” —

Once a patient is aware of the findings, then it's up to the clinician to move the patient's mindset to where they are ready to learn about possibilities. This transition is crucial if a practice wants to increase the average case size in new or existing patients. Beyond the economic value for the practice, it also allows the patient to actively participate in their treatment decision.

Dr. Spear uses a simple phrase to smoothly transition from a “report of findings” to a “what is possible” conversation. While he adapts it slightly based on what the patient is presenting with, he essentially asks, “Would you be interested in learning more about what we can do to correct _________?”

It is a simple but powerful question. First, it removes a power differential as it puts the patient back in charge and makes them responsible for their own treatment. Read my last article to understand how this helps to further counteract the effect of previous case presentations (see Friestad and Wright's persuasion knowledge model).

Secondly, when the patient agrees to learn more (and most everyone does), it causes their brain to listen to what you have to say. This is called cognitive dissonance and it was studied in the 1950s by Leon Festinger. Essentially, when people say (or do) something that they do not believe in, they create turmoil in the brain called dissonance. Humans then tend to change their beliefs to match their actions in order to relieve the dissonance.

So, what does that mean for our patients who agree to learn about possibilities?

Essentially, the act of saying yes is enough to change or strengthen their beliefs that they really do want to hear more. This results in a more open-minded and interested chairside listener. Does this mean they will move forward with recommended treatment? Not always, but it does ensure they will truly listen to what you have to say and consider it. This consideration is essential to building a strong practice.

Think about your own time in practice. How many times have you presented something to a patient to no avail, then suddenly years later the same patient tells you they are ready to move forward? Most clinicians I have spoken with attest that this really happens, but it won't happen if you don't show patients your findings and educate them on what is possible.

Adam McWethy is Vice President for Content Strategy at Spear.

​More “Frank Phrases”


Commenter's Profile Image Connita W.
July 14th, 2021
Great information! I completely agree with discussing/showing patients your findings and educating them on what is possible- it builds trust and if nothing else, it plants the seed.