The Consultation

The patient walks in. He’s a new patient, booked as a consultation. I don’t know anything about him but something tells me that this is going to be a painful appointment. I’m not sure why but I’m slightly anxious.

I hang up his coat and he takes a seat in the chair.

I haven’t even had a chance to introduce myself or ask how I can help and he says ‘I want composite veneers.’

Hmmmm. ‘Okay,’ I say. ‘Why do you want composite veneers?’

‘I want a perfect smile. My teeth are worn down so they need building back up so I want composite veneers. I want the best. I’m happy to pay but I want the best. I’m looking for the best cosmetic dentist. I don’t want bog standard, it has to be the best. I’m happy to pay.’

This guy hasn’t stopped to take a breath. My nurse subtly gets the oxygen cylinder out, ready for the inevitable vasovagal.

‘I want to know how many composite veneers you’ve done. I want to know how many different cases you have done with composite veneers. Can I see your work? Do you have any before and after pictures?’

He takes a breath and the oxygen is stowed away for the next lucky punter. It’s my turn to speak. ‘What is your main concern? What do you want to change?’

‘All of my teeth need composite veneers. I want to know how many composite veneers you’ve done. Can I see your before and after pictures?’

I take an educated guess at how many composite veneers I have placed. I explain that we have treated many more cosmetic cases and composite veneers are not the only possible solution. The patient listens as I briefly mention other aesthetic treatments. I suggest that it might be worth me taking a look at the patient’s teeth and then suggesting the treatment most appropriate.

‘Can I see your before and after pictures?’

I’m not sure why I’m here when a photo album would have worked just as well. I suppose that the photos would need something to hold them so I assist the photo album as a stand. I show the patient my favourite case that I have treated with composite build ups.

Composite veneers

The patient considers the photos and gives his verdict.

Oh, I see that these are bog standard composite veneers. That’s not what I want. The edges are rounded between the teeth. I want them to be even and straight. I’m happy to pay. Can you do that?

What I could have done…

It can be tempting to persuade patients like this and advise them what you could do differently to meet their demands. ‘Oh, yeah. The patient wanted them like this. We can do them straight and even for you, no problem.’

I could have banged on about the diagnostic wax up and how the patient can check that he’s happy with what we plan before we do the treatment. I could have done everything possible to give him confidence that he should have treatment with me.

What I actually did…

‘I think you need to see another dentist.’

For the first time, he sat in silence. He was the consumer and he wasn’t being invited to consume. I thought that I might need to explain more but I decided to wait for his questions.

But no more questions came. The patient’s confusion faded, he thanked me for my time and he left.

At no point was I even allowed to see his teeth.

It was quite a surreal few minutes. Fortunately, it was only a few minutes and I didn’t charge the patient for the appointment because he hadn’t actually let me do anything for him.

Alarm bells

There were the obvious alarm bells such as the patient having created his own treatment plan and now clearly just shopping around. And there was the feeling of unease as the appointment started. I cannot put my finger on what it was apart from a gut feeling that this was not a patient that I should be treating.

‘I cannot meet your expectations.’

Do not be afraid to say this. Especially with patients who make you uneasy or nervous. It’s much better for everyone if you are honest at the outset.

My big problem with courses for dentists where they teach about sales (ethical sales, short term ortho, you know the ones) is that they teach you how to sell to patients but they do not teach you about who you should be treating. Frankly, they do this because they do not give a monkeys if you sell your treatment to a nightmare patient. It’s not their problem; it’s yours.

As mentioned above, I didn’t even get to see this specific patient’s teeth. Even if I had, it is unlikely that he was going to give me the chance to suggest a treatment plan to him. I’m very grateful to him for this because he saved me wasting a lot of time.

Treatment planning is the key stage in providing any dental treatment. If you would like to read more on my philosophy to treatment planning, take a look at this next article.

How to treatment plan

Read Andrew’s philosophies when it comes to planning complex treatment.

Follow Andrew via email

Enter your email address to hear about Andrew's latest posts by email.