Does Your Practice Create Missionaries?

Build your relationships first….then your dentistry. ~ Bob Barkley

Does Your Practice Create Missionaries?

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“Being nice to people is just 20% of providing good customer service. All the smiles in the world aren’t going to help you if your product or service is not what the customer wants. Systems are 80% of customer service. The key is to devise systems that allow you to give the customer what he wants every time.” –Carl Sewell

The Power of Trust

Early in my career, I believed strongly that dentistry needed mass media campaigns to attract patients. All the “old guys” told me otherwise. They said, “The best communication is done in your office, one patient at a time.” Now, with fifty years of experience, I believe the best source of new patient referrals is the result of one-on-one trusting relationships with our existing patients and the exceptionally comfortable aesthetic dentistry they brag about to their friends. However, given the culture in which we live today, I believe that a tasteful public pronouncement of one’s practice philosophy, absent any statement that sets up expectation of a life-changing “miracle makeover,” is acceptable.

Today, there is great emphasis on TV commercials, and many dentists have colorful websites promising beautiful smiles and implying a life of success and happiness as a result. It is important to know that external marketing is expensive and needs to be a continuous effort. It is not a one-time splash. It takes time to develop an image/reputation in this way. If you take this approach, make sure you have the financial ability to stay the course and have the technical ability to deliver what the advertising agency promises you can do.

Marketing cannot resolve staff conflicts, high overhead, poor interpersonal relationships, and/or ineffective communication skills. Marketing cannot improve average technical skills, diagnostic acumen, cash flow problems, managerial and organizational ability. It cannot give you the confidence and competence to solve complicated interdisciplinary cases. Learning these skills and the knowledge to apply them appropriately requires dedication and discipline over time. It is not learned in a weekend technical or management seminar.

Attracting new patients is the result of building a reputation of competence and caring that exceeds our patients’ expectation with long-lasting health, comfort and naturally aesthetic dentistry. It is all the big and little things we do, such as a warm, caring, and empathetic team; developing trusting relationships; setting clear expectations; performing a comprehensive examination; respectfully treating people the way they want to be treated according to their behavioral style; helping patients choose a plan for life-long oral health; placing beautiful and comfortable provisional restorations; comfortable functional occlusion; and maintaining a clean, attractive reception room, operatories and bathrooms. These things require a commitment to excellence and attention to detail. The way the patient is greeted and seen by the doctor or hygienist at the appointed time matters. Fair and comfortable financial arrangements matter. Minutia matters.

The Post-Treatment Consultation

According to Kevin Hogan, author of The Science of Influence, the brain tends to remember that which happens first and last in sequences, events and life in general. The first appointment matters and the last appointment matters. People remember their peak experiences and how an experience ends and they generalize those two things back to the entire experience. This appointment is the last in the sequence on the new patient’s examination and treatment experience. It matters greatly.

This appointment is second in importance only to the new patient experience and examination. It is scheduled one to two weeks after completing a patient’s restorative treatment. This is the time to celebrate the masterpiece and reaffirm that the patient made a wise decision to accept treatment. It is important to discuss again the logical reasoning behind the treatment and determine that we satisfied the patient’s perceived need. It is important to review the long-term benefits and stress the patient’s responsibility for maintaining her/his oral health and financial investment.

It has been my experience that when patients have experienced the care, comfort, and aesthetics of our treatment, they feel the commitment to excellence of the entire team and begin to understand our purpose. When they believe we have done what is right for their best interest, they will find a way to pay a fair fee with gratitude and appreciation and welcome the opportunity to share their experience with several friends. A personal testimony from an enthusiastic patient has more impact than a scripted commercial. When we exceed their expectations, they become our marketing program (missionaries).

During this consultation, I use diagnostic models and digital photos to bring to mind the patient’s original problems. Many times, when the treatment is complete, patients forget the condition of their mouth before we began treatment. The before and after photos and models are powerful visual aids for illustrating the dentistry that was achieved, the treatment techniques that were employed, and difficult problems that were solved.

Together, we admire the finished results that fulfill the patient’s original desire. During the examination, the hygienist, laboratory technician, and lab assistant enter the room and admire the masterpiece. I point out how each team member contributed to the excellent result; and, restate the prognosis of longevity and health because the patient accepted treatment before her/his oral health deteriorated further.

Show with a mirror and photos the change in gingival health. Show how you refined the occlusion on the models and the results on final models and in the mouth. Explain why that is important. Confirm that their mouth is comfortable. Confirm that they are  happy with the aesthetics. Perhaps, say, “I hope you are as pleased with your smile as I am. What did your friends say? With the dentistry we have just completed for you and your renewed commitment to oral health, I believe you can look forward to many years smiling with confidence and eating most anything you want comfortably.”

After the treatment has been completed satisfactorily, it is important to reaffirm that the patient made a wise investment in her/his future health and happiness. Perhaps, say, “Mr. Important, you made a wise decision to have your teeth restored before your condition deteriorated further, I’m sure it wasn’t easy for you to make that decision because, in the beginning, you had no way to know what the final result would look or feel like. Thank you for trusting us to help you. It gives all of us a great feeling when we can help improve the quality of life for someone like you. That is why we enjoy practicing dentistry. Also, you might recall, before we began your treatment, I said that, when we finished, I wanted you to be able to tell me this is one of the best investments you ever made. How do you feel about that now?”

The Power of Influence

Many people feel good when given the opportunity to help other people. Why not let them know you would be pleased to help their friends who have dental needs. Ask them to be a missionary for quality dentistry. You might say, “Now that you have experienced what modern dentistry can accomplish, I want to ask a favor of you. Some of your friends and acquaintances most likely have similar problems as you had, but don’t know where to go for help. I want you to think about being a missionary for excellent dentistry. We would be pleased to help any friend of yours with the same care, skill, and judgment.”

Developing missionaries starts long before this appointment; it is a process that starts from the first telephone contact, the un-rushed diagnostic interview, comprehensive examination and diagnosis consultation, to the first time the patient is seated in an operatory for restorative treatment, and you say, “We want you to have a comfortable and pleasant experience today. If you feel any discomfort or need to rest, please let us know.” The patient has most likely never experienced this standard of care in a previous dental office. In the operatory, the patient is apprised of the treatment sequence and goals for today’s treatment. In my practice, we schedule rest periods during long appointments of four to six hours. We also have power shakes, magazines, and telephone available during these breaks.

One very nice lady, in her 40’s and recently divorced, came to us with a most unattractive smile hoping to turn her life around with a beautiful smile. After a thorough examination, she accepted a treatment plan for twelve maxillary crowns to create an aesthetic smile and improved functional occlusion. On the day of treatment, we followed our usual system and, at the completion, I sincerely thanked her for her cooperation, told her about my post-op expectations, and provided home care instructions, both verbal and written. Then I asked, “I hope your experience today was better than you thought it might be.”

It was important that she responded affirmatively to this question because, after the appointment, she was going someplace where people would know that she had been to the dentist. If we had been gentle, professional, and provided a pleasant and secure atmosphere, she would be very likely to repeat “It was better than I thought it was going to be.” In fact, though, she responded, “It really was very comfortable and much better that I thought it would be; and my new smile…well, now I look pretty!” What a wonderful day for all of us! The patient was called in the evening to verify a smooth recovery.

This lady went to a bridge party the next day. Two friends at the party knew she had gone to have dental work the day before and asked, “How was it really? It must have been terrible.” My patient repeated what she had been influenced to say, “It was better than I thought it was going to be, and how do you like my new smile?” Her friends were impressed. Then she added, “And these are just the temporaries!” Her friends couldn’t help but ask, “Who is your dentist?” One of those ladies, wanting similar treatment, became a new patient in our practice.

Taking the time to make excellent provisional restorations is one of our best referral sources. One periodontist tells his patients that he refers people to us because we make temporary crowns better than most dentists make permanent crowns. It doesn’t get any better than that.

Here is another personal story to make a point. Several years ago, twenty to be precise, at our local dental meeting, a long-time friend wanted to have dinner with me at a table away from the others. He wanted to ask a question. First, his story: “I was in the sauna after exercising the other day, and two men were talking, not paying any attention to me. One asked the other man, ‘How do you like my new teeth?’ The man said that they looked great, but said it must have cost a fortune to have all his teeth capped. The first man said, ‘It cost ten thousand dollars, and it was the best investment I ever made!’ The other man asked who his dentist was and he said, “Bill Lockard.” Now his question: “Bill, how do you get them to say that?”

That is what my book is all about! Everything we do in our office is a system designed to give the patient what he wants. The systems produce this kind of response. Unfortunately I hadn’t written the book at that time. My friend began to refer cases to me that he didn’t feel confident to restore.

In 1980 I decided to prove the validity of the dental missionary concept. I removed my office listing from the Yellow Pages for two years. The volume of new patients remained constant. The only person who seemed to be concerned or even notice was my mother. I think she called everyone she knew to tell them that I had not retired. Satisfied of the value of dental missionaries, I replaced the office listing in the Yellow Pages to please mother.


Systems take your practice from the vision to reality. A system is a set of ideas, information, and actions that interact with each other and other systems. Change one element in a system and that may adversely affect other systems. Any change must be coordinated with those responsible for other systems. Systems must be designed with clear goals, a standard of care, and definite sequence that is rehearsed until all team members know what to do, how to do it, when to do it, and why to do it in order to provide predictable and consistent results. Systems should be flexibly rigid to allow empowered team members to act appropriately in special circumstances.

Three Elements Important to Systems

  1. Mechanical Equipment – computerized system, digital x-rays, office décor, TV monitors and intra-oral camera in each operatory, music sound system, answering system, etc. 
  2. Information – thank you letters to patients and specialists, statement of purpose, expectations, and standard of care, patient records, appointment book schedule, management income statement, inventory control, treatment plan sequence form and new patient examination form. 
  3. The Interaction between People – the words we say and how we say them, considering the personality/behavioral style of the person to whom we are speaking. Also included are how and when to use diagnostic models, x-rays, and photographs as instructional aids, and appropriate dress code. 

The demographics of your patients and their perception of professionalism will greatly influence their decision. The office dress code should influence the patient’s opinion of your professionalism and credibility, not your idea of what is currently stylish. Each demographic model has a specific set of perceptions that we can identify in advance. People of a certain age, with a certain amount of education, living in an affluent area, buy for specific reasons. They possibly have very different values for technical excellence and aesthetics than those of another group with different education, marital status, living in a less affluent area or different part of the country. That is the socio-economic classification Dr. Pankey spoke about. These differences predetermine what each group will perceive as important to purchase and from whom to purchase it.

The inspiration for this concept of developing Dental Missionaries came from Dr. L.D.Pankey, Dr. Harold Wirth, and my father, Myers W. Lockard, DDS. Their thoughts and experiences impressed upon me how important it is to distinguish yourself at an exceptional level of professionalism and care that will enable you to succeed in doing the dentistry you enjoy with patients who appreciate the way you interact with them. The clinical excellence you provide – your caring and professional team, and the trusting inter-personal relationships you develop – changes lives, theirs and yours.

Bill Lockhard, Jr. DDS

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“Thanks so much for your continuing efforts to promote and advance the concept of the relationship based practice.” – Jim Otten

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