Why Dental Patients Say No to Treatment (And Why You May Be the Problem)

I'll never forget a patient who walked into a dental office in Alabama while I was consulting with the team.

We had just finished a meeting when someone knocked on the door. When the team opened it, there stood a woman wearing a house robe over her pajamas, bunny slippers, and hair that looked like it had been braided about two weeks ago.

She wanted to see the dentist about some problems she was having with her teeth. As it happened, the practice had an opening, so the team brought her back, took X-rays and intraoral photographs, and worked with the doctor to determine what treatment she needed.

A few minutes later, the doctor came looking for me.

"Dude, she needs $6,000 worth of treatment. She doesn't look like she could afford one filling. Do you really want me to tell her everything she needs and then have my office manager present her financial arrangements?"

Now, I understood his hesitation. He wasn't trying to be a bad dentist. He was concerned about overwhelming a patient who, based on her appearance, didn't seem to have the means to pay for extensive dental treatment.

But after years of working with patients and dental teams, I had learned something he was about to discover for himself.

"Yes. Do that."

He smiled, shook his head, and went back to work.

He explained the treatment she needed and why she needed it. He used her intraoral photographs to help her see what he was talking about, and he confidently explained how much better she could feel after getting the work done.

Then his office manager met with her in the consultation room to discuss the financial arrangements.

What happened next nearly knocked them over.

"Do you take cash?" she asked.

The woman walked out of the office and returned about 20 minutes later with $6,000 in cash for her treatment.

Six thousand dollars.

Some people keep their money in bank accounts. Others keep it under their mattresses.

You never know who you have sitting in front of you.

And that's exactly the point.

How Many Decisions Are You Making for Your Patients?

I can't tell you how many dentists I've worked with who are excellent clinicians but become surprisingly timid when it's time to recommend treatment.

They see a patient who looks like they're struggling financially and decide not to bring up the expensive crown. They suspect someone won't want to hear that several teeth need treatment, so they soften the recommendation. Or they tell themselves that the patient has declined treatment before, so there's no point bringing it up again.

I understand why they do it. Most dentists genuinely care about their patients. They don't want to embarrass someone, appear pushy, or recommend something the patient may not be able to afford.

But here's what I want you to consider.

Who gave you permission to make that decision for them?

That doctor in Alabama was about to make a $6,000 decision on behalf of a patient he had barely met.

And he would have been wrong.

Now, I'm not suggesting that every patient has $6,000 hidden in a mattress. Many patients have real financial limitations, and we need to respect those.

But we can't know what a patient is willing or able to do until we give them the information and opportunity to make that decision.

Your job is to diagnose the problem, explain the treatment, communicate its importance, and help the patient understand their options.

Their job is to decide.

Don't do their job for them.

Are You Actually Asking Patients to Schedule?

There's another problem I see almost everywhere I go.

A doctor diagnoses treatment, explains what needs to be done, and tells the patient something like, "We should do this as soon as possible."

What does that mean?

If the treatment is important enough to recommend, why aren't we recommending when it should be completed?

In the practices I work with, we often aim to schedule major treatment within three to five days and minor treatment within five to ten days, when clinically appropriate.

That means we need to confidently recommend the patient to schedule within that timeframe. It's as simple as telling your hygienist or assistants, "Because this is major treatment, we should schedule them back in the next 3 to 5 days even if you have to rearrange my schedule."

Not someday. Not whenever they get around to it. Now if you've read my book on scheduling you know, we are not rearranging the schedule, but we are putting the idea in the patients head that this is really important.

Imagine the difference between saying, "You need a crown. Let us know when you're ready," and "I suggest we get this taken care of within the next three to five days.

One statement communicates a diagnosis. The other communicates a recommendation and gives the patient an opportunity to act.

And yes, sometimes the patient will say no.

That's okay.

At least we've given them the opportunity to say yes.

What Happens When the Patient Says No?

This is where I believe case acceptance becomes much more complicated than people realize.

I've watched team members become so uncomfortable discussing money that they rush through the financial presentation, avoid explaining the patient's actual responsibility, or never offer reasonable payment options.

Sometimes they're afraid of estimating the insurance benefit incorrectly. Sometimes they're uncomfortable telling someone they owe several thousand dollars. Sometimes they just don't want to hear the word "no."

The problem is that patients can't agree to a financial arrangement they don't understand.

And what about the patient who knows the price but still doesn't schedule?

Too often, we interpret that as rejection.

But what if they're confused? What if they don't understand why the treatment is necessary? What if they understand the need but can't figure out how they're going to pay for it?

Those are three very different problems, and they require three very different conversations.

Patients need to hear what they need to do four to six times before they will start to understand the importance of accepting treatment. This can be a simple strategy that your entire team participates in, but if they only hear what they need 1 to 3 times, they will likely leave your practice confused.

Sometimes the patient simply isn't ready, but in my experience, most teams don't understand the value of repetition.

The Lesson From the Lady in Bunny Slippers

I still think about that office in Alabama.

What would have happened if I hadn't been there that day?

Maybe the doctor would have presented all the treatment anyway. Maybe he would have mentioned only a filling or two and suggested they revisit the rest later.

We'll never know.

But we do know what happened when he set aside his assumptions and gave the patient the opportunity to decide for herself.

She said yes.

And she returned with $6,000 cash.

So here's what I'd like you to do tomorrow. Pay attention to the conversations you'renothaving with patients. The treatment you're hesitant to recommend. The scheduling commitment nobody asks for. The financial options that never get explained because someone assumes the patient can't afford them.

You might discover that your patients aren't saying no nearly as often as you think.

Sometimes, we're just afraid to ask.

You've probably heard the saying, "You miss 100% of the shots you don't take."

Well, that applies to dentistry, too.

It's not your job to decide whether your patients will say yes. It's your job to give them the opportunity to say yes.

If this sounds familiar, I'd love to hear what your practice is experiencing. Sometimes the first step toward improving case acceptance is recognizing the conversations your team has been avoiding.

Jon Rutty | That Dentist Guy

Jon has spent more than 15 years consulting with over 150 dental practices on case acceptance, scheduling, patient communication, team performance, and profitability. Learn more at ThatDentistGuy.com.