Case Acceptance Isn’t a Script. It’s a System (E.149)

Dr. Wade Kifer: Yeah, I, I, if I recall it's about 2009 or 10, somewhere back in that range. So a long time. Nearly the turn of the century. Dr. Wade Kifer: That's right. Well, today you're here, uh, as part of our Clinical Calibration Institute faculty. You are, I wanted to get this right. You're a part of the COIs, uh, center faculty. What's your specific title there today? What do you do at the COI Center?

Dr. Wade Kifer: Uh, well, I'm a clinical instructor at the COI Center and a course facilitator, so I go up and try to help with the, uh, treatment planning and occlusion course a few times a year. So just try to help out and. Give back as much as I can up there. I love that so much. Um, and it's been great to watch you from COI student to Coys mentor to to instructor.

It's been quite the journey and one of the things that you say to me all the time is, yes, I can nerd out on the science, but the science doesn't matter if you don't know how to communicate it to your patients. And that's what I wanna get into today. In this episode, which we're titling, case acceptance is in the script.

It's a system, and I know you're very systematic and you do have scripts, but you've also taught me that if patients are saying, no, it's not, you're not losing them because of that, you're, you're losing it because you never got aligned to what Yes. Really looked like. So I'm gonna, I'm gonna give you that as your jumping off point. How, how do you keep case acceptance aligned with the team in your practice? Dr. Wade Kifer: Well, I mean, I, I, it's not one thing, right?

So case acceptance doesn't start, like you say, a line or anything. So first we had to have our philosophy and I mean, not to sound cheesy, but it's not like sitting down and going, writing down your philosophy or anything. But for us as a team. We're all on the same page. You know, we meet monthly, probably five to six hours talking about everything we do. Um, I always say, you know, John COIs taught me how to do high quality dentistry, but I wasn't doing it even when I learned it.

Um, and I give. Bruce spared a lot of credit for teaching me how to communicate it. So for us, you know, I've been doing this long enough now that there's no magic. If you're out there listening, there's nothing I do that you can't. I. Do. Um, but one thing we do is we train on it and we practice it. We rehearse it, and it's not a script, but everyone on our team is on the same page.

We all, we do risk factors that Dr. COIs taught and that Bruce Baird teaches, and we communicate those to our patients. In a system. So when we have a patient come in, they know our philosophy, they know we wanna lower risk for their overall health and for their mouth. Um, I like to look at the patients and say, if I could predict what you're gonna look like in 15 years, wow. Dr. Wade Kifer: And I like it. Keep doing what you're doing. It seems to be working for you.

But if in 15 years we see that you have the potential for a lot of problems. What do we do to change? Because you don't want those problems, right? So if we can eliminate those problems, then it's there. So there's always two phases for a treatment in our office, it's one, fix the damage you have done to your teeth. Two, what do we do to lower the risk of that damage? I. And that's our philosophy. So there's no script for us. It's just talking to the patients about that.

And the hygiene is worried about the risk for your overall health from your gums. You know, the whole office is looking at occlusal risk. For example, if a tooth's broken, did it break because there was a caries problem, an erosion problem, or a bite problem? Yeah. If we control that risk, then we do it. Because I also tell the patients if what damaged your teeth? Isn't fixed. It'll, my restorations won't last either.

So we take a philosophy where the whole team is on the same page and we meet on it. And if you're anything like most offices, it's like just 'cause you tell a team once outta sight outta mind, you know, we're going over the same things. Every year with our team reiterating and reiterating, and then over time it just starts to sink in. So it doesn't happen overnight either. It's, it's a lot of work, but it's rewarding and it makes things work a lot smoother.

Well, you giving a success clue here and on investment grade practices, we're always talking about what makes this business more valuable. And part of that is team alignment. I mean, without team alignment, revenues are up and down, depends on how many days you work, depends on who showed up to work, you know, all of that. Mm-hmm. And, um, it's funny, you and, uh, Jackson Bean and all, uh. John Aler. I can just keep going down the list. I'm seeing you in my mind's eye.

You all say the same thing. We have half a day, a month that we're doing this. Now Jackson will say we do a poolside with adult beverages. I don't know what they do in Arkansas. And you're a practice. Uh, you're probably not, you're not poolside in the winter for sure. Dr. Wade Kifer (2): No, no, no. Not in the winter. It's beautiful now, but not in the winter. I love it. And so you're doing this in Arkansas, right?

So do you mind sharing, just to give some context around what your collections are annually? Or production. Or production per hour, anything like that? Like where you were maybe five years ago, where you're today? Does it, is it. Consistent. Does it stay strong? Does it grow?

Dr. Wade Kifer: Yeah. You know, I mean, we're, we're like any office, um, you know, a couple years ago we were stale, so we didn't go up, you know, we're up a little bit this year, you know, but I, when I was at PDAI was at 300 an hour, and now, you know, I'm over 1200 an hour. Um, just personally myself and as much as I like to. The meeting time and people say, well, I don't have time. I can't put it in.

I mean, if you add up all my doctors and my four hygienists, you know, we're probably 3000 an hour and we're doing eight hours of meetings a month. Yeah. Dr. Wade Kifer: So we're giving up $20,000 of production time to meet. Yeah. Dr. Wade Kifer: And so that sounds crazy to some people, but I would say we wouldn't be that productive per hour if we didn't. Do it right. And so I always tell people, put it on the schedule. Six months from now, just start with four or five hours a month.

You don't even know what it is, but if you add up your hourly office, it almost hurts to take that time off right at that point I. I will then come up with what the topics need to be. Where are we struggling? How are we not in alignment? Um, 'cause I don't wanna waste the time either. We wanna be productive. Now we have fun too. There's always one meeting a quarter where we just surprise the team and say, Hey, we're going bowling. I. Yeah, Dr. Wade Kifer: yeah, yeah.

For a couple hours or whatever and, and you need to do that too. But, you know, we'll meet tomorrow. We have a two hour meeting, it's, we're taking an hour outta lunch and an extra hour. So we're only losing one hour of production. But that time is important and that time is what allows us to grow. 'cause we're doing philosophy, we're doing.

We try something new with collections or finance plans, the whole office has gotta be on the same page because if you're not, you just look like you're, I don't know, not in sync. It's just not smooth, you know? Um, we talk because I mean, my average treatment plan given to a patient's over $6,000, you know, and these patients that need a filling. So when your average is that big, you're doing a lot of 10 and 15 and $20,000 treatment plans. You can't fumble through those.

You don't go to Chick-fil-A and they give a $10,000 treatment plan. You know, if you're going somewhere high end, that's gonna give you a big treatment plan, right? Dr. Wade Kifer: It's gotta be rehearsed, it's gotta be practiced, it's gotta be, it's gotta be right. Yeah. I love that. So, uh, I'm gonna slow this down because you just, you dropped so many golden nuggets there and it's on this topic.

It's like K'S acceptance is not a script, it is a system, and part of your system is team training. And that is literally why Bruce and I develop the Clinical Calibration Institute. Yeah. Like, uh, we didn't even realize until about five years ago, that's what we were doing. Like as you and other people were coming through coaching and, and, and we'd say, okay, well is everybody on the same page with this? And let's like go through a form and you've really taken this to an art form. You're like.

Here, let's all look at this one case and how would we treatment planet, and what did we miss and did? Did we get bike guard? No bike guard? Do they need fluoride? Are they hot based on their risk? So, you know, just in the beginning we would have offices just monthly, pull a couple of cases and go through the case and get everybody, which seems silly. Like why would I get a brand new employee who's working at the front desk even attempt to write out a treatment plan?

Well. Because they've heard, they listen in the hallway, they pick up things, and that's gonna be the person, the patient ask, should I have this time? Mm-hmm. So it's always gonna land on your least experienced, least knowledgeable person to kind of close the loop. Sometimes and say, man, I trust the doctor. And in fact we sit down each month and we go through this like even your newest youngest do that. So that was a huge piece that you dedicate the time to training.

And that's how CCI got born because. Think about it. I mean, well, you tell me you're coy strain, so you've got a master caries, perio, you've mentioned occlusion several times. Airway is now standard for comprehensive exam. Right? So caries, perio function, airway, aesthetics, emotional risk, like that's. There's five or six things you have to master.

So as a clinician, how many years and how much time did it take to say, I'm really feeling good about the biological and lifestyle risk of caries and how to manage that. I've got my perio dialed in, I've got function occlusion of it. What does it take to like be at the top of your game? Dr. Wade Kifer: Well, you know, I mean. I was up at the COI Center last week and I had someone that basically said, well, you've made it. And I said, Y, yeah, I'm further along than you are.

But when we just go back to the meetings with the team, we meet with the team and we spend three hours and we talk about. Perio for those three hours, and that seems like a lot. They still don't know a fraction of what, you know, in three hours, right? Dr. Wade Kifer: Every quarter we add something, you know, we may spend the rest of that quarter just doing perio, and it's not that we're not neglecting everything else, but. It takes time.

So if you can just get your team better at one thing a quarter, and then you look up four years later or five years later, and you're almost just a master at all these things, but it, it, you can't teach an entire team and you yourself can't learn an entire occlusal philosophy or anything in a month. Right. You know, it takes time. So, I mean, I have the benefit of saying, you know, I've been doing advanced education, I. Even outta dental school since 2008.

I graduated in 2003. And so it's easy to say, well, you've mastered a lot of different things and I have, I still have a lot to learn. Right? Right. And so it's tackling one thing at a time and going, okay, I went to this class. If you will go to a class or go through PDA and say, I'm gonna, there was a lot of information, let me start here and master that. There's almost this sense of accomplishment of, oh, I got better at that. Now let me go tackle.

This, and so it, you know, each year you get a little better, your production goes up, your patients get healthier, all that goes in, and then that's almost there, but you still need a review on some of those things that you've mastered too. So especially as you bring new team in and everything else. So that's what I would say is it's not overnight. You know, and a lot of times you look up and people, someone says, well, you, you've made it or you've done this, and you don't.

You'll never feel like that until someone sells that to you. Then you look back and you go, well, I have done quite a bit of stuff, but in the process you're not thinking that way, so you just have to do it. Well, and there's, there's some listeners on this podcast going, well, good for you, Wade Kier. You're a COIs instructor. I'm not. So where do I get the training materials to train my team like that? That literally is the birthplace of CCI is.

Yeah. We're so blessed to have you and Kim Koch, who does the caries research for COIs. Uh, Dr. COIs has generously allowed us to use his medical history as a, as an icon, you know, to talk about how to integrate, um, medical, dental histories. So all of this training is online. We walk you through some of those, uh, team meetings. We're helping, like CCI has on its campus. Outlines and facilitator guides for staff meetings from an hour to five hours. We have virtual trainings.

You can do masterminds, you can do communities you can tap into. 'cause unfortunately not everybody's wake er and they know how to teach all this stuff. Dr. Wade Kifer: They can though. It's, you know, I mean, I got into teaching this stuff only because I was there learning and giving my experiences and someone said, well, that's neat. So then you're on stage.

But. I'm there on stage some teaching, but then I'm talking to Michelle about the Perio program and Michelle's teaching me stuff and then I go back and I implement some of it, and then I hear something new, and next time I talk to Michelle, I bring up something. She goes, well, that's really good. And now we're co collaborating. And it's just being around people. So I know you're wanting to get mastermind groups going.

I know that's getting rolling right now and everything, so we learn from each other too. And you, everyone, a bunch of people can go to a class I. And listen, and everyone picks up something a little bit different. Yeah. Right. And, and some people have natural skills in one area versus another. And so that's what the great part is when you get with colleagues and meetings and stuff, a lot of the learnings on the hallway Oh, yeah.

Dr. Wade Kifer: Together and talking and like, oh, I picked up, oh, I, I remember him saying that, but that didn't click that way. Right. So, you know, I, I think that's very valuable part of all this. Yeah. And thank you for bringing out the master minds in communities. It's, it's a very different experience being in a curated group of like-minded folks. Dr. Wade Kifer (2): Yeah. Versus just jumping into dental town and asking a question like, that's two very, very different. Things. Alright.

Bringing back to this topic of case acceptance and script or no script, there's a system, there's a lot of training behind it. You, you, you, I get that, but there are scripts. I know you've also said, oh my god, my team rolls their eyes every time. 'cause I say the same thing every time. So give us some of your, um, things that help you connect with patients during the new patient exam when they might be a little frightened or embarrassed. What do you, what are some of your.

Takeaways that you can give us today? Dr. Wade Kifer: Well, you know, I, I've, I've said this line before and it gets a laugh, but we have our scripts and our philosophy and we've explained that to patients, but then it's really the linking. And I know Bruce talks about the linking, and I always dig down deep and, and I want to get deep into their why and why they have the problems. And I always say, if I can get the patient to cry, I've won.

I. And that sounds bad 'cause I'm not trying to make 'em feel bad. But if I can get 'em to connect on such a deep emotional level, if they can afford the treatment, they'll do the treatment. Yeah. Because if whether it's the embarrassment, frustration, just imagine your patients who've come in and every time they go to the dentist, 'cause I know you hear this, please don't find anything today, doc. Dr. Wade Kifer (2): Mm-hmm.

Dr. Wade Kifer: Please don't like your job's to not find something, so then you feel guilty. And so when they do that, I turn around and go. I'd be frustrated too, if every time I came in, I. You had a problem. I had a problem. So I understand your frustration. So I want to get on their side and now all of a sudden it's not, don't find something, doc. It's me on their side, not me against them. So if I could say anything, it's how do we link with the patients enough that we're on their side.

We don't want to find anything either. And if we do. I'm the solution to their problems. Not telling them they have problems. Let's not just fix the tooth. Let's figure out why this is happening. Now that be wrong. Some people just need to pick up a toothbrush. We all have patients that do crappy jobs and don't have problems. So what do we need to figure out? Let's get on the patient's side emotionally. So it, it takes energy. That's why I don't, I can't do this five days a week, every week.

'cause it's emotionally draining for me and my coordinators, and my assistants because we're in it with the patients. But it's way more rewarding doing it that way. You know, I've, I've also heard you say to patients, I love the linking and all of that's like in our first course on how to do that. But you actually, um, give them a common enemy. You know, this isn't your fault. Yeah, it could be. Pick it from there. Like you tell patients like, man, whatever.

I see, just know it's not, it's probably not your fault. There's other things happening here. Dr. Wade Kifer: Yeah. And so when we get a patient who's got problems, you know, one of the lines I always use with patients is caries cavities is a bacterial infection. Periodontal disease is also a bacterial infection. If it was all how well you did, you'd either have both or neither.

And so many of our patients have one or the other, meaning your immune response has a lot to do with whether or not you're getting these things. And so I will tell patients all the time, I'm sure you have friends that do worse than you do taking care of your teeth and don't have your problems. I'm sure that you know, you know patients that took great care of themselves and end up with cancer and you don't feel guilty if you get a medical diagnosis now. I mean, if you smoke and get lung. Cancer.

Yeah, it's probably your fault. And, and, but a lot of things happen to us and we don't feel guilty, except when we go to the dentist, we always feel guilty. So in this case, we're gonna figure out what works for you because it's not fair. Sometimes you have to do things extra to keep your mouth healthy than your spouse. For example, all the time was your spouse that never flosses and doesn't have the. Problems the other spouse does. And I'll say, that's not fair, but that's the way you are.

That's your immune system. So it sucks, but we're here to help. We're gonna figure out what you have to do to stay healthy, and that's different for every person. So don't feel guilty. Well, I will, I, I, so many light bulbs going off in my head in that one vignette. And you know, I think at our best, that's where medical and dental, uh, care is going is individualized care. Yes. And I love that. That was a new aha for me. They either have. Carrie's or perio? Both or neither.

Like there's, there's a range here and we've got a figure. Yeah. It's kinda like Pete and I, you know my husband Pete. Dr. Wade Kifer (2): Oh yeah. Pete could eat anything. Right. For breakfast. He had an egg, he had sausage, he had those frozen hash browns. He had black coffee. And I'm thinking, oh my God, I would die if I would literally die because I'm allergic to eggs. I'm gluten free. I am this, I'm that.

And so mine is, I'm like, look, honey, you could have my breakfast, which is broccoli, asparagus. Steamed with sweet potato and some mango. And I'm thinking, yum. And he's like, that is disgusting. And so, but his biology, my biology, very different. Dr. Wade Kifer: Very. And I use that exact same line almost because I tell patients, I say, I'm sure you have friends that eat whatever they want and never gain weight. And other people look at a donut and gave five, gained five pounds.

That's the exact line and the patient shake their head. Right. And they can relate that to metabolism is just something we were given genetically. And I mean, there's things we have to do. So you may be the person who has to watch what they eat, you know, all those factors. And it's the same way in dental. Don't feel guilty.

Yeah. Well, even though you're not heavily scripted, I. Just benefited from you sharing some of those things you routinely say, and I can see how it comes from your philosophy and your mindset of, Hey, you know, I. I'm gonna be in this with you. Yeah. This may not be your fault. Let's discover what's going on. Let's prevent it from happening. You might be different. I mean, you really do have these nuggets of, of great conversation, right?

Yeah. That, that get you on the same side as the advocate, uh, for care. Dr. Wade Kifer: Yeah. And our script in our office is in the front end explaining the philosophy. Right. So we, that sound like. Dr. Wade Kifer: So we, we come in and we basically say in our office, we're gonna look at these five main areas. We're gonna look at your bite and jaw, joint teeth, gum and bone. We're even look at growth and development and the aesthetics. And we're gonna look at your potential for problems.

'cause everyone has a different potential for problems. And when you come in our office, we kind of take a medical model approach. 'cause we're gonna say, if we can take that potential for problems, what do we do to lower that potential? Mm. Does that make sense? And then they'll say yes. And then so afterwards is when I start going into those certain things. When they're high risk for caries and not perio, I might use the diet analogy or vice versa.

Um, I'll use analogies when I talk about termites being an infection that they have in their mouth, and I've given that in a couple speeches, but those are, then I individualize it to it, but it's always lowering risk. And it's always on their side. It's never a blame gang. Well, I can see if your role playing that with your team, why it takes five hours a month, the, you know, and why you would wanna spend three months on, on perio, I mean, yeah. Um, yeah.

Wade, such a joy being with you always. Uh, thank Dr. Wade Kifer: you much. You have definitely built an investment, great practice. You are a terrific leader. You are an amazing clinician and a, a really good friend. So thanks for being here today. Dr. Wade Kifer: Well, thanks for having me. It's fun.