Episode #493: Helping Patients Make Good Choices, with Dr. Jim McKee

Your average intelligent patient wants a healthy mouth. But for that to happen, they need help making good decisions. And to guide you into developing informed, enthusiastic, and committed patients, Kirk Behrendt brings back Dr. Jim McKee from Spear to share the wisdom he learned and applied from his predecessors. Don't just sell crowns — give patients the choice of better oral health! To learn how, listen to Episode 493 of The Best Practices Show!

Episode Resources:

• Dr. McKee’s email: [email protected] 
• Dr. McKee’s Facebook: https://www.facebook.com/jim.mckee.104
• Dr. McKee’s social media: @jim.mckee.104
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Links Mentioned in This Episode:

Dr. McKee’s Advanced Occlusion workshop at Spear: https://campus.speareducation.com/workshops/advanced-occlusion/details/syllabus

Dr. McKee’s Demystifying Occlusion seminar at Spear: https://campus.speareducation.com/seminars/demystifying-occlusion/details/schedule

Dr. McKee’s study club: https://chicagostudyclub.com

Main Takeaways:

Put your patients’ needs first.

Inform and educate your patients.

Break down treatment into stages.

Make patients feel informed, not sold to.

Give patients time to think about treatment. 

Quotes:

“Everyone hears “complex treatment planning” and they think there's going to be a full-mouth reconstruction. Not true. I've done a lot of full-mouth reconstructions two crowns at a time. And it may take six, seven years to do the whole case. But it was done at a pace that the patient could afford to do it, both maybe financially and emotionally, because sometimes patients really aren't ready to make that full commitment. That’s what I mean about helping patients make good choices.” (5:22—5:48)

“What I did in the early years, I would do the two crowns and I'd forget about the rest of the case. What's changed is, if we keep the patient’s best interest in the forefront of our treatment planning thought process, that was what forced me to learn how to phase treatment. And once I could phase treatment, my case acceptance went up. Because face it, you're going to do a full-mouth rehab, or someone needs that level of dentistry, whatever it is. That's a big ask. And a lot of times, patients simply can't do it. So, therefore, it becomes helpful as a dentist if you can break that down into stages.” (5:48—6:24)

“There's an old saying that every full-mouth rehabilitation is a number of single-unit crowns on the same patient. So, if you can start breaking it down to make it easier for you too, [you will] really enjoy starting to take on more complex cases.” (6:24—6:42)

“I was teaching at The Pankey Institute, and a dentist said something that I'll never forget. He goes, ‘I try never to take an impression of more than six teeth at a time.’ Because for a crown and bridge, if you're going to take a full-arch impression, that's a lot to do and to keep everything dry and get accurate margins. The key to being able to do that is having good provisionals. And once you can master that . . . then you can start to break those cases down to help patients make good decisions.” (6:54—7:29)

“[I] have a discussion with [patients] to raise their knowledge level because, quite frankly, they can't make good choices if they don't have a knowledge base to support that decision. So, part of our job is helping them understand what they need to do. Because otherwise, what are they going to do? They're going to choose the cheapest option because, in their minds, a dentist is a dentist is a dentist, and a crown is a crown is a crown. They look at it as a commodity-based thought process simply because that's logical for them to do that. I get that. We all know, though, that it’s more than a commodity, especially with the cases that we’re seeing today.” (10:28—11:07)

“When I was a young dentist, I saw a lot of dentists who would go to continuing education, quite frankly, spend a lot of money on it. But they couldn't come back and explain it. And therefore, if you can't explain it, continuing education becomes an expense, not an investment. Continuing education should always be an investment in the future of your practice. And honestly, if you look at it from a financial perspective, there is no better return on investment that I have had in my personal life than the money I spent on continuing education. And I've spent a lot over the years, but it allowed me to have such a different vision of dentistry than I had before I went to the CE program.” (11:47—12:29)

“Looking back, what continuing education was for me was really a marketing tool. It’s interesting, because dentists market to patients. What I ended up doing with occlusion and joints really led to not marketing but positioning [our] practice in [our] community so that when a dentist had a situation that came up, they would call our office. So, really, instead of trying to gain a new patient flow from existing patients — again, I didn't plan this — ultimately, it came from a dentist in the community. And I'll tell you, dentists are going to send you more patients than patients will.” (14:08—14:48)

“The money that I would've put into marketing, I just shifted to CE. And I had money left over, when you look at what the average practice spends on marketing.” (15:33—15:41)

“I was a young dentist studying in Pete Dawson’s class, and I said, ‘That works for Pete Dawson, but it won't work in Downers Grove, Illinois. I'm just in a suburb outside of Chicago.’ He said something that the minute I heard it, it changed my thought process. Every dentist has those watershed moments in their career. This was absolutely one of them. Pete said the average intelligent patient wants a healthy mouth. And they're going to do what's necessary to achieve it — as long as they understand the problem and your solution makes sense.” (15:59—16:35)

“I needed to understand the problem before I could explain it to the patient. And I had to explain it to the patient in a way they understood it before they could say yes to the solution. So, it forced me to understand the conceptual part of it, but it forced me to develop the verbal skills to explain it to the patient so they could go home and talk to their spouse and say, ‘Okay, here’s what we talked about at my consult today. Here’s what I think we should do.’ That's the toughest part. It’s not the dentistry, it’s the verbal skills.” (16:48—17:21)

“I was a single-tooth dentist because that’s what we were taught. I always said dentist school is like going to auto mechanic school, but all they tell you is how to fix the carburetor. So, you get really good at carburetors. Or you get really good at exhaust systems. You're really good at different parts. Putting them together, I think, was the change in my treatment planning. Hearing people like Bill Robbins talk about global diagnosis, hearing people like Frank Spear talk about facially-generated treatment planning, hearing people like Pete Dawson talking about the top 10 things you need to know about occlusion, all of those reshaped my thinking from a crown on number 18 to simply, ‘Okay, this tooth is part of a system. It’s got an overload problem or a decay problem. I need to restore it. How does that fit into the system now?’” (17:58—18:52)

“Dentists, we all fear rejection. I didn't want to get a “no” out of the treatment plan, so I put it off and kicked the can down the road. What I realized is I wasn't giving the patient enough information so they could make a good choice. Once I started frontloading the education at the beginning of the exam, as opposed to doing it all at the consultation appointment, they could have time to process it. They could have time to think about it.” (20:17—20:47)

“Connecting with the patient is having a conversation based upon what their needs are, not what I want to talk about. From there, by the end of the exam, they're ready to say, ‘Okay, what do we need to do to find out what type of joint I have?’ That's the goal, was to give them enough information where they're almost asking for the solution. I'm going to lead them right up to the cliff so they can look over and see the promised land. Well, that's our next appointment.” (23:08—23:34)

“Learning occlusion and joints is the fastest way to build a practice because no one wants to do it. And there are enough patients in every community that need this where you could easily become the go-to person and be busy almost instantly.” (24:49—25:01)

“The diagnostic practice model in my practice is one column of production for the doctor, and a second column of production for the assistant. And then, you have your hygienist as well. Now, the reality is, my assistants will outproduce my hygienist every day of the week because of diagnostic records. Because in order to do this type of practice, the patient can't make a good decision until they have enough diagnostic information to do it, because you can't offer good solutions until you have enough information to do it.” (26:11—26:50)

“Dentistry has gotten bigger since I've become a dentist. We just used to have to look at the teeth. And when esthetics started becoming important in the ‘90s, we had to start looking at the gums, because we had to get the gums in the right position. Then, we had to start looking at airway. Then, we had to start looking at joints. It’s become a bigger process, which is why, many times, the diagnostic model of practice management is extremely effective today.” (29:48—30:13)

“Me helping you decide on this is selling. That's how I felt when I was a young dentist. Pete Dawson said it best: do you want to sell crowns, or do you want to have people get a healthy mouth? That was another Pete quote that changed my thinking. I was selling crowns because that was the commodity I had to sell. Once I started to have a different thought process about helping people get a healthy system, it forced me to think about how the whole car worked and not just the carburetor.” (31:13—31:42)

“Step back and say, ‘Here are your options.’ And maybe your best option at this time is to do nothing, ‘Let's revisit in six months.’ But to be able to do that, a dentist can't be in need. And basically, I'm talking about financial need. I saw a lot of young dentists get out of school, buy big houses, buy big cars, join country clubs, get the second vacation house. And all of a sudden, now, when they want to do the consultation, the patient had to say yes because they had two mortgages to pay, or they had whatever. L.D. Pankey said it’s a lot easier to go into a consultation with a few bucks in your pocket because you're not under need now.” (31:51—32:31)

“Another L.D. Pankey quote is, ‘It can never be more important for the patient to accept the treatment plan for the dentist than it is for the patient.’ And many times, if you can keep your personal overhead low, it gives you a choice at the office. You don't have to treat the difficult patient. You don't have to stretch the treatment plan to do it.” (32:33—32:57)

“You have to meet the patient to see where to start the discussion process. I don't care where they are. I'll meet them where they are. But I need to know whether I'm starting on the first floor or I'm starting on the 10th floor. That's, I think, the key to connecting with a patient. Because if they're on the first floor and you start on the 10th floor, they feel like they're being sold to because they're being presented something — they don't understand the problem, so your solution doesn't make sense.” (33:57—34:26)

“Ultimately, put the patients’ needs first.” (35:11—35:14)

Snippets:

0:00 Introduction.

1:40 Dr. McKee’s background.

3:00 How to create a busy practice.

7:45 Why this is an important topic.

11:08 CE should always be an investment.

13:17 CE can be a marketing tool.

15:43 Understand the problem and how to explain it.

17:34 How Dr. McKee’s practice evolved.

19:44 Start by educating your patients.  

25:24 Become a diagnostic practice.

28:17 Dentistry is more than just about teeth.

30:48 Selling versus helping the patient decide.

34:46 Last thoughts on helping patients make good choices.

37:43 Dr. McKee’s courses at Spear Education.

Dr. Jim McKee Bio:

Dr. Jim McKee is a member of the Spear Resident Faculty. He has maintained a private practice since 1984 in Downers Grove, Illinois, where he treats a wide variety of cases with a focus on predictable restorative dentistry. He is a member of the American Academy of Restorative Dentistry and former president of the American Equilibration Society. He has lectured both nationally and internationally for over 25 years and directs several study clubs. Dr. McKee graduated from the University of Notre Dame in 1980 and earned his dental degree from the University of Illinois College of Dentistry in 1984.