Season 5: Episode 129: Why Patients Say, "I'll Think About It" and Never Call Back the Treatment Acceptance Crisis in Dentistry

📍 I've been thinking about a conversation I had recently, and honestly, I haven't been able to get it out of my head. You know how sometimes you just hear a conversation or you have a conversation and you find yourself reflecting back on that over and over and over again because of maybe one thing someone said or how they said it, or how you would go back and redo that or have that conversation differently? I happened to be talking to a dentist who was frustrated because there was a significant amount of, diagnosed treatment that was sitting unscheduled.

Now, if you've been in dentistry long enough, you've probably heard some version of this story before. The assumption is usually that patients don't understand treatment, or they can't afford it, or maybe the treatment coordinator isn't following up consistently. Those are typically the first places people look. This dentist was no different.

As we were talking, he kept coming back to the same conclusion: we have a treatment acceptance problem. And I remember saying, "Maybe, but I don't think that's actually the problem." And then there was this awkward little pause and one of those moments where someone isn't sure whether you're about to say something insightful or completely ridiculous. And to be fair, from his perspective, my comment probably sounded ridiculous.

Patients were leaving without scheduling. Recommended treatment wasn't moving forward. Revenue was sitting there untouched, and what else would you call it? But the longer I do this, the more convinced I become that we spend a lot of time treating symptoms while completely missing the cause, and I think that's exactly what's happening in many dental practices.

Not just with treatment acceptance, but with leadership, communication, team dynamics, growth, all of that. We become so focused on what's visible that we stop asking what's underneath it, and that's what I wanna talk about today. Before we get into that, if you're new here, welcome. I am Sarah Beth Herman, MBA, founder and CEO of Dentistry Support and four other organizations.

And while Dentistry Support is often the starting point for these conversations, it is rarely where they end. Some episodes will be very much so dental. Others, they won't be. We'll talk about business, leadership, and neuroscience because I'm absolutely obsessed with it, communication, decision-making, and occasionally, the things that make absolutely no sense until you stop and really think about them.

And after more than twenty-five years in dentistry, I found that the most interesting questions usually have very little to do with teeth. They have everything to do with people, and today's episode is a perfect example. Because what I've come to realize is that most treatment acceptance problems aren't really treatment acceptance problems at all. They're decision-making problems, and there's a difference there.

One of the things I find fascinating about dentistry is that we spend years learning clinical skills. We become experts in diagnosis, treatment, and procedures. Yet most of us receive very little education on how people actually make decisions. And when you think about that, it's really strange because every day we ask people to make decisions.

We ask them to trust us. We ask them to invest in their health. We ask them to move forward with recommendations that may affect their finances, their schedule, their comfort, and sometimes their identity. Then we act surprised when they hesitate.

And I don't mean that critically, because I've done it too. But over the years, I've become increasingly curious about what is actually happening in those moments. Why does someone sit in a chair, acknowledge they need treatment, agree with diagnosis, ask thoughtful questions, thank the doctor, and then disappear? Because if they understood the problem, shouldn't the decision be easy?

The answer, it turns out, is no. Understanding something and deciding something are two entirely different processes, and that's where things get interesting One of the biggest mistakes we make is actually assuming that people delay decisions because they lack information. Sometimes that is true. Most of the time it isn't.

Think about your own life for a minute. Have you ever delayed something you knew you needed to do? A difficult conversation, a financial decision, maybe a health issue, or even a business decision. Something you knew needed your attention.

You probably didn't delay it because you didn't understand it, right? You delayed it because there was something about it that felt uncomfortable. Something maybe unresolved, maybe uncertain. I don't know.

But in my opinion, it's not a character flaw, it's just human nature. And when I started looking at treatment acceptance through that lens, everything began to make more sense for me. Patients aren't necessarily resisting treatment. They're often resisting uncertainty.

They're resisting the feeling that comes with making a decision they don't yet feel fully comfortable making. And the more I learned about neuroscience, the more I realized how much this really matters. Because the brain doesn't process uncertainty the way most people think it does. To the brain, uncertainty can feel remarkably similar to danger.

And not because danger exists, because the brain is constantly trying to protect us from potential threats, which means every unanswered question becomes important. Every unknown becomes magnified, and every concern becomes louder. And suddenly, what looks like procrastination may actually be something much deeper. It may be the brain doing exactly what it's designed to do: protecting the person from the perceived risk.

The challenge is that perceived risk and actual risk are rarely the same thing, and that's exactly where we're gonna go next One of the things that changed the way I look at treatment acceptance was learning more about how the brain processes uncertainty, and not necessarily from a dental perspective, just a human perspective. The brain is constantly trying to answer one question and one question only. Am I safe? what's Interesting is that the brain doesn't just respond to actual danger, it responds to perceived danger, and uncertainty often gets categorized as danger.

If you've ever had a medical test and waited for the results, you know exactly what I mean. The waiting is often worse than the actual answer. Your mind starts filling in blanks. You imagine scenarios.

You create stories. You start solving problems that don't even exist yet. Patients do the same thing. A dentist may see a straightforward treatment plan.

The patient sees unanswered questions. The dentist sees a crown. The patient sees a bill. The dentist sees an implant.

The patient sees surgery. The dentist sees periodontal therapy. The patient sees discomfort,. Now, neither person is actually wrong in any of these scenarios.

They're simply looking at the situation through different lenses, and if we're not careful, we actually end up communicating from our perspective instead of theirs. One of the most common things I hear in dentistry is, " But we explained everything. We had them sign it. They saw it.

We laid it out. We had pictures. We had a video." I believe that.

Most dental teams do explain everything. The challenge is that explaining and reassuring are not the same thing. A patient can fully understand what needs to be done and still feel uncertain about moving forward. The question isn't always whether they understand the treatment.

The question is whether they feel comfortable making the decision, and that's a different conversation. And I think it's one of the reasons some practices consistently outperform others when it comes to treatment acceptance. Over the years, I've noticed there are a handful of reasons patients tend to delay treatment. Money is certainly one of them.

But honestly, I think we overestimate how often money is actually the primary issue. I've seen patients spend thousands of dollars on treatment without a single ounce of hesitation. I've also seen patients postpone treatment that costs less than a family dinner out. If money were the only factor, those situations would not exist.

What I have found is that patients are often wrestling with questions they haven't voiced yet. Sometimes they're trying to decide whether they trust the recommendation. Sometimes they're wondering if the treatment is really necessary, or they're comparing your recommendation to something they read online. Sometimes they're afraid, Sometimes they're overwhelmed, and sometimes they're carrying around experiences from years ago that have nothing to do with your practice.

I remember speaking with a patient years ago who seemed hesitant about moving forward with treatment. The team assumed that it was financial. After a longer conversation, she shared that she'd been in a traumatic dental experience when she was a child, and that included her being papoosed, That included her not being able to move and wishing her parents were there and not knowing what to do. She went on and on about that very private and personal experience.

And do I think everything was handled right in what she told me? No. That's for a different episode But no one in the office had asked about her prior experiences. No one knew what she had gone through.

What looked like a financial objection was actually just fear, and fear has a funny way of disguising itself. It rarely announces itself directly, and people don't usually walk into a practice and say, "Hey, I'd love to schedule this treatment, but my nervous system is trying to protect me right now." Instead, it sounds something like, " I'll think about it." This is where the conversation gets bigger for me because the more I've studied decision-making, the more I've realized that this isn't just a treatment acceptance issue.

It's a leadership issue. It's a business issue. It's a human issue. Think about how often we do the same thing.

How many decisions have you delayed, not because you lacked information, but because something felt unresolved? Maybe it was hiring someone. Maybe it was ending a partnership. Maybe it was launching a business or making an investment or having a difficult conversation or something along those lines.

Most of us aren't waiting for more information. We are waiting for certainty. The problem is that certainty rarely just arrives. At some point, we have to move forward before we have all of the answers, and I think that's one of the greatest challenges of leadership, learning how to make thoughtful decisions without demanding perfect certainty first.

The same thing applies to patients. They're trying to make the best decision they can with the information they have. The more we understand that, the more empathy we bring to the conversation. The practices that consistently excel in treatment acceptance don't seem obsessed with closing patients.

They're focused on helping patients feel comfortable enough to make a decision, and I think there is a difference there. When you listen to the conversations, you notice something. They're not rushing. They're actually curious.

They're listening to what's going on. They're paying attention to what's being said and what's not being said. They're looking for concern behind the concern, the hesitation behind the hesitation, the question behind the question, because often what a patient says isn't the real issue. It's the clue that leads you to the real issue.

And I found that some of the strongest treatment coordinators aren't necessarily the best communicators. They're actually the best listeners, and those are very different skills. A great communicator knows what to say. A great listener knows what needs to be heard.

And I believe that my next podcast episode, it's already in the works, is something you're gonna wanna listen to, and it's a lot about emotional intelligence and understanding what that means when you are hiring someone or when you are coaching someone. It's gonna go a long ways, especially after you've listened to this episode One thing that I've become increasingly convinced of over the years is that people want to be understood before they want to be advised. I see this in dentistry, in business, in leadership.

I see it in everyday life. When people feel understood, resistance tends to decrease, trust tends to decrease, conversations become easier, decisions become clearer, and relationships become stronger. And that's why I don't think treatment acceptance starts with a treatment plan. I think it starts with trust.

Long before the recommendation or the financial discussion or the follow-up call, trust is being built in the interactions, in the phone call, the greeting, communication, the consistency, the experience, if you will. By the time treatment is presented, patients have already formed opinions about whether they trust the people in front of them, and that's not something that happens in a single conversation. It's something that is earned over time. Before we wrap up this episode, let's get to my favorite part of every episode, our That's Good moment.

One of the biggest takeaways from today's conversation is what looks like indecision often isn't indecision at all. Sometimes it's uncertainty, sometimes it is fear, and sometimes it is a lack of confidence. But sometimes it's simply a person trying to make sense of a decision that feels bigger to them than it does to us. Another thing worth remembering is that information alone rarely changes behavior.

If it did, all of us would make perfect decisions all of the time. The reality is that people make decisions emotionally and then work hard to justify them logically. And perhaps the most important lesson for me is this: The better we understand human behavior, the better we become at almost everything, from leadership, communication, business, to relationships, and even dentistry. Because when you understand people, you stop trying to force outcomes and start creating environments where better decisions can happen naturally.

Thank you for spending part of your day with me. These are the kind of conversations that keep me curious, and I hope they do the same for you. If today's episode made you think about treatment acceptance differently or leadership differently or even your own decision-making differently, then it was time well spent. And if you know someone who could benefit from this conversation, share this episode with them.

And be sure to tune in next week. I'm talking all about emotional intelligence, and even if you've learned everything you could possibly learn about that, I think you're gonna find some things very interesting. And lastly, we offer free training every week at dentryst support.com/freetraining and also at sarahbethherman.

com/freetraining. I would love to chat more with you every week, so please tune in every Monday at five AM Pacific Standard Time when we release brand-new episodes. As always, thank you for listening. I am Sarah Beth Herman, 📍 and I'll catch you on the next episode.