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Dentists Who Invest

Podcast Episode

Full Transcript

Dr James: 

Hey team, what is up everybody? Welcome back to Dennis Huw’s Invest podcast. I have sat in front of me a particularly interesting doctor today. We have just been catching up, before we hit the record button, All the white communication and how important it is for dentists. So we’ve got a real treatment store for you today. This episode is not so much about investing in financial markets as such, but more about investing yourself, which is actually more important, in my opinion. Dr Asif, how are you today.

Dr Asif: 

Very good and lovely. I’ve been a beautiful summer day. I think it’s the first day that I’ve actually I’ve got my hoodie off and I’ve got my sweat top off, so I’m enjoying the sunshine. It’s right in my eyes as I’m looking at you, but you’re still looking handsome for where I am, yeah me it sounds like guns out.

Dr James: 

I’ve got my hoodie on. It’s a little bit over here in.

Dr Asif: 

Ireland. Yeah well, yeah, you’re in Northern Ireland. We’re further south down in the mainland in London.

Dr James: 

Good Send the sun westwards. Okay, send the sun westwards to Ireland. It’s just stopped raining here, which means the flipping rainy season is over, which, by the way, is all year. Okay. But we do get this little window in, like May, june time, which we call summer. Okay, so I’m basking in it right now, but it’s still not quite warmed up yet, so hopefully you can send the sun over my way. Anywho, dr Asif, for those who have yet to meet you in the audience today, it might be nice for you to tell them a little bit about who you are and what you do.

Dr Asif: 

Yeah, firstly, I don’t use the title doctor anymore simply because, although I qualify as a dentist, same as yourself I don’t actually practice anymore. For the last 15 years I’ve been spending my time working with dentists, helping them to achieve their goals in a non clinical sense, which typically translates into business goals the actual outcomes and the commercialization that they wanted from their careers. I don’t do coaching. I call what I do consulting, and it’s largely because I like to break things down, understand them, reconstruct them and then put them into a framework, much like we were talking to the dentistry, so that people can follow it and maybe achieve some of the things that they want. And so that’s what I spend my time doing now with dentists. I’ve been doing that now full time for about 15 years, and the reason why that might be interesting for some of your listeners is that pretty much whatever problems or ever thoughts or whatever scenarios they’re facing in a non clinical sense, in a business sense, it’s unlikely that I wouldn’t have faced them myself previously, and so if we can talk about that today and help some of your guys, I’m happy to do that.

Dr James: 

That sounds that fun, because the whole point of this podcast is everything and anything financial and bridging the gap between the stuff that we get taught at uni and the skills that we need in the flipping real world. Okay, because here’s the sad thing right, you can actually be a killer dentist, technically, right. However, you’ll not be able to serve as many people as you potentially can unless you’re able to communicate effectively, which is part of what you do, and then also understand the skills of business, because those are inevitably entwined into density to a degree, of course, but you have to make it all about service. Whenever you serve people with the highest standard possible. That happens to your skills, but also your language. Then I feel that everything else just flows from there.

Dr Asif: 

Yeah, I think it’s an interesting point. I think, as you were talking, I think one of the things that struck me and I say this to people that I work with as well there’s probably nothing more common in dentistry than the unrewarded, brilliant, technical dentist, and this is something that we see sort of all the time, and I think, as dentists, we’re so interested in enamel, enamel prisons, preserving tooth substance and being very technical about what we do, and, especially if you’re very good at that, it may blindside you from the other skills that you need in order to be successful in whatever you mean by successful in your career. And so some of those things may be, like you teach, about learning how to invest and learning how to use the money that you’ve already made. It may be about improving your communication. It may be about understanding numbers. It may be understanding human nature. I think these are all great inquiries and great skills to learn, to complement your brilliant technical skills in order to, I think, commercialize what you’ve invested most of your life to try and learn.

Dr James: 

Awesome. And you know what, whenever I listen to you talk, I’m reading between the lines and I’m sensing that there is probably a great story there that allowed you to have those epiphanies. Because here’s the thing about every single entrepreneur it’s always wrapped around some sort of moment where they had a realization in life, where they realized what they didn’t know, they learned it, and now they elevate those around them to help them get to that position.

Dr Asif: 

Yeah, well, the story that comes to mind and I hope is relevant to your audience. But it’s the first day that I started general practice. So I finished FD, I did a year in the hospital as an SHO and then I started in general practice and I worked for a fantastic guy, a lovely guy called Mr Sharma, and he said you can come on practice, you can do three or four days a week, you know, tell me what you need and here’s the surgery We’ve got plenty of patients, go and make some revenue and do some nice dentistry. He knew the people at the hospital that I was working with, so we had some association that way and off we went. On the first day I remember sitting down it was a paper, it was a paper practice and they put 14 or 15 record cards right along my countertop to let me know that on day one at nine o’clock I’ve got 14 patients waiting, and this is something I should be really happy about. And as the day went on, this pile of record cards never went down. It was always like 14 or 15 cards waiting, some of them emergency, some of them were check up, some of them were treatments prescribed by some of the dentist that I’d never met because it’s my first day. So I was absolutely knackered on the end of my first day. I was shattered, I think. I went to bed about 6 30 and woke up literally I think, 6 30 the next day. I was so tired and I went back in at the end of the first few days, actually spoke to Mr Sharma. I said why are we working like this? And he said what do you mean? And I said this how? He said this, how everybody works. And I said Well, doesn’t make any revenue, plus, it’s really tiring and and it’s it’s, it’s just not going to work for me. So he said Look, just do whatever it is that you want to make yourself happy. So I actually trained my own nurse. I trained my own receptionist. I cut down the number of patient. I was interested in the number of patients that I was seeing. I classified different kinds of treatments in different kind of slots. I made sure my exam was slightly longer so I could get to talk to people and within three months I was actually earning more than Mr Sharma. So he said why don’t you show me what you’re doing? And so I showed him what I was doing and he had the same results. He said what other ideas have you got? So I said we could expand the practice and on the back of an envelope we drew it all out and we expanded the practice During all this time. Can I just say he didn’t pay me and I never asked for any money. It was just that we were friends and we got on and it was just brilliant building things. Now the funny thing is is that by doing that, him, his friends and my friends heard about what we were doing because they were curious and from there I got referrals and I got people asking me to do that kind of work and after a few years I realized quite early on in my career I was making more revenue from actually helping people with explaining this kind of stuff than I was from actually doing dentistry, which is why I ended up doing this full time. And I think the epiphany that you were talking about is if it doesn’t feel right and it doesn’t stick right with you, then it’s okay to question it, make an inquiry, because typically a better way of doing it. And I think that I then just applied that to absolutely everything. I applied it to the exam, I applied it to a daily. I applied it to nurses, I applied it to dentists, I applied it to practice managers and all I wanted to do was try and make sense of what was going on and I think by doing that and pulling on that thread I ended up running courses and having a client base and doing the work that I do, which is as you know we were talking about earlier, james entirely by referral. And it’s really satisfying because when people come to see me, I haven’t asked them to come and see me, they’ve made their own inquiry. So it’s really pleasant relationship because I know that they’re after something and they’ve done their own homework before they’ve come to speak to me. So it kind of gets me out having to spend a lot of my time on marketing and building a profile. I could spend that time just with the people I’m working with and helping them out.

Dr James: 

That’s awesome. Well, you know what. You know what springs to mind A little lesson I learned about business ages ago, which is there’s actually three parts to every business, no matter how complicated, no matter how simple, right? Whether you’re flipping Coca-Cola, whether you’re a dental practice or whether you’re a lemonade stand, right, you have three components to your business. Number one is marketing. Number two is sales. Number three is your products, right. So marketing is how you spread awareness, right? How do lots of people go about marketing TVIverse, instagram content, however they choose to go about that? There’s lots of ways. It’s basically just raising awareness. Anything that raises awareness in a positive way is your marketing, right. Middle part sales Sales is the proper sales, if you want to use that term, because not everyone likes that term okay, but let’s say. In lieu of a better word today, let’s say that that’s the name for that part of the process. What it actually is is describing the value of what you do and relating it to the needs and wants of the individual to find whether or not you’re a good fit. That’s how you communicate properly, right. That’s what that process is right. So there’s that part of the business, because you don’t want to say yes to everybody, no matter what. Your business is right. If you genuinely can’t help someone, you can’t take money from them, can you? Yeah, I’m sure enough. Then, when you shook hands on that, that’s like the deal side of things. That’s the agreement. Then you serve them on the product side of things. So you give them what they want, right, and as long as you give those people loads, then you’ll always have happy customers, right. But you just have to figure out a way in which you can do that repeatedly and then you have a business right. So it’s always those three components. But think about it like this If your product is so good that, whatever someone invested in you, you give them many multiples of that investment back, that it’s just the most unbelievable deal in the world, and you can do that repeatedly. That’s the hard part, by the way Hard part you’re fit. If that is so good and it’s such a good deal, those people will tell their friends. And then they’ll tell their friends, right, and then it grows in this quadratic way. So that’s how you know the product really good, okay, because?

Dr Asif: 

then you don’t need marketing right, yeah.

Dr James: 

Yeah, someone told me that I was like whoa, I get business now on just the most simple, easy, fundamental, relatable level, and that’s why that’s one of my favorite things to share about the world of entrepreneurship.

Dr Asif: 

Yeah, yeah. So I completely agree. There’s nothing actually more powerful than product market fit, which shortcuts the entire three things you said. So you’ve got marketing, you’ve got sales, you’ve got product. But if you can make the product fit the market, so you’re giving people exactly what they want, how they want it, at the price they want it then it becomes much, much easier. If you haven’t got a good product market fit, you have to spend a lot more money on marketing, you have to spend a lot more time on sales because you’re trying to convince people, because the product isn’t quite there, and so I think spending as much time as you can honing that product so that’s absolutely what people want and, as you said, go slightly above and beyond what people want gets you out of having to do lots of marketing and having to do lots of sales. And interestingly, I think this applies to dentists and dentistry and dental practices, because most of the people that come to visit dental practices live in the same geographical area. They don’t look online and come from Netherlands or from Newcastle. If you’re in Northern Ireland, they’re going to come probably most likely within a five-mile radius of that dental practice. If that’s the case, they already know that dental practices exist. They’re aware of it and they are already but probably got some idea of the reputation of that practice. So having that product market fit for a dental practice means looking at the patients that we’ve got and letting those patients do word of mouth. I think that is the most powerful way to grow a dental practice. Even practices that I’ve seen that are using social media and using content as a way of growing and improving their practices. If you actually pull the hood up and look at what they’re doing, it’s still largely word of mouth that’s driving it. The content in the social media is increasing the case size. It’s increasing what the patients can expect from the practice. It doesn’t typically increase the numbers of people coming to the practice in the first place. I think that’s an important distinction. And I think the other thing that I wanted to bring up, because you mentioned product market fit, is have you ever heard of Net Promoter Score?

Dr James: 

I have yet to hear of that. What is that?

Dr Asif: 

So if you like product market fit, you’re going to really like Net Promoter Score. So Net Promoter Score is something you can look up online. It’s not mine, it’s a general business term but I use it quite well because it applies to dentistry and the theory basically goes that unless 70% of the current people that are using your service are willing to recommend it to another person, you actually don’t have a business. Because you’re going to have to spend so much in marketing and so much time in sales that it tells you straight up it’s probably not going to work. Your product doesn’t fit the market. If you’ve got a very high NPS Net Promoter Score, 90 or 95% of people would use you again and recommend you to others. You don’t need to spend so much time in marketing and sales and that’s how you test or measure whether your product market fit is good or not.

Dr James: 

Awesome. I love that. Yeah, it’s a really tangible, quantifiable way of achieving that. Yeah, boom.

Dr Asif: 

Yeah, and dentists love quantifiable. You know specific, you know step by step approach to things, even if they can’t be broken down in that way. We like to break it down in that way because I think that’s the way that we’re trained and we like to see it in that way as well. You probably see it with your stuff as well, which is, you know, you want to give them the concept and give them the theory, but in the end, people like it broken down. And the interesting thing is, you know, when you try and break something down and explain it, it forces you to break it down. It forces you almost to slow down and understand all the steps and be better at them as well. So there’s a benefit on both sides.

Dr James: 

Yeah, that was the dentist in me talking right then. Yeah, yeah, protocol is the word, right. We love our protocols, don’t we?

Dr Asif: 

Yeah, and we like rules and regulations. Yeah, there’s, you know.

Dr James: 

I can relate. I can relate. There’s like a little bit of like warming, comfort and just having some sort of system that you can follow. And here’s the thing lots of dentistry is like that and we make the mistake of thinking that things outside of dentistry can’t be like that as well. Now, you can only protocol something so much as you can protocol it. If you know what I mean. There’s always going to be the chance that there’s going to be unexpected events and things that you might not, that might surprise you that arise, but at least you’ve got something to refer to. Yeah, and business is exactly like that, which is like what I just said just then about the sales, marketing and product thing. Right, that’s the protocol for every business, every single thing. If there’s a bottleneck in anyone’s business, it’s one of those three things. It’s just a dent from a high level. It’s one of those three things. It’s just a getting right down specifically found out how you address that.

Dr Asif: 

Mm, hmm, yeah.

Dr James: 

Okay Question. So we’ve talked a lot about these concepts from a really really, really high level, right, let’s bring it right down to the nitty gritty to be really granular for the people who are listening. So, obviously, through doing what you do and meeting and interacting with lots of dentists and helping them in the issue. Let’s talk about the sales side of stuff in the community. We don’t want to use that word because not everybody has a connotation which is favourable for that, but let’s say building value, because when we build value, then what that allows the patient to understand is just how good we are as a dentist. Right, and we need to do that to some degree, because we’re not explaining that they have not been at dental school and have, like, flipping 10 years in the field, like we do, okay, they’re not going to be able to understand that value unless you articulate to them in a language that they understand, which is a beautiful way of putting it. And here’s the thing Just when you said earlier, just what you were saying earlier about the dentist who’s very, very, very talented, okay, but does not, does not, is not able to allow the patient to understand just how talented they are because of how they’re communicating. That is a travesty, right. That really upsets me, right, because you can get really, really, really good at dentistry yet not be valued in the way that you deserve, right? So, on that note, naturally you come across these scenarios all the time. What are the top things that you see? What if you could go out there and wave your wand and say dentistry, dental surgeons of the UK, fix this and you’ll get better at communicating? What are the most common things that you can see that you come across?

Dr Asif: 

Yeah, okay. So just just using your concept and use your framework which I think makes sense to think to your listeners and also to you, which is this marketing, the sales and this product, and these business concepts exist. You can look them all up. The trick is, I think, to actually apply them specifically to dentists and dentistry in a language, in a way that we understand. So, of the three things marketing, sales and product dentist in this country tend to be strong on two. They tend to be very, very strong on product, which is the technical delivery of their dentistry the composites, the veneers, the compomas, the root canals and all the rest of the stuff that we do. That’s called product, that’s the product part of what you’re talking about, and they’re very strong on that. For some reason, dentists have become enamored with marketing, so they’re very, very good at marketing, branding, logo, talking about themselves, going on social media and doing all the things necessary, and there’s nothing wrong with that. I’m just saying we seem to have got our heads around making a name for yourself online and using social media, so I’m not really worried about that side of things, which leaves this bit in the middle, which is the weakest bit in the profession and the weakest bit in your business framework, which is the bit called sales. And dentists don’t like the word sales, and I can see that you’re trying to find something that’s a bit more palatable, so I’ll give you something that’s a bit more palatable. I don’t like to call it sales, I like to call it conversion, and conversion simply means that you explain your product to somebody and then you see how many of them accept, and the difference between the number of people have heard it and the number of people that accept is just called conversion, and a nicer way to put it is just treatment plan acceptance. If you’ve got a treatment plan, you want to have it accepted. Of course you would, otherwise you wouldn’t have given them that treatment plan. So the other word that we want to use, that sales, is treatment plan acceptance. In a business framework, other people would call it sales. We can call it treatment plan acceptance and we can measure it by the metric of conversion. Now, if we say this is the weakest bit, and if you ask me the question, if I could go out there and wave my flag and say, look, what’s the one thing you’re all missing? It’s the sales, treatment plan and conversion bit. That is happening at a very, very specific point in the journey of the patient. In the practice, conversion happens right in the last four minutes of your exam, when you look at the patient in the eye and they look at you and then you’ve finished your treatment plan explanation and they say well, how much is it? Can I have it on the NHS? What about this? What is again? Can you run them through? Can I think about it? Are you going to print it out? Is it going to hurt? And then we end up with a gigantic mess which is meant to take three or four minutes at the end of the exam but actually takes 16 to 20 to 30 minutes. There’s no way that a dentist can offer those kinds of explanations and that kind of service to absolutely every patient that comes in. They can’t spend 20 minutes trying to convince each patient. So it puts them in a really awkward position, which is, if they know that most patients aren’t going to be able to understand what it is they’re saying without a 20-minute explanation at the end, they’re forced to start considering at the beginning of the exam whether this is the kind of patient that deserves my full-fat explanation or not. And so we then end up having to guess which patients have to have this long explanation and which one doesn’t. And all of this is because at the end of the exam, when we’re having that sales conversation, that treatment plan conversion conversation, that treatment plan acceptance conversation, the dentist has been obsessed with the technical side of doing the exam and there’s a whole communication that’s occurring in the exam and it’s that that the patient is saying yes or no to and it’s unlikely they’ve fully understood the technical explanation. It’s the quality of the communication that they’re actually judging, not the technical work. And if you’re very, very committed and very focused on your technical work, you may be missing and you may have overlooked that the communication is the bit which is letting you down, not the actual technical bit. And I can see you nodding and you probably don’t want to interrupt me, but it’s worth saying at this point. When I’ve trained dentists about treatment plan conversion and acceptance and let’s say I’ve trained over a thousand dentists I always get them to self assess their communication score out of 10 before they start doing any work. So I’ll ask you, james, what do you think most dentists rate as their communication out of 10 before they are given any communication training?

Dr James: 

I have experience on this. I have experience on this. Most people are actually operating in this zone where they think they’re good communicators. Now, I might be. I’m really intrigued to what you’re going to say here and, for anybody who’s listening, I have no idea what’s going to come out of Hasif’s mouth yet, so I might make myself look really silly. But here’s the thing. Here’s what I experienced. Most people rate themselves as about a seven or an eight. Most people think they’re good. Most people think they have a certain level of adaptness. And here’s the thing. Right, it’s because it works for them, right? But the thing is they don’t know what they don’t know and they don’t know quite how good they could be. And it’s one of those things. If you did know, you would do it. So you’re always going to rebound to the seven or eight level.

Dr Asif: 

Yeah, so it’s almost exactly that. So they always rate themselves exactly seven out of 10. I think they’re being polite. They actually rate themselves kind of eight out of 10. But they’re saying seven to be modest and just leave some room for tolerance and some room for humility. But really what they mean is look, I’m not bad and I know where that comes from. It’s because in their current environment their current patients seem to quite like what they’re doing. So you haven’t got any negative feedback, so why wouldn’t I be sort of a seven out of 10? The next question is are you getting the treatment plan acceptance and are the patients responding to the type of treatments that you really want to do in the way that you’d like them to do, the way that you’d love them to respond? The answer to that is a little bit more shaky. So once we’ve gone through some communication training and we’ve broken the exam down into a series of steps and we’ve gone through how the communication is happening whilst you’re doing the exam, their communication and their acceptance quite typically will double just by going through that kind of training. At the end of that training I then asked them to assess and ask them to re-score what they thought their communication was at the beginning. Based on what they’ve learned now, do you think the score still stays to seven?

Dr James: 

No, it goes down, but I’m intrigued to see very much.

Dr Asif: 

Two or three, they rate themselves at. Wow that much, wow that’s a big shift and I think that’s the thing that if you believe that your conversion, your communication is pretty good and it hasn’t been peer reviewed, that, james, is completely different to how we look at every other clinical modality within dentistry. We know our endos are good because we peer review it. We know our crowns are good because we peer review it. We know our veneers are good because we peer review it. Hell, even when dentists go on courses they will do an aesthetic course or an operative course they will cut a crown. Then they’ll run up to the lecture and say, look how shit my crown is, can you improve it? They’ll show it to their colleagues and say, look, how bad my crown is, show me yours. How are you doing? Let’s improve. But when it comes to an exam, we don’t apply that same kind of peer review. We don’t apply that same kind of comparison. We’ve simply self-assessed that it’s pretty good and if it’s not quite as good as you think it is, well, this is then you being blindsided in the middle part of your business framework, which is conversion, sales, treatment and acceptance, whilst being good at technical bit and the marketing bit. If I’m not mistaken, earlier on you said all three bits have to work in order for the business to work. It can’t have bits of it missing. And in that respect, principals will perk up and say, well, I run a business, so I can see that maybe this bit is an area that we can improve. And if this guy’s on your podcast and he’s saying that’s the one area that I should focus on, maybe I’ll go and assess whether that’s something that can be improved. Associates may think well, this can apply to me because I don’t run a business, I’m merely a dentist that works in the practice. I think that’s a bit of a mistake. I always, when I’m working with associates and talking to associates, try and encourage them to understand that you as an entity on your own are a small business, most small businesses in the UK. So the government, ons and HMRC will class them as micro-businesses, and there’s five million of them in the country. Most micro-businesses have a turnover of about £250,000 a year and have no employees, and that really does fit the typical kind of associate profile. And so I like also associates to think of themselves as a business and to think of those three things that’s applying to them as well, and then seeing how they can improve, not just on the technical side, but on those three aspects the product under the conversion and on their reputation and marketing within the practice as well. So this also applies to those guys as well.

Dr James: 

Love that and you know the crown prep analogy that works so well and it’s so visual for so many dentists, because think about your crown preps when you look back one year out of foundation dentistry, one year out of university right, those, how they looked, right. And if there were anything like mine, they were like hideously ragged. You know they weren’t in proportion all of that stuff, right? I’d ever really understood just quite how not so good they were until I got loops and I was like, oh my God, these are not great, right. But then what do you do? You refine your crown preps, right, and it’s an iterative thing. You get gradually better Right. And then when you go on courses and your crown prep look amazing and you look back and you think, wow, that was wonderful right. And look how much effort it takes for your crown preps to get better right. And communication is exactly like that, right. But at the time before you have loops right, because it’s from your own perspective you think it’s all right because you don’t know any better right, until you see people who are really swive at it. Are you with me? Yeah, so it’s exactly the same process and that’s why that analogy really works. So, through watching dentists undertake communication day to day. It must be some common no knows some common clangers that they got.

Dr Asif: 

What are those? Okay, yeah, so there’s, there’s, there’s hundreds of them, but I will give you, I think, the three that will make the big, the three that will make the biggest difference.

Dr James: 

All right All right.

Dr Asif: 

So at the start of the, at the start of the exam, and let’s just do like a kind of script and make it a bit more interesting, which is, you know, I’ll play both patient and dentist, the patient, the patient, the patient will come in. Actually, let me ask you first, james, you know when the patient comes in? If you still practice dentistry, by the way, you don’t, do you?

Dr James: 

I left clinical dentistry two years ago two and a bit Okay.

Dr Asif: 

All right, fine, so it’s still. It’s still recent enough for you to remember, right, yeah, okay, all right. So you know that bit where the patient comes in and you go hey, mr Jenkins, how you doing Love to see you, have you been? How’s the wire? Take a seat? Yeah, so the patient walks in literally that’s kind of the conversation happens and Mr Jenkins takes a seat. How long before that seat goes supine and you’re in their mouth, typically for most dentists?

Dr James: 

Oh, typically for most dentists, I think. Sometimes the chair is going supine, is it?

Dr Asif: 

Yep. So give me an actual number. What do you think? I’ll give you the measure.

Dr James: 

Okay. So if I had to pick a number, I would say 20, 30 seconds.

Dr Asif: 

Actually, okay, not, you’re not far off. The average dentist will take the chair back in 90 seconds 90 seconds of them being seated right. Within 90 seconds of them coming into the surgery. Oh, and walking the door, yeah, so we so we say that the exam starts the minute the patient walks in through the door, not when they’re sat in the chair, but literally from the very the very first thing that happens, or the entire interaction, is like an experience for them, much like it is when you go to a hotel the whole things and experience right from when you’re dropped off at the front door of the hotel, anyway, so most dentists will take the chair back in 90 seconds. Now, if you ask most dentists, james, what kind of treatment would you love your patients to accept? What do you think they’d say Best, yeah, but what kind of items of treatment may be subluthing?

Dr James: 

Oh, they’d say. They’d say the veneers and the cosmetic stuff and the ABB right.

Dr Asif: 

Okay, and ABB? What’s that case going to cost?

Dr James: 

I would say that will probably like a six, seven grand kiss Most people Right.

Dr Asif: 

Okay, good. So you work in investments and you work in you know helping people to understand. You know how to get from A to B with finances. Does the equation make sense that the patient faced you and spoke to you at the start of the exam for 90 seconds and then, at the end of the exam, you’re then going to try and sell them a six, seven thousand grand case? It’s a bit of a tall order when you put it like that, right?

Dr James: 

Yeah, so there’s the. So that’s the first big one. All right, which is at the start of the exam.

Dr Asif: 

You cannot be taken the chair back for any patient, including routine patients, in 90 seconds. Why? Because we simply haven’t understood why it is that they’re there. Now. I know some patients will say my tooth is hurting and we’ll take them back. Some patients will say I don’t have any problems. We still need to spend some time talking and listening and understanding why the patient is here. Because it takes a lot of effort for the patient to turn up. They’ve got to ring up the practice, speak to the receptionist, find a time, book the time, put it in their calendar, get in their car at that time, leave work, make excuses, try and find car parking, turn up, listen to your receptionist, apologize because you’re going to be late, listen to some magazines and then sit in your chair to tell you there’s absolutely no reason for them to be here. So there’s a reason why they’re there, all right. So we need to find out if they’ve got a problem. We need to understand how they’re experienced the problem, because if you’re going to try and explain that the solution you have for them at the end is 7000 or 3000 or 800 pounds, then they need to be able to get there and then some dentists will say well, I can’t do that because most of my patients are stable patients. I’ve looked at them for ages, so it’s impossible to do that as if, how can I speak to them for 10, 12 minutes, like you’re saying? Because it makes no sense because they’re all dentically stable. So which I would say, the kind of work that you want to do and you mentioned ABB, which is, I see that as well very people. It’s very popular thing for people to do 6, 7000 pounds and then you can do that, but you can’t do that. So which I would say, the kind of work that you want to do and you mentioned ABB, which is, I see that as well very people. It’s very popular thing for people to do 6, 7000 pound case. Are you going to do that kind of case on an unstable patient with rampant caries, you know, poor period, irregular attendee Are you going to do those kind of cases and that kind of patient? The answers probably no. Are you going to do that kind of case on a stable patient with great dentition, who’s stable, with good period, who’s regular attendee? The answer is I’m most likely going to be doing those aesthetic cases on those kind of patients when those kinds of patients come in to see you in the practice. What do they say when they sit in the chair? They say hello, dark, love to see you haven’t got any problems, just here for my checkup. But if we’re going to sell them or going to offer them, I would say not sell. Sales is is the word that you are using, and I like to use conversion or acceptance. If we’re going to offer this to them, if it is what they want and it is something they’re interested in, then it’s at the start of the exam. We can get those people interested by listening to how they’re talking about their teeth, what their aspirations are, and actually structuring a conversation to spend some time with them. Otherwise, in the way that I’m working, we don’t have a mandate to offer them work at the end of the appointment, which is where the conversion is taking place.

Dr James: 

I love it. Well, it makes it makes total sense, and we yeah.

Dr Asif: 

So the first big one is is the amount of time you’ll spend talking to the patient at the beginning of the exam, whether or not they’re here with a problem or they’re here with no problem. That’s a big differentiator between good and poor communicators. Love it. The second one it happens in the second part of the exam. So the exam is split up into three parts. There is the bit where we listen and understand what the patient wants. There’s the bit in the middle where we actually do the dental checkup the UNI and your and your listeners were trained to do. And then there’s a bit when we sit them back up and explain the findings of all those things. So there’s three things that happen in, there’s three things that happen in the exam. And so the second big one big mistake is what happens in the middle of the exam. So in the middle of the exam that’s the checkup. And dentist love the checkup bit, the actual intraoral and the clinical and that side of it, because they can just be their technical dentist again. And so they’ll say listen, you seem to have a problem with your tooth. It seems to be keeping you awake, it seems to be hurting you. Let me take you back and have a look, and the idea is is that I don’t really know what the patient is saying, but when I get to get in there I’ll have a look Once they get, once they get in there and are doing the intraoral examination. The big mistake here is to believe that only the dentist, the operator, is extracting information from the patient. At the same time, at the same rate, the patient is extracting information about you. How you’re going about the checkup is in an orderly fashion. Are you hurting them? Is it making them wince? Are you using technical jargon? If you’re starting to explain pathology options and treatment while the patient is supine and you’ve got a mask on and your nurse is making a noise in the background, maybe this isn’t the best time to have that conversation. So, misunderstanding that the middle part of the examination, which is where we do the clinical checkup, is an opportunity for you only to extract information, I think it’s a little bit incorrect. I think the patient is also making their mind up about you and they’re making their ideas of how treatment with you might go based on how you’re doing the checkup. And so, yes, we want to have a technically brilliant checkup, but we also want to make it patient-centric and we want to make sure it’s for the patient, it’s not for us. And so not hurting them, not doing a BPE that causes any discomfort, explaining what we’re doing, not explaining the treatment because we don’t give up our opinion yet, because we don’t know all the information, not using jargon and not trying to give them options while they’re supine, and certainly not trying to convince them to have the treatment that you’ve just discovered whilst they’re supine. I think that’s also something that a quality practitioner probably wouldn’t be doing on a regular basis. And so I think that’s the big one in the middle of the exam that happens and paying attention to that, or understanding that, can massively increase the quality of both the exam and the experience for the patient and for the conversion at the end. Love that Okay. And then the third one is at the end of the exam and that’s called the presentation phase. So these three phases in the exam, which is the middle bit, which is where you understand what the patient wants sorry, the beginning bit, where you understand what the patient wants, the middle bit where we get into what their problems are and taking our kind of findings, and the third bit is presenting what we’ve found and the presentation is really in terms of equations, in terms of specifics, an addition of the first two bits. You’ve done your findings, you’ve listened to what the patient wants. So now you have a mandate to present something based on what they said and based on what you found. If you get over to P phase, the presentation phase, and you’ve got a record of your findings but you don’t really know what the patient is here for or an understanding of how they’re experiencing their problem, it’s going to be difficult to relate your technical solution to what they wanted. And then we go into justification mode, which is here’s the treatment you should really have, it it’s the best. It’s the best because it’s technically the best, but the patient hasn’t understood why it fits their needs. So, over in P phase, the P phase and the presentation phase. One of the big mistakes is dentists think that it’s the quality of their explanation at the end of the exam which is causing or not causing conversion. I can tell you from having seen I don’t know who’s seen the most dental exams in the country, but if there was such a weird competition as who’s seen the most practitioners and the most number of exams in the country, I put my hat into the ring and I don’t think I would lose. I’ve seen hundreds of dentists do thousands of exams over and over again, so I can tell you with great degree of certainty that the end part of the exam is not the most important bit. That is where the problem is showing up, where you’re getting the resistance from the patient and you’re getting some weird questions and you’re getting pushed back and it feels very undignified for the dentist because they’re not sure whether or not to carry on explaining and pushing or whether they should sit back and respect the patient’s wishes. But the problem is not occurring at the end of the exam. It’s occurring right at the beginning, where the patient hasn’t really properly felt. They’ve been listened to. Maybe the intraoral part wasn’t really a great experience for them, great for the dentist, not for them. And so the problems are all turning up in the presentation phase, but they started in the initiation phase and, if we use a clinical analogy, if someone’s composites aren’t turning out to be brilliant, they shouldn’t be asking how you’re polishing them drains, what polishing materials are you using? We probably need to go back and look at cavity design, because we all know that 70% of any restoration being successful is a cavity design. If that’s correct, everything else becomes much easier. So with the clinical analogy, we’re trying to polish something that wasn’t properly constructed in the first place. So I think the big mistake is to try and believe that what’s what your experience at the end of the exam, in terms of what the patient is saying back to you about your treatment plan suggestion, is where the problem is occurring. It’s not happening there. It’s the sum of the other two parts. Shall I give you one more? Yeah, bonus one. Let’s do it All right. And the other thing is worth working out is that this structure is massively predictable, is happening every single time we do a checkup. So dentists think that they can sometimes think what they can do is get the patient in the chair, fill some rapport hey, buddy, how are you doing? How’s your holiday, what are you up to and do all this kind of stuff. And then, towards the end of the exam, then offer them a huge treatment plan and, based on the rapport, they’re going to get the acceptance Okay. Well, the rapport doesn’t really make much sense unless it was a conversation about why they came in. So, for example, if you went to see your accountant and he spent 15 minutes talking about you, about Liverpool Football Club, manchester United Football Club, premiership, how well Newcastle are doing, didn’t talk to you about what you think about your accounts, how much tax you’re paying, and then said at the end I can offer you some management information services before Grande Year. You probably wouldn’t really value the conversation about the football. You probably want to talk about your taxes a bit more, right? Okay, so that rapport is useful and it certainly doesn’t cause any problems. But thinking that’s the same as understanding why they’re having the communication, having the base on which to operate the exam, is probably not quite right. So that rapport at the beginning doesn’t really work and trying to get that rapport at the end probably doesn’t really work as well. I think what the patient is after is someone that’s very, very good at their communication, because you’re trying to get the patient to understand that something is quite technically difficult. In that respect, at the end of the exam there’s always a few things that we have to cover off for the patient. We have to give them options. It’s our medical legal requirement to give them options. We have to give them risks. It’s our medical legal responsibility to give them risks. We have to give them a recommendation. It’s GDC standard 3.1.3. You have to give them your recommendation. You also have to get consent. There’s quite a lot of stuff happening at the end of the exam. If you’re having to do those for every single patient and every single case that you’re doing, I think it’s worthwhile for most of the people that are working as dentists and your listeners to try and get those four things in order. What I’ve noticed is that the patient will say, okay, that sounds pretty good, but it’s expensive. What are my options? Then the dentist might say well, we can do it, not as a white crown, but we can do it as a porcelain crown, but we can do it as a porcelain crown, but there’s risks with that. Then they’ll go into risks. Then the patient is now leading the conversation, jumping between all the things that we have to do, which is options, we have to do risks, we have to do recommendations. At the end of this, we have to get consent. Trying to get those four things in order and separate them out is really, really useful. It sounds a bit more like this I’ve listened to you. You’ve got this problem. I’ve checked your teeth. Here are your x-rays Now, based on what I’ve seen. I’ve got some really fantastic recommendations for you, some options. Of the options I’ve got for you, which are three, which are the ones I’m going to put forward first, I like to explain them to you. Once I’ve explained them, I’d like to explain which one I think is the one that you should go for. I’ll then explain the costs and then you can talk to me about that. Then, based on what you’ve understood and what you’d like to do, I’ll explain the risks that go along with it, because not anything is guaranteed in the biological system. We’ll do our best to eliminate them, but it’s my professional obligation to explain that to you. Once you’ve done those things in order, you then have consent. When we’re doing an exam, there’s so many things that we have to do. There’s time pressure, there’s people pressure, there’s UDA pressure, there’s commercial pressure, there’s regulatory pressure, which is one of the things that I’m bringing up now. All of this has to happen simultaneously. In that 18, 20, 30 minute examination, there’s an awful lot of stuff to manage in terms of layers of information and layers of process. There’s an awful lot of stuff to communicate in order to get the patient A to B smoothly, ironically and powerfully, whatever the patient says at the end of that exam determines what work you’re going to do, and that’s going to determine what you’re going to earn, what you can reinvest in terms of courses and therefore define your entire career. That checkup is not easy, that checkup is not straightforward. That checkup, and what they’re saying at the end of that checkup, the end of your communication, is actually a career defining conversation. That’s why, when you ask me the question if you could run around a profession saying what’s the one area you should focus on Is it product, is it sales, in your words, or is it marketing I’ve hopefully made the case that it’s the sales treatment plan acceptance conversion bit that we could be way, way better at. Constent is to train. They’re absolutely brilliant at it and they have a much more satisfying experience in the practice for themselves and for their patients, which is the most important thing.

Dr James: 

I agree. Thank you so much for sharing all of that. The crown prep analogy really, really, really worked because it’s super visual. You can picture your old crown preps and then your new crown preps. Communication is just exactly the same. It’s those old crown preps from back in the day versus the tabletop, beautiful Emacs glowing on lay perhaps that you do later in your career. I love that Very, very, very visual. Where can people find out more about yourself?

Dr Asif: 

as if yes, as I said, I accept all my delegates and all my clients from referral. It’s just the way that I’ve grown my business. It’s not any other reason. You can get to the referral page landing page, learn about the exam site or anything else you want to contact me. I think if you Google the exam cycle PYP just type those words into Google then a squadron strategy or squadron business with name of my company will come up this landing page. You can put your name down for an intro. There’ll be a two hour webinar every month where I explain in a bit more detail about the exam and some of the concepts we discussed today At the end of it. If you’re interested and you think it was appropriate and you like the kind of stuff that I say, you can sign up to the course. If not, then that webinar that I’m doing is not a two hour sales pitch. I’m actually teaching you about the exam and the importance of the exam and some of the stuff that we discussed today. The idea that I have with that webinar is that if you like the way I teach you in the webinar, you’re probably going to love the course. If you don’t like the way I teach you in the webinar, then no, you’re not going to like the course so that we can park company that way. If they Google the exam cycle, pyp and squadron strategy or squadron business will come up. Then that’s the landing page to hit for me.

Dr James: 

Lovely stuff. Thank you so much for your time today. Many words of wisdom imparted today, many pearls, many gems. It was extremely fun to take part in it. I know that there’ll be a lot of value for the listeners. Thank you so much, my friend, and we will speak super soon. Awesome.