Presenting Treatment Plans the Comprehensive Way – PDP048

Jaz Gulati: How do you like to present your treatment plans? And I mean that like, in terms of your body language, and your verbal communication, and your written communication. Do you just say, hey, you’re gonna need three appointments and it’s a crown and the splint and that’s it? Or do you like to take a screenshot of their chart and you print the appointment schedules with the fees there?

Or do you like to just present verbally and that’s it? Or do you like to invite them back for a second visit? We can show them all the photos and present them all the options. And they walk away with 78 pages of a plan. Now, none of these options are wrong or right. It really depends on. Your workflow, but I really want to tap in to Zak Kara’s workflow because he is someone I admire so much.

I do believe he has mastered the art of treat ment plan presentation because he spent so much time focusing on this one element and of course he is a massive fan favorite. So, Protrusive Dental Community, I still don’t have a better name for you yet. Welcome to episode 48 of the Protrusive Dental Podcast.

I’ve got Zak Kara on today who 38 episodes ago. So episode 10, he came on and wow, like his episode was so popular. That’s like an almost like a gateway drug for the rest of the podcast. Like once you listen to his, you get hooked. That’s how good and that’s how big of an impact it had. And for a long time, it was second in terms of the most listened to episode.

Just behind restorability with a restorative consultant. But then of course over time it’s actually became the number one spot until of course Jason Smithson come and came along and we talked about onlays and vertipreps and then Jason just blew everyone else out of the water.

So that’s that. But hey, Zak is a massive fan favorite. You may have heard me mention his name so many times before and I’m so stoked to share the episode we recorded in lockdown actually with you all today as you would expect, with an episode about treatment plan presentation. We do talk about how to present your fees, when to present your fees, the different ways to do it.

Do you, I mean, I like to sometimes give my patients a ballpark figure for phase two and phase three, whereas Zach didn’t like going down there too much. And it was just an interesting variation and how some of the difference, subtle differences that we all adopt. And I picked up loads of takeaway points from this episode, a quick shout out for those of you listening from Texas in the USA and West Midlands in the UK.

For some reason, you two places in the USA and UK are almost like pockets of super spreaders of the Protrusive Dental Podcast and a lot of my listeners come from there geographically. It’s very interesting. So, shout out to Texas and the West Midlands. Community, you’re in a bit of luck.

Protrusive Dental Pearls
I’ve got two Protrusive Dental Pearls to share with you today. One is quite a relevant one to do with treatment plan presentation, and I’ll tell you that in a moment. And the other one is some very good news I have to share with you as well as a fantastic clinical pearl I’m going to give you. So the first pearl is an ebook that I’ve shared on the Protrusive Dental community Facebook group just search that on Facebook if you’re not part of it already and it’s an e book.

And it’s an e book by someone called Dr. George Cardoso who has almost become like a friend of mine now. I’ve been chatting to him quite a bit. He’s actually next week’s guest on the podcast. His e book is titled 16 Steps to Get More Treatment Plans Accepted Today and oh my goodness is full of absolute gems. So I want you to check that out. Almost like something it will prepare you for next week’s episode and I think you’ll get more value from next week’s episode if you read that ebook, it’s just brilliant.

He’s the founder of Make Me Clear, which is an online platform to be able to generate really beautiful looking but very educational in a patient friendly way, treatment plan reports and letters for your patients. And of course it ties in very nicely with today’s episode. It’s just one way of presenting it.

So do check out the ebook on Treatment Plan Acceptance on the Protrusive Dental Community Facebook group, and I’ll also add it on protrusive.co.uk/treatmentpresentation. So it’s all there for you in the show notes.

The second Protrusive Dental Pearl I have to share with you is the clinical one, and it’s also tied in with some really good news. The podcast has a sponsor. So I want to say a massive thank you to Mini Smile Makeover and Enlightened Smiles for sponsoring Protrusive Dental Podcast. This means so much. And for those of you who know Payman Langroudi , he’s actually a fan of the podcast and he’s got a great podcast himself called Dental Leaders, where you go one on one with different leaders and they interview them and their journeys.

I’ve really enjoyed listening to those episodes. So check that out, but really a massive thank you for the sponsors, because without this sponsorship, I cannot grow and add on different softwares and equipment to really enhance the experience for listeners. So, it’s an interesting way of sponsoring because the chat that I had with Payman Langroudi who is head of enlightened smiles and mini smile makeover and I found that he’s a fan of the podcast and then he approached me and I said this sounds great and I said as a sponsor he would do I said hey, what do you want me to say?

How do you want me to pitch it and the most beautiful conversation happened Payman said to me, “Jaz I’m a fan of the podcast. I trust you. You already came to the mini smile makeover course last year and you already use Enlighten. Just, I trust you. Just carry on.” So, never before has a sponsor allowed a sponsee to be so expressive.

So, thank you not only for the sponsorship at MSM and Enlighten Smiles but thank you for letting me do it in this way, where I get to share with the listeners, what I like. And it’s something I genuinely believe in. So let me share with you guys a really cool instrument that I bought from Cosmodent.

So if you’re in us, you can get from Cosmodent. If you’re in the UK, you can get it from enlightened smiles website is called the CASI, C-A-S-I instrument. Now, the reason I love this one so much, and I first learned about it at the mini smile makeover course, which I went to in London about. I got some almost a year ago now.

And it’s just fantastic because I’m not a massive fan of buying these instrument kits because what happens with these nonstick instrument kits is you have only one or two instruments that you’ll probably end up using and then the rest of the seven or eight instruments go to waste, right?

So one thing that actually Payman spoke about over a year ago at that course was that he likes to buy one instrument and maybe buy two or three of those, of that one instrument because it’s the one he uses all the time. I’m still someone who uses just a microbrush and a probe for his posterior composites.

That’s all I use, right? But for anterior composites, I like some good instruments. And this CASI has just been amazing. I like this. I like the shape of it. I’ll tell you why. Okay. The one side. Okay. It’s really good to actually adapt composite on like veneer it on. So allow it to just flat pack it on, but it’s got a lovely curve to it which means that instead of using my finger, which I sometimes do, I use my glove finger as a palatal matrix.

I know some of you are vomiting in your mouth. I apologize, but this is a better way of doing it than my glove finger because it’s got this lovely contour. So you can use it to sort of make your freehand palatal stent for an incisor and the other instruments.

So it’s a two in one. The other side of it is just perfect. It’s like an IPCL with a curve and it’s just flexible. And it’s just so perfectly shaped to shape the interproximal contours and get your line angles in. So I know that for anterior composites, it’s just the one instrument I need. So, check out Enlightened Smiles or Cosmodent if you’re in the U. S. If you want to get the CASI instrument. The one I have is a 3C, which is suitable for central incisors and canines. I didn’t buy the lateral incisor one because I just feel I can use this or a flat plastic to be frank and honest with you. But it’s a great instrument. So thank you so much once again to MSM and Enlightened Smiles for the sponsorship.

And I’ll put a link to that instrument, which I like to use. So it’s something that I enjoy, not something that they’re pushing and that’ll be on the website. So I hope you guys enjoy the podcast episode with Zak Kara and I’ll catch you in the outro.

Main Episode:
Zak Kara, welcome again to the Protrusive Dental Podcast. You are a fan favorite.

Zak: Ah, has it unlikely.

Jaz Gulati: A hundred percent. You’re 12 listens away. So I dunno if you saw last year the most listened to episode was Oz Alani.

Zak: Was it?

Jaz Gulati: And I keep checking again, like, you know how far you are ’cause you were second, and you are now 12.

Zak: You are now in lead board.

Jaz Gulati: I should actually, you’re 12.

Zak: Am I really from being, from being what? Number one.

Jaz Gulati: You’re 12 listens away. Okay. That’s from last year. Jason Smithson came along and just literally blew, blew, blew the competition away. Yeah, as you do.

Zak: I’m no Smithson. I don’t do this. I’m not hard skills. I’m soft skills. Just-

Jaz Gulati: Well, that’s exactly why I had you on that. Out of the 20 odd episodes I’ve done so far, you listened to the podcast. You must have heard your name, you must have, your ears must have been burning.

Zak: Literally, I’m out running, I’m out running with you in my ears. And it’s always like, Zak, I’m like, what? Why? I mean I appreciate it, I’m really honoured, I’m really honoured that people would listen.

And I’ve had some really lovely feedback, so thank you if you’ve messaged Zara and a few others in, even in recent times. And some of the students I used to teach in at Portsmouth, King’s students, who are coming down on outreach. Quite a lot of people just comment and say, I wondered if it was you.

And then it became obvious as the podcast went on kind of thing. So, yeah, I’m honored that people would take kind of my opinion, with the gravitas that they do with their-

Jaz Gulati: No, it’s a hundred percent deserved, honestly, that impact. So if you haven’t listened to that episode please do listen to it. I think it’s about episode. 10, I think in the series. That’s a great lot- So many communication gems in there. And that’s exactly why I brought you back to talk about something that is very dear to your heart, something that you’ve worked on. And I know there’s something that we should all be working on and that’s how we communicate to patients.

But specifically, we can talk about for hours on that. So what can we fill an episode with for now is presenting to patients.

Zak: Love to. And do you know what? This is definitely something that’s close to my heart. And the reason why, I’ll probably give a bit of backstory, one of the reasons why this came up, do you remember literally last week? By the way, should we give the context of the fact that we’re three weeks into lockdown right now recording this?

Jaz Gulati: We’re three weeks into lockdown, I’m wearing scrubs.

Zak: Which is, I’m here wearing a Jimi Hendrix t shirt, although Jaz just told me we were doing a video recording of this. So we can do a video cast or pod, whatever you techno people will call it.

So I wanted to put some hair wax in, because I was like, I’ve literally got out of bed hair, and it was like a bit here and a bit, anyway, whatever. So I’m looking I didn’t-

Jaz Gulati: I forgot to tell you about that, sorry.

Zak: That’s all right, no worries. You’re the one who has to get up every morning and sort your bug out, so.

Jaz Gulati: That’s it. But can I just say, the benefit of wearing the scrub for me is this. So, a week into lockdown and I was really struggling to get my work mode on. So I thought, okay, you know, dress for the occasion, okay, and that has really helped me to actually just crack on. It has.

Zak: Do you know what? I can see that. I can expect, I can sense, one of the things that’s happening in my life is everything’s just blurring into one. And but it does, this limbo period just feels like that period between Christmas and New Year’s, doesn’t it? Where you’re just not sure what time of day it is.

And the mad thing about it is, without going too much into rest mode, we are, I think, all sensing a bit more about what we, what our bodies really want to do. And how our minds work best. And I do, naturally. I’ve always been a night owl. I remember back in my Sheffield student days, as an undergrad, always doing my revision at 10pm when everybody else has gone to bed.

I used to have a mug which had the Guardian logo on it. And the Guardian mug, which was the triple size mug. It was a mug times three in terms of volume. And I used to take it upstairs like a bowl. And I used to sit there with it, and I used to be drinking my coffee all night, and, yeah, be up till, yeah, ridiculous 6 o’clock, and not get up till 9 or 10.

Jaz Gulati: I was the same. Me and my friend Clifton used to do all nighters at the IC. But, one thing that has changed me, is not only the baby coming along, that really changes your sleeping patterns, but, I read the book, Why We Sleep. Have you read that one?

Zak: Yeah, actually, yeah, I haven’t read all of it. I got about two chapters in and I was like, whoa, I’m gonna die. So I’m not gonna lie. I’ve veered on to other bits of the time. Yeah, but you’ve loved it.

Jaz Gulati: So far? I’m about halfway through and it just rings it home, doesn’t it? You know the importance of sleep and how we are all depriving ourselves and this knockdown period is an opportunity for most people to to catch up and I’ve been enjoying the odd nap here and there, which is very unlike me, but it’s our opportunity for our bodies to heal.

Zak: You’re right. Challenge always brings new avenues.

Jaz Gulati: And talking of new avenues now, people who want to, whenever the day comes, that beautiful day comes, when we can see patients again. We can be what you’ve been doing with Tubular’s Live Aid as well is basically gearing people up so that we can go back, re energize, refreshed, full of knowledge, full of new skills, soft skills.

So the soft skill I want to really pick your brain on is presenting to patients. And I knew that this was something close to your heart a few years ago when you’d sent me a recommendation. This must have been two years ago now, to read that book by Barry the art of case presentation.

Zak: Yep.

Jaz Gulati: Tell us about that book and tell us about has that had a major influence on you and what else has had an influence in the way that you present to patients before we then come onto the question.

Zak: I’m a firm believer that we’re all a patchwork quilt. We’re all a patchwork quilt of where we’ve come from. Who we’ve been influenced by. Sometimes some of the systems that you’ve just happened to have fallen into, like for example, you end up in a dental practice, a couple of years out of university, you’re surrounded by some colleagues who do things in a certain way.

And you begin to believe that that is the way to do it. And no matter how much training you had beforehand, which, let’s be really honest, as undergraduates, very few of us were lucky to have tutors who really got this and did it, I would say, in a world class way. But really at the time, you’re kind of flustered by the whole kind of that thing that you do as a dental undergrad on a clinic.

You feel like you’re riding a unicycle that’s on fire and the world is on fire and you have to chase the dental nurse who thinks that you’re the worst thing since God knows what, you know? You remember those days? And so dental school is very much about just having basic hard skills and you don’t know what you don’t know.

So, the Barry Polanski thing came from a great author, by the way, great, great book. Haven’t read it for a few years, but I picked up on that because I spent some time at the Panky Institute in Miami, Florida. And Panky, if you don’t know, is a little bit along the lines of Dawson Spear, actually to be really brutally honest, my opinion is that Panky’s a little bit more dogmatic than that.

A bit more old school than that. Maybe evolving in recent times. But their foundations are essentially based on what they call the three legged stool. And their three legged stool is personal mastery, financial mastery, and clinical mastery. And the philosophy behind it is that you simply can’t have one longer leg on the stool because something else will topple over.

And to be really, again, brutally honest with those of you listening, I think dentistry has got it really wrong over the years. I think dentistry has been full of people who are hard clinical technicians who are really good with their hands, no doubt gifted way beyond what I’ll ever be and even aspire to be.

Because the more I got to know myself and understood my values and my attitude to life and actually why I bother getting up in the morning, the more I realized the fun bit is actually the people and the personal mastery stuff. So yeah, the art of case presenting comes from that because, actually it’s probably quite a controversial word, maybe a word that you want to get into, but the philosophy behind it is basically that facts tell and stories sell.

And the truth is that if you want to convince anybody to do anything, and I don’t mean this in a manipulative taking advantage of vulnerable people kind of way. I just mean this in, let’s say for example, your life partner, your wife or something. You want to have your wife, Sim, do something and you know it’s in her best interest, but you kind of just like, come on, I want to twist your arm, right?

How do you do that best? You don’t just tell her to do it, or you suggest it. You even be, try and be tactful. One of the most successful ways is actually to make it part of a bundle of well, what better way to describe it than a story, give analogies, give representations and use metaphors. And that made me go back to my roots.

And I did an a level in English, which is a bit weird for some people who-

Jaz Gulati: I knew it. I knew you had this. Everything makes sense now. Why are you different? It just makes sense now.

Zak: Yeah. So I did. I know in English and unlike most dentists I had, I just had this natural thing where I did love writing essays and I still like writing essays. I am not in a, not technical essays necessarily, but you know, I’ve been toying with this idea of starting a blog and doing a this and doing a that. And do you know what? I just wish I had 48 hours every 24, I’d do loads of stuff. Yeah, so that’s where really the soft skills stuff came from.

Jaz Gulati: Well, on that note of facts tell and story sell, case presentation is the very close cousin, or even the sibling, or maybe it’s the very same as another important part, which is closing. Closing the case. Closing the, in quotation marks the deal.

Zak: Now you you make me want to be sick.

Jaz Gulati: I know, no, but here, I know, but this is true. Call it what you want, but this is selling. So the, one of the questions I wanted to ask you is, what are your thoughts on the phrase? Because I know you like to think differently, but what are your thoughts on the phrase, to sell is to serve?

Zak: You’re so controversial. Look, this is the word sell. I totally, totally get it. It’s a really controversial word. And I think that’s because when you do, we will do this mental algebra all day, every day. We’ve all got this inner monologue, haven’t we? And we all do our little sums and we work out our equations and we go, okay, well, I think that equals that because all these things go together, right?

If you work out the square root of how words make you feel. I think the word sell actually conjures these images of manipulation, deceit, vulnerability, people being taken advantage of. And I think one of the reasons why is because the noun a sell is, as we know, used in magic tricks.

It’s used in an act it’s basically, it could be argued a disappointment. It’s a disappointment that’s usually resulting from being deceived about the merits of something, wouldn’t you say?

Jaz Gulati: Yeah, absolutely.

Zak: And so, the word sell has these negative connotations, but the verb sell is just semantics, it’s a trade, It’s an exchange. And whether you like it or not, that is what we do. We exchange, if you’ve gone to dental school and you’re listening to this, and you’re not aware that you’re trading your time, your skills, your services, the knowledge in your head for something, which is probably money. Then, you haven’t got your head screwed on right because we’re all doing it and there’s nothing wrong with saying sell, but as long as you’re not miss or abusing that word, let’s say.

Jaz Gulati: So as long as you’re doing justice in an ethical way, but the reason why that term it helped me is because I also come from this background that selling is a dirty word. I wasn’t comfortable with it. I wasn’t, just for the reasons that you said, the noun, I think you put it beautifully. The noun of sell, it’s not so well perceived. And in my earlier years one, two, three, maybe even three years out of dental school. I’d find it really difficult to tell the price of something to a patient.

I would find it difficult to, even though I know this a crown will be better for them than a large composite. Maybe it’s from fear of rejection, or value, or whatever. That I would struggle, but then something that Barry Olton teaches and a few other people.

Zak: Bazza gets a shout out every episode as well, you know that?

Jaz Gulati: He does. Yeah, literally both legends. Hi Barry. Moving on from Barry Polanski to Barry Olton, and Barry Olton really rang it home for me now to serve, to sell is to serve. So when you sell to someone, you would do, so when I adopted that mentality that actually by selling, let’s use the word selling, selling this crown to this patient instead of a large composite because the fact that there’s only a thin buccal and lingual cusp remaining and really in the long term indirect restoration, cuspal coverage.

Although three times more expensive is definitely the best thing for that patient and well, that’s it. So that’s my old roots, isn’t it? Coming through, it’s expensive or is it you know-

Zak: Is it a greater value?

Jaz Gulati: Yep, a bit bigger, or as some of the gurus say, a bigger investment.

Zak: Investing in yourself, investing in your health, investing in your future. No matter how you want to spin it, I appreciate that, yeah. No matter how you want to mould your vocabulary around this, the truth behind it for me is that our value is not in the carpentry. Our value is not in the mini arts and crafts.

And I’ve said this for years, we are humans with empathy, and hopefully we make dentistry a comfortable and a seamless experience. And we’re not lifting things and hunting things. We’re not producing stuff or growing stuff. We’re kind of connecting people. And we’re nurturing relationships with people.

And do you know what part of that is that you have to trade your care for something? And do you know what?

Jaz Gulati: Just say it’s money, money.

Zak: It’s money. It is. Give me your money. The truth is that in this disrupted world we’re living in increasingly. So let’s face it, whether we like it or not.

Jaz Gulati: In these unprecedented times.

Zak: Oh, stop. If you say unprecedented or webinar, I am actually going to strangle you through my screen. Do you know what? The deeper than the word selling the sales coaches, in my opinion, don’t really get it. Their motivation, if your motivation is deep rooted in fear because you’re afraid of being replaced or because you’re only concentrating on your habits and your skills and your knowledge.

You haven’t gone deep enough to understand why you’re actually doing it, your values behind it. And then you can understand your aspirations. Then you can know your emotions. Then you understand yourself better. And you know what? Your attitude is a byproduct of all of that. Isn’t it? If your attitude is right, and you’re conveying the right message, you won’t worry about the words that you use because people will come flocking to you. Do you see?

Jaz Gulati: 100%. And then when these people come to you on referral, and then let’s say we’ve had this consultation, and that just reminds me of a story. A few weeks ago I went to my old school and I did a bit of like speak to the Year 9s, Year 10s, and they’d come to your store and they’d learn about dentistry.

Zak: Oh, you’re such a soft lad. I love it.

Jaz Gulati: Had a morning off, I thought, let’s give back to the community. So I did that, and I didn’t know this nurse would be there. And this nurse came from a different region, and she had some connection to the school, and we were there together. And she was three years into dental nursing, and she worked in a predominantly NHS practice.

And we just sort of for a moment, exchanged our stories. So her story was that she would nurse for someone who would see up to 60 patients a day. And I am a dentist who sees 8 to 12 patients a day sometimes. And then we exchanged, okay, how long is a usual checkup? Oh, about 5 to 10 minutes. So when I said, oh, a new patient consultation with me is around about 50 minutes, sometimes an hour. She was, literally, her mandible hit the floor. She was-

Zak: For sure, her mandible.

Jaz Gulati: Her mandible hit the jaw. Her mandible hit the floor because, because she was just wait, how do you, what do you do for the other 50 minutes? So, this is the complete paradigm shift that she had to have to understand my world of it. So let us-

Zak: Yep. No, go on. I just, sorry to interject, but I think that’s really the root of why sometimes some dentists misinterpret one another. Because if you haven’t been exposed to a world where maybe you take longer over things, the perception might be that you’re wasting people’s time, you’re just doing it slower, and you’re just trying to craft a bit more, you know, ring a bit more cash out of that person.

And I don’t genuinely believe that that’s true because if you are, you can legitimately look somebody in the eye and you can offer X solution to solve Y problem, pain, worry, distress, whatever you want to call it. If you can’t do that, you’re not serving them very, very well. So the answer to your question, selling. Is it serving? Is to sell to serve? Yeah, it is, but the sell is the semantics which maybe gets it misinterpreted.

Jaz Gulati: Yeah, that’s very fair, that’s very fair to say. So, I don’t want this episode to be in specific is about the actual data gathering or information gathering part, the examination, the questions, because we’ve done a little bit about that. Also you went around to different tubal study clubs and you did a beautiful presentation about how to communicate to patients during that. But I want to do the bit where you’ve now, found out the patient’s goals, their wants and needs, you’ve done your complete examination, you have your diagnoses and you have maybe a couple of different treatment plans in your mind.

Let’s talk about presentation. So first question is what percentage of these patients do you bring back for a second treatment plan presentation appointment. Is it always? Is it sometimes? How do you do that?

Zak: Okay. I think really what you’re asking about is choreography. And I mean, choreography without making people shudder and think about like role play.

Jaz Gulati: I’m gonna interject you there as well, Zak. You said roleplay, you said choreography. Have you read Nudge?

Zak: Actually, do you know what? It’s right here. It’s sitting here in my bookcase. And I haven’t, no. It’s next on my list. Why?

Jaz Gulati: No, listen to it. It talks about, gosh.

Zak: You’re such an audio book junkie, aren’t you?

Jaz Gulati: Yeah, no, I must say, and it talks about choice architecture. Which is you say choreography, but it reminds me of choice architecture. So for those listening, it’s the way that different options are presented. So whether you’re in a canteen or whatever, the way that the different food is presented at different levels, whether it’s your eyesight or below, it influences your decision.

So it talks about in healthcare, how can we make patients pick the option that is the better option for their health overall. So I didn’t really come away with massive learning points on how I apply it to dentistry. Perhaps I need to listen to it again, but it’s very interesting. You say choreography, another way, choice, architecture. So let’s talk about, please tell us about your choreography role playing.

Zak: So if you’re roughly, in my world, I invite everybody back for a follow up consultation, but I’m not dogmatic. Everyone’s got their own workflow, and by the very nature of the practice that you’ve fallen into, the colleagues you’ve had the way they do things, I actually started in my first, let’s say, private practice position a couple of years out of university.

I was just picking up the ropes, learning the ropes. I was developing my own style, getting to know myself and what felt right in my hands, in my words. And it takes time to craft that, doesn’t it? Because no matter how much you look at yourself in the mirror and you say the words in a particular way, you get these kind of spiels that become normal to you.

It doesn’t quite always flow until you hit the ground and you go, okay, right, I’m going to have to say this to this person in the way that I practiced. And you kick yourself after. And you go, I didn’t mean it like that. And you kind of look back and you critique, right? It’s all part of the growth that we all have.

So, at the beginning, I used a shotgun treatment plan. And what I mean by shotgun treatment plan is I’d have a 45 minute new patient health check appointment. Check up, if you want to call it Jaz’s check up. And I essentially sat there and I used to do the examination and I’d put some photographs and radiographs on the screen and I’d start seeing things and I’d start pointing them out.

Bang, bang, bang, bang, bang. Here’s my shotgun. And I would start putting a treatment plan together. And in classic, SOE exact software, it’d be an itemized treatment plan and boom, it’d be in somebody’s hands.

Jaz Gulati: So the patient’s there. So you’re back is to the patient while you’re doing this on computer. Let’s talk about that for parts of it.

Zak: Yes, at that point, it was like that. Yes. And a lot of dental surgeries, particularly when you’re a younger associate, aren’t really geared up for this, are they? They’re not really arranged in such a friendly way where you can actually have a conversation side by side a patient because the reason why I evolved this and it’s become how it is now is because why somebody chooses something often comes down to whether they know, like, and trust you.

If they know, like and trust you, then what happens is they’re actually, you’ve gone up in their estimation one level and actually this happens beyond dentistry. The thing I always love to do is tell myself, nobody’s going to believe what you believe in until they believe in it themselves. So if you can have somebody come up with a solution themselves to the problem that you have highlighted.

And they put the words, you’re not putting the words in their mouth, but they spit the words out themselves. Holy moly, well you’ve just nailed it right there, haven’t you? So I used to think dentistry was kind of reliant on talent and personality, but what I realised over time was that I’ve become now, reliant on set plays.

You know like in American, American football, there’s set plays, there’s scripts, there’s ways that they’ve rehearsed and I choreograph this stuff and then I come along and on my good days, I put my salt and pepper on top and I do my talent and I do my personality and I do my charisma and suddenly you’re like, boom, I feel like freaking Spider Man today because there’s like just webs, boom, boom, everything I touch comes to, just works, right, and then on those days, it’s self perpetuating joy and you honestly come to work I can’t fail today, this is all great.

And actually what happens is you produce better restorations, patients walk out the door and advocate you, they become raving fans, we’ve talked about that before, Paddy Lund’s kind of way of approaching things. So when you told me about the theme of this podcast, why do I invite patients back? I actually broke that down in my head.

Why do I invite them back? Well, I enjoy bringing patients back for a presentation appointment because I don’t call it a presentation appointment, I just call it a follow up consultation. It’s for a few reasons, and one of them actually is quite a serious, important, medical, legal reason. And the reason is because, in my eyes, you can’t adequately consent somebody for x solution to y problem, because you can’t do that in one appointment, necessarily, in my opinion.

Because it takes time for people to warm up to you. To open up to you, to trust you, to see you’re credible, you’re not a charlatan, you’re not a sell, you’re not an act, you’re really doing it because it’s in their best interest. And if you want to go even further, then you could say Montgomery level consent.

You’re going to go with Montgomery level consent. That level of detail needs to be appropriate to the person or the patient, or any reasonable patient under those particular circumstances. But for that reason, it’s ironically pretty impossible, isn’t it? How can you possibly get to know somebody in a shotgun treatment planning type appointment?

How can we know what’s reasonable for that person, or what’s unreasonable? Because we’re not blinking psyc I’m sorry, I’m not, I’m not psychic. Get to know somebody slowly and steadily, and my approach to it is that I at all stages want to mitigate my risks. I mitigate my risk by getting to know my patients.

And I do that unhurriedly, I hope, and hopefully personably. And if you then do the extra salt and pepper, hello buzzer again, if you do your comfortable dental injection technique and by the way, Barry hasn’t taught me, I’ve never even met the guy, I’ve just spoken a couple of times online and seen some of his work online and things, but people are influences like that around you, mate, you see, actually, that is how you join the dots, boom, boom, boom, boom, and suddenly, that’s, for me, the real art of being a successful dentist.

Jaz Gulati: Well, what I was hearing there when you said about the bringing them back for the reasons of consent is never treat a stranger is what the theme of that was basically to get over that.

Zak: Didn’t just say that on his podcast.

Jaz Gulati: Absolutely. So you bring them back. Because of the fact that one of the benefits is the consent, it reduces a risk overall. And then when you follow that up with your excellent work, but if someone’s listening to this, and they’re thinking, oh, you know what, when this lockdown finishes, I’m going to go back, I’m going to invite all my patients back for a follow up appointment. Well, you need to make sure everyone’s in on it, you actually need to it. Get your receptionist, nurse, you can’t just suddenly just, off the bat and not do it.

Zak: Yeah, yeah, exactly. And do you know, this is the thing that takes time. Quite a lot of students who I used to teach, there’s one who I think of in particular, I won’t call him out because he might be embarrassed, but he always used to say to me, how do I start doing this complex work?

The truth is that you can’t start doing complex work until your team trust you. Your team don’t trust you because they don’t know you. They don’t know you well enough yet. They’ve not seen you vulnerable. They’ve not seen you scared. They’ve not seen you elated and enjoy it. They just don’t necessarily, and why would you?

Because there’s an awful lot of really not very nice, not very, very good dentists out there over the years, sad to say. But now, our generation are having to kind of bear the consequences of that. People don’t trust easily in our field. So if your team love you, trust you first, then they’re more likely to recommend you to your patients.

And that’s how you increase your skillset, not only soft skills, but then you can start branching into more complicated treatments and so on . For me, really, the other reason, not only just consent, but the other reason is it’s really important you know, and a patient needs to know, what their problem is.

It’s problem awareness. And that takes time as well. Until they can commit to a solution, they need to believe what we believe. They need to approach the dentistry in the way that I like to approach it, because I’m sorry to say it’s my house, my rules. And they need to know, like, and trust you, like we said.

Jaz Gulati: They need to come up with a decision, but also gives you the time as a person who’s going to be sharing the different options with them, some time to actually put something together.

Zak: Exactly, and if they don’t trust the fact that you’re doing that for the right reasons, then you actually might be a bit stuck.

Because a lot of people at that point are sitting there thinking, imagine a new, from a new patient’s point of view, they walk in the door and they’re expecting a certain thing because they haven’t been geared up to, this is the way they do it in this clinic. And so what they do is they’re expecting an answer at the end of the appointment, where they might be sorely disappointed at that point, right?

They might feel let down, they might actually feel that they trust you less. So actually you’re not wrong. If you go back after lockdown, let’s say, and you’re back into dentistry, maybe dentistry is going to change altogether, but who knows? That’s another conversation. You hit the ground running, put together these wonderful treatment plans, actually you might come across in a very- they’re quite the opposite way that you intend it.

Jaz Gulati: Absolutely. You have to make sure this is all part of something bigger. The thing I want can I just do before you move on to the next one?

Zak: Yeah. Next thing. The other thing that’s part of that, by the way, the choreography I say is kind of, if you break it down from a person’s point of view, a patient’s point of view, they know absolutely nothing about you.

They’ve never seen your face rewind to the very beginning of the steps. What do they know about you beforehand, and what are you producing online, for example? Because that’s where most people look, isn’t it? Your website, your blog, your Instagram feed, God forbid. How many Rolex watches you’re wearing, and whether it shows your Ferrari logo and Ferrari badge or whatever, you know?

Be very conscious that that sends a signal. And I hate to say it guys, but if you’re ultimately you wish to live quite a pretentious life where you’ve got logos and brands around you and you’re swimming in this world of stuff, you’re going to attract a certain type of patient. So beware, be wary.

Don’t be just diving in because you think that that’s the way to do it. So you have to know what they’re going to get beforehand. You have to ask yourself why they found you. What are their expectation levels? What are the systems that you have as a team? And what are they slowly, slowly, get there, step by step.

You don’t ask somebody to marry you on the first date. And that’s what a lot of dentists do. And that’s what I was doing first a couple of years out of uni. I was asking people to commit to extensive treatment plans, asking to marry them on the first date.

Jaz Gulati: You mentioned about bringing them back every time. The way that I do it at the moment is in something you mentioned, the Panky, I can mention a lesson we can learn from the Dawson Academy. Which is there are two types of patients. There’s your general patient. And there’s your complete patient. So, my general patients, who I say, this patient, you need a crown and a filling, go see the hygienist, here’s your plan, it’s gonna cost you that much.

Obviously I don’t say it in that way, but then, there’s your complete patient, which needs a whole lot more, and they need to really understand what they’re getting themselves into. And sometimes you have someone who has really complex needs, but their mental attitude and their goal is of a general patient. So, you have to suss out the patient as well.

Zak: And they don’t know yet how they’re going to feel after you’ve started to help them, right? And you don’t know either. So for me, if you want to boil this down into a journey, it’s problem awareness first, because it is risk, sorry, it’s risky to make big decisions and maybe invest, if that’s the word you want to use, financially in something without knowing its value.

So that’s first and then solution awareness and then they’re going to have some interest in what you’ve got to provide and slowly but surely they’ll come to trust you. And one of the ways that you can actually have a general patient become a complete patient, let’s say, if that’s the philosophy you want to use, is you can solve some of their relatively surface level problems with an affordable way, a minimal investment, if that’s the term you want to use, of time and money and whatever.

So low stress. And what you’re demonstrating at that point is, hey, I’m a good guy. I know what I’m doing and I’m not going to push you. And that’s cool. You take your time at whatever’s, whatever’s right for you. Play the long game, play the long game.

Jaz Gulati: And you also demonstrate that you’re someone who’s listened to that patient. Cause that’s what they wanted. Yes, they have needs. That should be met that are beyond what they’re even aware of, like you said, but it all starts with actually good foundations and getting that patient just healthy and happy and have their own goals met before you then educate the patient about actually and that’s a whole part of it.

I just remember the other thing I was going to say, based on what you said about what is your online presence like, that’s what I was going to say. And a huge percentage of people before their appointment will Google you. So you need to make sure that what you’re projecting out in the World Wide Web is the same thing that you coherently want to-

Zak: Has he? It’s not 1997, is it?

Jaz Gulati: I don’t remember.

Zak: World Wide Web! Wow, that’s the first time I’ve heard that in a while.

Jaz Gulati: It’s a long time coming.

Zak: I agree, completely.

Jaz Gulati: Quickfire yes or no question. Does having a consult room make a difference to patient acceptance?

Zak: Yes, but probably negatively.

Jaz Gulati: Fantastic. Interesting. Cool. So then now we’re going to get into the-

Zak: Ooh, I love that you don’t even want to delve into that because it’s so controversial.

Jaz Gulati: It is controversial, you know? Okay, I’ll be honest.

Zak: I call a presentation room or a consult room a hard sell room. Usually it’s a small room, it’s a cupboard, people feel locked in, they feel encapsulated, no matter how much you allow them to put pointing their feet to the door or use all these philosophies behind allowing them to feel like they’re in control.

Oh, you’ve got a lovely screen and it smells nice and you look, there’s lots of ways to manipulate people, but I’m really sorry to say, I think in my opinion, it veers more if you’re going to call it a spectrum, I think it’s more of a hard sell than a patient being in charge kind of way of doing things. If it fits into your workflow that you have to use a separate room, then that’s a separate subject and a separate methodology.

Jaz Gulati: Do it because you want to, because it’s something that you feel is a comfortable environment, rather than what some people do is because they read or heard somewhere that actually their case acceptance will go up if they do it in a different room. That’s not necessarily what should be the case.

Zak: Do you know what, Herschel, if you listen, I don’t even know if Herschel listens and watches. He does-

Jaz Gulati: Yeah, he’s a cool guy, man, yeah. Hi Herschel.

Zak: He said something the other day which resonated with me, which is that in the first few years of his career, he thought the aim was to get people to say yes and he came a point, came to a point in his career where he just went, Oh, all right, I’m not just here to get people to say yes. No, you’re not. And you know, it takes some time, I think, to, to be burned a few times and hurt a few times and go, am I really bad at this or something? No, it’s completely fine to just hold somebody’s, treat it this way.

Hold somebody’s hand through the journey of their their dental life. Their dental future, and if you’re a really committed, caring person who will stay in one location, like the Raj Ahluwalia’s, for example, of the world, who’ve literally been in the same room with the same dental chair.

Jaz Gulati: Tiff Quereshi as well.

Zak: Yeah, exactly. Guys like that who are giants. If you want to stand on the shoulders of giants like that, be less millennial. Just be a bit old school, be a bit kind of it’s not about me, it’s about other people. And you have to be quite vocational about it if you want to, I think, be the best you can be.

Again, maybe I’m a hypocrite for saying that because I’ve contorted my career in lots of ways and moved countries like you have and worked abroad and all that sort of stuff. So, there isn’t an only hard and fast rule, but hopefully this will inspire you in some way and help you kind of think about what’s really right for yourself.

Jaz Gulati: Well, beautifully said, but also echoing what you just said a few minutes ago is playing the long game. So let’s talk about the appointment. So now the patient’s back for the follow up appointment. What can you, because I know you’ve studied this in great depth, what can you teach our listeners about how to, I don’t know if I want to use the word successful, or a having a good or a appropriate treatment presentation appointment.

Can you tell us about maybe, I don’t know, I have no idea which direction you’re gonna go in now. Maybe you’re going to talk about different personality types and how to present different personality types. Maybe you’re going to say about letters and photos or what, how do you want to now? I mean, the microphone’s yours, my friend.

Tell us about presenting to patients. Tell me how to make me someone who is okay, ultimately, how am I going to get my patient?

Zak: I was just about to give you a compliment Jazzy. I was just about to say, you’ve got really good at this because you allow your guest to take the reins. This is wonderful. And now you’ve started to go old Jazzy, where he just talks and talks.

Jaz Gulati: I know, I know, I’m getting, but the thing is, I’m biting my tongue because I don’t want to. Well, how do you get patients to say yes, at the end of the day? Look, at the end of the day, look, I know you just said, Herschel said, okay, it’s not about getting patients to say yes, but a part of presenting is because you would have come up with a plan that is in the patient’s best interest, and it’s a type of dentistry that you want to be doing.

Okay. And obviously you want to choreograph your treatment presentation so that actually it gets the patient to do what is the right thing for them that meets their goals in a way that is ethically, and that’s something that’s within as you as a dentist in your sort of bracket of complexity. So tell us about how we can ultimately choreograph this appointment in the best way possible.

Zak: That was very succinct. Well done, Jaz. Can we have a round of applause for Jaz? Okay, so look, I think the way to think about this is, in everything in dentistry, start with the end in mind, right? But if you’re going to start with the end in mind, you then have to break down every step of the journey.

If you want to present effectively to patients, we said it begins at the beginning with the awareness stage. So for me, I know what you’re expecting me to answer is literally when the patient is face to face with you in the room, how are you setting this up? How are you choreographing? Where’s the computer screen?

Where do they sit? Do they sit on the dental chair? Do they sit on a separate chair? If they’ve got their partner with them or their friend or whatever, do they sit in, how does this actually literally work? But just pause for a second and think. The relevance of that is actually that you need to know where a patient started on their journey.

When they became aware of you, what did they see? How much do they know about the solutions already? Because you need to customize this. And some of that information you can actually achieve, or you can receive, sorry, in some of the pre chat stuff. And I mean way back. I mean, for example, if your system is patient finds out about us online.

They see your blog. For example, I’ve started recently during lockdown starting to produce some hopefully really awesome resources for patients where they feel like they’re in charge of the situation where they are starkly comparing the difference between what we do in a clinic environment versus direct to consumer, at home braces type solutions, for example.

One of the things I’m working on at the moment is actually like a DSD, like a Facially Generated Treatment Planning thing like SPEAR used to do 20 years ago, 30 years ago. Why don’t we show patients more transparently what we see as dentists? Because if they’re seeing stuff like that, they’re instantly forming a kind of perspective on this is what Jaz and Jaz is about, this is what he does, and geez this guy’s valuable because he knows this stuff.

And you know it pitches you in a certain pocket of their mind where they go, this guy’s a giver. Do you follow? So I don’t want to go too woolly about this, but awareness starts with all of that stuff. And if they’ve got some backstory about you, not because you’re trying to convince them, some of that actually might be a valuable resource because you can then say, okay, well, here’s your whatever you want to call it, facially generated treatment plan.

This is what you came up with. What solutions do you think there might be? And that’s how you can start to mold the conversation, for example. The other aspects of it then, what did they receive from the clinic beforehand? Again, if you’re an associate, young associate yet, let’s say your first five years, 10 years qualified, you maybe don’t have your own environment where you can mold quite so much yet, but if that’s the case, then help me with my episode 10 numbers and get us the extra 12 so I can get to the top spot because we spoke about being a linchpin in episode 10, right? And being a linchpin actually comes down to you taking the reins a little bit and showing the team around you that you care about this.

And the way you can do that is, for example, you could come up with email sequences. You can help to communicate with patients beforehand by having that phone call we spoke about. It’s all about moulding what’s right for the type of patient you want to receive at the end, and what they might need to see on that journey before they get to you.

I, for example, then talk to a patient by WhatsApp beforehand. And I’ve got WhatsApp on my desktop now. So I’m literally like, old school MSN messenger probably before a lot of people’s time listening to this, but bang, bang, bang, bang, bang, bang, bang back and forth like that. Right.

Jaz Gulati: And because do you have a separate number for like, just?-

Zak: Yeah.

Jaz Gulati: Cool. So you have a WhatsApp. And this is again, part of the pre appointment sort of chat, or this is-?

Zak: Absolutely. This is way back. So, if you want to know my flow, it’s patient finds out about us, some sort of campaign, or they’ve found out about us from a friend, or a word of mouth, or whatever.

It’s very rare for somebody to just walk past and enter, let’s say, if you want to call it a funnel, call it a funnel. If they want to enter that and just walk in off the street, then they actually they need to pre qualify themselves for why they’re there. And, without being too rude or harsh about this, one of the reasons why is, who’s it that spoke? Is it the Implant Ninja guy? What’s his name?

Jaz Gulati: Ivan. Ivan Chakun.

Zak: Hello Ivan, if you’re listening. Ivan, spoke about this and actually I’m just seeing as I wanted to talk about it. This is my really rough version of what I’ve just been working on these last couple of days of what I would call green flag, amber flag, red flag patients.

Okay. And I’m trying to work on ways of kind of going, is this person my patient? So, and the reason why is because, lo and behold, start at the end, this bit. Sorry about all the rustling paper if you’re just listening to the audio version of this, but, Jaz’s like, God, I cannot produce radio with you.

But the ideal patient for me, I’ve just jotted down a few points. Smooth treatment results as planned. Arrange appointments and keep them. Fun to be around. Make our day rewarding. Pay without asking and on time. Maintain the result for years with minimal issues, minimal relapse, home care, low follow up stress. So if I want-

Jaz Gulati: A unicorn!

Zak: Yeah, the unicorn patient. Now, how do I get the bloody unicorn patient? Well, I’m sorry to say that I’ve worked in some clinics over the years and a lot of practices don’t know, because they’ve not thought about it. They just let anyone in the funnel. If you let anyone in the funnel, what’s going to happen is that you get any old crap at the bottom, don’t you?

And you don’t get the fun patients to be around. You have stressful life and a stressful career. And the importance of that is that you know what you’re going to get afterwards. And, like I was saying, if you’ve got a funnel, you’ve got to start with the right people to get to the right people at the end.

Right? If you’re going to start having to filter people out, well that becomes time consuming, it becomes stressful, and it actually relies an awful lot on variables, and it relies on team members to say the right things, and sometimes those team members are not empowered to do it, and they feel embarrassed to do it, and they don’t know the right words to use, and so you end up with people halfway down the funnel who actually should have never got in in the first place, and only then do you all realize, holy moly, we’ve made a [inaudible] And that’s when you then get, like I was saying before, the patients who aren’t so fun to be around.

The patients who book appointments and cancel them short notice and so on and so forth. But then it also comes down to the practice environment. It’s your location. It’s your facility. It’s what your team members say and how the stuff that really their own vocabulary, the stuff we were talking about earlier, pre first appointment.

Some practices I totally appreciate have like a treatment coordinator type approach, or they have a consultation of some sort of nature where somebody can get to know a bit more about what they offer, or maybe now in lockdown, a virtual consultation of some description, maybe that would be a worthwhile use of your time.

Jaz Gulati: In your case, it’s the telephone conversation, right?

Zak: Yeah, for me, it was always a telephone conversation. Actually, I might, through all of this evolve that into a video consultation because I can get a lot more from a patient in that sense. I’ve even been trialling and testing out methods like SmileMate, for example, which comes from dental monitoring which is essentially a way of building some value about what you do beforehand, so patients can even send you photographs of their mouth.

And yeah, the crap photos, they’re retracted with fingers and they’re an occlusal that’s out 30 degrees like this, rather than 90 degrees perpendicular, but-

Jaz Gulati: Better than some dentists.

Zak: And the truth is that, patients actually respond quite nicely to that. Patients actually quite like the fact that we’re different to most.

Jaz Gulati: That’s called smile mate.

Zak: It’s called smile mate. Yeah. Smilemate. com or something like that. I think so. Something like that. Yeah. So at that point, now I’m only just getting to the bit which I thought you probably thought I was going to start with, which is the first appointment, right? And then during the first appointment, we’ve talked already.

We do about this. We do a discussion. We have a blame free, judgment free kind of stylish, we do our very best to signpost our way through the examination process. So patients are getting nuggets of information, but not trying to receive it all in one go. And then really the main crux of it is the second consultation where you come back to somebody with a piece of paper in your hand or in my world, a massive iPad pro screen, a PDF that you’ve been putting together with a risk assessment of stuff, but using words that actually matter to them.

So, for example, I’m actually going to pick it up on my screen whilst we’re talking. The way that’s broken down in my world is goals and concerns, recommendation, overview, which gives them a kind of step by step, and it’s not stabilisation, phase one, blah, blah, blah. It’s not. It just says healthy teeth and gums, step two, diagnostic and further planning. Step three, a smile you’re proud of. Step four, a care plan.

Jaz Gulati: I love it.

Zak: Do you like that?

Jaz Gulati: I really like the in patient’s own terms. I’m gonna be nicking that one.

Zak: Steal away, no problem. And do you know what? That’s, that point you then, I said it before about problem awareness. That’s the point at which I then talk about my bespoke dental health report. Which is a bit wordy, I probably need to evolve that a bit. But it’s basically a way of demonstrating to somebody that they’ve got this red risk for this. Thing and this and this and this, and then you can dive in a bit more as well. So verbally, what I’ll do is I’ll talk ’em through this plan and I’ll tell them, and I’ll talk like this in Inform.

Jaz Gulati: So make it really tangible. Look, you’re there. You’ve got the iPad screen. This is something you’re presenting to them on the iPad screen at the moment. And do they have their own printed version in their hand as well?

Zak: No, I email it afterwards because I’m as green as can be.

Jaz Gulati: Right, so you’ve got the iPad screen, you’re sort of, with your finger, you’re sort of scrolling down as you’re explaining?

Zak: Yeah, and I’m in certain times I sort of launch into kind of pretty stock spiels. I have kind of like, I’ll go down a rabbit hole of let’s talk about teeth. Let’s talk about the health of every one of your teeth. Your teeth. When we look at teeth, it’s really important that we check them from a biological point of view. That’s, is there a hole in it? Is there soft decay? You might remember from episode 10, we talked about soft decay because patients don’t care about caries or decay.

Soft decay. And then I talk about teeth from a mechanical point of view, chipping, wear and tear, broken edges, fracture lines, for example. And then I talk about teeth from the point of view of their foundations. And what I’m trying to get into the person’s head is that, particularly in a slightly more complex case, we need to tackle each one of these things step by step, so that the foundations around them, the mechanics of every tooth, And the biological health of each tooth sound because without all those three, again, three legged stool, without those three things, your tooth’s buggered. I don’t say that, but you follow what I’m saying? You’re trying to give it to them in tangible terms without overcomplicating it or too, you don’t woolly it up too much.

Jaz Gulati: So I imagine at this point you’re showing them some graphics regarding each three members of those stools.

Zak: Correct. And so I’ve got an app on my, gee, I don’t even know what it’s called, on my iPad. I’m gonna look that up and check it out for you, but it’s a really cool app. It was really expensive a few years ago, like two or three hundred pounds app, but it’s got some diagrams and stuff. It’s got some videos and stuff on it, which are quite useful.

And then there’s a couple of other resources. Again, I’ve sent them over to you Jaz and you can stick them on jazz. dental or the Facebook group or whatever. And those types of things are so valuable because you can then actually show people in real world terms. This is what we’re looking at right now and you’re also adding credibility at that point.

You can actually, the trick of what I’m doing as I’m showing them their problems, is I also have a set bank of photographs for X Condition, which are my work. Where I can say, as you can see with Jane here, she came to see us like this. And all I do is a very rapid swipe through of and this is what we did, and da, and da, and da, and this is her at the end.

But we’ll come to that in a second. And what we’re doing is we, I don’t ever let myself get, hopefully I can say ever, 100 percent of the time, don’t go too far down the rabbit hole that you start getting sidetracked with questions. But equally, don’t be so didactic that it’s like a lecture. Because I used to work with a guy who is just literally like a robot in his new patient consultation and his presentation appointment.

It is almost cringeworthy to listen to because you can tell the patient has switched off after 10 minutes and they don’t want to be there. So what’s the point? It’s not adding value at all, it’s losing value.

Jaz Gulati: You need to show your personality and that you’re passionate, that you’re the sort of personality that’s going to be getting along with that patient and this is another opportunity for you to show that you are the right dentist for this patient, or maybe you’re not. But then that’s where you can find out.

Zak: Jaz, the other thing is that it’s not just because I’m a care and sharing kind of guy. It’s actually quite selfish without being a nasty person about it. I don’t want to treat people who are a pain in the arse. And if we haven’t got a connection at appointment two or appointment three, well, I’m cool with cutting all losses at that point because I don’t want to have to get to appointment 10 and find out.

And the presenting doesn’t actually stop there either. As you know, the present presenting the presentation of your treatment plan is an evolving feast. Although we’ve got it in black and white or in my world, purple and white on some of our treatment plans, you get through to solutions and you start delving into whether this sounds right for solving their problem.

Hopefully they’ve told you the solution as you’re getting down that journey. But every appointment, appointment on appointment, you’re continuously managing expectations. You’re gauging your rapport with that person. You’re looking at whether they’re punctual, whether they pay their bill, whether you’re demonstrating your care with your pain management.

You’re working out whether their treatment has worked in the recommended way and they’re caring for it at home. And ultimately then you get predictable results for predictable patients who actually aren’t just robots, who actually want to be around them.

Jaz Gulati: They now have a pretty good insight in terms of what’s going on. And in the very beginning of that, you gave them an overview of, okay, we want a healthy mouth. Then eventually step four we want to be a care plan. I forgot the terms that you use exactly. But then how do you actually now tell the patient? Okay, so based on all this stuff that I’ve just told you about, this is what you have, and where we want to go, ideally, there must be some options, and sometimes there’s more than just one option. And the other day in the Tubules Live Aid with Riaz Yard, did you watch that one?

Zak: Yeah, that’s exactly how we ended up coming to talk about this in the first place, because I commented on it too.

Jaz Gulati: Yeah, we were talking WhatsApp, and so for those who didn’t catch that, so Riaz Yard, essentially the way he presents to patients is there’s a comprehensive most ideal plan so getting the gingival zenith perfect gingival surgery orthodontics several restorations and this is like the gold standard okay but that’s gonna be the highest fee for the highest value see why I did that zach see already he’s rubbing off on me but then some patients it will be something not quite to that level, but something that will still be fairly, I forgot the terminology, he used for that middle one.

Zak: So it would be something like an acceptable result, let’s say. Or maybe it’s compromised.

Jaz Gulati: Yeah, I think it’s compromised. Compromised, yes, because then instead of ceramic, you might be using composite in some places, for example. And then there’s a bare minimum, that actually, if you’re not going to have this, then you’re actually dangerous for me to treat you or I don’t feel comfortable treat you or it’s just ethically wrong.

Zak: Maybe that’s the point at which you do what’s necessary to get that patient pain free and you refer to, I don’t know, a therapist in your team and that might be the patient then comes full circle later, a year, two years, five years later, and they’re suddenly ready Because they’ve got to know like and trust you guys as a team. So that’s one method. Are you basically asking what’s my method?

Jaz Gulati: Well, I’m coming. I’m about to come onto that. But with that method, we need to understand that what Riyazian was trying to say was that, yes, there are these plans. One thing that will affect which plan is most appropriate for them is that all the plans will be clinically appropriate but the the main factor will be is the affordability.

What can the patient afford and in real world that’s important So he will tell them the appointment beforehand or earlier on is that okay if you’re gonna go for a comprehensive plan it’s around about this region. Is that the sort of thing that you’re looking for the ballpark figure and then you sort of know which level you’re pitching out so you there’s no if the patient says look I can only afford 5, 000 pounds or the option compromise and I can’t afford the 25, 000 pound plan a, you mentioned it because the patient needs to know what the gold standard may be, but you’re not going to spend too much time on it. So that’s his method of doing it.

Zak: The difficulty with that and with greatest respect to Riyaz, he’s a fantastic clinician. The only thing I don’t like about that is it actually, actually two things. One is that it means that it’s geared towards the fee. It’s geared towards finances, i. e. if you can accept X result because your finances say so, you’re opting into that plan.

Well, I don’t like that for some reason because, for example, if I’ve got 25 grand in my pocket and I want your perfect no compromises, all frills, all bells and whistles plan, but I don’t, and I can’t consent to perio surgery because I absolutely will not have surgery in my mouth, I won’t have scalpels, I don’t want sutures, blah blah blah, I’m a TV presenter.

Obviously I’m a TV presenter. And I don’t want to show blue sutures, even for one day or two days and I can’t get time off. Then it’s not acceptable plan to me. That’s not consent, consensual in the slightest, is it? It’s not certainly not an informed result, suggestion. The other aspect of it is that the people who opt into the bare minimum, you aren’t actually consenting thoroughly.

If you’re not explaining what that does involve and what the benefits of it are. I don’t know in detail exactly what reality solution or methods involved. So I’m not knocking it in the slightest, but my way of doing it is, and I would recommend this particularly early on in your career, my methodology with it is have everybody focus only on phase one care to begin with for two reasons.

Again, two, I love the two reasons, right? So first reason is that at the beginning. It actually, when you’re not quite so experienced and you’re not quite so you’re not so sure of your own results that you can achieve, it’s okay to boil it down into very straightforward steps one by one by one. Do you follow what I’m saying?

Jaz Gulati: Yeah, so phase one is healthy mouth.

Zak: Absolutely, which we can all achieve because if you’ve been to dental school, you’ll know that phase one is just, is biology, isn’t it? And yes, it’s mechanics to some degree, but you can pause on mechanics. Because you can provide a nightguard, let’s say, which will buy you some time.

It will actually test, as you’ve spoken about lots of times in your other podcasts, it will test people’s compliance. It will see whether they are suitable for any more complex treatment solutions in the future. And it can be used as a diagnostic tool as well, so it’s like win win win. And then in the meantime, you’re also testing their compliance, their home care, and whatever else with regards to their foundations around their teeth, for example.

Just rewinding ever so slightly, one of the reasons why on our second consultation, we combine that second consultation with a, we call it professional hygiene visit, scale and polish. If you live in a different world, if you combine those two things together, what you’re doing is you’re selling the benefits of all of that stuff that we stand for on day one.

It’s like an opt in strategy. You are not allowed to opt out of it. And I don’t treat anybody who won’t accept a professional hygiene visit on day one. And the reason why is not because I’m an arse. I am a bit, but it’s also because I believe in longevity and the things that I provide, whether it is bare minimum compromised or gold standard, all of those things require some taking care of.

And I’ll say it to patients in these words. As much as I love taking responsibility for my work and I really believe in how long it lasts, what you do at home is going to have a greater input on that and greater impact on that.

Jaz Gulati: And that’s evidence based.

Zak: Yeah. And it’s teamwork. And it really is. It’s our result. If you want to go even more fluffy at the Panky Institute, they call it a co production. This is a co production. This is a diagnostic co production. This is you having your input. This is the treatment result is a co production. If you go home with a numb lip and you chew your lip, well, it’s not a very good result, is it?

Well, is that my fault? Is that your fault? Is it both of our fault? Probably both. What else do you want me to share? I think-

Jaz Gulati: Well, you talk to us. I think you’ve summarized it beautifully in the way that, okay, actually if the ideal plan for that patient, let’s, let’s talk about that same patient who needs 25, 000 worth of work towards the ideal where we talk about Riyaz’s way of doing it, where we heard on the Tube it was LiveAid, so your way of presenting is that you, you know, the second appointment you will have your iPad, you will show them their plan on the iPad, give them a good in depth knowledge of what is their condition of their biology of every tooth, the mechanics of every tooth, how that fits into their goals, what the general overall aim is, and then when it comes to the final options, you’re gonna say, well actually we need to start with phase one.

So you’re not gonna fire and trigger the sort of 25, 000 proposal, the letter with all the appointments, you’re going to say no, because yeah, because even if in a parallel universe, if you even if you did present that 25, 000 plan, the phase one is still coming first.

Zak: Essentially, yeah, for sure. And the way that, for example, let’s say it could even be argued that you don’t actually even prep teeth in phase one. And I do to some for some situations, but let’s say, for example, if your isolation is meticulous, if your caries excavation is ideal, if you really know what you’re doing with proper bonding techniques, you can actually build what I would call a posh core. So that’s a giant size composite with all your fancy anatomy and contact points.

And you can actually, what’s the purpose of a restoration. Biological seal, correct convexity and contours, so we minimize periodontal breakdown and we improve hygiene. And it creates, it just creates a seal, doesn’t it? It actually gives you some mechanical strength. Now, if you protect that tooth in such a way that you can actually come back to it in phase two or phase three, that’s the way I explain it to people.

I explain this will buy us some time. And nobody knows how long some is because that kind of relies on how long it takes to get back to completing the rest of your phase one plan which might be driven by finances, it might be driven by time, it might be driven by your jet set lifestyle, where you’re abroad all the time, or whatever.

You may relate it to the person, because that really matters. And then, when patients come to phase two or three, the way you’re explaining it is that we’re doing some further planning at this point.

Jaz Gulati: Well, the patient actually, so the patient will be aware of the fee of the appointments in, that are encompassed within phase one. Sure. Phase two and phase three, they know that they exist, but, roughly do they know what phase two and phase three may involve in the future?

Zak: Yeah, so, so, yeah, I do. I outline it at the very beginning, but I explain how would all of that seem to you. If you had a healthy mouth where we are confident or we’ve reduced as much as physically possible, the risk of pain, broken teeth, and improve things in terms of the way things look, particularly with front teeth, but I’m not providing elective treatment at that point.

Would you be happy with that solution, do you think? And again, I’ve got a bank of photographs on my iPad from six previous cases and I’ll show them the full mouth stage one solution. And that might be even, I mentioned posh cause, but some teeth do have to have just provisional crowns on them.

So I’m not scared if you probably know this already, I’m not scared of prepping a tooth and sticking a luxo temporal or bisacryl provisional crown on it and sticking it on with some polycarboxylate, some poly F, because that’s a long term way of treating a tooth. What does a provisional crown do?

Still provides a bacterial seal, still provides good contact points, still improves hygiene, still protects the tooth mechanically, right? You’re buying time. But the patient’s opting in. Oh, I don’t need to have the definitive long term ceramic crown yet, no. But we know, and I know, you and I are on the same wavelength, aren’t we, buddy?

Because we know that that wasn’t ever intended to last forever. The other thing, just briefly, that you can do there, Jaz, is a way I then pitch things when I get to phase two, which is kind of the jumping off point for further planning and stuff, is the patient’s got to know the fact that we really care about the way, you’ll love this because of the theme of your podcast, Protrusive, because patients will understand the way that occlusion works better.

You can’t have a patient understand occlusion on day one, even if you’ve got the fancy diagrams, the fancy model. You remember that thing I showed you from DNR from years ago? All sorts of clever things you can use to explain it, but really you’re demonstrating your care for your attention to detail every single appointment.

You place a restoration, you polish, you shape, you this, you that, whatever. And you know what happens at that point is I don’t actually give an itemized fee per item after phase two. If you go to BMW, you want to buy a car.

Jaz Gulati: After phase one or after phase two? Sorry, I was trying to stop you there. So, just to clarify. I’m trying to understand that.

Zak: Phase one, I do provide an itemized fee per item breakdown. For Perio, by the way, I don’t. I actually include Perio stabilization. So, anything of that sort of nature as a package. Because I’m not interested in patients who want to come and just have one thing done and then come back three months later but they’ve fallen off the face of the earth and they’ve not, they’ve not really, whilst I hate having to approach it this way, having to pay a fee for a service does sharpen people’s mind.

It sharpens their mindset. And if your strategy is that’s a package of treatment, which includes X, Y, Z, you can even include the bells or the whistles. You can have the hygiene products included the electric toothbrush. You’re bundling it all in. Then I would do that as a package.

But just to clarify what I was saying before, as I shoot off on a thousand tangents as ever, phase one is itemized, phase two is where we start doing some further planning. I don’t-

Jaz Gulati: What I want to know, Zak, is when you’re presenting at that appointment and the patient now knows exactly what phase one’s going to involve and also know in the future what phase two and phase three will involve, but do they walk away with a number for phase two and phase three? So this patient who needs 25k worth of work to be in the comprehensive category. They don’t yet know what they don’t yet know. They don’t yet know.

Zak: Well, I’m not evasive, but if somebody asked me point blank, so let’s say you’re the patient and you’ve gone, okay, well how much is a crown after that? I will tell them fee per item is this, the fee that we charge to do that. Long term and last for decades if it’s well maintained is between this and this is generally this kind of vocabulary.

Jaz Gulati: Otherwise, you don’t offer that ballpark figure to-

Zak: Not generally not generally but unless for example that a patient has been offered a provisional crown or recommended provisional crown in phase one, you do have to, as part of that item, I’ll say this will require a definitive crown because they can’t opt into the provisional crown and then you have them twist their arm later for a bit more cash. And actually that’s quite a, no, that’s not a way to make friends and compatriots yet.

Jaz Gulati: So they know they’re, sorry to talk about numbers, but this is something that so many young dentists struggle with actually how to actually send patient a plan that makes sense to them.

And this is the beauty of the way you explained to them, but also a one that phases pricing and money appropriately in practice. So they know about their, so they’ve had, they’ve gone through phase one. They’re at the end of phase one. How do you now signpost phase two? How do you know the patients are ready psychologically and financially for phase two?

Zak: How do you know they’re ready psychologically because they’re still attending and they’re still fulfilling all of the green flags that we had identified at the beginning. And if there are any amber flags, which, occasionally I’ll look after patients who’ve got one or two amber flags.

I’ll give an example. Somebody the other day prior to lockdown gave us their details. Clever little strategy I worked out, by the way, is that we actually, as part of their flow of getting to submit a request for an appointment or getting to know us better, we asked for their details twice. One point on the journey at the very beginning and the second point where they’re actually arranging a, I have an online scheduling software which is called acuity scheduling or Calendly is another one for example. So they’ll arrange a phone call with me at a certain time and they have to input their details again in there And if somebody inputs their email address differently from one to another or their phone numbers got one digit different, for example I receive those bits of information together and I’ll kind of have a little flag in my head that goes, why’s that person putting their details differently from one to another?

And sometimes it’s because they’re just a bit kind of on guard about you, which is understandable. They put in a digit wrong because they were kind of like I don’t really want them to phone me, but sod it, I’ll have to put my number in because they’re forcing me to put my number in kind of thing. Do you follow?

Jaz Gulati: Interesting.

Zak: So that would be a little amber flag for me, just a subtle one, but I would skim over it. I’d have it in my head and I’d go, not sure, but okay. And coming to what you’re asking, at the end of phase one, you know a lot better which flags the person still has, or hopefully they’re all green flag patients.

And if they’re ready and they trust you and they like you and you have good camaraderie and you like being around them, that’s the point at which I’ll offer them. What would you like to do next? How would you feel about spending some time with us so that we can look at things in more detail?

Or, quite often what they’re doing at that point is they’re going, what can I do next? Can we move on to the, when can I have the crown on that tooth? Or when can I have the and that’s the point which you know you’ve got somebody who really gets what you’re doing.

You can also at that point assess whether they’re suitable in terms of their hygiene and this and you know, then you can properly itemize a treatment plan that makes sense, but I don’t at that point for phase two onwards the point I was trying to make before is that I don’t at that point onwards give them an item itemized step by step per crown per this per that and the reason why is because if you go to BMW you want to buy a car BMW don’t tell you how much the wind mirrors cost.

They don’t tell you much. The windscreen is, they didn’t tell you much. The alloys are, you might have choose optional extras for certain things, which is fair enough. You can do that. But I provide a flat fee, the fee to achieve complete stabilization of your health and achieve all your goals. A smile you’re proud of, or however, however you wanna pitch it is this.

Jaz Gulati: Is that a panky thing?

Zak: Yeah.

Jaz Gulati: I knew it because that’s exactly how Hap does it as well. My, my principal Hap Gill, who for a long time he needs, he needs to get onto a podcast for sure. But yeah, it’s how Hap taught me to do it as well actually, so it’s

Zak: interesting. Do you like it? Do you think that makes sense?

Jaz Gulati: I do like it. Yeah, I do like it.

Zak: And the reason why Jazzy, the reason why I like it at that point is because the fee, the total fee at that point doesn’t make any odds to that patient. That patient, remember, is a different entity to the patient that you were entertaining at the word go when they didn’t know anything about you, they weren’t sure about you, they didn’t care about how much you say you are nice and how you say your treatments are comfortable treatments and so on.

Because they now know it, and they like you and they trust you. And then at that point really, the conversation isn’t about the total fee, it’s just about affordability. And that’s when you can go, okay, well, how about if how would it sound to you if we divide it up on a payment plan, blah, blah, blah, blah, blah.

And that’s when you can offer different solutions. Because if they’ve got an objection at that point, it’s not the total, I promise you, it’s how it fits into my budget.

Jaz Gulati: Brilliant, which leads really, really nicely to my final question is that many dentists struggle talking finances. Something I struggled for a long time, and I don’t think I’m, yeah, I don’t think I’m quite there yet.

I think everyone’s got a certain number. Beyond that number, they start getting all actually what does Linc Harris say? Is it a discomfort number or something like that? And I think it’s the fear number, the discomfort number, something like that, yeah, where you start thinking, oh, actually, you doubt yourself or whatever.

Zak: Hey, I used to be scared in VT or DF1 of when a patient used to ask me, so how much is the implant? And I used to start with, but we don’t, well, we don’t do them here, but it’s like, no problem, no problem, no problem, no problem. So it wasn’t me. And then you go, well, about 2000 plus. And in your head, you’re like two and a half, really. And people just go, oh, you know, the ball could have the price.

Jaz Gulati: Have you ever had a patient laugh at you when you’ve given them a price?

Zak: No, actually. Why, I’ve laughed at you?

Jaz Gulati: That’s happened to me in the, during my DF1.

Zak: I want to give you a hug.

Jaz Gulati: This was, but during DF1, a patient took his tooth out and afterwards, he was a non English. He was a refugee. We sort of bonded because I’m also a refugee. I came to the country when I was six years old and he’s a refugee.

Zak: Sock story all the time, Jaz.

Jaz Gulati: Always a sock story. But anyway, so it was a cool guy, but then, look, he was NHS exempt and I took his tooth out. He says, okay, how much do I have an implant? And I said sort of like, you know, just over 2, 000 pounds or whatever. And he actually just started laughing. He was like He was like, wait, wait 2, 000 pounds? He just literally started laughing. And you know what I did? I started laughing as well!

Zak: It is contagious, isn’t it?

Jaz Gulati: That’s happened to me. That was a really awakening moment for me. You know what? I need to actually take ownership of what we charge as a profession. Not because I didn’t do implants at the time. I still don’t do implants. But I need to value the care that you provide. So when a patient, that kind of patient laughs at you, they don’t value what you have to offer.

Zak: Exactly. Nail on head. They don’t value, because they probably don’t understand. And one of my favorite questions to ask back to them without being a politician is, well, what do you understand by a dental implant? Oh, it’s when they’re screwing things. It’s just Makano, blah, blah, blah. And then you kind of, you’re basically-

Jaz Gulati: I get it in India.

Zak: You’re so foreign right now, I love it. Brexit, tell ya.

Jaz Gulati: Anyway, so overcoming, oh yeah, okay, so, how to help young dentists talk about money.

Zak: Okay, well, It all comes down to the value that the patient, places on X result. And if you’re skillful at it, you don’t talk about the thing, because patients don’t buy quarter inch holes, they don’t buy quarter inch drill bits, they buy quarter inch holes.

They want a solution. They don’t want the thing that makes the result happen. So they don’t care what you’re going to screw into their jawbone. Don’t say it like that. But they’re not interested in the acting and the act of doing it and how long it takes necessarily. Some people will, but really they’re interested in the end result.

So that end result might be so that you can chew on this side of your mouth comfortably evenly so that all your teeth touch when you chew, which may reduce your chance of chipping and breaking and blah, blah, blah of other teeth in future. It will be important that we do da da da da da, and the procedure for that will be blah blah blah blah, benefit feature procedure statements, as we said on the other podcast.

How do you start getting comfortable about money? Well, I was scared about and do you know what? There’s a certain gravitas that happens over your career, which is why you shouldn’t run before you can walk, which is that at the beginning of your career you look like you’ve got pound signs in your eyes because everything’s expensive to you and the reason why is because you were probably receiving a student loan of a thousand odd quid or something maybe 1500 or whatever it is these days per semester and that’s a lot of money to you.

And the reason is because it’s within the context of your life. But if you start to explore what a patient believes, is going to achieve that result for them, what it involves, how many steps it might take and then you start to demonstrate it, which might be photos, videos, testimonials of people’s results, or a photograph of somebody being ecstatic about the result or whatever then you can kind of go, okay and to achieve this result, It will be important.

We do this. Then you actually starting to get a bit more value, but I appreciate that in that straight off the bat. Give me the answer. That moment is actually quite a treacherous moment.

Jaz Gulati: I think the more times that you have that moment in your career, the more you realize that it’s not about that number. Just like you said, it’s about giving them the care that they want and they deserve in and doing the dentistry that you love doing. And eventually. The money becomes a side thing. It’s all about how many people’s lives you can transform and making workful, being fulfilled. But you need to appreciate that we are in an industry where you are, right at the beginning we said we’re exchanging our time, our skills, for something at the end, which is money, and we need to be mindful of that.

Zak: Sure, and it really is, without being too fluffy about it, it’s all about knowing what you’re worth. But you don’t know what you’re worth until you really understand your why and you believe it. Not believe it because you’re faking it, but you believe it because it’s really true.

Jaz Gulati: Beautiful.

Zak: I was losing my mind at the moment at the end there. You like that? Are we ending on that?

Jaz Gulati: I think end on that, my friend. Any closing comments? I love that. You answered all the questions that I wanted to ask you. I think the listeners got a good grasp of what the presentation involves in your case. And we talked about a couple of examples. We talked about the Riyaz Yahweh, but we also talk about the way you do it and the differences and what the listener might take away is they might find their middle ground or something that they find most comfortable for them. Something that’s coherent with their existing environment.

Absolutely. And it’s going to be a combination because we’re all the patchwork quilt, come full circle to what we said at the beginning. There’s nothing wrong or right about my method or Riyaz’s or whatever. It’s just what suits me from the demographic that I look after, where I pitch myself in comparison to other people out there.

Zak: Because, they are a reference point. It has to be that way. But if you believe what you believe, because it’s true, because you’re being true to yourself and not just because your mate, that you graduated with, does it a certain way? Then, that’s what’s going to really come across with true gravitas and you’ll be valuable. Your hourly rate though, isn’t the reason why.

Jaz Gulati: Beautiful. Love it. Thanks so much, Zak. We’ll always appreciate you having you on mate and until the next episode.

Well, there we have it guys. Thank you so much for listening. All the way to the end. Do check out that ebook on the protrusives and the community on the website. And of course, I’ll put all the show notes up on the website as well. Of course, the full video will be on protrusive. co. uk and on Dental on Tubules if you want to get CPD or CE if you’re part of Tubules. Otherwise a few teaser episodes will be available on Instagram as usual. So thanks so much for staying all the way to the end and I’ll catch you in the next episode, which will be with Dr. George Cardoso. And they’ll be about crystal clear. Treatment plan that is and how to really make them stand out and how that can be such an important part But it’s actually the next episode will be very much a continuation of the themes that we discussed today So if you enjoyed today, you will love next week as well. So I’ll catch you next week guys. Thank you so much for listening.