ROUTINE PURCHASE DECISIONS

Consumers buy many low‐cost, frequently used goods and services. These are low‐involvement purchases because they do not involve much thought or consideration by the consumer. These purchases do not involve much financial or psychological risk. (Examples include soap, fast food, and routine dental care.) The buyer often has a brand preference (or loyalty) that is strongly affected by “top‐of‐the‐mind” awareness rather than conscious decision‐making. When they go to the store to purchase bath soap, they generally do not agonize over the decision, weighing the merits of each type of soap and researching the values and other consumers’ preferences for each. Instead, most shoppers pick up their usual brand without thinking much about it. (This is brand loyalty.) Advertising keeps the brand at the top of the consumer’s mind so that when they are ready to make the purchase, they remember the brand.

In dentistry, regular dental patients make routine purchases every time they respond to a call for a “recall” or “periodic maintenance” visit. Most of the dental work at this visit is routine for most patients. (This includes cleanings, fillings, and often basic crowns.) Patients, as dental consumers, do not think about whether to purchase the service or not and from whom to purchase it. Like buying their usual deodorant at the store, they purchase based on familiarity and habit.

Routine purchase behavior works to a dentist’s advantage when a patient returns for routine periodic maintenance without consideration of going to another dentist. It works to a dentist’s disadvantage when consumers do not have brand loyalty to their office but instead go to an office on their insurance panel. In this sense, consumers view dental care as a commodity with no brand loyalty. They do not have much involvement in the purchase decision. They simply look for the most inexpensive care, which their insurance plan may dictate. In these cases, practitioners should try to develop “brand loyalty” for their practice. Nevertheless, they must realize that they may lose some consumers (patients) to other “brands” (dental offices) because of the insurance pricing inducements.

PROBLEM‐SOLVING PURCHASES

These purchases involve the purchase of high‐involvement, generally expensive items that have a long lifetime. (Examples include new cars, home entertainment systems, and reconstructive dental care.) The buyer must first learn the criteria for selection, then shop for the good or service based on those criteria. When buying a new car, many people research the various makes and models, check Consumer Reports or other online consumer guides, and agonize over the model, color, and options. This is all because automobiles are generally purchases that a person will live with for several (or many) years. They are expensive, so there is a high desire to be satisfied with the decision. (Many people even justify a poor purchase decision to reinforce their previous decision.) If someone finally admits that they made a poor choice, chances are that they will tell everyone about the shortcomings of the item they purchased.

In dentistry, dentists see problem‐solving purchase decisions each time the patient worries about the treatment. This may be because of large costs, potential side effects, or excessive fear. (A simple alloy may be a significant life‐altering event for a highly fearful patient.) Before a patient commits to spending many thousands of dollars for complex treatment, they may check with trusted friends or family members. The patient may research the expected treatment or get a second professional opinion. A dentist must not see these efforts as distrust, but instead as the consumer’s search for information and an evaluation of alternatives before committing to treatment. In other words, this is healthy consumer behavior. Because patients evaluate the service after they complete it, dentists need to follow up with the patient, ensuring that they are satisfied with the work and trying to solve any problems identified. In this way, practitioners encourage a positive postpurchase evaluation by the patient. This encourages the patient to recommend the dentist to friends, family, and trusted others.

OFFICE ATMOSPHERE

Patients often make a conscious or subconscious decision about a dentist within the first minute after they arrive at the office. They make this based on their feelings about interpersonal relations and the office atmosphere. Patients who perceive a warm, trusting relationship between the dentist and the staff will assume that the same trusting relationship will develop with them. Likewise, they will perceive a rigid, formal, or controlling atmosphere as not leading to trust. Many patients view office cleanliness as a surrogate measure for the dentist’s attention to detail.

TRUST

Patients must believe that a dentist is working in their best interest, not the dentist’s own. This is especially true for extensive, complex treatments. Simply telling a patient “Trust me, I’m a dentist” is usually not enough. The practitioner must prove it through their actions and office personnel interactions. It may take a long time for some patients to develop that trust. That is why dentists may see patients for several years of routine maintenance visits before the patient feels comfortable enough to commit to a large, expensive treatment plan.

EXTENDED COST OF SERVICE

Money is always a consideration in the treatment decision. The absolute price is not as important as the conditions of payment. How long do patients have to pay, and how will the payment fit into their family budget? If payments are reasonable (a patient perception), most patients accept this decision.

PREVENTING DISCOMFORT

A dentist must not cause pain before, during, or after treatment. This means the dentist practices excellent injection techniques, using sedation (nitrous oxide/oxygen or chemotherapeutic agents) when indicated and halting treatment if the patient has pain. The practitioner can ease discomfort with a soothing atmosphere, music headsets, and other distractions. Nearly 15% of the US population are true dental phobics who need exceptional help (beyond that generally done for patients) to have a pain‐free dental experience.

ESTABLISH A RELATIONSHIP

A dentist must establish a one‐to‐one personal relationship with the patient. Most people will only commit to large treatment plans once they establish that relationship. Patients may make smaller, routine purchases (such as a “cleaning” or basic fillings) but generally will not commit to a large, high‐involvement purchase (such as an oral reconstruction) without a relationship and the trust that is inherent in the relationship. Often, patients will not “buy” expensive treatment for months or years until they have developed the trust required for such a commitment. The patient comes to a dentist knowing that they are the expert. The patient must gain trust by discovering that the dentist is looking out for the patient’s interests.

LEARN PATIENT WANTS

In this step, a dentist’s listening skills become critical. They must ask probing questions and listen to the answers. This allows them to offer solutions that satisfy the patient’s needs, not the dentist’s technical solution to a dental problem. Understanding the patient’s “why” is essential to understand what might motivate them to seek treatment. The practitioner should listen to the emotional side of the patient. (The previous part of this chapter on communication gives several techniques, including feedback and self‐disclosure.) The patient may make an off‐hand comment about how pretty someone’s teeth look. They may be saying that they would like a mouth that looks as good and healthy.

DECIDE PATIENT NEEDS

Here, a dentist’s professional skill, care, and expertise come into play. A dentist must decide the various treatment options based on their clinical and patient examinations. Helping the patient to understand their condition is also important. Patients who do not perceive a need are less likely to accept the recommendations. Part of a patient’s understanding of their condition is to link the condition to the consequence. Using such phrases as “I’m concerned about…” or “Because that leads to…” will help patients connect their condition to the consequences, especially when no treatment is done. Many patients present routine, small‐involvement needs that are easy to decide. Patients with complex treatment, psychological, and medical needs may require significant time from the practitioner to reach a decision.

TEST THE BUY‐IN

It is important to test the buy‐in to know if the patient understands the condition and its consequences. A simple question of “How concerned are you with…?” can help gauge if the patient fully understands their condition and its consequences. If they do not understand these two critical pieces, discussing solutions will only lead to them not accepting treatment. If the patient does not understand their condition and consequence, more time is needed to educate them on those factors.

OFFER SOLUTIONS

In this step, the dentist uses their diagnostic and planning skills to decide on the appropriate plan of treatment that addresses the patient’s health or disease state and resolves the patient’s treatment wants. Many adults learn best through methods other than oral communication (Box 24.3). Audiovisual aids, such as videos, pamphlets, or flip charts, can help show a patient the problems and solutions. The solution to a patient’s need is the technical procedure that a dentist does, but the solution to the patient’s wants is the benefit of treatment.

ANSWER OBJECTIONS

Many dentists are offended by patients who challenge or question their treatment recommendations. Really they should view this as a positive step because the patient has not discounted what the dentist has said and recommended. Instead, the patient is processing the information and trying to understand and internalize it. They must do this before they agree to treatment. They are interested, but have significant questions that the dentist must help them to resolve. What if this crown has bad esthetics? What happens if the implant does not integrate? Are there less expensive alternatives? The objections often involve the four decision points: discomfort, trust, time, and money. The practitioner should view each probing question as an opportunity to educate the patient about the proposed treatment and to educate themselves about how the patient perceives the dentist. Some people want technical information about the procedures. They decide logically, trying to exclude emotions. Others want more assurance that the dentist can solve their problem. They decide on a “gut” or emotional level. By finding the type of objections, a dentist can often respond in an appropriate way that satisfies the patient’s reluctance to go on with the suggested treatment.