One? Two? Three?
Studies have shown that half of the orthodontists in the United States use a one-visit case presentation. The premise is that patients are ready to say "yes", so why not strike while the iron is hot? That would be correct if getting people to say "yes" was the sole purpose of a case presentation and if it worked almost 100 percent of the time. However, there has been no study showing that it works almost 100 percent of the time, and in addition to its role in gaining case acceptance, case presentation also plays a role in patient education.
Patient education actually begins before the patient walks in the door for the first time; it begins when the patient is sent educational material about the practice and about orthodontics. Many orthodontists believe that this material, plus a brief guesstimate of the problem, treatment, and fee at the first visit, is sufficient. It may be sufficient to get a substantial number of people to accept at the first visit, but insufficient for another substantial group of people. It is incorrect to assume that patients and parents are not interested in learning about their condition and its correction. That is merely a rationale for not spending the time at it.
Since one object of a case presentation is to gain case acceptance, it seems logical to try to maximize the number of acceptances. The object is not to see how little you can get away with, but how much the patient wants to know beyond a simple explanation. A common practice in education is the use of visual aids. The patient's own diagnostic materials are perhaps the best visual aids available. To obtain, process, and prepare these for presentation takes more than one visit for most practices.
Many one-visit case presentations take more than one visit simply because only the mother accompanies the prospective child patient, and she may not accept the responsibility of saying "yes" without consulting her husband about the fee. However, what has actually happened is that the decision to say "yes" now hinges on the fee. People who are quoted a fee at the first visit know the price; they don't know the value of the service. This is inappropriate for orthodontic treatment, unless perhaps if you have the lowest fee in town and are flooded with patients on that basis. Even a low orthodontic fee is a significant amount of money for most people.
It may be that the idea of the one-visit case presentation was born of a desire to conserve the time and expense of a more comprehensive case presentation, and to qualify the prospective patient's financial ability or willingness to accept the fee. It may have arisen at a time when orthodontists had waiting lists and could afford the risk of non-acceptance more easily.
Whatever the reason, the concept is wrong for a health-care service that will be delivered over a relatively long period of time and that benefits from establishing a relationship and an understanding of the value of the service. Once the value is appreciated, the fee will not generally be a problem, even for people who started out shopping for price.
Furthermore, we are increasingly encountering prospective patients who have been told they must have a second opinion. Unless an office gives such a person a way to make a value judgment, the patient is left with only a price judgment or a personality judgment. Shoppers used to be anathema to an orthodontic office. The way to get rid of them was to quote a fee. Today shoppers are commonplace. As in the past, not all of them are shopping for a fee. Contrary to the past, competition has made them worth greater effort. Just as it became feasible to reopen many abandoned gold mines when the price of gold became high enough, it is feasible to invest some time in shoppers when competition for referrals and case acceptances increases.
Will prospective patients who may be ready to accept whatever the orthodontist says about treatment and fee at the first visit be lost to the practice if that readiness is not gratified at the first contact? There is absolutely no basis in fact for such an allegation. People seem to accept the usual office procedure, whatever it is.
And the real question is not whether they will more often accept the fee after the more thorough case presentation, although that has been my experience. The question is: are they better patients following a procedure that explains their condition and recommended treatment on the basis of a thorough diagnostic workup? Time spent before the start of treatment establishes the value of the service. It sows the seeds of cooperation. It also sows the seeds of patient referral.
A thorough case presentation works very well for patients for whom you are not ready to start treatment. It not only gives the orthodontist a baseline for the patient's condition, but it gives the patient a feeling of being a part of the practice already and a feeling of being in good hands. Not many patients drift away from such a practice.
Children of divorced parents are likely to be a large percentage of today's average practice. Whatever additional problems they may present to an orthodontist, case presentation is one. A one-visit case presentation will not often work. Future problems can be avoided by having face-to-face meetings with both parents and a clear understanding among all parties about the division of responsibilities.
Perhaps the worst feature of the one-visit case presentation is that it trivializes the diagnosis. A famous orthodontist once claimed to have cephalometric vision. Not many of us do. Orthodontic diagnosis cannot be done thoroughly on the basis of a cursory examination--even if that impression is going to be confirmed by a more thorough diagnostic workup. Furthermore, if one's case acceptance is high, and almost all referrals are going to undertake orthodontic treatment anyway, why not do the diagnostic workup first and operate from all the strengths that information and thoroughness provide?
Are more people likely to be impressed that an orthodontist is so good that he or she can tell at a glance what the problem and solution are, or will they more be impressed with thoroughness and an explanation of their unique, individual condition and its correction?