November 19, 2025 • 12 mins
What if the biggest reason patients delay necessary care isn’t price or insurance, but the quiet doubt in our own voices? We dig into the hidden driver of case acceptance—front desk mindset—and show how two simple defaults transform conversations at checkout: assume the patient can afford the treatment and assume the patient wants the treatment. When that belief is solid, tone, body language, and word choice snap into place, and patients feel confident moving forward.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Paul Etchison (01:06):
Have you ever found yourself frustrated that
the patients agreed to treatmentin the back, but then they went
to the front and they didn'tschedule?
Have you ever heard your frontdesk give a treatment plan and
you can hear the doubt and thenervousness in their voice?
And then you know that thesecases are not always being
accepted because of the tone ofour speech.
(01:27):
And it's all because of somemindset traps of the front desk
team member.
Now I want you to think of someother industries.
Imagine a personal trainer whoassumes that their client
doesn't want to get fit.
They're never going to pushthem, they're never going to
challenge them, they're nevergoing to expect any results.
Or maybe like a financialadvisor.
They assume their clientdoesn't want to invest, can't
(01:47):
afford to invest.
So they never recommend theright plan.
And in both of thesesituations, the client loses.
And it's not because of areality, but it's because of the
professional's mindset.
And the same is true in ourdental offices.
If your team carries the wrongassumptions, patients will not
move forward with the treatment.
And that's what we're talkingabout today.
(02:10):
Now, you are listening to theDental Practice Heroes podcast.
I am your host, Dr.
Paul Etchison, a dentist, acoach, and author of two books
on dental practice management.
I also own a multi-doctorpractice that collects nearly $6
million a year.
I practice two days per month.
And on this show, I sharestrategies that help you to
(02:30):
build profit freedom and apractice that runs smoothly
without you being chained to it.
So let's dive in here.
I remember one time we had aconsultant come into our
practice and we werespecifically focusing on the
front desk.
And we did this exercise wherewe had everybody write down
personally, you know,anonymously, what is a lot of
(02:51):
money to them?
Like if they went to thedentist and they had a
treatment, they needed to getsome treatment done, what is the
amount of copay that would makeyou feel uncomfortable?
And we asked everybody, and asyou can imagine, it's different
for everybody, depending on howmuch income you have, depending
if you're just a single parent,or maybe you're not married,
you're living alone.
(03:12):
All these factors come intoplace because what you think is
a lot of money is not what otherpeople will think.
So we do this exercise to showthat there's no way for us to
know.
So that brings us to the firstmindset shift that we need with
our front desk team members.
Now, this is not just frontdesk.
We need this for the wholeentire team.
(03:33):
Everybody needs to be on boardhere, but we need to always
assume that the patient canafford the treatment.
I remember back in the day, Imight have been 32 years old at
the time, and I went and waslooking at a sports car.
I don't know if it was mymidlife crisis car.
I don't feel like I was goingthrough a midlife crisis.
I just kind of wanted a fastcar.
But I remember asking if Icould test drive one.
(03:55):
And the guy said, Are youactually thinking about buying
it or do you just want to driveit?
And that really rubbed me thewrong way.
Because I wanted to be like,bitch, I could afford this thing
in cash.
But I didn't say that.
I was just like, well, Iactually want to buy it, but I
kind of don't right now.
You know, I was offended.
Like, how dare you assume Ican't afford this car?
(04:15):
Now, obviously, I'm 32.
It was an expensive car.
I wasn't dressed up like Iwould have oodles of money just
pouring out of my ass.
But the thing is, I wasprejudged and it led to me not
buying the car.
So there's something I want youand your team to understand.
And it's that we do not havethe right to decide what is too
(04:35):
expensive or what is not tooexpensive for our patients.
If we are prejudging theirfinances or we're projecting our
own biases, like of what wethink is a lot of money, that is
going to show up in the tone inthe language.
And when we assume that theycan't afford it, we are
unconsciously leading them tosay no.
Now, if we go back to ourmission as a dental office, that
(04:58):
we want to help as many peopleas possible.
And the way that we help themis we get them to say yes to
treatment and we get them thetreatment that they need to get
dentally healthy.
Okay.
So if we are using these biasesand these projections and
they're leading to lowercaseacceptance, we are actually
harming the patient.
Okay.
It's not like, oh, well, that'stheir problem.
No, we are doing more bad thangood.
(05:20):
So the only way to not prejudgeis to assume that the patient
can afford the treatment, nomatter how old they are, no
matter what they look like, nomatter what they're wearing,
where they came from, the waythey talk, anything.
We cannot prejudge ourpatients.
You do not get to decide forthe patient.
You do not prejudge them.
You do not project your biases.
(05:41):
You have to present itconfidently, assume that they
can afford it, and let themdecide.
That is the only way to treatpeople fairly.
So make sure that we assume thepatient can afford the
treatment.
Now, our second bias that we'regoing to talk about is we need
to assume that the patient wantsthe treatment.
And I'm talking about up infront.
(06:01):
I mean, we got to do this inback as well.
Now, if you're one of mycoaching clients, you've been
through my four hurdles of caseacceptance.
The first two hurdles of caseacceptance are done in the back
end by the clinical team.
Okay.
And that's that the patient hasto like us and trust us, and
they have to believe that theyneed what we're recommending.
Now, us from an ethicalstandpoint, we need our team to
(06:22):
believe that we would neverrecommend something that
somebody does not need.
So if a patient comes up to thefront desk and there's
something on the treatment plan,they need to assume that
patient needs that.
And if they don't trust thatthe patient needs that, I want
to have some differentconversations with that person.
Like, why are you not trustingwhat we're treatment planning?
Like, what kind of ethicalbreach have we ever had in the
(06:44):
past?
Like, tell me where this iscoming from.
But those are the first twohurdles.
Okay, so the third and fourthhurdles, those are done by the
front dust team.
And it's that we need to figureout a way for the patient to
afford it, like make the money,the payments work in their life.
And we need to figure out a wayfor them to make it work in
their life, whether that be fora different, maybe the schedule
(07:05):
in the future, maybe they'regonna schedule a big one visit.
You were gonna figure out whatis important to that patient.
But what we need to assume, weneed to assume that they want
the treatment.
So this means we have to assumethat they value the treatment.
We can't look at this personand say this person drinks
Mountain Dew all day and playsvideo games.
They don't give a crap abouttheir teeth.
No, we can't make thatassumption.
(07:26):
The doctor wouldn't recommendit if the patient didn't need
it, and we have to assume thatit's yes, they want it.
If we assume anything else thatis a roadblock to the patient
saying yes, it will show up inour speech, it'll show up in our
body language, and we will besteering the patient to say no.
And if we do that, we areharming the patient because
they're not getting healthy tosomething that they ethically
(07:49):
have been diagnosed with andthey need.
The patient is here at ouroffice because they want to be
dentally healthy.
Don't assume anything elseotherwise.
So that's the second mindsetshift.
We've got to assume that thepatient wants the treatment.
So, first, assuming that thepatient can't afford it, and
two, assuming that the patientwants the treatment.
(08:09):
So, those are the two biggestthings that will make a
difference in the way that yourfront desk team and the rest of
your team talks to patientsabout treatment, but they're
hard things to overcome becausethese are deeply rooted things
in their psychology.
These are deeply rooted valuesthat they have and ideas about
money and ideas aboutprofessionals and dentists and
(08:32):
all this other stuff that'sbound up into this emotional
creature that works at youroffice.
So these are sometimes verysimple in theory, but sometimes
harder to fix at your office.
You can't just make two rulesaround that.
You need to discuss thesethings as a team.
You need to do like workshopactivities, you need to role
(08:53):
play, and you really have tohave your team deeply understand
how if they are bringing biasinto their presentation, they
are doing harm to the patient.
So, tactical takeaways for thisepisode.
Train your team.
The default assumption is thatthe patient can afford the
treatment and the patient wantsthe treatment.
And next, audit the language.
(09:13):
Listen to your team present,have them record a few case
presentations.
Do they sound confident andassumptive, or are they more
hesitant, apologetic?
Are they like more like, uh,it's gonna be $1,200?
Oh gosh, I'm so scared to tellyou that.
Are they like that?
Or are they like, it's gonna be$1,200?
How did you want to take careof that?
It's gonna be $1,200.
(09:34):
How did you want to take careof that today?
You know, the confidence thatmakes a big difference.
And role-play some scenarioswith your team members so that
they have to practice andrecognize the assumptions that
they're making.
And lastly, you know, checkyour case acceptance.
This is a very easy metric totrack, and it's also a very easy
metric to improve, but it takesa team effort.
(09:54):
So, case acceptance, it's notjust about what we say, it's
about what we believe.
If your team assumes thepatients want the treatment and
they can afford it, everythingabout their tone, their body
language, and their confidencechanges and patients pick up on
it.
So when you shift the mindset,the words work and the treatment
(10:17):
gets scheduled.
Confidence, it's contagious.
Assume the yes, and patientswill say yes.
And if you're wondering whatother things you really should
be training your front desk onso that they can be the most
effective as possible and yourpractice can help the most
people, check out our coachingoptions at
dentalpracticeherous.com.
We are happy to take youthrough this process of making
(10:38):
your practice the best it can beso you can have the best life
possible.
Set up a free strategy callwith me.
I'm happy to talk to you aboutit.
Thank you so much for listeningtoday.
I really appreciate it.
And we will talk to you nexttime.
Have you ever found yourself frustrated that
the patients agreed to treatmentin the back, but then they went
to the front and they didn'tschedule?
Have you ever heard your frontdesk give a treatment plan and
you can hear the doubt and thenervousness in their voice?
And then you know that thesecases are not always being
accepted because of the tone ofour speech.
(01:27):
And it's all because of somemindset traps of the front desk
team member.
Now I want you to think of someother industries.
Imagine a personal trainer whoassumes that their client
doesn't want to get fit.
They're never going to pushthem, they're never going to
challenge them, they're nevergoing to expect any results.
Or maybe like a financialadvisor.
They assume their clientdoesn't want to invest, can't
(01:47):
afford to invest.
So they never recommend theright plan.
And in both of thesesituations, the client loses.
And it's not because of areality, but it's because of the
professional's mindset.
And the same is true in ourdental offices.
If your team carries the wrongassumptions, patients will not
move forward with the treatment.
And that's what we're talkingabout today.
(02:10):
Now, you are listening to theDental Practice Heroes podcast.
I am your host, Dr.
Paul Etchison, a dentist, acoach, and author of two books
on dental practice management.
I also own a multi-doctorpractice that collects nearly $6
million a year.
I practice two days per month.
And on this show, I sharestrategies that help you to
(02:30):
build profit freedom and apractice that runs smoothly
without you being chained to it.
So let's dive in here.
I remember one time we had aconsultant come into our
practice and we werespecifically focusing on the
front desk.
And we did this exercise wherewe had everybody write down
personally, you know,anonymously, what is a lot of
(02:51):
money to them?
Like if they went to thedentist and they had a
treatment, they needed to getsome treatment done, what is the
amount of copay that would makeyou feel uncomfortable?
And we asked everybody, and asyou can imagine, it's different
for everybody, depending on howmuch income you have, depending
if you're just a single parent,or maybe you're not married,
you're living alone.
(03:12):
All these factors come intoplace because what you think is
a lot of money is not what otherpeople will think.
So we do this exercise to showthat there's no way for us to
know.
So that brings us to the firstmindset shift that we need with
our front desk team members.
Now, this is not just frontdesk.
We need this for the wholeentire team.
(03:33):
Everybody needs to be on boardhere, but we need to always
assume that the patient canafford the treatment.
I remember back in the day, Imight have been 32 years old at
the time, and I went and waslooking at a sports car.
I don't know if it was mymidlife crisis car.
I don't feel like I was goingthrough a midlife crisis.
I just kind of wanted a fastcar.
But I remember asking if Icould test drive one.
(03:55):
And the guy said, Are youactually thinking about buying
it or do you just want to driveit?
And that really rubbed me thewrong way.
Because I wanted to be like,bitch, I could afford this thing
in cash.
But I didn't say that.
I was just like, well, Iactually want to buy it, but I
kind of don't right now.
You know, I was offended.
Like, how dare you assume Ican't afford this car?
(04:15):
Now, obviously, I'm 32.
It was an expensive car.
I wasn't dressed up like Iwould have oodles of money just
pouring out of my ass.
But the thing is, I wasprejudged and it led to me not
buying the car.
So there's something I want youand your team to understand.
And it's that we do not havethe right to decide what is too
(04:35):
expensive or what is not tooexpensive for our patients.
If we are prejudging theirfinances or we're projecting our
own biases, like of what wethink is a lot of money, that is
going to show up in the tone inthe language.
And when we assume that theycan't afford it, we are
unconsciously leading them tosay no.
Now, if we go back to ourmission as a dental office, that
(04:58):
we want to help as many peopleas possible.
And the way that we help themis we get them to say yes to
treatment and we get them thetreatment that they need to get
dentally healthy.
Okay.
So if we are using these biasesand these projections and
they're leading to lowercaseacceptance, we are actually
harming the patient.
Okay.
It's not like, oh, well, that'stheir problem.
No, we are doing more bad thangood.
(05:20):
So the only way to not prejudgeis to assume that the patient
can afford the treatment, nomatter how old they are, no
matter what they look like, nomatter what they're wearing,
where they came from, the waythey talk, anything.
We cannot prejudge ourpatients.
You do not get to decide forthe patient.
You do not prejudge them.
You do not project your biases.
(05:41):
You have to present itconfidently, assume that they
can afford it, and let themdecide.
That is the only way to treatpeople fairly.
So make sure that we assume thepatient can afford the
treatment.
Now, our second bias that we'regoing to talk about is we need
to assume that the patient wantsthe treatment.
And I'm talking about up infront.
(06:01):
I mean, we got to do this inback as well.
Now, if you're one of mycoaching clients, you've been
through my four hurdles of caseacceptance.
The first two hurdles of caseacceptance are done in the back
end by the clinical team.
Okay.
And that's that the patient hasto like us and trust us, and
they have to believe that theyneed what we're recommending.
Now, us from an ethicalstandpoint, we need our team to
(06:22):
believe that we would neverrecommend something that
somebody does not need.
So if a patient comes up to thefront desk and there's
something on the treatment plan,they need to assume that
patient needs that.
And if they don't trust thatthe patient needs that, I want
to have some differentconversations with that person.
Like, why are you not trustingwhat we're treatment planning?
Like, what kind of ethicalbreach have we ever had in the
(06:44):
past?
Like, tell me where this iscoming from.
But those are the first twohurdles.
Okay, so the third and fourthhurdles, those are done by the
front dust team.
And it's that we need to figureout a way for the patient to
afford it, like make the money,the payments work in their life.
And we need to figure out a wayfor them to make it work in
their life, whether that be fora different, maybe the schedule
(07:05):
in the future, maybe they'regonna schedule a big one visit.
You were gonna figure out whatis important to that patient.
But what we need to assume, weneed to assume that they want
the treatment.
So this means we have to assumethat they value the treatment.
We can't look at this personand say this person drinks
Mountain Dew all day and playsvideo games.
They don't give a crap abouttheir teeth.
No, we can't make thatassumption.
(07:26):
The doctor wouldn't recommendit if the patient didn't need
it, and we have to assume thatit's yes, they want it.
If we assume anything else thatis a roadblock to the patient
saying yes, it will show up inour speech, it'll show up in our
body language, and we will besteering the patient to say no.
And if we do that, we areharming the patient because
they're not getting healthy tosomething that they ethically
(07:49):
have been diagnosed with andthey need.
The patient is here at ouroffice because they want to be
dentally healthy.
Don't assume anything elseotherwise.
So that's the second mindsetshift.
We've got to assume that thepatient wants the treatment.
So, first, assuming that thepatient can't afford it, and
two, assuming that the patientwants the treatment.
(08:09):
So, those are the two biggestthings that will make a
difference in the way that yourfront desk team and the rest of
your team talks to patientsabout treatment, but they're
hard things to overcome becausethese are deeply rooted things
in their psychology.
These are deeply rooted valuesthat they have and ideas about
money and ideas aboutprofessionals and dentists and
(08:32):
all this other stuff that'sbound up into this emotional
creature that works at youroffice.
So these are sometimes verysimple in theory, but sometimes
harder to fix at your office.
You can't just make two rulesaround that.
You need to discuss thesethings as a team.
You need to do like workshopactivities, you need to role
(08:53):
play, and you really have tohave your team deeply understand
how if they are bringing biasinto their presentation, they
are doing harm to the patient.
So, tactical takeaways for thisepisode.
Train your team.
The default assumption is thatthe patient can afford the
treatment and the patient wantsthe treatment.
And next, audit the language.
(09:13):
Listen to your team present,have them record a few case
presentations.
Do they sound confident andassumptive, or are they more
hesitant, apologetic?
Are they like more like, uh,it's gonna be $1,200?
Oh gosh, I'm so scared to tellyou that.
Are they like that?
Or are they like, it's gonna be$1,200?
How did you want to take careof that?
It's gonna be $1,200.
(09:34):
How did you want to take careof that today?
You know, the confidence thatmakes a big difference.
And role-play some scenarioswith your team members so that
they have to practice andrecognize the assumptions that
they're making.
And lastly, you know, checkyour case acceptance.
This is a very easy metric totrack, and it's also a very easy
metric to improve, but it takesa team effort.
(09:54):
So, case acceptance, it's notjust about what we say, it's
about what we believe.
If your team assumes thepatients want the treatment and
they can afford it, everythingabout their tone, their body
language, and their confidencechanges and patients pick up on
it.
So when you shift the mindset,the words work and the treatment
(10:17):
gets scheduled.
Confidence, it's contagious.
Assume the yes, and patientswill say yes.
And if you're wondering whatother things you really should
be training your front desk onso that they can be the most
effective as possible and yourpractice can help the most
people, check out our coachingoptions at
dentalpracticeherous.com.
We are happy to take youthrough this process of making
(10:38):
your practice the best it can beso you can have the best life
possible.
Set up a free strategy callwith me.
I'm happy to talk to you aboutit.
Thank you so much for listeningtoday.
I really appreciate it.
And we will talk to you nexttime.
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