Why Patients Start Treatment But Never Finish: Understanding the Psychology of Momentum

Discover the psychological key that unlocks patient follow-through with the endowed progress effect—a powerful concept that transforms how dental professionals communicate about treatment plans. This game-changing approach doesn't require changing your fees, procedures, or recommendations—just the way you frame patient progress.

Through a fascinating car wash punch card study, we explore why patients who feel they've already made progress are dramatically more likely to complete their treatment. Rather than overwhelming patients with everything that needs to be done, learn to recognize and celebrate the steps they've already taken. For new patients with extensive needs, acknowledge that simply coming in was "half the battle." For returning patients after a hiatus, reinforce that they're "the type of person who cares for their teeth" rather than making them feel they're starting over.

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Episode Transcript

Paul Etchison (00:02):
Have you ever wondered why some patients say
yes to large treatment plans butthen never schedule, or why a
patient might start a treatmentplan and not finish it?
We always want to blame moneyor fear, but sometimes it's not
either of them.
Sometimes it's just becausethey feel that it's such a large
thing to complete that it's noteven worth trying.

(00:22):
They become discouraged andthey procrastinate it.
All right, today I want tointroduce you to a psychological
concept that you can startthing to complete that is not
even worth trying.
They become discouraged andthey procrastinate it.
All right, today I want tointroduce you to a psychological
concept that you can startusing immediately with your
patients and I promise you it'sgoing to change the way you talk
to your patients.
It's called the endowedprogress effect and it is the
key to helping people followthrough without changing the
plan, the price or the procedure.
Now you are listening to theDental Practice Heroes podcast.

(00:46):
I'm your host, dr Paul Edgison.
I'm the author of two books ondental practice management, a
dental coach and the owner of alarge five-doctor practice in
the South suburbs of Chicago.
My goal is to teach you how topractice less days, make more
money, all while taking greatcare of your patients.
So if you're looking to havemore freedom in your life
because your practice runs sowell, then you're in the right

(01:07):
place.
Let's get to it.
All right, let's talk aboutthis endowed progress effect.
There was a study and it waswith car wash punch cards.
They gave one group of people,they gave them a car wash punch
card.
It had eight stars on it andevery time you got your car
washed you got a punch.
And every time you got your carwashed you got a punch.
So you had to get eight carwashes to get a free car wash

(01:27):
right.
And then they gave anothergroup a different card.
This one required 10 punchesinstead of eight, but two were
already completed.
So in both situations they justhad to get eight car washes,
but in the second situation theyalready had some progress
toward it.
And what these people found isthat the people that had the
progress were so much morelikely to finish it.

(01:47):
So what's up with that?
Think about that If we havesomething partially completed,
we're more likely to finish itversus starting from zero.
So how does this appear withour patients?
Well, it appears a lot of timeswith large treatment plans.
It's such a big thing tocomplete and they feel like they
have no progress.
So how can we alter the waythat we speak about it to get

(02:08):
patients to finish treatmentbetter and, especially, to say
yes and follow through with bigtreatment plans?
So think about this situation.
I know this happens all the time.
You've got a patient that comesin.
They haven't been to thedentist in maybe 10, 15 years.
They're high fear.
They come in and they need aton of work.
You're telling them what theyneed and you can just see the

(02:30):
discouragement in their eyes.
They knew it was bad, but theyhad no idea that it was this bad
.
And then you give them thislong treatment plan with a bunch
of fees and all this stuff andyou send them home with it
because they got to read it over, because it's so long, and then
we wonder why they never comeback, right?
So one thing that I like to dowith patients like that is,

(02:50):
after I explain everything tothem, I like to see if they have
any questions and then I liketo encourage them, give them a
little bit of hope.
I want to let them know.
Hey, I know we shared a lotwith you today and there's a lot
of things that need to be done.
But the hardest part, I assureyou, was you just coming in
today to find out what this is.
I know it feels like we'restarting from nothing, but just

(03:11):
the fact that you're here andhave found out what we need and
we can start scheduling to getit done, that is a huge step and
that is half of the battle.
So let's keep that momentumgoing and make sure we get you
back to do whatever X, this part, whatever this quadrant or this
tooth or something, becausethen it takes the pressure off.
Then they can pat themselves onthe back and they can say hey,
you know what?
Yeah, it was really hard for meto come in here, but I did come

(03:38):
in and I want to keep thatmomentum going All right.
The next one is think about apatient you had.
You did their treatment, you'vegot them to carry free, they're
just on normal recall and thenthey go away for maybe two,
three years.
Now when they come back, theymight have some work that needs
to be done and they might feelreally crappy about that.
So one thing I like to do withthose patients is I always like
to reinforce that they are thetype of person that cares for
their teeth.
I'll say, hey, I know that youhaven't been in here a while,

(04:01):
but you are the type of personthat cares for your teeth and
you were doing a really good job.
I'd hate to see us lose all thisprogress we have because we
just took a little dentalvacation.
Let's keep that momentum thatwe had before and get right back
on track.
We're almost there.
We just need to see you back totake care of these two teeth
right here.
So again, we're anchoring tothe progress that we've already
had.
It's not like, oh crap, I needthese two crowns.

(04:23):
Oh man, that's so much to do.
It's like, no, look ateverything you've done before
today and that's how far you are, and now it's just these two
little crowns.
It's just this baby step, andthen we're back to where we were
.
We have momentum.
We're keeping it going byframing it about what's already
been completed, instead ofsaying you know, you went away
and now we're back at zero andlook what we got to do.

(04:45):
We are not back at zero.
Never, never, never make thepatient feel that they're back
at zero, all right.
The next way to do this is thinkabout patients when they have a
big treatment plan.
After we see the patient for avisit, we'll often sit them up
and give them the post-operativeinstructions and they'll say
okay, next time we're gonna takecare of this, this and this.
If you are doing that, onething you need to do is you need

(05:07):
to make sure that you don'tforget about what was already
done.
Remember, we want to talk aboutwhat was already completed.
We're riding that momentum Now.
We might still have a lot ofthings to do, but let's not
forget about all the things wehave completed, as well as the
things that we just completedtoday.
Okay, so, since we started, wecompleted these two quadrants.
We just have one more to go.
We just have two more to go.

(05:27):
We're almost there.
Let's not lose that momentum.
Make sure you schedule this onein the next month so that we
can keep going and to get youback at your best dental health,
because sometimes patients willjust say you know what?
I got a lot done, but you knowthis was enough for the year.
I don't need to keep going, andwe also want to focus on that.
Cavities continue to spread.
We don't want to ruin theinvestments that we've already
paid for and already completed.

(05:48):
We don't want to break thosenew things that we already put
in their mouth.
So latch onto the stuff that'salready completed to help you
keep that momentum to go forwardand get your patient to say yes
again.
Just because they said yes oncedoesn't mean they will continue
to be saying yes.
And remember this is a patientthat's already at your practice.
They've already been diagnosed,they've already had treatment

(06:09):
presented to them.
They just need to schedule itand complete it.
It's a lot less frictioncompared to somebody that's
calling your office and needs tobe converted over the phone,
needs to show up for theirappointment, needs to be then
diagnosed and all that and so on.
So no matter what situation werun into with patients, we want
to give them the idea thatthey're almost there.

(06:30):
They've completed so much andthey're almost there.
The key is really simple.
People don't follow throughbecause something makes logical
sense.
They follow through when itfeels like they're already
succeeding and they don't wantto lose the progress they've
already made.
It's that whole loss aversionidea.
So when you're presentingtreatment, you're collecting
payments or maybe you're tryingto get a patient to finish what

(06:51):
they started, ask yourself howcan I recognize the progress
that they've already made andyou're collecting payments, or
maybe you're trying to get apatient to finish what they
started ask yourself how can Irecognize the progress that
they've already made?
And you're not changing whatyou're doing, you're just
changing the way that you'reframing it.
So here's what I want you to dothis week with the patient.
Pick one patient interactiontoday where follow through is
going to matter.
And maybe it's a patient that'shesitant, maybe it's somebody
that just came in and hasn'tbeen there for a while.
Maybe it's somebody that wentaway for a little bit and came

(07:12):
back, or maybe it's somebodythat only partially completed
their treatment plan.
I don't know.
But you want to use thatendowed progress effect.
You want to reframe it.
Show them what they've alreadydone and see if they're more
likely to continue forward andride that momentum.
I assure you they are.
And if you want help gettingyour entire team aligned on case
presentation principles likethis, you need to check out our

(07:35):
coaching options atdentalpracticeheroescom.
This is the sort of stuff thatmakes case acceptance automatic.
You've got to train this stuffto your team.
I thank you so much forlistening and spending a little
bit of time with me today.
We will talk to you next time.
Have a great week.