Turning your GOOD practice into a GREAT practice by taking advantage of work you are already doing!

We as professionals have too many things going on in our work and lives to continuously think of every novel solution by ourselves. This is emphasized best by Pabolo Picaso “Good artists copy, great artists steal.” We are artists by nature and must save time by learning from others, not just other dental professionals, but companies that are directly or indirectly involved in our field. Take for example Google and Yelp. 


We all have received good and bad reviews posted on those sites. They are external reviews that serve as a way for prospective patients to see if you are a match for services they require, but what about internal reviews? Internal reviews are reviews on current patients to see if they are a match for your clinic. At another point, emphasis will be focused on external reviews, but for now internal reviews will be the main focus as this is the easiest protocol to start today. 

The Set up

Are you already doing this? Yes, even if it’s not being done with intent we all rate our patients. All that needs to be done is implementing the patient rating onto the patient’s chart notes after every procedure. This is important because you are creating a treasure trove of information that you can wield to your advantage. This process is already happening and takes no significant effort to accomplish. Protocols for internal reviews can vary depending on what the end goal is. I keep things simple and recommend a minimum that after each procedure a rating is given for the experience that you perceived the patient had vs the attitude of the patient. Create an auto note to the end of every procedure to immediately start implementing this. 


5 – great patient / great experience

4 – great patient / neutral experience

3 -great patient / negative experience

2 – good patient – good experience

1 – good patient – negative experience 

0 – dismiss patient- rude – inappropriate 


Notice that there is no such thing as a bad patient listed. They are here to see you and are paying you to do so. The only patients that have a negative connotation are patients that should be dismissed for reasons of your choosing, but usually I reserve that right as being rude to staff, inappropriate, or need some sort of psychiatric help that my office is not equipped for. The goal is to establish which ones are worth investing more time in. As you continue treating a patient, their particular rating can vary, but the goal is when they reach a level 5 you should ask them for a review. 


Great patient vs good patient: the only difference between the two is great patients seek you out because of your reputation. Good patients which are still incredibly valuable and make up the bulk of your practice especially as you begin, are patients that are coming to your office because it is convenient for them. Convenient in terms of location, the insurance you accept, the services you provide. Nurturing every patient to become a great patient is the key to a successful practice and implementing this system is an easy way to start tackling this challenge. 


5 -Great patient / Great experience – Once you achieve a class 5 experience you should ask the patient for a review (preferably Google). The appointment that results in being a 5 star experience should also result in giving the patient 5-10 referral cards with their names already on it. You can also kindly ask them to just copy and paste the original review to Facebook, Yelp, and any other rating service you like. It will be easy for them as they have to only copy and paste. It’s best to immediately ask even if it’s the first appointment that happens to be a 5 star experience to begin the review process. 


4 – Great patient – had a neutral experience. If the patient is rushing to get out, but the treatment was a success. It’s not that you can’t try to get a review or give a referral card, but you want to be able to have a higher probability that they will follow through. If this is the last appointment that they see you then give it a go, but if a better experience can be given then wait to get a better review. Changes of a 4 can begin right after this value is assigned to a patient’s experience, you do not have to wait for the following appointment. 


3 -Great patient had a negative experience – patient had a painful experience in the office, but that is sometimes the nature of the game. Again, it’s not to say you wouldn’t get an emotionally intelligent individual who does realize and appreciate the time you took to resolve their problems even if it was painful, but pain can make people not behave with the best mentality so the probability most likely won’t be as high. It’s best to wait until a more favorable experience is achieved, it can also be due to an error from the front desk or back office staff. Ex. Long endo appt


2 – Good patient – had a good experience; patients in these categories are coming to your practice because it is of sheer convenience. The goal is to turn them into great patients. Notice how there is no good patient with a neutral experience. That is because for these types of patients a neutral experience and a good experience is the same. More work has to be done on these patients to make sure that they still want to continue to visit your office if they move. One clever way to do this was observed by accident. Before covid we had an area for coffee where upon request my staff would get them water or make them a coffee. My recommendation is to never make complimentary services seem standar and instead offer the same services, but now it will be appreciated more. It’s almost like they are getting preferential treatment and this is not a trick, but rather a physiological reinforcement that these complimentary services receive more appreciation because it has to be actively sought out instead of it’s just there. 


1 – Good patient – had a negative experience in the office – always review what is causing the negative experience and it’s ok to ask the patient for their input. Most patients are willing to give that information. First ask for what they appreciated from the office and then ask what could have been done better by you, the staff, or the process to make sure a better experience could have been achieved. Sometimes nothing is going to satisfy those patients and they will remain getting class 1’s and this is useful information because it can at least point out where the improvements can be made to minimize these types of patients. The good thing is they usually keep coming in and they won’t leave a bad review or a good one which is the best option in this scenario. By continuing to understand where improvements can be made or what conversations you are having you can nurture these patients to progressively get better at each appointment. 


0 – Dismiss patient- rude – inappropriate. With every one of these scores you should definitely tailor it to fit your practice and standards. For me any patient that treats my staff poorly is an automatic dismissal.  Working on these types of patients rarely have led to anything good and being able to identify them is important. Being all on the same page is important as well so having emotionally intelligent staff that are able to distinguish someone’s bad attitude from circumstantial (ex. pain) vs psychiatric is important. 


Referral program: 


Thank you email- This will contain a more detailed explanation of your office’s referral plan. How our referral program works:

  1. You have been given referral cards with your unique account number. Your account number is [PatNum]
  2. Give your referral cards to your friends and family and instruct them to follow the instructions on the card
  3. Once your referral starts treatment (exams/x-rays do not count as treatment) a $25 credit will be applied to your account
  4. Redeem your credit towards your own treatment or sales products
  5. Have a wonderful experience and refer others to earn additional referral credits

Any questions? Don’t hesitate to call or email us.

Referral cards – if possible integrate the referral cards to the back of business cards. It is worth having in writing what the card represents to attach value to it. 

Team Execution 


It’s crucial to implement an action to every rating and have your team aware. The back (Dentist, Hygienist, Assistants) should all write in the progress notes what designation the patient gets before they walk out to the front desk. It’s important to discuss which team members are going to be responsible. Never make the assumption that they will figure it out or leave it vague. 


5 – For the first time they receive this rating, have the front desk  ask for a review on the platform of your choice preferably on the spot. If possible, have a dedicated computer, laptop, or tablet for reviews so it doesn’t interfere with the flow of the office. I believe in striking while the iron’s hot and this would be an excellent opportunity to show your thanks for a class 5 patient by giving them an envelope with the referral cards inside and telling them they will receive an email with the program’s instructions. A picture can be taken of a team member giving them the referral cards and a social media post can be made from it.


4- Have a team member take a picture with the patient. Make sure to smile! Have these posted to your facebook and instagram. The back office dentist patients and assistants are perfect for this. The goal is to get something out of the appointment that can be used as a marketing tool and a picture is a great start to make the next experience even better. 


3 – The brain is an association machine and it will be the default way of thinking that “all procedures in a dental setting are bad because I just had a bad experience.” Tie the negative experience to that specific procedure or condition. This is crucial. You want to be able to make sure the patient understands not every dental experience is going to be a traumatic one. Write down what it was next to the level 3 assignation and have everyone who reads it understand what needs to be said




Patient experience: 3 : Patient had RCT and had a difficult time getting numbed up. 


When reading this the doctor should say “You truly did an excellent job tolerating a negative experience. The good news is every other appointment will be different and you know that even at its worse you rose up to the occasion” 


The front desk can reiterate the same message, but with a text message. Additional streamlining can be done by having a document with messages pre-written. 


2 / 1  – For both of these patient experiences they are coming here out of convenience. The goal is to make sure you show that more focus on what makes your office unique is emphasized. It can be as simple as 

  • we use distilled water for all our procedures
  • to make sure we are up to date in all technology
  • We use paperless charting
  • We use digital x-rays

0 – Front desk drafts a dismissal letter, patient chart marked as dismissed, and it is written why on the chart notes. The protocols of the standard practice of dismissing a patient for your specific state should be reviewed. 


The logic


What are the benefits of internal reviews? 


  1. Understanding who your core patients are – you can’t fix a problem if you are unable to identify it. Not understanding your core patients can make life difficult. Take for example Mr. Frank. He is a good patient that shows up for his appointments, is courteous, and gets all the treatment done. Because he’s a good patient and not a great patient he only comes because you accept his insurance. One year you stop taking his insurance and he disappears. If this is a majority of your patients you will suffer needlessly. Employing this system beforehand lets you convert those good patients to great patients. 


  1. Understanding who to market to – marketing styles will differ slightly. For example, all the good patients can hear about what makes your office better to attempt to convert them to great patients. Sending out a mass email focusing on that will solidify your great patient base that they made the right decisions and sway the good patient base to turn into great ones. 
  2. Understanding who to give referral cards to- although at any time you can give referral cards, you would want to stack the odds in your favor that you are getting great patients in return. Just think about the last recommendations you followed. Was it because someone said “oh Dr. So&So is soooooooo ok.” 


  1. To reduce patient leakage – Referrals don’t just happen, teams earn them through relationship building, demonstrated quality, and improved patient experience. Patients leaving the practice most likely are of the “good” variety. If you start to see a pattern of the great patients leaving that tells you something is seriously off. 
  2. Set off automatic delegation – if all staff members are on board a quick meeting is all that is needed and light supervision to ensure this methodology can be applied without a hitch. They are simple instructions and if the team is unable to do them then an investigation as to why should be taken.   
  3. Delegate when there is down time- probably my favorite reason. If your team experiences some down time you can offer to call the 5 star patients that have been marked that slipped away, call the 4 stars to wish them well to convert them to 5 stars the next time.


Become the great artist that you are and steal every great concept and make it your own. Don’t copy it, steal it! My philosophy may not be pertinent to your way of practice, but having a system that is unique to you will prove to be a valuable asset. You are already doing the work so reap the benefits!

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