How to create a ‘pre-suasive’ dental practice


Creating the right atmosphere can help patients feel more at ease.

As a Cialdini-certified trainer, I help other dentists learn about Dr. Robert Cialdini’s principles of ethical persuasion and apply them in their dental practices.

Ethical persuasion is an essential part of being a great clinician. You can’t help your patients unless you can persuade them to accept your diagnosis and treatment plans. Cialdini discovered that ethical persuasion is based in six main principles: liking, social proof, reciprocity, authority, scarcity and consistency. When you keep these principles in mind, you find that your case presentations become more persuasive, that patients are more likely to make and keep appointments, and that you provide the sort of amazing care to patients that helps a practice grow and thrive.

Last fall, Dr. Cialdini published a new book in which he shifted his focus from the art of persuasion to setting the stage for persuasive attempts. In “Pre-suasion,” he talks about how things like a person’s physical environment, emotional state and current thoughts can affect what sorts of messages they’ll find persuasive and how likely they are to be persuaded.

It’s a great book, and I’d recommended it to anyone who’s interested in creating a really great dental practice. One of the most important takeaways is that small things can have a huge effect on later decisions. If a patient is refusing to get a crown, is it really because he doesn’t care about his teeth? Or is he just aggravated because the bathroom soap dispenser was empty, and so he likes you a little less than he did earlier today?

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Cialdini focuses on how subtle environmental cues change people, for instance, how the view outside his office window changes his writing style. Little things in your office also change people and their receptivity to treatment. It’s time to put some thought into creating the right pre-suasive atmosphere in every part of your office.

The reception and waiting area

When a patient walks into your office, what are they thinking about? Unless they’re regular patients with a long history of easy appointments and cavity-free check-ups, they’re probably worrying about one of two things: the possibility of pain or the possibility of expensive dental work. You can use pre-suasive techniques to distract them or to make them feel more at ease.  To create a positive atmosphere in your waiting area, try:

  • Hanging photos of people with great smiles. Since frightened people naturally seek out the safety of a group, photos can help them feel more at ease. The smiles will refocus their attention from pain or cost to smiles and teeth.

  • Adding a complimentary coffee and hot beverage kiosk. The unexpected gift will help them like you and your office, and the warm drinks will relax and soothe them.

  • Utilizing lights and decor that mimic natural light and the outdoors as much as possible. Cialdini cites research about how the weather has a dramatic effect on people’s outlook. Help people feel like it’s a sunny day by paying careful attention to your decorating choices.

  • Offering soothing entertainment. Research has shown that tablets with games have a mild sedative effect, so make some available. You may even want to publicly post a “leaderboard” with scores to encourage a sense of fun and togetherness for your patients.

The bathroom

Make sure your bathroom has a really good mirror. Most people can’t help looking in mirrors, and it will refocus your patients’ attention to their appearances and away from pain. Human nature means that most of us are more willing to take big steps to protect our looks than to protect our health. A patient who has just looked in the mirror may be more willing to accept a necessary root canal or crown than a patient who hasn’t, because now they’re focused on their appearance rather than fear of pain.

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The hallways

Your hallways are important, even though patients will only experience them for a few moments. Keep the décor cheerful and smile-focused. Use the space for inspiration, not advertisements, so that your patients understand that your main focus is on helping them, not on making money. In general, prominent advertisements for procedures can be very risky for a dentist, since it sends the message that you’re trying to “sell” a treatment or a vendor. Think carefully about each poster, flier or model you add to your practice.

The patient bays

In a well-run office, your patients are going to spend most of their visit in a patient bay. In many offices, they have a lot of time to look around the bay and take in everything – your décor, your tools, even the brand of sterilizing wipes you use. You need to be especially attentive to the arrangement of the bays. Helpful touches include:

  • Personal photos of you or your hygienists. These humanize you and your staff and can make it easier for patients to like you and trust your advice.

  • Diplomas or certifications. These convey authority with no effort on your part.

  • Photos of past, happy patients. Worried people naturally seek out a crowd. Seeing a crowd of happy patients who succeeded with their treatments will make your new patients want to succeed with their treatments.

  • Anything but ads. As I mentioned before, ads make it look like you’ll put profit ahead of patient well-being.  Keep promotional materials for procedures out of site unless you’re actually answering questions about that procedure.

  • Reading materials that emphasize aesthetic appeal or health. A copy of a financial magazine will focus patients on the cost of treatment rather than on the health or aesthetic value. There’s a reason that health, beauty and home and garden magazines make great reading material for your patients. They aren’t only interesting and calming, but they also shift attention to areas where you can help them.

  • Impeccable maintenance. If your patient bays look dingy, sloppy or poorly maintained, patients will think that you’ll do dingy, sloppy and poor work on their teeth. Walk through each bay with a critical eye at least once a week and resolve any issues immediately.

The employee-only areas

The pre-suasive mood in your employee-only areas could be even more important than the mood you set in your public areas. Why? Because, as Cialdini discovered, what we look at effects how we perform in our jobs. He cites the example of an employee engagement consulting group who discovered that they did better work when they could see the employees they were supposed to engage. They started putting poster-sized portraits of their clients’ employees in their workspaces and saw their performance improve dramatically.

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Your employees also need reminders of why they’re there and who they serve. Your reception desk and hygiene teams may get to interact with patients all day, but what about your billing and scheduling teams? Does your IT person understand that patient service is your number one priority? Put pictures of your patients throughout the office so that your staff members remember who they’re serving.

Another interesting sidenote from Cialdini’s research is that inspirational posters actually improve job performance. Don’t be afraid to use them, and swap them out occasionally so that they feel fresh and new all the time.

Finally, it’s important to send the message that you value your employees. Think about adding little ways of saying “thank you” to your staff-only areas. Maybe a fresh bouquet every week, interesting coffee choices or nicer headphones will help your staff feel appreciated at work. Create an environment where even the back office staff feel appreciated, able to succeed and ready to focus on patient care.

Without pre-suasion there can be no persuasion

Cialdini’s work on pre-suasion hammers home an important point. There is no generic “patient” or “employee.” Everyone you talk to is being tugged in different directions by their hopes, their worries, the food they had for breakfast and the last thing they saw before they walked into a meeting. You can’t force your patients to prioritize health or accept treatment. You can’t even persuade everyone to agree with your goals for treatment. You can, however, create an environment where your patients are more likely to prioritize their oral health and your staff members are more likely to prioritize your patients. And creating that effective pre-suasive environment will help you build a thriving dental practice.

You can find information on Dr. Phelps’ upcoming events and training opportunities at:

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