Okay, so we are going to talk about expectations, because it will literally make or break you. I believe this is the overview that we shared with the webinar what we what it's about. Hopefully I actually talked about that. These are our objectives. First, going to talk about definitions of success, how that might mean different things to different people, and then go into expectations for everybody on your collective team, not just in your office, your patients, your doctors, everybody, and how to make everybody accountable, assign responsibilities and work better with those on your team. So, definition of success. Well, that's a tricky one because everybody has a different opinion. Typically, sleep doctors are going to go by the standard definition of success, meaning AHI under five, you know, when they do a diagnostic sleep study, AHI is under five, they say, no apnea, you're fine. That's kind of what a lot of the sleep physicians will use. Get the AHI under five, keep the oxygen above 90, you've succeeded. And that's where it stops right there. That can vary depending on who, what your sleep doctor's training was. If they were trained to really focus on RERAs and little disturbances, well, they're going for zero. So, that's a little harder to please them. But it totally depends on their training, and it will depend on your relationship with them. We will get into that a little bit later, how that could skew their opinion. So, a primary care doctor, I work with a lot of primary care doctors who are referring patients after a patient has seen a sleep doctor, gone into the CPAP witness protection program, and then not using anything, their primary doctor then sends them to me. So, primary doctors are the ones who are doing the daily do. You know, they're the ones who are seeing these patients every month for just managing regular stuff, you know, their blood pressure, their diabetes, their normal stuff. So, they're hearing all the complaints. You know, they're the ones who hear when the patient comes in, like, oh, I'm so tired. So, if you can treat the patient who feels better, patient comes in, I'm feeling great. Whoa, you've won. You've won with the primary care doctor. They want to see things that they're checking regularly, blood pressure, you know, A1C getting better, and they want to know the patient's using it. Depending on the primary care, they may refer to a sleep doctor. If they're not comfortable doing follow-up sleep studies, they may refer to the sleep doctor and then go off of the recommendations that show up at the bottom of the sleep study. But most of them don't know how to read the nuances in a sleep study. Let's say AHI is 15, but each apnea was 45 seconds long. That's probably bad math, but, or AHI of 15, and each one was 10 seconds long. Those are very different stories. But for them, they don't know that. And so, you may have to help them understand that. And I find that they're really open to that. All right. Definition of success in our world by the dentist standard. Standards, John Remmers, if you're familiar with him, he invented the autopath and like 100 other things, and he's pretty much a genius and a really big fan of dentists treating sleep apnea. His definition, the definition we kind of go by, cut the AHI in half and get it under 10. So, that's our standard definition, still keeping the oxygen above 90 if possible. And then we're going to add in, you know, minimal side effects, no bite changes, and compliance, are they actually using it? What does the patient care about? Their definition of success is you've fixed their chief complaint. They came in and said, this is my problem. The appliance fixes that problem. They don't care. Sorry, they don't, unless they are, you know, a sleep doctor themselves, or even a physician, something, you know, they don't care what the AHI is. They don't care. They want to know, can I get back in bed with my spouse? If yes, great. If I can play with my grandkids, that's really, their success is going to be much more subjective and feely and solving their problem. Okay. So, which one's right? The one with the biggest hose, that's who wins. So, that's going to depend on your practice. These are, they both, these children are mine, and they both started out with squirt guns, and then one got the hose, and so he wins. But if your patient flow and your people driving the bus are sleep physicians, well, then they're going to tend to be right. You have to please them. You have to please the people who are coming, who are sending the patients to you. So, is any one person right now, but you're going to kind of lean towards where are they coming from? Who's driving the bus? All right. As dentists, we want to know, what's the formula? What's the secret sauce to succeeding? What do I do? I'm a ketchup girl, personally. I will put ketchup on lots of things, but that may not be your thing. So, there's all kinds of sauce there. But my secret sauce, why I am successful, why I have made it this far, is communication. My ability to communicate with all of the people on the team, and really the words that I say. I've done this long enough that I found the words. I found my words. Will they work for you? Maybe not exactly. You might not have the extra that I've got. I am definitely extra. But the words that I use are my secret sauce, and they are the key to my success. So, getting into expectations. Expectation is the root of all heartache. I found heartache on this waterfall that I was hiking because I was not allowed to climb the chains and get in it. So, I expected to be able to. I couldn't. I was heartbroken. Not really. Because then I moved on to another one that I had no expectations for, and I found this in the middle of the woods, and it was pretty awesome. So, managing expectations. The key to your success is going to be communicating and teaching expectations, and managing those, and setting the foundation for everything. So, biggest one is setting expectations for the patient. And there's multiple areas that we need to set those expectations. What is the process? What is this magic plastic going to do? What do they have to do? They don't just get to show up and we do all the work for them. They got to do stuff, too, and we got to do things. All right. So, this kind of breaks down who's responsible for what. Diagnosis, that falls on the physician. I know that's up for debate, but in my world, that always falls on the physician. Educating the patient. In the best case scenario, the physician is going to educate them about what's going on. In my world, my referring physicians trust me. They know what I say. They know what I do. So many times, they'll say, well, you got sleep apnea. Go see her. And they leave it at there. And I hate that they do that, because the patient sometimes, lots of times, shows up, has no idea why they're there. They know, well, I got sleep apnea. I stopped breathing 15 times an hour. They missed that part. So, it is our job, often, to educate that patient, teach them what's going on, and why do we even care about treating this? So, the physician sets the stage. I find a lot, we have to do more of that. Choosing the appliance. I have that conversation with every patient. We talk about different styles. We talk about what I think is best for them. Now, are they really choosing the appliance? Maybe not. I'm leading them to what I think is best, and I will tell them why, so that when I say, yeah, I really think this is best for you, they will say, oh, yeah, yeah, right. So, they're getting a say in the choice, but you're leading that. Giving good instructions. That's on you. That's on me. If I don't tell them what to do properly and clearly, they're not going to do it. So, being really clear about instructions is going to be key. I tend to give them verbally. I give them written, and if I think they're going to forget, I tell them to get out their phone and say, hey, you might want to video me telling you this, so that they've got no excuse why they couldn't follow them. But the actual following of those instructions, that's on the patient. I will tell them, you know, Blue Cross does not pay me enough money to come to your house and put this in your mouth. So, you're going to have to do that. You're going to have to listen to what I say. So, that's on them. If you've told them what to do, it's on them to follow it. Follow-up appointments, back on you to make sure you've got them, but on the patient to make sure they come. Follow-up testing, back to the sleep doctor, and then determining success, that is a team effort between everybody in this equation. All right. So, setting expectations on the process. Now, in the next bunch of slides, I have put, if I've put on there my actual words, I've put them in color. So, like verbatim, that is what I will say to patients. When they come in, I will say, this is a process. I'm not Amazon. I can't pull it out of my drawer and send it to you in two days. Like, that's not how it works, where they may not understand that. So, a layout, start to finish. How does this go down? And then I alert them to any potential complications. And I may over-exaggerate some of them, saying, well, could be a lab delay due to COVID. They don't have employees. You know, where it used to take two weeks, now it takes four weeks. Prior authorization, if we have to go through that, I will maybe exaggerate that a little bit, so that when it turns out better than what I laid the foundation for, they think I'm awesome, and it's really just that I did a good job of overselling how it might be difficult. So, like I said all the time, you are not a crockpot. I can't set you and forget you. That was probably actually the commercial with the new wave oven or whatever it was, but they may not know what that is, so I used crockpot. We're going to need adjustments. We can't ignore it. And that sets the stage for them not expecting day one, this is a miracle, and we're never going to have to adjust anything. I can disappear right off into the sunset and never come back. Not everybody asks about efficacy. Some people are like, yep, sounds good. Let's do it. My doctor told me I needed it. Let's go. Other folks are going to say, well, how successful are you with these? You know, what's your rate of success? How often do these work? And they're looking for numbers. They're looking for statistics. So, if you've done a bunch of them, give your own statistics. Say, well, you know, this is how often we succeed with patients like you. Or, you know, give them a general idea. If you have done one, one appliance ever, and you say, oh, yeah, my success rate is 100%. Maybe you don't want to go there. That might be a little overselling things. So, if you haven't done a bunch, you can use your friends as examples, your mentors as examples, or go from the literature. Say, well, you know, 85% of the time for people just like you, this works. I have no way of knowing that if you're one of the 15 that it won't work for. And I will say, there's no guarantee that this will work for you. Because I do get asked, how can you guarantee it? Nope, can't. There's no guarantee this will work for you. Can your cardiac surgeon guarantee that the stent-heap lysis is going to prevent a heart attack? Nope. That's dramatic, but same idea. But I always follow that with what I can guarantee is that I will do everything I know how to make this work for you if you are willing to work for me. So, I'm not guaranteeing it's going to work. I'm going to guarantee that I will try everything. And I take it one step further to say, you know, I know a lot of people in this field. And so, they sometimes know things that I don't. So, if I've run out of my ideas, I'm going to look to them for ideas. And that's really confidence boosting for a patient to say, hey, we're going to do everything that's possible to make this work. All right. Going through side effects with patients. Before they ever sign the consent form, before it ever even lands in front of them, we go over what the potential side effects are. And I use real normal people language. Now, that's not hard for me. I used to get in trouble in dental school all the time for speaking like a normal person. And so, it's paying off now. And I go through the big ones. You know, I say, hey, you might have muscle soreness. Lots of people do. You can alleviate it by stretching. More saliva. You might have tooth movement. But I go through them. And that way, I've said it. I've explained it in a normal way. And then, if they don't have muscle soreness, they're like, oh, she's amazing. Yeah, no, I just set myself up for success by telling you what might happen. And then, the consent forms. Hopefully, you have a really good one. Some of them get a little extra, like me. But I say, well, the consent says you can chew it up and swallow it. I've never had anyone do that. Please don't be the first. So, I'm covering the fact that it says things like that. But also saying, yeah, you know, I never really had anyone do that. Make them read your consent form. I hope it's excellent. There are people who can provide you, they're lawyers, who can provide you with really good consent forms. But make them read it. How I get them to read it, because I'm not going to hover. I stay in the room. But I'm not going to hover. What I'll say is, you know, read through this. If anything sounds unfamiliar, I want you to ask before you sign it. It's kind of tripping them, like, oh, she might be trying to sneak something in here on me. So, just by saying that, I actually get them to read it, which is part of informed consent. But you know patients all the time. Sign it and done. And then, that's not really informed consent. Cost. Cost is a big one. Be upfront. You know, your fee is your fee. Like, don't be embarrassed by it. If you're charging $15,000, maybe you should be embarrassed. But your fee is your fee. Like, this is it. Be honest. People appreciate honesty. And try to sugarcoat it. Give them a good estimate of what your out-of-pocket cost is. I would rather err on the side of too much and give you a refund than try to hit you up later for $0.37. Okay? Like, nobody likes financial surprises. And most patients have had that experience with a hospital or a doctor's office. They've had a procedure. And they're like, whoa, I didn't know it was going to cost this much money. So, just be upfront. So, unless you're going to drop a million dollars at my doorstep, totally fine with that. You know, I don't like financial surprises. And they really appreciate when I will say, I don't like financial surprises. Most people don't. And then I lay it out there. They almost always say, thank you. I really appreciate that. That honesty about it. Now, it is so much easier to estimate what their out-of-pocket is if you are in-network with insurance. I'm not telling you that you need to be in-network. I'm not telling you you shouldn't be in-network. I'm just saying it makes it easier when you already know what they're going to pay and you can expect. The expectations are really there. Be careful with some balanced billing schemes that go on with billing companies unless you are not very fond of your license. And then, yeah, you do whatever you want. This is the biggest one. Finding their why. Not mine. Not my team's. The patient's why. That is their chief complaint. Why did they show up in your office? Why do they care that they have sleep apnea? And when you can figure that out, you always have the ability to go back to that when they're saying, oh, you know what? My teeth hurt for five minutes in the morning. Okay. But you said when you came in that you couldn't sleep with your spouse because you were snoring so loud. Does sleeping with your spouse outweigh five minutes of tooth soreness? You bring that to their, oh, okay. So then they can live with little stuff like that. How I get that out of the patient is the first thing I say every time I walk into the room, tell me a story. What led up to you getting a sleep study? So I find out what right there, you're finding out there why. Why do they care that something's going on? And then I'll ask them, how did you get to me? And sometimes it's simple as, well, my doctor told me to come. And other times it's, well, you know, I had a CPAP and I had such bad panic attacks from it that my doctor said, oh, you know, go see her. Okay, so you've got one more piece to the puzzle there. One more thing to tie back to helping them understand what's going on and finding out what's gonna get them to keep pushing forward. Now, sometimes you will get folks who pull like, you know, if they pull out the laundry list of like, of drugs and you're like, oh, your full-time job is taking pills. But they may come to you with a laundry list of problems and list 21 things that are wrong. Okay, well, that's a little overwhelming. I don't know that I can fix 21 things. In that case, we're gonna need to reign it in. And I will say, if I could make one thing better for you, what would that be? And there you're gonna get their real chief complaint. You're gonna get their real why, their top number one thing. And so if you're having a hard time reigning it in, that's a great question to say, to ask, to figure it out. All right, and sometimes we have to get what people don't wanna talk about, are giving up bad habits. You know, lots of sleep patients, lots of any patients, lots of any people, me, have bad habits, okay? And I will say, I can only help you to the extent you are willing to help yourself. If you are going to leave your TV on volume 700 all night long, guess who's not getting good sleep? You, my appliance can't fix that. And other bad habits we have that their sleep doctor has already talked to them about and they've kind of blown it off. But plastic, my skills cannot overcome these bad habits. So we have to have that hard conversation sometimes, not always, but sometimes, and you've gotta be willing to have it. All right, moving on to physician expectations. The biggest thing here is communication. Communicate with them. If you, I assume most of you are regular dentists, you like dentisting, I don't, but if you are and you sent your patient with a toothache off to the endodontist to get a root canal, endodontist never said anything, they did it, they just, whatever, never sent you any communication, you'd be kind of upset. So same thing with a physician. They wanna know that their patient is taken care of. And so if you take them on and never communicate, it's gonna make them pretty hot. That might be the last referral you get. So, but because everybody's different, you need to find out what they expect and what they want. Do they want a letter each step along the way? Do they want a letter? Do they want a phone call? Do they want an email? What do they want or how do they want it? Some people just wanna know when it's done, realize we are never done, but we've titrated it, everything's good. They just wanna know when they're coming back. Whatever they want, you need to have that conversation with them and find out what do they want. But no matter what they want, keep it short, sweet, and to the point, there are some software systems that will generate like a seven paragraph letter with all kinds of fluff and like three words that are actually important. And nobody, not you, not your physician, nobody has time to read that. And guess what? They're not going to, and they don't have time to read through all that trying to find out what you need. So keep it short, sweet, to the point. Hey, we seeded the appliance today. We're gonna titrate, good. Most of them will really appreciate you keeping it to the point. This is what I do because it works for my physicians. I send them a letter. They want them, I securely email or fax them to their sleep coordinator is how it works in my world. But if we were unable to contact the patient, I write back like, hey, thank you for the referral. We were unable to contact this person. I would be happy to see them in the future if they so choose. That leaves the door open for them when they're ready. They may go back to the sleep doctor in six months and be ready. So I've left that door open there. I will send them a letter if they're not a candidate or if they're not a candidate right now. Somebody who's been hiding out and hasn't gone to the dentist in 12 years. They've got 16 cavities and me putting those appliances probably gonna break something off. They're not a candidate right now. We have that discussion with the patient. I help them formulate a plan, but I send it back to the doctor saying, hey, not a candidate right now. Perhaps CPAP is their best option now. And I pass the ball back. I will send a letter after we take impressions and say, hey, we're gonna seed it on this date. I will send a letter when we've seeded it. Hey, we're starting treatment. And then I send another one when they're ready to be referred back. And that seems to be how much communication my physicians like to have. It's not overkill for them and it's not under communicating. But I always send them back for that follow-up sleep study. Number one way to make a sleep physician mad is don't send them back. Again, that might be your last referral. They'll start referring to the guy down the street. All right, managing expectations of other dentists. So I like to say that I'm not a real dentist anymore. I mean, I am, I have a license, but I am not your person to do a crown because I haven't done one in years. So I come into sometimes with conflict with all my patients have a regular dentist, okay? And I'm not trying to take over anything, but we're dentists. There's a secret section of the DAT before we can get into school that talks about how detail-oriented anal we are. So we're anal people, like admit it, own it. And when dentists have patients come in and something has changed, something's different, we notice all those little things and then we freak out because that's what we're trained to do is freak out. And we are taught nothing about sleep or TMD, TMJ, like in school. And so most dentists just don't know. And so we're coming in and they're like, I don't know about that. We are also taught that the perfect occlusion nobody actually has it, but the perfect occlusion will cure cancer, fix the hole in the ozone layer and solve world peace. Guess what? It doesn't. But we're taught that while we're waxing up, I don't know if anybody else had to wax up the little, I don't even know what they're called, like the interfering slopes and working and non-working. And clearly I've never used it, but in the four colors of wax and God rest her soul, sister Sarah Jean Donegan, I'm sorry, I've never used it once. She was an excellent teacher, but never used it once after that. So, especially when, you know, our teeth are only supposed to touch 10 minutes a day. So we are trained to think that perfect occlusion is the pinnacle of existence and it's not. So how do we manage that? So I send a letter. I don't send an update letter all the way along to dentists because it's just too much. It's overkill. But I will send a letter saying, hey, I'm starting treatment and I will list some of the side effects. What could happen? Just so that they're not surprised by it. And I will also say like, hey, your patient is supposed to be doing stretching exercises, is supposed to be using their morning repositioner. They're supposed to be, it's just letting the patient have some of the responsibility. As dentists, we take to like, take all ownership away from patients. Like we put it, we just carry the burden of all the things. You know, when a filling fails because the patient drinks 18 Mountain Dews a day, and you're like, oh, my filling must suck. No, no, your patient sucks. Their habits stink. So we tend to take on that responsibility. So I lay out, what is your patient in charge of? I will also say, hey, it might be better to do your dental work on this patient in the afternoon. If it's 7.30 a.m. appointment, they've taken out their appliance, 13 minutes, just enough to brush their teeth and hightail it to the dental office. Guess whose bite's gonna be off? It's gonna be real hard to prep a crown when their bite is a moving target. So afternoon appointments may be better. I let the dentists know that if you're gonna do major work, you got 16 veneers planned, this appliance is not gonna fit. I can deal with fillings. I can deal with a crown or two. We're cool. But if major work is planned, let's have a conversation. And I will, in a very nice way, ask them not to mess with my stuff. Like a toddler, don't mess with my stuff. Please don't adjust the appliance. Let me do it. And I will go through that with patients and tell them, please do not let anybody else adjust this. If you do, all warranty is null and void. And when I say that, they're like, yeah, okay, no, let anybody else touch this thing. And I will remind the dentist, usually this happens over the phone. When we call their office to get x-rays and things like that, I remind them multiple times, even sometimes, I'm not stealing your patient. I am not stealing your patient. For anybody who's a general dentist and doing sleep, that's gonna be a little harder conversation. I'm gonna tell them, oh, teeth give me hives, not doing that. So that's easy for me. It's not easy for somebody in the general office, but you have to say, hey, I am not gonna steal your patient, and then don't, don't do it. Don't be that guy or girl. All right. Managing expectations of your staff or your team. Okay, they have to know sleep patients are maybe a little different than regular dental patients. Sleepy people are a challenge. I mean, if they have a toddler, yeah, hit them up about an hour overdue for nap time. What are they acting like? Okay, I hope nobody is showing up in your office acting like that, but they could. But sleepy people are a challenge. We need to give them a little bit extra grace. People will fall asleep on you amid conversation. Happens to me all the time. I have to remind myself it's not because I'm boring. It's because they're tired. They might be grouchy. So they may have rough interactions with you or the front desk or your assistant. Now we don't tolerate aggressive behavior, but know that they've been tired a really long time and they've been dealing with this problem a really long time and they just want some help. Lots of people will be more emotional. Tears, have some tissues close by, especially when you're talking about their why. You're gonna get some tears in there. Now, some people are really well-suited for all of the feels, the feelings, and some people are not. So if you're putting somebody in a room to get the feels, get somebody with a personality that's nurturing, not me. If you've ever known a DISC profile, I'm a D, I'm direct. Yeah, feelings, they're not required for this. So I'm not the one who's gonna shut that down. So get somebody who understands and has compassion and cue your inner somebody really nice if it needs to be you. Okay. Your staff may give you some pushback about medical insurance and dealing with medical insurance. And if you don't deal with it, cool, ignore this. But it's a different world and they've not been trained in it. So it'll be a challenge. You might wanna pick up a few bottles of wine for your front desk person who might be filing insurance, only if they like wine. There are people out there to help you. There are billing companies, be careful. Most of them questionable. So again, unless you'd like to retire by losing your license, maybe caution to who you trust with that because it's not them that's going down, it's you. And quite friendly, I worked in prison for five years. I know what they eat, okay? Yeah, you don't wanna go there. It's a lot of macaroni salad and coleslaw. So unless you're really jazzed about mayonnaise, keep on the straight and narrow. It gets easier with time. Assure your people, it's gonna get easier, I promise. But there's a reason for working with medical insurance because it makes the yes easier. It makes it so much easier for a patient to say yes to treatment when their medical insurance is kicking in and paying half or 80% or the whole thing. It just makes your life way easier. Okay, I'm gonna play this video here. All right, this guy's my cat. And he is playing with a twist tie. So if anybody wonders why I can't get things done at night is because my cat demands that we play fetch with his twist tie for hours and hours. And if I don't acknowledge him, he gets on my desk and he knocks all the papers off. And so we play twist tie fetch for hours and hours. And please note the grumpy old one in the back who yes, she is in fact sitting in a Gobert box from Costco. The box came in and she commanded it as her own and you will have to pry it out of her cold dead claws. So yeah, she's not motivated by anything. Okay, my point of this video is if I can teach my cat how to play fetch, you can teach your staff how to follow a script. Mm-hmm, scripting is worth its weight in gold. Laying out what to say. If they've never said it before, like, oh, they're gonna get nervous. They're gonna get nervous. It's gonna be awkward, it's gonna be weird. Patients are gonna think, do they really know what they're doing? So scripting, helping them know what to say is gold. And if they don't know what to say because it's not in the script that you've made yet, that is a great question. Dr. Johannes will answer that for you when you see her for your consultation. So they don't have to have an answer for everything, but that is a great question. Now, you may also have the old fat grumpy one in the back who's not interested in scripting and cool. That's on you. All right, let me see if I can not see the cat again. Okay, for your staff, let them see the good stuff. Let them hear what happens when a patient comes back after they've had treatment and things have changed, things have gotten better. Let them hear that, okay? Let them get the feels. You're gonna get it because you're gonna hear it no matter what. Like, you're gonna be interacting with that patient. Let them hear that, okay? Because that hits you, when you feel that, it hits you in the gut, okay? And your staff, your team, they get those feels. They get that feeling. Like, they're on board. They're on board. It's probably dopamine. I don't really know. But by experiencing that, your team is gonna get a why. They're gonna get their own why. Why do I show up to work and do this every day? Why? Well, because I changed someone's life. Promise, they never altered anybody's life by sucking up spit, okay? That's the hard reality of it. Is it necessary? You bet. But do any of them feel like, oh my gosh, I just changed the world with this saliva ejector? You didn't. But when they see, oh my gosh, this person's life changed and the patient's in tears and everybody's in tears, oh, you just found, they just found a reason for being there and have found a reason for working harder. But it is your job as the dentist to help inspire them, help them find their why. You can't find the why for them, but you gotta do the work to help them find it. All right, last expectations. Your own. Probably the biggest one in here. You gotta manage yourself, okay? Nobody else is gonna manage you. You're gonna suck. Just being honest. You're gonna suck. Do it anyways. Your job is to suck less tomorrow than you did today. So you will get better, but you have to push through. You're not gonna have 100% success. Not everybody's gonna say yes. Not everything's gonna work out the way you want. Be okay with that. You know, in the dentisting world, we're used to it. Everything works just like we want. I mean, your DO amalgam on 19, well, I don't know if it doesn't amalgam anymore, but your feeling is almost always gonna work and it's gonna be great. And you're really good at it. But in the medical world, things are a little more unpredictable. So you will not have 100% success. That is okay. Sometimes better is the best we can do. Okay. You'll be frustrated. Promise it's no more frustrating than trying to do a DO composite on 15 with cheeks that are this thick and a tongue that won't stop moving and a pool of saliva. Okay. It is not as bad as that, guaranteed. So it's frustrating. Can be frustrating, but you will work through it until that is no longer frustrating. Everything is sales. Okay. This is sales. We are selling patients on why this is best for your overall health. We are selling our team on why we need to do this for patients, but everything you do in life is sales. You know, so people get creeped out like, oh, sales, I don't like sales. Everything we do is sales. I sell my 11 year old son daily on why he needs to take a shower after football practice. Well, because I don't want the police showing up looking for dead bodies when it's really just your stinky sweaty feet, okay? So I have to sell him on that. I have to sell my kids on things all the time. Everything is sales, okay? Best way to learn sales, I think, is joining a network marketing team. I'm not advocating for any team or company, but best way to learn sales is just learn how to sell, like do the selling of other things that are not this. But getting better does not happen by chance. It happens by choice. You have to choose. I'm going to get better. I'm going to lead my team. I'm going to lead my patients. I'm going to lead my sleep doctor, and I'm going to be in charge of me. I'm going to lead myself in this. I'm a big fan of reading. These are just three of my bookshelves, the ones that the cats did not get up on and knock over, but I'm a big fan. I cannot claim that I've read every single one of these books, but most of them, okay? And I had to choose, like, what are my top ones? Oh, that's hard. That's hard when you got this many. So these are my top six that teach you how to be a leader in your practice, in your life. It spills over into everything you do. Start With Why is a great book on finding that why. You find your why. You can help your team find their why. You can help patients find their why. When you know your why, everything else is pretty easy. My favorite on this list is Extreme Ownership. I have not read it. I listened to it. Best way to hear that book is on Audible because it's actually the SEALs who wrote it that are speaking on the Audible. Fair warning, it can be a little intense. I found myself with anxiety as they're telling stories of their time, and then I had to remind myself, they wrote the book, they lived. Okay, it's gonna be all right. Might wanna speed it up just a little, though. It's a little less intense. Fantastic Audible book, but yeah, it gives you a little, gave me anxiety, but it's great, totally worth it. Last expectation, expect to be changed. You can't do this and not have your life changed, and you can't do this and not have it spill over into everything you do. So expect that if you stick with this and you push through, you will be changed because you know that you have changed someone else's life. My good friend, Jameson Spencer, talks about the ripple effect all the time, how we're not just treating one person because that one person, when they are changed, it changes the life of their spouse. It changes the life of their children. It changes the life of their grandchildren, changes the life of their coworkers, their community, their church. It spreads out like a ripple, a drop will spread out, and you will have an effect on so much more than just that one person. But beyond the ripple effect, my good friend Kip Covington, who is like a next level kind of guy, like you do something cool, he's gonna next level you. He's gonna take it up a notch, like flipping around with like a, yeah. He's amazing behind a boat, in the water. He's awesome, and he's an awesome dude all around. But he took that ripple effect and took it one step further. One drop is creating a ripple, but ripples create waves, and waves change landscapes. So by treating one person, it might just be a drop, but it's not because it will spread, and it will spread to their community, their family, their community. And if we're all doing this, we're affecting communities around the world, around the country. And when we change all of that, we have the ability to change a landscape, the landscape, the future of the health of this country, by focusing on well care and not sick care. And we really, as a collective, have the ability to change the future for so many people. So get cracking, and get that drop in the bucket, and start changing people's lives. Questions? Thank you, Dr. Johannes, that was awesome. And we do have a few questions. So let me go to the questions a minute. Alrighty, speaking of teams, how do we teach our team members what to say? Okay, so I actually wrote out scripts for all kinds of circumstances. And did I like one day show up, and I'm like, oh, I have a magic script for everything. No, because weird stuff happened, weird things came up, and I wrote down a script when it happened. So I have accumulated scripts over time. But I have one for when my staff is calling out to a new patient who was referred. So I have it listed, and it is on the same color sheet. It is a blue sheet, I don't know what color you want, but it is a blue sheet. They know what sheet I need to make this call, and what's gonna be said on there. I have a separate one for somebody who's calling in as not a patient who was referred to us, someone from the outside. It is lime green. So they know somebody who's calling that we've never talked to before, grab that sheet. I make it easy for them to grab it. And I said, as things come up, sometimes something weird, and my staff's like, I don't know how to answer that. I will write it out. I will write it out, and we actually have a book up at the front phone for situations like that. So one of my people liked to have it in a book that she could flip through, that's how her brain worked. My current front desk likes it on the computer. So she can click, she's just smarter than I am. So she likes to have it on there, and be able to click and say, oh, this is what I say. So I taught them, not by throwing all of them at them at once, but as things came up, I gave them the script. And I say the same thing every time, not because I'm reading it off of a piece of paper, because over and over again, I found out what worked, like what worked for me, how did I most clearly communicate that to my patients? And so anybody walking by the room when I'm saying it, they're like, you say the same thing every time. Darn right I do. You know why? Because it's effective. So sometimes I just have my staff hang out outside of the room, listen to me say it, listen to me say it, listen to me say it. By the third time they're saying, they know. And so repetition, so sometimes it's in writing, I don't want them reading off of anything to a patient, that's weird, but over the phone they can, but you say it enough times, sounds totally natural. So that's what I did. And I will add to that, when I was training new employees for me, I'll have them bring in a little note card with some bullet point reminder marks when they're first starting to kind of talk to people about things. And I'll just tell them, you know, pull out your note card in front of the patient and just say, you know, I wrote down a few notes about your situation ahead of time, and I just wanna make sure I touch base on all of those. And it could exactly what you said, be the exact same conversation that they might be having with everybody, but that patient doesn't know it. And it also gives that new employee a little bit of a security blanket so that they feel a little bit more confident about doing that. So that's a great suggestion. Okay, another question here. What if a patient gets upset that they don't feel any better do you refund money? Hmm, short answer is no, but that is because I, going back to expectations, I laid that groundwork months prior, okay? When I had that conversation about, there is no guarantee that this is successful for you. We talk about the definition of success. We talk about how this is medical treatment. Sometimes our bodies are unpredictable, but having a really excellent consent form helps with that. So really, really get somebody who knows what they're doing to get your consent forms. So laying the groundwork, setting the foundation, like from the beginning, I'm kinda telling them, you're not getting a refund. I don't care what you do, you're not getting a refund without saying those words. So it really doesn't, knock on wood, come up for me because I've spent so much time saying, all right, we're gonna try all these things. We haven't run out. So the answer is no, I'm not giving a refund, but we go back and I will go back to say, hey, remember when we talked about this? Remember when you signed this? Remember when we did this? And I do it nicely, not as harsh as I'm saying now, but I always go back to it. Remember when we talked about this? And so, no, but tying it back to, I've already laid such a good foundation for that, that it's not a surprise down the road. Perfect. I 100% agree with all that. Setting the stage can just be completely invaluable. This next question, I think I'm gonna steal from you because I literally just had this exact scenario happen a couple of weeks ago. What if a patient gets upset and leaves a negative review, either like Google or social media or whatever? So my experience with this was very interesting. It was a patient who actually, a patient's wife who never had walked in our doors. Her husband, we never even treated and she posted an extraordinarily inflammatory negative review in there, suggested she was gonna bring me up on charges and everything. It was so over the top. And I read it. It was obviously taken aback and not happy in the least. So I went to all my team members who had contact with this particular family and got all the information I could so that I knew the sequence of events and everything. And I called her. I had anticipated possibly just responding. It was a Google review, just responding on Google. And I thought, no, then it's just gonna be a screaming match on Google. That's not what I want at all. So I picked up the phone and called her and took her completely off guard. And I knew that she was gonna be very upset and need to vent. So I just introduced myself and I said, I see that you're pretty upset. And I just shut my mouth and I let her just spew forth such venom. It was unbelievable. And we were able to work out the conversation. And by the end of it, she had completely calmed down, appreciated the phone call and ended up removing the review. And she is the one that said, I'm gonna remove that review. Clearly, she didn't say I was wrong, but she did say that the experience ended up being completely different than what she had anticipated. So I think sometimes you need to just confront someone directly, but very, very calmly. At least that was my experience. I think I was told that as a care connotation. Yeah, which it can be really difficult because right when you read this negative review, I mean, you feel a lot of like, hey, what the heck, man? I didn't do anything wrong. Of course. So it's hard to sometimes put your feelings in check. So, yeah. And it's gonna, based on what energy are you bringing to that conversation? If you're coming in hot, this is gonna blow up. Okay. So it's hard, especially for someone like me, I've got a personality, I'm aggressive. So it's hard for me. I have to channel my inner other friends who are way nicer and more chill than I am. So I have to channel that and just be really conscious of the energy I'm bringing to the situation because that person, in this case, I'm assuming she was untreated and she was super sleepy. So guess what? It wasn't her, it was her husband. Okay, okay. So people who are tired or who are just frustrated, they can be jerks, just straight up jerks. They're toddler, they're two-year-old toddlers who didn't have their nap. They're throwing temper tantrums. But if you come at a toddler hot, if you come aggressive at that, okay, this is just gonna blow up. Okay, so carrying a different energy to that. And really, yeah, you totally knocked her socks off by what she was expecting was a confrontation. Like a verbal assault on Google is what she was expecting and what she was looking for. And that is not what she got. You took her off guard and it turned out really awesome for you. Yeah, I got lucky. Okay, last question here. What if the follow-up sleep study doesn't meet the referring physician's definition of success and they tell the patient they should go back on CPAP and this is already a CPAP intolerant person? Okay, well, then they go into the CPAP Witness Protection Program. Just kidding. So that is all gonna depend on the relationship that you have with that physician. If you have laid the foundation, so I'm guessing in this case, you wouldn't have a really great foundation with that doctor if they're like, nope, back on CPAP. Because none of my, I'd like to think, none of my referring doctors are just gonna say that. You know what they're gonna do? They're gonna pick up the phone or they're gonna send me an email. They always reach out to me when that follow-up sleep study isn't what we want. So because I have a long relationship with them, they will always reach out to me and I've taught them, I've had to teach them, hey, this is not all we can do. Like there are other adjustments to be made. We just think this is the sweet spot. So we can always adjust more. So I've had to, over years, teach them, this is not final, this is not my final offer. You know, we can go back and forth some more. But if it's someone, say it's their first referral to you or it's the first, you know, you got the referral from someone else, like primary care dog. Primary care dog is happy, but they sent the sleep study off to the sleep physician. Sleep physician says, get on CPAP. Well, guess what you gotta do? You gotta pick up the phone and call them. Okay, I don't like, I don't love talking to new people who might be hostile anyways. I've been screamed at by a sleep physician. Thankfully he's retired now. But it's uncomfortable, but you gotta do the uncomfortable to get where you wanna go. So having that conversation and you come in, don't come in hot again. Come in like, hey, I saw this. I just wanted to talk about it. Okay, then you've said, hey, I just wanna talk about it. Instead of saying, you're wrong, not good. Come in gently and say, did you know that? And sometimes you can ask it in a question. Did you know that when I send them back for the sleep study, we have adjusted to subjectively where we think is best, but we're sending them for the sleep study to let me know if I need to adjust further. And that's sort of, if it's a new person to you, you're saying, hey, this is not final. We can do more stuff. And they're fairly reasonable people. They wanna help people. They don't sit around like thinking like, how can I be the world's biggest jerk? They're not that at all. They just want their people to get better. And so when you bring that to the conversation like, hey, I can do more, I've found that they're open to that. So, but come at it with questions or from a kind, a soft place rather than an aggressive place. And I can also add to that, that if it is a physician that you have not dealt with before, it actually presents a pretty cool opportunity to be able to reach out to that physician, again, very kindly and almost kind of a, hey, the patient really likes their appliance. They're doing well with it. Do you think it's okay if maybe we try titrating a little bit further and maybe have another follow-up sleep study in a couple of months? Are you open to trying that? Cause they really like it. They actually wear it. And they really struggled with CPAP. I don't know that they're ready to give up on the appliance. And I told them I wouldn't give up on them either. And just having that conversation, oftentimes it will really win that physician over that, oh, wow, you actually care. So that can go a long way as well. Okay, so we're kind of getting short on time here. So have a great evening, everybody. Dr. Johannes, do you have any final words for us? Setting your expectations is really laying the foundation for your success. Perfect. Get out there and do it. Yes, perfect. I agree.

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Dr. Johannes

importance of expectations

dental practice

communicate expectations

success

patients

team members

referring physicians