How To Use The Anchoring Principle

ONE SENTENCE SUMMARY

Using the principle of anchoring to communicate more clearly with patients about their treatment options, and to guide them to make good decisions.

WHAT DOES 100% CONFIDENT MEAN?

1. You can come up with an anchor for every treatment

2. You can role-play examples #1, 2, and 3 below

3. You consistently use the principle of anchoring when presenting treatment to patients

What Is Anchoring?

Anchoring is the principle of comparing (or anchoring) one treatment option to another option first that is less desirable and/or more expensive.

Why Do We Need to Anchor?

High quality dentistry can be expensive. But that doesn't mean people won't pay for it. People buy things all the time that are expensive, as long as its important enough to them.

One of the differences between dentistry and other things people can buy is that people know how much a meal in a restaurant should cost, or a good bottle of wine, or a TV, or a car, or a vacation. But they don't have any concept of how much dentistry is supposed to cost.

In order for them to understand how much it costs to fix their dental problems, we have to put it into context for them, and we do this by anchoring.

How Do We Do It Differently Than Other Dental Offices?

Step 1: Understand the patient. What are their frustrations? Problems? Goals? Priorities? Values? Don't make assumptions - ask questions and listen.

Step 2: Based on that understanding, and using our expertise, formulate a solution that we know will make the patient the happiest, with the lowest chance of long term regret.

Step 3: Use the principle of anchoring to guide the patient to that solution.

How Do We Anchor?

Before discussing the treatment plan that we know will make the patient happiest, with the lowest chance of long term regret, first ANCHOR it to another solution that is less desirable and/or more expensive.

EXAMPLE #1

The BAD way:

"Dr. Bennett says you need a crown to fix your broken tooth. The cost for the crown is $1,200. Or if you want you can do a filling instead and that costs $400."

The GOOD way:

"Mrs. Smith, Dr. Bennett says you've got a badly broken molar. When molars break like his, they break in 1 of 3 ways. First, they break right down to the bone, in which case they can't be fixed. Teeth like this have to be removed, and since it's a really important chewing tooth, you will likely want to replace it. You can expect to spend several months and several thousands of dollars to replace it. And even if we do the world's best bridge or implant, it's still not quite as good as the tooth you have right now in your mouth.

The second way they break is not deep enough to reach the bone, but they break into the nerve of the tooth. This is when people develop abscesses, or really bad toothaches. The solution is a root canal and then a crown, which usually costs in the range of $2,500, takes a few visits, and sometimes requires a root canal specialist.

The third way teeth like this break is into the tooth, but not deep enough to reach the nerve. This is the way your tooth broke. So even though it's unlucky that you broke a molar, at least it's not as bad as it could have been. Teeth like yours can be fixed with the crown alone, and it will cost $1,200. If you can afford it, that's the way I think you should go. Does that make sense to you?"

NOTE:

Based on what we understand about the patient's values and priorities, we've decided that a crown will make the patient the happiest, with the lowest chance of long term regret. (This is not always true - sometimes we believe that exo and implant, or exo and nothing are the right choice for the patient).

The crown costs $1,200. But before presenting that fee, we put it into context by anchoring it to something that is less desirable and/or more expensive. In this case, we've actually anchored it to TWO other solutions - exo and replace vs RCT/core/crown.

We've presented 3 options to the patient, but they are not all equal. We are making a clear recommendation and guiding the patient toward the solution that we think is best for them.

EXAMPLE #2

The BAD way:

"Hey you need a root canal and crown, and it's going to cost $2,500. Are you ok with that?"

The GOOD way:

"Mrs. Smith you have a big cavity in that molar that is causing infection, and that's why your tooth has been so sore. A lot of times the infection gets so bad that the tooth can't be fixed. We have to remove it, and since this is a really important chewing tooth, you're probably going to want to replace it once it's gone so that you can still chew your food properly. Any replacement we do isn't going to be as good as your natural tooth, and it can take months to complete and cost anywhere from $4,000 to $7,000. And even if we do the world's best implant or bridge to replace that chewing tooth, it's still not quite as good as the tooth you have right now in your mouth.

The good news is that you've caught this infection in time and it's still fixable. Dr. Bennett has come up with a plan to save that tooth, get rid of the soreness, and strengthen it so it doesn't break again. She wants to see you right away, so you can be done in a couple weeks, and the cost is $2,500. Does that plan work for you?"

NOTE:

If you just blurt out the words "root canal" and "$2,500", the patient will have a negative reaction. Those are scary words. We have to put them into context.

So before discussing the plan that we know will make them happiest, first anchor it to something less desirable and/or more expensive. In this case, we are anchoring to exo and bridge or implant. By the time we exo, maybe graft, and then do bridge or implant, the patient will spend many weeks if not months, and many thousands of dollars. Not to mention that the end result is still not going to be as good as the tooth she has right now.

EXAMPLE #3

The BAD way:

"Your implant will cost $4,600."

The GOOD way:

"Replacing your missing tooth with an implant is an excellent choice. If you don't have enough bone, and you need major grafting to rebuild your bone before it's ready for an implant, you can expect to spend 6-12 months and $6,000 to $7,000. You also would probably need to go see a specialist.

The good news is that Dr. Ling has reviewed your 3D scan and you do have enough bone right now without the need for major grafting. That means your treatment will take about 4 months and cost $4,600. And Dr. Ling can complete the whole thing right here in our office. Does that plan work for you?"

There is an Anchor for EVERYTHING

TREATMENT ANCHOR

1 hr recall Perio sc/rp

Perio sc/rp Refer for perio surgery

Perio surgery Exo and dentures

Fillings Endo

Endo Exo and replace

Crown Exo and replace

Implant Implant and major graft

Implant and major graft Denture

Whitening Veneers

Invisalign Fixed ortho, or veneers

4 veneers 10 veneers

10 veneers 24 veneers

24 veneers 24 veneers in Oakville or Yorkville or NYC

Removable overdentures All-On-X

All-On-X All-On-X by surgeon

etc.

Here are 2 more advanced examples:

If you are presenting a bridge, you can anchor it to an implant.

And if you are presenting an implant, you can anchor it to a bridge.

It all depends on how you phrase it and where you put the emphasis.

EXAMPLE #4: Guiding the patient towards the IMPLANT

"Mrs. Smith, there are 2 ways to replace this tooth. The first is with a bridge. The bridge costs $3,800, which is a little bit less expensive than the implant. And it can be done in a few weeks. But bridges don't last as long as implants, and sometimes there are side effects like sensitivity or even root canals on the anchor teeth.

The second way to replace that tooth is with an implant. Implants are a bit more expensive, $4,600, and they take longer to finish. But implants last longer than implants, are easier to keep clean, and avoid problems on the anchor teeth. If you can afford it, and if you are ok waiting for a few months, then that's the route Dr. Ling thinks you should take. Does that plan work for you?"

EXAMPLE #5: Guiding the same patient in EXAMPLE #4 towards the BRIDGE instead of the implant

"Mrs. Smith, there are 2 ways to replace this tooth. The first way is with an implant. Implants tend to last longer than bridges, but they can take months to complete and cost around $5,000.

The second way to replace that tooth is with a bridge. In some cases bridges don't last as long as implants, but Dr. Ling feels confident that you are a very good candidate. The bridge doesn't require any surgery or bone grafting, can be done in a few weeks, and will cost $3,800. If that sounds good to you, this is the route Dr. Ling thinks you should take. Does that plan work for you?"

NOTE:

In example #4, based on what we know about the patient's values and priorities, we've decided that the implant will make them happiest with the lowest chance of long term regret. So we guide them to that solution by first anchoring the implant to the bridge. Even though the bridge is the less expensive option, we can still use it as an anchor by emphasizing that it is less desirable than the implant.

In example #5, for whatever reason we've decided that the patient is better off with a bridge instead of the implant. So we present the implant first as the less desirable and more expensive option, and then guide the patient towards the bridge.

Implants are not always the right solution. And neither are bridges. The key is to understand the patient. Once we know what's important to them, then we can use our expertise to help guide them towards the right solution.

Super duper advanced anchoring:

In examples #4 and #5, not only is the order that the treatment is presented important (less desirable and/or more expensive FIRST), but it's also important to describe the features of each treatment in the correct order.

The ideal order goes like this:

1. First option (the anchor)

2. Good news about the first option

3. Bad news about the first option

4. Second option (the preferred solution)

5. Bad news about the second option

6. Good news about the second option

Here are examples #4 and #5 again, with these sections highlighted so you can follow along.

EXAMPLE #4: Guiding the patient towards the implant

FIRST OPTION: "Mrs. Smith, there are 2 ways to replace this tooth. The first is with a bridge.

GOOD NEWS ABOUT THE FIRST OPTION:

The bridge costs $3,800, which is a little bit less expensive than the implant. And it can be done in a few weeks.

BAD BEWS ABOUT THE FIRST OPTION:

But bridges don't last as long as implants, and sometimes there are side effects like sensitivity or even root canals on the anchor teeth.

SECOND OPTION:

The second way to replace that tooth is with an implant.

BAD NEWS ABOUT THE SECOND OPTION:

Implants are a bit more expensive, $4,600, and they take longer to finish.

GOOD NEWS ABOUT THE SECOND OPTION:

But implants last longer than implants, are easier to keep clean, and avoid problems on the anchor teeth. If you can afford it, and if you are ok waiting for a few months, then that's the route Dr. Ling thinks you should take. Does that plan work for you?"

EXAMPLE #5: Guiding the patient towards the bridge

FIRST OPTION:

"Mrs. Smith, there are 2 ways to replace this tooth. The first way is with an implant.

GOOD NEWS ABOUT THE FIRST OPTION:

Implants tend to last longer than bridges,

BAD BEWS ABOUT THE FIRST OPTION:

but they can take months to complete and cost around $5,000.

SECOND OPTION:

The second way to replace that tooth is with a bridge.

BAD NEWS ABOUT THE SECOND OPTION:

In some cases bridges don't last as long as implants,

GOOD NEWS ABOUT THE SECOND OPTION:

but Dr. Ling feels confident that you are a very good candidate. The bridge doesn't require any surgery or bone grafting, can be done in a few weeks, and will cost $3,800. If that sounds good to you, this is the route Dr. Ling thinks you should take. Does that plan work for you?"