Case Presentation and Case Acceptance with Dr. Benjamin Turnwald

Alec Goldman (00:01.014)
Welcome to How I Grew My Practice, a 15-minute podcast presented by NexHealth. My name is Alec. Being joined today by the Dr. Benjamin Turnwald, Founder, CEO, and Dentist of Turnwald Dentistry based in Illinois. He is here to talk with us about case presentation and case acceptance. Dr. Ben, what's going on? How are you doing?
Benjamin Turnwald (00:22.916)
Hey, I'm good. I'm good. Thanks for having me.
Alec Goldman (00:25.430)
My pleasure. If you don't mind, we start all of these podcasts with just a quick introduction. If you don't mind sharing a little bit about yourself, how you got into dentistry, how you became a dentist, how you opened your practice, if you can just share a little bit about yourself.
Benjamin Turnwald (00:40.944)
Yeah, sure. I've been practicing for about 14 years. I moved to Chicago after dental school, which is where my practice is, suburban Chicago. And yeah, I got into dentistry. I was always just a big science nerd. And I am the son of two small business owners. And so I knew I wanted to own my own business. So I connected medicine with small business. And that led me to
Benjamin Turnwald (01:11.568)
to dentistry. And also, I know everybody says this, but you know, it's wanting to help people and offer a service that you know, you don't feel like you're having to sell to people. It's like a need and something cool that you can offer.
Alec Goldman (01:26.498)
Very good. So diving into our topic on case presentation and case acceptance, I know this is gonna sound silly. I'm sure you're like, this is second nature to me, but can you define case presentation in your words and explain why case acceptance is so important to your practices bottom line? So, I'm gonna go ahead and start with a question that I've been getting a lot of questions about. And I'm gonna go ahead and start with a question that I've been getting a lot of questions about. And I'm gonna go ahead and start with a question
Benjamin Turnwald (01:45.232)
Yeah, so I would say case presentation is about sharing your knowledge with the patient based on what you see. I think a lot of times in dental school, we think it needs to be this elaborate, planned out treatment plan, which a lot of times it does need to be. But I think one of the things that stresses us out about it is that we feel like we have to make all the decisions as the doctor at the dentist and that's something that I have since changed my mind on. So that's case presentation and then I'll say, I mean, case acceptance really is at the heart of two different things. One is you can't change people's lives and make them healthier if they're not accepting needed treatment. And two, coming from a business aspect, that's how you keep the lights on. That's how you pay your amazing staff.
That's how you know, keep the office clean and can afford the latest and greatest technology and, you know, the best labs and X, Y, and Z. That all basically comes down to being able to turn a profit. So, of course, most importantly is our patients and giving them really good dentistry and helping them get healthy. But then secondarily is, it's also a business. So I mean, case acceptance is a monster. It's not something that happens in one event. It's definitely a process, but it's really at the heart of what we do, both from an ethical standpoint and also from a business standpoint.
Alec Goldman (03:28.878)
So you mentioned there was kind of a school of thought of how you originally learned case presentation versus what you're doing now. Can you share with our audience a little bit more about your process of how you're going about case presentation today?
Benjamin Turnwald (03:46.960)
Yeah, so in dental school, we're taught that doctor knows best. And you do your evaluation, you put together your treatment plan, and you prioritize as the doctor what needs to be done first, what needs to be done second. So we call it phase one, phase two, phase three, and you just kind of you decide that, you plan it, you put it together, and then you present it to the patient. And maybe there'll be different options for different phases, and of course, we all know that we have to, you know, review benefits and alternatives with our patients. But for the most part, you're basically deciding which problems are the most important, what needs to be addressed first, and then maybe if there are problems that you don't even talk about, that's, you know, something that you talk about down the line.
So that's at least kind of an overall overview of how I was taught in dental school. And then also you sort of present it that way. So you think about putting the fires out first and then anything that the patient would wanna do from like a cosmetic standpoint is kind of an afterthought once you get them stabilized. So that can be unfortunate sometimes because someone might come in wanting veneers or wanting their smile to look better, and then you spend a half hour talking about how their gums are unhealthy. And so that may be the case, and that may be something that's important to bring up to the patient, but you might then lose them as a patient because you didn't address why they started coming in to see you in the first place.
Alec Goldman (05:31.906)
So really starting from the patient perspective and addressing, you're saying addressing their core need of what they actually need from a health perspective and then following kind of the aesthetic.
Benjamin Turnwald (05:45.564)
Yeah, I mean, everything else is kind of an afterthought. It's, hey, you have these significant disease processes going on. We're going to address those first, and then we can talk about doing veneers, or then we can talk about getting your teeth to look better. That's sort of the way that we're taught in dental school to do it is to get the diseases under control first, and then move to the fun stuff.
Alec Goldman (06:17.090)
Makes sense. I mean, speaking as a patient, I know that there's such a, I guess a stereotype perhaps that in medical, in dental, you have lots of cases being presented to you and it feels like there's a lot of pressure for you to kind of make a decision you're not really sure. Speaking of pressure, there's obviously a huge cost. I guess, how do you address financial concerns during case presentations? And like, what are some strategies to help overcome those cost barriers that patients have.
Benjamin Turnwald (06:51.856)
Um, so I think there are different ways to do that. Um, one, I think you need to get to know your patient from the onset and just really understand where they're coming from, what they value. Um, and I do that in my practice doing a 20 to 30 minute preclinical interview with, um, all of my adult patients. And one of the things that I do hear a lot from, um, those interviews and one of the questions that I ask is, why did you leave your last dentist? And there's usually three top things that I hear. One is that I was treated rudely at the front desk. Two is that the hygienist was too heavy handed or did uncomfortable cleanings. And three, I felt like I was being sold treatment. And so the sold treatment one, I think, is where we really have an opportunity as a profession to really kind of switch gears
Benjamin Turnwald (07:50.856)
change the discussion to make it a little bit more patient centered so that the patient feels, I mean, this is what I have on my website. You're in control. You're in a judgment free zone. You're going to be involved in the planning process. I'm going to tell you what I see and what I would do, but that doesn't mean that's what we end up doing. It's going to be very, very collaborative. So I think as you do that and you get to know your patient.
Um, and you can also show them some empathy for that instead of just being like, here's the treatment plan. It's going to be $5,000. Take it or leave it. You know, your, um, your financial problem is your financial problem. I think, I think one offering them first figuring out what they, what it is that they want and what it is that they value. Cause if there are certain things that they don't value, then
Benjamin Turnwald (08:47.044)
you're probably not gonna end up doing that service or that dentistry for them. And that might be okay. It might not, it might, and it might. For me, sometimes, you know, if someone doesn't value keeping their teeth, okay, I'm gonna help you with your emergencies until one by one you lose your teeth and then you get to the point where you can't eat a steak anymore and then you start to value your teeth and then you come to me and you're like, okay, I know we talked about this. I'm ready to restore my teeth. Okay, now we can have a different type of discussion than we could.
five years ago when it wasn't important for you when you lost that first molar. So I think getting to know the patients and also getting them to own the problems. So if someone doesn't think that they have a problem, they're not gonna have value for it. So that's where the concept of transparent dentistry comes in and I'm a huge advocate of photography and scanning.
You can only show so much on an x-ray and patients have no idea what they're looking at when you're reading an x-ray anyway. But if you can show somebody somehow using a visual aid what is going on in their mouth, then they can start to own the problem and that's going to be the first step towards getting them to start to value it. And then they're going to have to also understand what the consequences are of letting that disease or that problem progress.
Benjamin Turnwald (10:14.148)
And then kind of the final step is actually how much money do they have in their bank account? Can they actually afford it? That's kind of like the last step that I consider because you know, I've had Patients that are you know making minimum wage and Somehow they find the way to do a $10,000 treatment plan because the
that we've talked about, they have such high value for, they go up to the bank and they take out a loan, or they have an aunt or an uncle who is willing to sponsor the treatment for them. People will find the resources if they value something. And then you have someone who comes in driving the brand new sports car who doesn't wanna do anything and spend any money, and you know it's not an actual financial problem, it's the fact that they don't value.
what the treatment is. So I think you have to work on getting to know your patient, getting them to accept the problems they have and then getting them to value it before you really analyze their checkbook. So I never try to read a book by its cover based on a patient's car or a patient's purse or the kind of clothes that they're wearing because I've done full mouth reconstructions on every type of patient.
Alec Goldman (11:38.518)
The trust component makes all the sense in the world, especially I guess I, Dr. Turnwald, I think I mentioned to you that I have a Maryland bridge. So I had this big procedure where I had to decide if this is something that I wanted to put to your point, you know, do I value, am I going to put my money towards, um, and something that I really appreciated about my dentist was that he just, he really felt like he was on my team. It felt like he was in my corner and gave me the time to come to the conclusion that it's something that I think that I.
I needed just from a health perspective. So I think to give the space and time makes a ton of sense and thinking about a patient from a long-term perspective is, I think, vital to keeping a patient for a long term so that they don't go somewhere else. But you mentioned just like going about educating somebody. They're not going to pay for something that they don't value. What are ways that you're educating patients so that they actually come full circle to see the value that you're presenting?
Like what are the different strategies that you put in place to make sure that somebody's learning about.
Benjamin Turnwald (12:42.588)
Yeah, so I think one of it is just time. In my practice, it's time spent with the doctor, depending on what type of practice you're in, and how heavily contracted you are with insurance, and what type of patient volume you have. I think that we've become so like, it's become so normalized to just see a doctor for like two minutes whenever you have a problem.
Benjamin Turnwald (13:12.572)
that's kind of translated into dentistry as well. So, I mean, just seeing somebody for 20 or 30 minutes and talking to them, I get so many compliments on people being like, I have never had a dentist spend this much time with me before. And that automatically increases your credibility and your trust because you've done something different than every other dentist has done for them potentially. So.
And people want to be heard. They want to tell you their horror stories about the dentist. They want to tell you how awful it was to get their third molars out. And like, yes, we've heard those stories a million times, but, you know, we're so like, it's become so normalized to, you know, talk as fast as you can when the doctor walks in the room, and I'm talking about medical doctors as well, like, that you're just kind of programmed to do that. And so I think.
Benjamin Turnwald (14:09.796)
you earn a lot of trust when you just spend the time with the patient. And one of my favorite things that I love hearing when someone comes into a preclinical interview with me or even a second opinion or a consultation is they'll throw a treatment plan at me on the consultation table. And they'll be like, I don't think I need this. My current dentist or my last dentist told me that I need a deep cleaning and I need
Benjamin Turnwald (14:40.476)
this crown on this tooth and it was gonna be all this money and I just, I don't think I need it. And so I know as soon as I hear that, that that patient was either described what they needed and not why, and it was probably done pretty quickly. So they, the reason I like this is because they come in and I can see the fees on there. And my particular practice is, I'm kind of known as the not very cheap doctor on the block.
And so I can see right away that my fees are going to be higher. But I take that as a challenge, because then what I do is I probably almost always see the same thing that the last dentist probably saw. I think where I'm a little bit different is the way that I describe it to the patient. So instead of telling the patient, let's use the deep cleaning as an example, instead of telling the patient that, hey, you have gum disease, you're going to need this deep cleaning and it's going to be.
$500. I would say, okay, let me take a look at your x-rays. Okay, yeah, so one thing that I'm seeing on your x-rays that I'm concerned about is, so you can see where this white stuff, you can see your teeth and then you can see where this white stuff is, kind of looks like sheep's wool. Yeah, yeah, I see that. Okay, that's the bone around your tooth. Then I take my hand and I'd be like, this is where your bone should be, this is where your bones at now. So in a normal healthy adult,
you. So what's happened over time is that you've had permanent destruction in your jawbone that has caused you to lose support around those teeth, which can ultimately lead to that tooth being lost. And then I pause. Pause for effect. And you're almost always, as soon as you tell someone there's permanent destruction of anything in their body, they're going to be like, how do I fix that? Okay.
Well, there's different ways to fix that. Probably the most straightforward would be to do some gum therapy with one of my hygienists. Well, how much does that cost? It's about $800. And then the wheels start turning, you pause again. And then I almost have a hundred percent success rate with what we call scaling and root planing. But a lot of times if you can just one, make the patient understand what, what the condition actually is.
what's going to happen if they don't do anything about it and then use a soft word to describe it. Like who wants to have a deep cleaning done? Like who wants to have scaling and root planing done? Like that sounds awful. And I know that my hygienists are trained to give very comfortable cleanings and make sure that patient's completely comfortable and numb during scaling and root planing. So I'm confident calling it gum therapy. And so then that patient leaves who just told me, the last dentist told me I needed
a deep cleaning for $500 and they're walking out of my practice with a scheduled appointment for an $800 gum therapy appointment, which is the exact same thing. So it's not so much about charging more and charging less. It comes down to, I was able to help that person make the right health decision because of the way that I spent time with them and the way that I discussed the problem with them.
Alec Goldman (17:53.410)
Dr. Turwald, is there one specific story, perhaps like a case that you presented, where you're just very proud that you were able to turn the decision of the patient from probably walking away from a decision that would really hurt their life from a health perspective and end up being influenced in making the decision to actually see a procedure? And I'm sure you're thinking I have hundreds of these things and thousands of these things, but is there one specific story that really resonates with you?
Benjamin Turnwald (18:25.336)
Um, I mean, there was just a patient that I finished up treatment on maybe six months ago and, um, he was a long-term patient of mine and, you know, I had seen him probably, well, he's been in the patient, he's been in the practice longer than I have, um, since I bought my practice from another doctor. And I had told him like early on in my career that I was seeing some wear on his teeth and that he should get a night guard and my verbal skills probably weren't the best back when I told him that, but he remembered it.
and never did the night guard. And so one by one, I started seeing him for these emergency appointments where he was breaking teeth and he needed, he had already had like two implants by that point and his wife was telling him his teeth were starting to look short. And he was really concerned about being able to eat steak. He was, I don't know, maybe in his 60s. And he's like, I asked him, do you wanna be able to eat steak in your 70s? And he said, yes. And I'm like,
we should probably have a further discussion about things. So he agreed to come back and I got photographs and full records and went through kind of a list of all the things that I saw. And it ended up turning into a full mouth reconstruction because now at this point he needed to have a crown or a restoration on every single tooth. And he told me, you know, I'm really mad at myself.
because I feel like I could have prevented this if I just sort of listened to what you said 10 years ago. And so he's like, I'm really glad we're having this conversation now. He's like, I wish it wouldn't have cost me $60,000, but I'm really glad that we're having the conversation because it is really important for me to be able to chew a steak. And so I was able then to do that patient's treatment and restore his teeth so that, yes, of course they look really great and everything.
I was happy with, but more importantly, he now knows that he's making the right decision to prevent this problem from progressing in the future. And also, he's confident now that he's going to have teeth to chew with as he goes through life. So, it's not always about something that big. And I'm not here to say that I do full-month reconstructions all the time. I do a couple a year.
Benjamin Turnwald (20:48.188)
But those types of examples, I think, are the things that really make you feel good when you go home at the end of the day, because you're like, man, what I say to people actually can have a profound effect on their lives.
Alec Goldman (21:00.970)
That's awesome. Um, and that is quite a story. Um, it's, uh, this man really must love steak. Uh, Dr. Turnwald, thank you so much for joining us today. I know that we're at the 21 minute mark. Um, but really great having you on. And I know that we'll be doing this again soon.