CATEGORY 16 AUSTRALASIAN DENTIST INNOVATIONS I stopped blaming cost for unaccepted treatment plans. I saw a patient a few years back. A few extractions, crowns and fillings needed. I went through it properly. Showed her photos, explained the crowns, explained what happens if we leave it. She nodded, saying it made sense. Booked at the front desk. She cancelled four days later. No reason given. I never saw her again. I told myself it was the money. That is the easy answer, and sometimes it is the right one. But I tracked it loosely for months, and the pattern did not fit. Plenty of the patients who disappeared could afford the treatment. Some had health fund cover sitting unused. A few came back long after with the same tooth, now unrestorable, and paid considerably more for a worse outcome. So I started asking the ones who came back what happened. The answers were remarkably consistent. They went home, someone asked what the dentist said, and they could not explain it or forgot most of the conversation they had in surgery. They had a printed plan with item numbers and dollar figures. Nothing on it told them what a crown was, or why the tooth would not simply be fine if it did not hurt yet. I had spent seven years supervising students at Griffith. I know how to explain things. I am not convinced that was ever the problem. I sit patients up, move them across to the chair beside me, and take them through it on the screen. Photos, radiographs, the lot. I can see them understand it. Then they walk out with a printed plan covered in item numbers, and that is the only thing that survives the drive home. A partner asks what the dentist said. The patient reaches for the document, and the document does not answer the question. The plan dies at the kitchen table and you never hear about it. That last part is what bothered me most. We do not get feedback on this. We see the cancellation, not the conversation that caused it. So we fill the gap with the easiest story, which is that the patient could not afford it. I tried longer explanations, which mostly made patients more polite and no more informed. Printing intraoral photos, which helped a little. Writing notes on the back of the plan by hand, which helped more, though I could not do it for every patient on a full day. Nothing scaled. What eventually changed my thinking was realising I had the timing wrong. The treatment plan is not the end of the conversation. It is the thing the patient carries into a second conversation, the one that happens at home, without us. Every plan we hand over is a document written for a dentist, sent into a room where there is no dentist. So I built something to sit alongside it. The dentist still produces their plan as usual. Alongside it goes a plain language explainer with visuals, one the patient reads at home on their phone and can show to whoever asks. It carries the practice logo and colours, so it arrives as something from their dentist rather than from an app. That is the whole idea. It does not sell anything, it does not chase anyone, and it does not replace the conversation in the chair. It gives that conversation somewhere to live afterwards. I am not going to claim numbers I cannot back up yet. It is early, and I would rather report real figures later than impressive ones now. I have stopped assuming every declined plan is a money problem. Some of them are comprehension problems. If a patient cannot explain the treatment to the person who asks, they are unlikely to proceed with it. Worth asking your own patients who return late what actually happened. The answers surprised me, and I had been reasonably confident I was explaining things well. u Dr Raymon Krause is a practising dentist in Queensland and the founder of Treatly, a treatment plan explainer built for Australian practices. www.treatly.au The quiet no By Dr Raymon Krause Raymon Krause
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