When patients don’t accept treatment, most dentists assume it’s about money — but the real breakdown often happens earlier in the process. In this episode, Kirk Behrendt brings back Dr. Jim McKee to share the five questions that determine whether a patient will say yes and whether you should take the case.

You’ll learn how to diagnose the real problem, frame expectations, evaluate timing and affordability, and build the kind of trust that prevents conflict in complex dentistry. Listen to Episode 1046 of The Best Practices Show!

Main Takeaways:

• Case acceptance starts when the dentist clearly understands the problem and has a predictable solution.
• Patients say no when they understand the complaint but don’t understand the real diagnosis or why the proposed solution makes sense.
• Many declined treatment plans are a timing issue in the patient’s life, not a fee issue.
• Affordability often comes down to phasing treatment while clearly explaining the risks, changes, and potential added cost over time.
• Unrealistic expectations — clinical, financial, or both — are a leading cause of difficult cases and post-treatment conflict.
• Trust is built by accurate diagnosis, transparent expectation-setting, and having the clinical skills to manage complex problems.
• You should trust your “spider senses” and be willing to lose the case early rather than getting stuck in treatment you can’t deliver predictably.

Snippets:

00:00 Where the “five keys to case acceptance” came from.

00:05 “Checkers vs. chess” patients and why Julie’s case changed the conversation.

00:07 Why tooth-based solutions fail when the problem is skeletal or joint-based.

00:11 Unrealistic expectations and the hidden mismatch between insurance and “perfect” dentistry.

00:17 Why “too expensive” is often a timing issue, not the real reason patients delay.

00:19 The money question: phasing complex cases without surprising patients later.

00:25 The trust question and why sustaining practices are built on relationships, not volume.

00:30 How to think through failure points before you start treatment.

00:33 Why it’s better to lose up front than disappoint a patient mid-treatment.

00:38 Where to learn more: online training, hands-on workshops, and a Chicago study club.

Guest Bio/Guest Resources:

Dr. Jim McKee is a restorative dentist and educator focused on occlusion, TMD, and restorative diagnosis. He is a member of the Spear Resident Faculty. He has maintained a private practice since 1984 in Downers Grove, Illinois, where he treats a wide variety of cases with a focus on predictable restorative dentistry. He is a member of the American Academy of Restorative Dentistry and former president of the American Equilibration Society. He has lectured both nationally and internationally for over 25 years and directs several study clubs. Dr. McKee graduated from the University of Notre Dame in 1980 and earned his dental degree from the University of Illinois College of Dentistry in 1984.

Guest Resources Mentioned:

• Online program through Phelan Dental Seminars: https://courses.phelandentalseminars.com/tmd-pds
• Advanced Occlusion Workshop at Spear Education : https://app.speareducation.com/events/workshops/advanced-occlusion

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