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Based on what I see, day in and day out, there's a lot of confusion in the marketplace on what actions, activities, and so on, stimulates your patients to return time and time again to your practice. Too often, we assume (incorrectly) that just because we've seen a patient once, they owe it to usto come back.That is dangerous and erroneous thinking. In fact, that kind of superiority complex can get a business, any business, in a boatload of trouble in a hurry.No one, and I mean NO ONE, has to return to our businesses if they don't want to.So, what are some "killers" you can identify and quickly eliminate in your practice to ensure your patients return AND refer? Here are five of them...1.) Results perceived (and actual) versus results desired.That's right, you have to deliver what your patients want! They're footing the bill. Give them what they want. Build the relationship with them, and later they'll be more receptive to what you recommend. Full-mouth reconstructions don't happen in one visit and neither does building a relationship. You have to deliver the results patients want. It can be perceived or actual, depending on the situation. Nonetheless, give them what they want.2.) Is it easy to do business with your practice? It's amazing to me, the number of companies that have actual "sales prevention" departments. I'll give you an example: I've purchased thousands of dollars worth of pens and cool gifts for my clients from Myron, the specialty pen manufacturer. I emailed them once, asking if I could order a refill for my $3.00 pen that I really like. Here's the answer, verbatim, from their email:Thank you for taking the time to express your interest in Myron's products and services. In response to your letter, Myron does not carry refills or inserts. We advise you to visit your local office supply store to inquire about generic refills or inserts. Or simply call us to re-order new pens and Pocket Pal diaries.So, here they have an opportunity to make MORE sales to their clients and they turn me away to another store. Are you doing this with your patients? Are you not recommending and carrying a fluoride rinse? Floss they can purchase? Toothpaste? Sonic toothbrushes? WHY NOT? They have to buy it somewhere! Why not carry it, at the very least as a convenience to your patients?3.) Money issues.This is a particularly HUGE pet peeve of mine. I abhor businesses, and will not patronize them, if they will not allow me to make purchases with my preferred method of buying: American Express. I have a VISA and MasterCard, too, but I really like getting the miles and cash back for using my AmEx. WHY do companies insist on not taking a particular kind of credit card? You should take any kind of payment that your patients want to give you. You must realize that you are losing sales and production if you make it hard to buy from you. Further, if you are not offering financing that YOU control, then you're missing the boat. You could be earning thousands in interest by offering safe, convenient, fair payment plans that allow patients to get their work done on their terms, and allow them to afford the best dentistry delivered.4.) Value – Perceived and Actual. Are you missing the magic moneymaker? The value of a service is determined by how your patients feel when they leave. They tell you how much value they find in your practice by referring others and telling you in your surveys (you ARE sending out surveys to your patients aren't you?). In the real world, perceived value is worth as much, and oftentimes more, than actual value. How patients feel about the value you deliver is critical. If you fail to gauge this on your practice success barometer, you're missing out. What do patients GET for doing business with you? Do they just get good service and good dentistry? Or, do they get something more? Come on - use your imagination. 5.) Not understanding the importance of marketing. You had to assume that I would include marketing in here somewhere, right? Of course. Marketing your practice isn't something to be taken lightly. It is important that your whole team understands what marketing is all about. It's critical that they know what the goal of your marketing is, and that marketing a business never stops. It's constant. Businesses, dental practices included, go belly-up without a constant and predictable stream of new patients. Marketing your practice is a planned event, with planned and predicted outcomes. For example: If you mail out 1500 postcards every three weeks, religiously, you will see a nice, steady flow of new patients rolling in every month, keeping your new-patient-slots full.6.) Strong patient flow today – Strong patient flow tomorrow. It is easy, when you are booked out for a month or more and referring people to your friend across the street, to think that you don't need to market for a while. It's easy to think that you can take a "marketing break" and start-up again when things slow down. But, why would you ever want things to slow down? That's crazy! Isn't the whole point of marketing to get patients in the door and watch your practice grow? If you get too overwhelmed, get people in to help you. Take on a new associate. Hire more office staff. Get a bigger building. Whatever you do, even if things look rosy now, be sure to realize that there's a 30-60 day ramp-up period with new patients coming in the door and getting their production and their referrals on the books.7.) "We didn't see any results from our first couple newsletter mailings. It must not work for me." Truthfully, I have seen newsletters NOT work for a couple of my clients. They're no longer clients, either. After we found out how they were running their practice and learned about their disciplinary history from their dental boards, it’s no wonder. A blessing from the Pope wouldn't have helped.If you expect results from marketing programs of any kind, you and your team have to be 110% committed to their success. It's no different than adapting a new technology to use in your practice. Your whole team has to be 110% supportive for it to be successful. Embrace change. Encourage change. It has to happen.Marketing programs and advertising pieces get the phone to ring. Your team must sell the appointment and SELL to the patients once they arrive. There are lots of ways to drop the ball there... And, you can't blame it on the call generation technique, either!One thing I've noticed about human nature: We humans need to be trained to do things. Seriously. We need to be trained how to be good clients of businesses. We need to be trained how to be good patients that show up on time for appointments. We need to be trained as toddlers how to go to the bathroom, for crying out loud! Now, as adults, thought is not even required.So, it would stand to reason that you would need to train your patients to refer to you, and that is going to take patience (just like mom had when she was potty training us), to get them to take action, refer, and refer again.If on that first, second, or even third mailing of a patient newsletter, your results are not where you expected, have patience. People need to be trained! Your patients are no different. Keep telling them what to do, and eventually they'll get the message. And they will begin to refer.8.) Mishandling of incoming calls. This is probably the No. 1 most common problem in an over-whelming majority of dental practices... and other businesses as well.I don't have the room, here in this article, to go into great detail about this, but suffice it to say, the easiest way to kill repeat visits, and first visits for that matter, is to mishandle phone calls of all kinds.Dead air is a big problem with a lot of offices. This mostly occurs due to lack of training, and the people answering the phone are not capable of, or interested in, selling an appointment. If the person answering the phone does not have the proper mindset to sell the appointment, they won't. Therefore, callers can easily change their minds before making the appointment. Practice. Educate. Review. Practice. That's what it's all about. Establish a system in your practice that covers the P.E.R.P.!9.) Lack of follow-up. This is another HUGE pet peeve of mine. All you have to do is train your front office staff to follow-up with patients that call and do not schedule for whatever reason. Send out these people information about your practice, why they should visit you versus others and what makes you unique. AND, included a special offer. This makes your practice even more enticing.Just by taking a couple easy follow-up steps, you could easily save 15-20 patients a year. Patients that you might never have gotten to do treatment on otherwise.Another area that many practices lack, in follow-ups, is post-op calls and post-op gifts. You have to do these if you expect referrals! Establish some guideline and begin it Monday morning.Also, review your systems in place for undone treatment follow-ups. Do you have something in place to handle that issue and is it being done?10.) Too busy. Not enough time to dedicate to patients. You can solve this problem by outsourcing non-revenue producing tasks. Hire cheap labor (think high school students) to take care of mundane, must-be-done-in-office tasks, like filing. I hear a lot of complaints from dentists that their team is overworked and overloaded, unable to get what needs to be done... done. Here are two solutions to this:Outsource things like insurance follow-ups and past due account follow-ups. This way, your team will be able to spend more time with patients. That's what it's all about, the patients! So, today, take a moment to consider each of these "killers" and how they might be affecting your practice. Make alterations to ensure that your patients keep coming back to you, time and time again.