Cognitive Disconnection

August 30, 2021
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You’ve probably heard of ‘cognitive dissonance’.  It refers to an individual having inconsistent or conflicting thoughts, beliefs, or attitudes.  Such ‘dissonance’ impacts decision making and realizing it might help one make better decisions.

Dentists suffer from Cognitive Disconnection.

Cognitive disconnection occurs when things that should be connected are not.   It’s done without malice.  Rather, it’s done out of ignorance.  Not stupidity or insanity.  That’s doing the same thing over and over and expecting different results.  It’s so common among dentists because it never been part of ANY curriculum, continuum or required CE course.

This is deficiency is particularly felt in disjointed, or disconnected systems.  This ‘disconnection’ impedes a system’s effectiveness.  In fact, it can shut it down completely.

And, the bigger and busier the practice becomes, the more the disconnection is manifest.  The result is that GROWTH STOPS.

I’d like to point out the cognitive disconnection that occurs in dental practices regarding one particular system, advertising, marketing, and treatment.

What, you might ask, is the connection between the 3?

And if you do ask it, as most dentists will, then you should appreciate the disconnect.  Because when advertising, marketing, and the dental practice cycle are not in synch, bad things happen like NO’s.

No to treatment

No, “it’s too expensive”.

No, “I don’t need to refer others”.

No, “I don’t need to come back so soon”.

And even…

“I’m not paying my balance.”

Each of these can be suppressed and even prevented by having a marketing system that is connected to every other part of the practice.

Advertising is the process of bringing awareness to an audience or marketplace.  It is, as my mentor Dan Kennedy says, “the process of bringing a suspect, prospect or buyer ‘out of the woods’.”


Note where most dentists pay most attention.  What do most CE courses focus on?

Proper marketing, at lease an understanding of the principles involved and the potential power it can exert is imperative in today’s complex marketplace.

For instance, people had to be made aware that it was possible to move teeth without wires and brackets.  That was first done by individual dentists, but it was unable to move the market very much.  Align had gone B2B, or business to dentist.

When Align Technologies went public, they then had the funds to spend on BRAND advertising. They eventually went B2C, or business to consumer. Their advertising made the public aware of ‘invisible braces’, something most people never heard of.  They created a ‘market’ or desire for the product of clear aligners.   Other, like Smile Direct Club and individual dental practices have bult upon that.

Orthodontists, who originally decried the process were forced into accepting it because the public demanded it.  Isn’t it amazing how many do clear aligners?

Advertising is only one form marketing and is usually, because it is aimed at a large audience, is expensive and often, for a solo practice with a limited marketplace, unnecessary.  Yet, we do see lone practices, effectively use advertising such as radio, cable, billboards, when the costs are justified by the potential ROI.  This is a very specific calculation that should be undertaken with extreme caution.

All dental practices do marketing, even those that insist that they don’t.  That’s because marketing is the message that is conveyed to people before, during and after they become patients.

A website is marketing.  A letterhead, business card, the texture, weight and color of the paper and the font used are all forms of marketing.  How your employees act, and look are marketing.  The color of the office walls, type of floor covering, lighting and cleanliness are all forms of marketing.

Dissonance and disconnect occur when Doctors or their advisors recommend marketing that is inconsistent with the actual experience the practice desires, or the experience a patient receives.

One of the most common mistakes occurs when a marketing campaign is undertaken, and all the members of the practice team are unaware.  Imagine promoting a service such as veneers or orthotics and offering a limited time fee reduction, and not telling the person who answers the phone that the offer was being marketed?

Imagine when the person presenting the financial arrangements isn’t made aware of such an offer?

Perhaps the greatest disconnect I the marketing-treatment cycle occurs when the marketing is not crafted in a way that facilitates the treatment and financial presentation processes.  This process is referred to as EDUCATION and PREFRAMING.

When a patient is educated prior to their visit about what is going to happen at the visit and the experience follows the plan, they are less stressed and hence able to absorb more information.  That enables them to appreciate the need for treatment or the connection with what they desire.

As marketing impacts patient expectation, it also facilitates treatment.  It cuts down on complaints and encourages compliance.

PRE-FRAMING is the process of connecting potential treatment to things the patient already knows or is taught.  Discussing how an oral sleep appliance compares to CPAP, Inspire or surgery in process, comfort and cost and doing this PRIOR to a treatment presentation is preframing and is the function of properly designed marketing.

While becoming a comprehensive marketing expert is nearly impossible while keeping your eyes on your main business activities, it is also unnecessary.

What is necessary is that you have a comprehensive strategy and an effective way to implement it.

The most effective use of your time is to educate yourself.  Become a smart consumer of marketing.  Don’t be an easy mark for the typical dental marketer who knows only a little bit more than you do.  Don’t be fooled by technological terminology and vague promises.  Don’t be lulled into complacency and let marketers swipe your credit card month after month, while your phones don’t ring and your operatory chairs are empty.

Educate yourself.  Build a strategy and plan for a way to implement it with a company you can both TRUST and VERIFY.

Start the process now!

To your excellent success and clarity,


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Dr. Michael Goldberg is one of the leading educators on dental practice management in the United States.

Michael ran and sold a prestigious group practice in Manhattan and has been on Faculty at Columbia University and New York-Presbyterian Medical Center for 30 years including Director of the GPR program and Director of the course on Practice Management.

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