FIELD NOTE 003

Question: Should presenting care belong to one expert—or be a capability shared across the team?

Health Path: Patient + Team + Practice

Status: An active experiment we are still refining

From the field

When people hear that our practices operate without onsite administrative roles, one of their first questions is:

Who presents the treatment?

It is a fair question.

Early in our growth, we welcomed treatment presenters to the team. The dream was to find someone with deep expertise, strong financial skills, high charisma, and the ability to help patients confidently say yes to care.

That person can be incredible.

They understand the procedures. They can explain financing. They know how to answer objections. They develop confidence through repetition, and conversion improves.

Having that person on the team can be awesome.

Until it isn’t.

As the presenter becomes more capable, everyone else gradually becomes less capable.

Soon, no one presents care except that one person.

When several patients need attention at the same time, a line begins to form. Patients wait after their appointments while the presenter finishes another conversation. Some become frustrated. Others have somewhere else to be, bypass the system, and walk out without scheduling.

Then the treatment presenter has a sick day.

Suddenly, no one can confidently present care. In some cases, no one is comfortable checking out the patient.

The more handoffs we create, the more opportunities there are for the doctor’s clinical recommendation, the team’s understanding, and what the patient ultimately hears to become disconnected.

Patients leave without a clear next step. The schedule begins to empty.

Meanwhile, the presenter recognizes how valuable they have become. Compensation expectations rise—understandably—and the practice pays because it cannot afford to lose them.

Then life happens. The presenter moves out of state, changes careers, or accepts another opportunity.

The search for a new unicorn begins.

We experienced this cycle more than once, and I eventually had to acknowledge how fragile the system had become.

This was not a failure of the treatment coordinator.

It was a failure of our operating design.

The Health Progress question

Specialization can make a practice more capable. It can also make the practice dependent.

A talented treatment coordinator can be a tremendous asset, particularly with large, complicated, multidisciplinary, or financially complex cases.

But should the ability to help a patient understand and take the next step exist in only one person?

That question led us toward a different model:

What if presenting care were not simply a job title, but a fundamental capability of the patient-care team?

The doctor remains responsible for diagnosis and clinical recommendations. That does not change.

But helping the patient understand the recommendation, connect it to their own goals, ask questions, consider financial options, and schedule the next step does not necessarily need to occur through one designated person.

The assistant who was present during the examination already heard the diagnosis and understands the conversation.

The hygienist may have spent an hour learning about the patient’s concerns, priorities, and readiness.

The doctor has clinical authority and the patient’s trust.

Each person already holds part of the relationship.

Why remove the patient from the people they know, move them into another room, and ask them to begin again with a stranger?

What we’re trying—and learning

Well before we removed onsite administrative roles, we began cross-training team members to present care and help patients schedule their next steps.

The goal was not to turn everyone into a high-pressure salesperson.

The goal was to make every team member capable of helping a patient continue moving toward health.

That sounds simple. It is not.

A hygienist needs to remain on schedule. A complicated presentation can consume significant time and create friction for every patient who follows.

Financial questions require confidence, accuracy, and clearly defined boundaries. Financing options are their own system. A team member who understands the clinical plan may not know how to manage a complicated insurance estimate or payment arrangement.

Different team members naturally have different levels of skill and comfort.

We are still working through all of this.

The model we are building has several layers:

• Every patient-facing team member should understand the Patient Path and the patient’s next appropriate step.

• Every team member should be able to reinforce the clinical recommendation in clear, consistent language.

• Routine care should not require an unnecessary handoff before it can be understood and scheduled.

• Complex clinical or financial conversations should have expert support available.

• The plan, financial information, patient concerns, and next step should be documented so the patient does not have to restart the conversation with each person.

• The practice should be able to function when any single team member is unavailable.

The principle we keep returning to is:

Democratized does not mean improvised.

If everyone presents care in a completely different way, we have not created resilience. We have created inconsistency.

A distributed model requires more—not less—clarity.

The language must be consistent. Responsibilities must be understood. Financial systems must be reliable. Team members need training and coaching. There must be a clear path for escalation when a conversation exceeds someone’s experience or available time.

We have not finished building that system.

But we know how we will judge whether it is working.

The outcome matters more than the org chart

There is no moral victory in eliminating a treatment coordinator.

If you have a talented treatment presenter and patients are consistently understanding, scheduling, and completing appropriate care, that is excellent.

Keep learning from what works.

On the other hand, there is no victory in saying that every team member presents care if patients are becoming confused and Care Progress is declining.

The question is not:

Who presented the treatment?

The more important question is:

Did the patient understand and take the next appropriate step toward health?

That is why we pay attention to Care Progress.

When Care Progress improves, our system is probably helping more patients move forward.

When it declines, we look deeper.

Is the problem isolated to a particular transition on the Patient Path? Are team members struggling with a certain kind of care? Are financial questions creating friction? Are presentations inconsistent? Are patients leaving without a clearly documented next step? Does the team need better tools, coaching, or support?

Care Progress is not a score we use to blame the team.

It is a signal that tells us where the system or the people working within it may need support.

Our goal is not to prove that a democratized model is right.

Our goal is to keep refining a system in which every team member can help every patient continue progressing toward health—and no single absence brings that system to a stop.

Try this in your practice

Imagine that your treatment coordinator unexpectedly called in sick tomorrow.

Ask yourself:

• Who could confidently explain routine care?

• Who could review financial options?

• Who could schedule the next step?

• Which patients would have to wait?

• Which conversations would not happen?

• What knowledge exists only inside that one person’s head?

Then trace the last 10 treatment presentations in your practice.

Did each patient leave understanding:

• What was recommended?

• Why it mattered?

• What the next step was?

• Who would follow up if they were not ready?

The answers will tell you whether you have built expertise—or dependency.

Compare notes

Which parts of care presentation should every patient-facing team member be able to handle?

And which parts are better supported by a dedicated expert?

—Josh