How and When to Use Cialdini’s Principle of Reciprocity to Ethically Influence Patients to Say Yes

Dr. Chris PhelpsBlog


How many times have you seen “free teeth whitening with new patient exam” plastered across a colleague’s web page or advertisement? Or, how many of us have tried it? I hear consultants tell their dentists to run such giveaways to drive new patients to their practices all the time. So what is wrong with enticing people with a gift such as this to get them through the door?

The problem is this: It isn’t a gift. It is a reward.

If you make an appointment, then you get whitening. The whitening only comes after an action or behavior by the patient-it is a reward for them doing something we want. A gift, on the other hand, is given without expectation of getting anything in return. Why split hairs? One reason is legal. In Oregon, for example, you cannot reward patients for making referrals without facing legal trouble. [1]

Secondly, most dentists don’t know that rewards, as opposed to gifts, have very little influence over patient behavior. Research from psychologist Robert Cialdini, PhD, and his team shows that gifts have more influence over a patient than rewards. Think of it this way: a new patient schedules an appointment, and is rewarded with whitening. What is their motivation to come to your office after they have received their reward? Compare it to this situation: What if, if after an initial exam, you said, “We are so glad you chose our office. Here is a gift card for whitening from us to say thank you. If you happen to have anyone looking for a good dentist, will you tell them about us?”

The patient who received the same free service as a gift instead of a reward for a behavior will be more likely to become a long-term patient. How and why this works is explained best by Dr. Cialdini and his research on the principle of reciprocity.

The principle of reciprocity

Cialdini defines the concept of reciprocity as the feeling that “I am obligated to give back to you the form of behavior that you first give to me.” [2] Simply put, people say yes to those they owe. If, for example, a friend remembers your birthday and gives you a gift, are you not more likely to reciprocate and give them a gift on his or her own birthday? The feeling of indebtedness motivates reciprocating behavior. In the context of social obligation, people are more likely to say yes to someone they owe.

Reciprocity in action

My office has harnessed the power of reciprocity in how and when we gift our new patients. Many offices offer tours when a patient visits for the first time. The difference between those offices and mine is that I understand the science and the rules we must follow in order to maximize the power of the gift.

Those rules are:

1. Always be the first to give.
2. The gift should be as significant to that person as possible.
3. The gift should be unexpected.
4. The gift should be given at the same time you make the request.
5. The gift should be given by the same person who makes the request.

Most practices go through the same motions on these tours, typically giving the same type of gifts (e.g., free Zoom whitening, or a Viva dental gift card for a complimentary exam). Here is the typical office tour and patient interaction I observe: (1) the new patient arrives and is met by a team member; (2) this team member hands them a gift (usually promotional materials); (3) the same team member shows the person the office; and (4) the team member hands the patient off to the hygienist or assistant. Once the appointment is complete, the patient is handed off to the scheduling coordinator, who asks if the patient would like to schedule a subsequent appointment. I like to call this type of interaction a missed opportunity.

If you want to set the stage for more yeses, you need to follow the five rules outlined above. Here is how we do it: (1) The new person arrives and is met by a team member; (2) the team member shows the patient the office; and (3) the team member introduces the patient to the hygienist or assistant.

At the end of the appointment, the person who will ask for the appointment gives the gift. For example, the hygienist says, “We’re so glad you had a great visit with us today. This is just a little gift from us to thank you for coming in.” In my practice we offer the patient a choice of either a Philips Sonicare AirFloss or Sonicare electric toothbrush. They then wait for the patient to choose a gift that is meaningful to them.

Then the hygienist asks, “Dr. Jones wants to get you back in for that crown, and I need to schedule you for your next cleaning. Does this week or next week work better for your next appointment?” This is the moment of power, people! The patient feels indebted to the hygienist in that moment, so what do they do to repay them? They say yes.

The tip of the persuasion iceberg

The office/new patient interaction is just a teeny, tiny tip of the power of persuasion iceberg. I have developed countless systems in my office tapping into all six principles of persuasion. What has it done for me? My new patient base has gone from 60 per month to over 300 per month. I have taken my no-shows from 13% to 3%. My two offices have grown by $1,000,000 each two years in a row. It is that powerful.

As a thank you for reading, you can access a downloadable visual to help your teams tap into the power of reciprocity during office tours at All I ask in return is a visit to my website to check out the other power of persuasion opportunities available to you and your team.


Published originally on Dental Economics. 

1. Smith M. Know the Rules before Rewarding Patients for Referrals. Fluence Portland. Published June 19, 2012. Accessed November 9, 2015.
2. Robert Cialdini on the importance of reciprocity. World of Business Ideas YouTube channel. Published July 8, 2009. Accessed November 9, 2015.