Build your relationships first….then your dentistry. ~ Bob Barkley


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L. Cunningham, D.D.S.                                                                                                                                                    Contributing Writer


Helping our
patients/clients to value fine dentistry has everything to do with how we are with
the patient during their initial (and continuing care) visits to our
office.  A close, ongoing examination of
how we structure and pace the New Patient/Co-diagnosis Experience is vital to our success in forming a trust bond with our
patients.  What we do after the initial
visits will wither enhance or detract from that image.


Patients enter our
practice in basically three ways: 1. With a dental emergency or “urgency”; 2. Through a visit with the hygienist; and
3. When requesting an examination.

It is our stated
objective that the vast majority (about 80-90%) of our patients enter the
practice through the Co-diagnosis process.





  1. Use the regular health history.  Have the patient sign the consent for
    treatment and the toothache questionnaire.
  2. Treatment Coordinator or chairside assistant
    conducts patient into the consultation room and reviews the health history and
    toothache form with the patient, taking time to listen to their fears and
  3. The interviewer excuses them and gives the
    doctor a synopsis of their emergency and the patient’s personality style.
  4. The doctor and the assistant decide if it is
    necessary for the doctor to interview the patient or have the assistant go
    ahead with the necessary x-rays.
  5. The patient is seated in a treatment room.  If the doctor has not yet met the patient, he
    is introduced by the assistant and takes a few minutes to establish rapport,
    review the history and diagnostic information.
  6. A diagnosis is made and the patient’s options
    are quickly and precisely explained to the patient.  The doctor or assistant discusses appropriate
  7. Palliative relief is provided to the
    patient.  The patient’s comfort is
    foremost.  Appropriate anesthetic and/or
    analgesic are administered slowly and painlessly.
  8. Future needs are quickly discussed in general
    terms.  The assistant helps the patient
    make and appointment with the appropriate doctor or specialist.  The patient is strongly encouraged to appoint for a comprehensive exam.





Patients are encouraged not
to enter the practice in this manner.  It
puts the focus on the old adage that, “I only want my teeth cleaned and
checked.”  It does not allow our practice
to be represented as favorably and comprehensively as we would like.  The job of the person taking the incoming
call is to tactfully and assertively communicate this to the patient.  If the patient still insists, they are
appointed to see the hygienist only.

The process is as


  1. Welcome package is sent.  If time does not permit the package to reach
    the patient prior to the appointment, they are asked to come in at least ten
    minutes prior to the scheduled appointment.
  2. The hygienist
    interviews the patient in the consultation room and takes about five minutes to
    review the health history and establish rapport.
  3. The doctor is introduced to the patient in the
    consultation room after being de-briefed by the hygienist.  Using the notes made on the health history
    and Personal Patient Profile form, he focuses mainly on the medical portion of
    the form and explains briefly what the IPT (Initial Periodontal Therapy)
    appointment entails.
  4. The doctor conducts the patient into the hygiene
    room, where blood pressure, bacterial slide and complete periodontal charting
    is performed by the hygienist.  The slide
    is viewed by the patient and the results are discussed by the hygienist.  AAP periodontal typing is done with an
    emphasis on the number and depth of pockets, bleeding points, and
    recession.  If a prophylaxis can be
    completed at that appointment, the treatment is completed.  If the patient needs periodontal therapy, the
    doctor is brought in at that point to
    make the diagnosis
    .  (See materials on Periodontal Team Management
    from JP Consultants.)
  5. After the doctor leaves the room, fees are
    discussed, financial arrangements are negotiated, and appointments are made in
    the computer in the hygiene room.
  6. The patient is encouraged by the hygienist and
    assistant to reappoint for Co-diagnosis with the doctor.
  7. Care,
    comfort, concern and professionalism
    are the main concepts to be




(85% OF New Patients)




  1. Telephone information is taken and recorded on
    the “Personal Patient Profile.  A
    convenient appointment is contracted with the patient.  Welcome package is sent.  Get patient’s permission to send a health
    history.  (If they are hesitant to fill
    it our at home, we will interview them and fill out the form for the patient.)


When the patient arrives on the day of the appointment,
they are acknowledged by name and
told that the treatment coordinator will be right with them.  Be sure to notice where they sit and notify
the T.C. Offer hospitality – coffee, tea, water and/or a magazine.


  1. 2.
    Treatment Coordinator/Assistant Role.

A.   Introduced
by the front desk.  T.C. explains her

  1. B.
    Patient is asked if they would like to see the
    office.  TOUR OF OFFICE.  Stress our emphasis on their care and
    comfort, especially sterilization and infection control.
  2. C.
    Interview in a private, preferably non-clinical
    place.  After a few minutes of social
    chit-chat, start the interview by reviewing the health history, dental history
    and the questions on the Personal Patient Profile.  It is
    not necessary to ask all of the questions on the Profile, just enough to get an
    understanding of the patient’s issues and establish rapport.
      Record a healthy history synopsis on the
    front of the “Examination Record”.
    Highlight or underline any particularly important information.
  3. D.
  • Be sure to ask the “expectations” question at
    the bottom of the Profile.  Record the
    answer word-for-word.
  • Ask them, “Would it be helpful if I share with
    you a little about us and what we are trying to achieve in our practice?”  This is a good opportunity to share the
    written “Practice Philosophy” and give them a copy.
  • In a spirit of self-disclosure and deep personal
    sharing, let them know that we are in the health business, not the tooth
    business,  Share your own feelings abut
    your experiences in health care and how our practice might be similar or
    different.  Write down their response.
  • If the patient has any cosmetic concerns, give
    them a copy of our “Personal Smile Analysis” and ask them to complete it and
    bring it with them on their next visit.
  • Review with the patient the value of full mouth
    x-rays, study models, and photographs by using a set of generic records.  Let them
    know that the patient and the doctor will determine which records are
    appropriate for them.
  • Review the medical and dental histories and make
    notes on the form for the doctor.  Excuse
    yourself and debrief the doctor about
    the patient’s history and personality style.  Emphasis is placed on the patient’s pace and priority.  The doctor
    is taken into the consultation room and introduced to the patient.  The T.C. stays with the doctor and patient
    only as long it takes for the doctor and patient to establish an initial
    rapport, then she excuses herself.
  • Doctor’s

A.  Social
– i.e. a conversation based on starting to establish a trust
relationship between the doctor and the patient.  Focus on who referred then, who you may know
in common, family, sense of humor.
Listen intently!

B.  Summarize
–  Health histories and interview forms
(Personal Patient Profile and Personal Smile analysis).  Use eye contact, feedback, acceptance, and
anchoring.  Remember the axiom, “God gave
you two eyes, two ears, and one mouth.
Learn to use them in that proportion.”     C.  Contract
– Decide with the patient’s approval which diagnostic data will be used to do a
complete diagnosis and establish a treatment plan.  For comprehensive restorative cases full
mouth periapical x-rays, mounted study models, and photographs will be
necessary before appointment #2.
It may be appropriate to make a separate “Records Appointment” to get
the necessary data.

  1. D.
    Screening exam – The purpose of the
    screening exam is to determine which diagnostic records are necessary and to
    get a get a general impression of the state of the patient’s mouth.  Be sure
    to emphasize to the patient that this is not a comprehensive exam.  Let them know that during their next visit
    you will have all of the diagnostic data and complete the exam and do a
    consultation if that is appropriate.  If
    possible it is beneficial for the patient to have an initial visit with the
    hygiene department (I.P.T.) prior to the diagnostic appointment, so that
    pocket charting, bleeding points and AAP periodontal typing will be available
    at the Co-Diagnosis 2 appointment.




  1. 1.
    Treatment Coordinator/Assistant role.

A.  The patient
is met in the reception room, greeted, and conducted into

exam room.

  1. B.
    Re-establish rapport with the patient.  Ask them if any other questions or
    considerations came up for them since their last visit.  Answer the questions you feel confident in
    and defer the others to the doctor.
  2. C.
    If the patient has completed a “Personal Smile
    Analysis”, review their answers and mark areas of concern for the doctor.  The doctor is notified that the patient is
    ready and the doctor is privately debriefed on the attitude, issues and
    concerns of the patient.


  1. 2.
    Doctor’s role.

A.   Doctor
takes a few minutes to “reconnect” with the patient, first socially then
picking up from the last visit as the Treatment Coordinator relays a summary of
her conversation with the patient.

  1. B.
    The doctor focuses on any questions or concerns
    of the patient and is careful to write down anything that needs to be addressed
    after the examination.  It is helpful to
    revisit their answers on the “Personal Patient Profile” and “Personal Smile
  2. C.
    Helpful questions and discussions that may be used at this time:
  • How do you feel
    so far?
  • Is there anything that you need to know about us
    or our philosophy that we haven’t discussed.
  • You may share with them – this is what I would
    want if I were a patient:  1).
    Gentleness, and 2).  A dentist who will
    help me need him less.
  • The differences between emergency, urgency, short term, medium, and long term treatment
    planning.  Quality and timing.
  • Do you want to keep your teeth for a lifetime?


  1. D.
    Exam sequencing.

    1. 1.
      The T.C./assistant charts missing teeth and
      existing restorations from the models and x-rays.
    2. 2.
      On the back of the Examination Record two lists
      have to be made: 1).  Diagnostic IssuesThis is a 1, 2, 3, etc. list of major issues
      to be dealt with in their treatment plan.
      Examples of commonly used issues are missing
      teeth, malocclusion and shifting, periodontal condition, caries present,
      failing restorations, bruxism, oral hygiene, pathology, etc. 
      Diagnostic Options.  These are treatment plan options in general
      terms with no fees attached.
      These options are usually broken down to mandibular and maxillary
    3. 3.
      Comprehensive oral exam.  Including tooth diagnosis, occlusal analysis,
      oral pathology exam, periodontal exam (If not previously done by the
      hygienist.) and completion of the entire checklist on the front of the
      Examination Record.
    4. 4.
      At this point the doctor conducts the patient
      and T.C. into the Consultation Room, where all of the diagnostic data is
      assembled on the counter to be discussed by the doctor and the patient.  The T.C. usually stays in the room in the
      background as the doctor summarizes his findings and co-creates  the treatment
      plan with the patient.  The conversation
      may be specific with a patient who thoroughly understands their options and is
      able to make a decision then.  This is
      particularly true of simple to moderately complex treatment plans.


  • At this
    point a very important decision needs to be made.  Depending upon the patient’s receptivity, pace (fast or slow) and
    priority (relationships or things),
    doctor must sense whether to continue the process or to reappoint
    for a separate consultation appointment.
    Sometimes hygiene appointments, particularly a series of periodontal
    root planings should be scheduled as a first phase of treatment before
    major restorative fees are discussed.
    This is because results of the root planing may alter treatment plan,
    and having the patient in for a series of appointments with the nurturing
    atmosphere of our team will made them feel more comfortable with who we are.




  1. 1.
    The Doctor’s Role.  (In a non-clinical setting.)

Ask the
following questions and record the answers:

  • How have you enjoyed your experience with us?
  • Have you decided how you want to see your teeth
    in 10 years?
  • How may we help you with your plan?

The doctor listens,
responds, gets agreement on the patient’s plan of                                              action, finalizes the treatment plan and quotes the fee, if appropriate at                                         that time.  The doctor asks the T.C. to discuss financial
arrangements                     and make appropriate appointments.  Doctor exits.


  1. 2.
    Treatment Coordinator/Assistant’s Role.

patient if there is anything that needs clarification at this time.                         Answers concerns.


treatment has been agreed upon, the T.C. discusses                 financial
arrangements, completes and has the patient sign a                  “Treatment
Estimate”, makes the next appointment and collects                          the down payment. 
The T.C. is responsible that all
financial                                    arrangements made by her be signed and dated
by the patient.


When the patient leaves, before going on to
another task, the T.C. puts the patient’s case in the computer for
tracking.  If the treatment is to be
phased, multiple cases are used.  The doctor is presented with an updated
tracking report every Monday morning.
The status of pending treatment is discussed and follow-up measures are


It is important that all patients be kept
in the periodontal recare system so that pending treatment may also be tracked
and the video used in hygiene to revisit
their need for restorative.























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