COMMUNICATING QUALITY TO OUR PATIENTS
Robert L. Cunningham, D.D.S.
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.
THE “EMERGENCY” NEW PATIENT
Use the regular health history. Have the patient sign the consent for treatment and the toothache questionnaire.
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 concerns.
The interviewer excuses them and gives the doctor a synopsis of their emergency and the patient’s personality style.
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.
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.
A diagnosis is made and the patient’s options are quickly and precisely explained to the patient. The doctor or assistant discusses appropriate fees.
Palliative relief is provided to the patient. The patient’s comfort is foremost. Appropriate anesthetic and/or analgesic are administered slowly and painlessly.
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.
THE HYGIENE NEW PATIENT
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 follows:
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.
The hygienist interviews the patient in the consultation room and takes about five minutes to review the health history and establish rapport.
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.
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.)
After the doctor leaves the room, fees are discussed, financial arrangements are negotiated, and appointments are made in the computer in the hygiene room.
The patient is encouraged by the hygienist and assistant to reappoint for Co-diagnosis with the doctor.
Care, comfort, concern and professionalism are the main concepts to be communicated.
THE NEW PATIENT EXPERIENCE/CO-DIAGNOSIS
(85% OF New Patients)
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.
2. Treatment Coordinator/Assistant Role.
A. Introduced by the front desk. T.C. explains her role.
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.
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.
D. Key Questions :
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.
A. Social graces – i.e. a conversation based on starting to establish a trust bond 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.
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. Treatment Coordinator/Assistant role.
A. The patient is met in the reception room, greeted, and conducted into
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.
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.
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.
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 Analysis.”
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?
D. Exam sequencing.
1. The T.C./assistant charts missing teeth and existing restorations from the models and x-rays.
2. On the back of the Examination Record two lists have to be made: 1). Diagnostic Issues. This 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.
2). Diagnostic Options. These are treatment plan options in general terms with no fees attached. These options are usually broken down to mandibular and maxillary segments.
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. 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), the 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. 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.
2. Treatment Coordinator/Assistant’s Role.
Asks patient if there is anything that needs clarification at this time. Answers concerns.
Whatever 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 assigned.
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.
THE ENTIRE OFFICE IS COMMITTED MAINTAINING AN ONGOING, PERSONAL RELATIONSHIP WITH THE PATIENT.