BY DIANNE GLASSCOE WATTERSON, RDH, BS, MBA
Dear Dianne,
I work in a great two-doctor practice, and we are quite busy. However, one of the things that bothers me involves scenarios when patients - especially new patients - are presented with a lot of treatment and periodontal needs at once. Many of these people have not had any dental work in a while and present with quite a laundry list of needed treatment. In my practice, new patients are scheduled in hygiene first, and we get two hours to perform all the chartings, radiographs, and assessments. I notice that during these two-hour appointments, patients are supersaturated with information, and it's hard to add a periodontal program on top of all their restorative needs without them becoming resistant. I am wondering if there is a way to approach the issue of needed treatment without being overwhelming and, therefore, increasing treatment participation in both the periodontal and restorative dentistry areas. Has this question ever come up before with other practices? If so, how have they handled it?
Is there any way to stagger this information? I try to discuss the periodontal treatment plan right after measurement, but if there is a ton of treatment, wouldn't it be better for the dentist to explain a small portion and then schedule a consult? That way, the patient is more at ease and able to process everything.
Sarah, RDH
Dear Sarah,
First of all, I want to congratulate you on being concerned about treatment acceptance. Hygienists can play a pivotal part in helping patients understand their dental needs. You've asked a great question, one that I am happy to address.
New patients often arrive bewildered and scared, and it is very easy to overwhelm them when there are extensive treatment needs. Many of these patients are phobic about dental care, which is one reason why their oral condition has become a train wreck. Think of such patients as being like scared little rabbits and how easily they can be frightened away. Patients can be so overwhelmed when the needs are huge that they do not come back. That's the worst thing that can happen.
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All the same, it is important and necessary to address periodontal infections first so that restorative dentistry can be built on a stable foundation. So, first things first. First things include anything that is causing the patient pain, and then, periodontal disease.
In the initial interview with the patient by phone, the business assistant will ask if the patient is experiencing any discomfort (I don't even like to use the word "pain"). If that's the case, the patient's discomfort is the priority and should be scheduled accordingly.
If discomfort is not an issue, then the new patient appointment with the hygienist would include the entire customary data gathering. Let's say the new patient has periodontal disease. The hygienist should ask some questions: "Have you noticed this area bleeding when you brush?" or "Has this area been sore?" or "Have you noticed this tartar buildup?" This is a prime opportunity for using an intraoral camera to show the patient what you are observing. The patient will hear the periodontal charting as well, and the documentation and communication build the case for definitive periodontal care. After the hygienist has made a determination of the level of periodontal severity, she or he would then say to the patient, "Based on what I see in your mouth and on the X-rays, there appear to be some concerns with your gums. So before I proceed any further, I'm going to have the doctor take a look." (I call this the "red flag" strategy.) This is the point at which you speak with the doctor out of the patient's hearing and make him or her aware of your findings.
Next, the doctor comes in and you introduce the patient. Always defer to the patient first: i.e., "Mrs. Smith, this is Dr. Jones." The doctor may or may not do an extensive exam at this point but will look at the charting and X-rays and in the patient's mouth.
"Mrs. Smith, from what I see on your X-rays and in your mouth, you have (early, moderate, severe) stage periodontal disease at work around some of your teeth. It is a chronic infection in the gums that, over time, destroys what supports your teeth. So what we need to do is treat that and get it under control, which is the first step in getting your gums and teeth in good shape. Then we can take care of any other dental needs you have."
At this point, you have not discussed restorative needs. That's coming. If the needs are extensive, you would then say, "Let's get your gum situation under control first; then let's set a time to meet and discuss getting your teeth back in shape. We have some options, so I'd like to think about what we can do for you and give you some choices." Discussing restorative needs should be reserved for another time when the patient has extensive needs. The reason: We're trying not to overwhelm the patient. If the restorative needs are few, I think it is appropriate to discuss it on the same visit. But anything more than a single crown or a few fillings will usually need a consultation visit separate from the hygiene visit.
For those with extensive restorative needs, I believe your practice will have good success giving the patients choices when choices are appropriate. I recommend that doctors prepare two or maybe even three treatment plans. Plan No. 1 is the bare minimum of what is needed to restore the patient to good oral health - fillings, extractions ... nothing fancy. Add it all up and give the patient a total for this plan. Plan No. 2 would be more involved with higher priced options, possibly bridges, more crowns, etc. In all scenarios, I recommend that doctors or treatment coordinators (whoever presents the treatment) do not present the patient with an itemized list of procedures, but rather give a total price for the plan.
Doctors will see greater treatment acceptance when they stop doing case presentations and start having case conversations. Dr. Nate Booth coined this phrase, and he described the case conversation as being less formal and more flexible as you discuss options. In conversations, the information flows both ways. The doctor or treatment coordinator assumes the mindset of a friend and consultant who understands the unique problems, desires, and life situations of the patient.
Some patients accept treatment immediately upon understanding what is needed, which is wonderful. However, Dr. Booth posits that the decision of whether to accept care may take weeks, months, or years. If the doctor pushes too hard, the patient will probably not return for treatment. When people are asked to accept a comprehensive dentistry option, they will say, "yes," "no," or "maybe." There needs to be a plan of action for each one of the three possible answers.
Thanks for being an astute hygienist, and feel free to share this with the doctor and/or treatment coordinator in your practice. RDH
All the best, Dianne
DIANNE GLASSCOE WATTERSON, RDH, BS, MBA, is a professional speaker, writer, and consultant to dental practices across the United States. Dianne's new book, "The Consummate Dental Hygienist: Solutions for Challenging Workplace Issues," is now available on her website. To contact her for speaking or consulting, call (301) 874-5240 or email [email protected]. Visit her website at www.professionaldentalmgmt.com.
