Perfecting the co-diagnosis

June 3, 2013
Many hygienists have experienced this situation in clinical practice: during the hygiene evaluation, notation is made of a tooth that is severely compromised because it has been patched and restored several times.

by Ann-Marie C. DePalma, RDH, MEd, FADIA, FAADH

Many hygienists have experienced this situation in clinical practice: during the hygiene evaluation, notation is made of a tooth that is severely compromised because it has been patched and restored several times. As the consummate dental professional, the hygienist informs the patient about the restorative needs of the tooth, the patient understands and is sold on the idea of further restorative work, and then the doctor arrives for the evaluation. The doctor says, "Let's watch it," and all of the hygienist's hard work evaporates with the blink of an eye.

Three things happen in that moment:

  • The hygienist becomes angry or embarrassed or frustrated because the dentist has undermined him or her in front of the patient, and episodes like this may cause the hygienist to stop prediagnosing.
  • The hygienist senses that the patient is confused by the conflicting treatment options and trust is diminished.
  • The dentist is upset with the hygienist for not letting him or her "diagnose."

How can the hygienist salvage this evaluation process? Stacy McCauley, RDH, MS, has developed a program to increase consistencies in communication and foster team/patient hand-offs in her program called "The Perfect Hand-off: Stellar Codiagnosis and Enrollment." Stacy has found that successful practices have mastered the art of the patient hand-off in the hygiene evaluation process. Achieving a high level of codiagnosis requires seamless communication between the hygienist, doctor, patient, and business team. After participating in this highly interactive program, participants will be able to:

  • Describe high impact communication strategies for codiagnosis
  • Demonstrate verbal strategies that increase patient compliance and case acceptance
  • Explain nonverbal communication dos and don'ts
  • Discuss strategies for making communication seamless between dental team and patients
  • Explore strategies for effective in-office hand-offs

By demonstrating calibrated communication strategies, the entire dental team will be in sync with the doctor to increase the standard of care, elevate patient trust, and ultimately increase patient case acceptance. When this shift in practice dynamics and communication occurs, the result is a happy doctor, happy team, and happy and healthy patients.

Stacy has experienced the consequences of not being in sync with the doctor, and how a poorly communicated message can derail the best of intentions. Even the best clinician can disrupt the case acceptance process by using poor communication skills, while the team can unknowingly spoil a presentation by not communicating effectively.

While coaching, Stacy noticed doctors and teams were hungry to learn effective communication. Every clinician knows what a patient needs from the clinical perspective, but not all clinicians know how to compellingly communicate that need so that it becomes the patient's want. Thus Stacy established her program.

Stacy has practiced clinically for a number of years and is a graduate of the Kellogg Community College dental hygiene program. She earned her master's in dental hygiene education, and has been a clinical assistant professor in a dental hygiene program. She was introduced to adult learning principles during her master’s program, and when she emphasized these principles in her teaching, she energized and engaged her students.

After leaving academia, she became the manager of professional education for Philips Sonicare for the Southeastern U.S. region. Her corporate career accelerated her speaking career by providing her with the training and opportunities to present both nationally and internationally. After a rewarding eight years in the corporate arena, Stacy transitioned into a new role with Inspired Hygiene as a hygiene productivity coach. While honored to present programs to the dental hygiene profession, she is constantly striving to learn as much as possible for herself, her clients, and her programs.

Stacy uses PowerPoint only to visualize or reinforce concepts. She has made a conscious effort never to read a slide to her audiences. Her programs are conversational, active, and fun, with the room set up banquet style so that she can engage every participant. Stacy sees herself as a facilitator, not a lecturer, and she provides participants with activities, hands-on applications, and training exercises.

Stacy is passionate about her husband, who has supported her both personally and professionally, and her daughter, Logan. She enjoys doing projects around her home and is an avid social media user. She is a teacher at heart, and is currently adjunct faculty at the University of North Carolina’s School of Dentistry. Stacy teaches didactically to dental and dental hygiene students, while also teaching part-time in the dental hygiene clinic, which keeps her grounded in hygiene.

Stacy is concerned about preceptorship, the fact that local anesthesia is not a professionwide standard of care, the public’s limited understanding of what a registered dental hygienist does, and the essentials of radiographic and periodontal protocols that are not maintained in many practices.

Stacy enjoys watching audiences connect the dots between what she is discussing and how they can effectively use the information in practice. Having fun while learning is one of the goals of her presentations, and she enjoys when participants have a good time exchanging ideas and learning from one another. She encourages others who are interested in becoming professional speakers to contact her.

Communication skills learned and demonstrated can empower anyone, whether it’s between doctor, hygienist, team members, and patient, or audience and facilitator. Knowing how to effectively communicate ideas to provide the best for the “audience” is the key to a stellar performance.

For more information on Stacy’s programs or Inspired Hygiene coaching, contact [email protected]. Stacy will be presenting “The Perfect Hand-off” at RDH Under One Roof on July 18. RDH

Thought for the month: Sometimes what we think is so impossible turns out to be possible after all. K. O’Brien

The INeedCE course for June

is "Oral Cancer Today: The Impact on Our Profession." The code to receive 50% off regular CE price is ANJUN13 – regular price $49, with code $24.50. Valid June 1 – June 30, 2013.


SEER (Surveillance Epidemiology and End Results) data demonstrates a decline in oral cancer for tobacco related sites; however, there is a strong trend toward an increase in human papillomavirus (HPV) implicated sites. How does this affect our methods of screening for oral cancer, and is the clinical oral examination predictive of histologic diagnosis at an early stage? Two-thirds of oral squamous cell carcinomas are discovered at an advanced stage with five-year survival rates impeded significantly; 82.3% when the disease is discovered in stage I or II, and only 33.5% when the cancer has metastasized. This presents a call to action to elevate our knowledge regarding examination of high-risk areas and explore adjunctive screening methods to complement the traditional white light examination.

ANN-MARIE C. DEPALMA, RDH, MEd, FADIA, FAADH, is a Fellow of the American Academy of Dental Hygiene and the Association of Dental Implant Auxiliaries, as well as a continuous member of ADHA. She presents continuing education programs for dental team members on a variety of topics. Ann-Marie is collaborating with several authors on various books for dental hygiene and can be reached at [email protected]. Min cum hic te pos a velicieniti ad quam

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