Are you as comforting as a mothers kiss?

Aug. 1, 1998
Despite the common complaint that the `human touch` is missing from a robotics-crazy world, patients still desire a little compassion from their dental hygienist.

Despite the common complaint that the `human touch` is missing from a robotics-crazy world, patients still desire a little compassion from their dental hygienist.

Colleen Reiter, RDH, MS

Your patient arrives 10 minutes late for her appointment. The baby was sick, she claims. That leaves you 40 to 50 minutes to provide her scheduled care - all under the guise of being unrushed. What typically happens? Would compassionate care decrease? Would some shortcuts through the treatment be taken in order to stay on schedule? Or are you able to schedule a second appointment with her?

Your communication with the patient is often the first corner cut in providing compassionate care. The second might be to postpone radiographs until the next visit. A third cut might be eliminating her full-mouth periodontal probing, checking only the pocket depths of her noted problem areas. Does this sound familiar? How many times a day do you experience similar circumstances before they alter your whole idea of compassionate care? After all, you probably became a dental hygienist because you wanted to help people. You did not do it just to hurry through procedures and push folks right back out the door, right?

With all of the changes in health care, compassionate care is becoming more of a challenge to provide.

The subjective view of compassion

The dictionary defines compassion as a "sympathetic consciousness of others` distress, together with a desire to alleviate it." So this could mean that compassionate hygienists are consciously aware of, and sympathetic to, what patients are experiencing and want to help them. Why is compassionate care important? With technology advancing at fast rates, the human element often seems remote or nonexistent. Dental hygiene appointments can leave patients feeling good about themselves and about their care - if compassionate care is an integral part of the practice. If it is not, patients will quickly devalue the care provided.

Carol Griffin, RDH, MS, of Atlanta, says, "Conveying compassion requires that I be totally focused on the patient I am presently with." Griffin, who is president of the Atlanta Dental Hygienists` Society, adds, "No issues, whether about other patients, staff members, the doctor, my family, or even my personal agenda, should alter the focus of individualized care. It is an important aspect of my patient`s perceived value for the care received."

Tunde McManimen, RDH, is the Oral Health Chair of the Georgia Dental Hygienists` Association. She summarizes her feelings about this subject as follows: "Compassionate patient care is something I endeavor to do. To me, this means treating the patient, not just the mouth. So my focus is on the patient as a whole. Patients come to see me with their individual histories, their victories and defeats, their concerns, and I listen to what they tell me. It means helping them understand, accept, and participate in their own care, motivating them, and, finally, seeing them take responsibility for their own preventive maintenance. They are the reason I have been in this profession for 20 years."

Take a moment and think about how you define compassionate care in dental hygiene. As you can see, compassionate care from the provider`s viewpoint encompasses a variety of areas. However, a lot of it directly relates to the interaction between the patient and operator.

Are you unable to be compassionate?

While descriptions and opinions are nice to hear, there is something more to the issue of compassionate care. There is also a dilemma at hand. Hygienists face a difficult or unpleasant choice. In fact, many hygienists make choices daily that are contrary to their reasons and standards for entering the profession. They are in a dilemma because they desire to provide compassionate care, yet are unable to because of other constraints beyond their control.

Doctors, for example, often insist that all patients are scheduled in 45-minute intervals, regardless of whether it allows adequate time for compassionate care. Their insistence might be based on production goals, overhead costs, or profit margins.

Another example might be hygienists who want to provide good care with the "promised" quality instruments. They may actually work with poor quality instruments or ultrasonic scaling devices in need of repair.

Patients who consistently arrive 15 minutes late for hygiene appointments are another example of constraints beyond the hygienist`s control. These incidents further stress caring hygienists and impede compassionate care. In many offices, patients who arrive late still expect to be seen and to have all scheduled treatment performed in the remaining appointment time. Such expectations often come from the doctors, the patients, as well as from other staff. Changes in the world are affecting the care you provide. Let`s look closer.

The continuous trend of improvements in dental materials and technology encourage even the most fearful patients to visit dental offices. However, these advancements alone will not make the patients happy or keep them reappointing. Patients want to know that someone truly cares about them.

While technology is good, it does not mean that practitioners are spending more time interacting and educating patients. Quite often, the faster someone works, the quicker the next appointment is scheduled because greater profits are generated. Unfortunately, compassionate care might be minimized in order to achieve such practice goals. Some of this mind-set has evolved from consultants pushing for higher productivity so more income can be produced.

While it is nice to have high-tech products, care is becoming unaffordable for patients without dental insurance. How much technology will patients tolerate if there`s a lack of quality and compassionate care, yet a steady increase in fees? It is often unaffordable for even those with dental insurance because of the co-pay amount. Patients will ask how much their insurance will pay before they decide whether or not to schedule the needed scaling and root planing. That is, they must first determine whether they can afford their portion of the treatment not covered by insurance.

How does unaffordable treatment affect compassionate care? When stating they can only afford necessary treatment if insurance will pay 75 to 100 percent of the cost, patients say they often experience less compassion from clinicians. What has happened to treating all patients with compassion, not just those who can afford the entire treatment package? You see, compassionate care implies that you care enough about the patient`s well-being that you will work with them to make it affordable because they need the care.

Far too many patients are now staying away from dental offices because they cannot afford the care and credit card debts are at or beyond the maximum. Hygienists are caught in the middle since they do not set the fees. However, you can be creative and propose affordable solutions for your patients` needed care during staff meetings.

Offices that accept a large number of these dental plans often find themselves with a heavy patient load, creating a greater strain on efforts to be compassionate. Cancellation call lists, for example, grow lengthy. Too busy to reschedule, the office tells the patient to call back in six months. When they do call, they are told that they have no openings for three to six months more. No wonder patients perceive a lack of compassion in dentistry.

The fee-for-service practitioners who wish to cater to wealthy patients are on the other end of the spectrum. They can schedule blocks of time for large cosmetic cases. Some providers are opening "cosmetic centers" so patients can have access to cosmetic physicians/surgeons and dentists under one roof.

In addition to changes in how dentistry is practiced, the general business world is also changing rapidly. Corporations continually stress the need for employees to improve customer service. So patients must live by these standards at work and also demand the same of others. They will have high expectations while they are in your chair. If compassionate care is missing at your office, they obviously will go elsewhere.

Within the past several years, corporate employers have started switching insurance plans before existing conditions are treated. Patients become exasperated because they bounce from plan to plan and office to office through no fault of the dental community. They just hope to find someone at their "next stop" who will provide compassionate care.

Time to slow down? Time to speed up?

Patients` attitudes and expectations are changing right along with dental procedures and the business world. There is, for example, a steady rise in the number of older adults. Their needs are important and often require extended appointments to complete dental hygiene treatment. The aging "Baby Boomers" are not far behind. This large group has dictated changes in everything thus far in their lives. Within this group of rapidly growing, sophisticated, and aging older adults, compassionate care is expected during treatment. Rushing isn`t an option! And, yes, they will go to the dental office down the street if they are not treated properly.

Then there are expectations stemming from a largely impatient, self-focused society during the busy Information Age. This impacts compassionate care and furthers the hygienist`s dilemma. Patients are better educated (on a formal level) and are technologically literate. Many are very focused on their appearance and are making the kind of money to do something about their looks. They are accustomed to pointing and clicking the computer mouse control and getting immediate results. So their expectation of getting quick results spills over into other aspects of their lives. They are now asking what you can do for them and how fast. Yes, they expect excellence at a reasonable cost, and they often desire immediate treatment. These patients live a fast, stressful lifestyle and expect good customer service everywhere they go. This is especially true in urban areas that are typically saturated with corporations.

Think about your personal experiences with other health care practitioners. How would you react if your physician did not seem to care about you? How long would you wait before voicing your concerns or requesting and demanding a change? Compassionate care is not something we do only if we have time - it must come from within each practitioner.

Do you torture for a living?

Many patients still find dental appointments to be stressful, complicating efforts to provide compassionate care. However, compassionate dental hygienists can serve as buffers to help alleviate patients` dental dislikes and stresses - if the circumstances are right. Unfortunately, distressed patients who encounter distressed hygienists likely have less compassionate interactions. What a challenge!

How patients perceive dental hygienists as a professional occupation will also impact their expectations for their appointment. What kind of reputation do dental hygienists have or how are they perceived?

While we know there are kind words spoken about hygienists, here are a few other words that patients use when referring to RDHs: "torturers," "cleaning ladies," "technicians," "gum-gougers," etc. Patients see hygienists as the lowest paid employees in the dental office with the least amount of education. Wow, what an image! These words might hurt a caring hygienist, but they are a stark reality of how hygienists are viewed.

Why are hygienists not seen as educated, responsible, and caring - such as nurses are? Why would the public overlook a profession that people enter because they want to help others? Is it that patients have had personal experiences that negate the caring image? Have they heard conversations about individuals entering hygiene "for the money?"

Could it be that our professional standards have dropped in order to accommodate the dentists with whom we work, or the dental insurance plans that we are forced to serve, or the daily production goals that are set for us? Maybe it`s because hygienists have had no visibility to the public. Remember, Americans seem to get their education from television shows. Consider how many television shows portray nurses as intelligent and compassionate. And then the question becomes: How many shows even mention a dental hygienist, especially in a positive tone? There is also a lack of consumer awareness about dental hygienists` credentials.

Some additional actions by the hygienist or dentist that can affect compassionate care are:

- Frequent staff turnover and lack of orientation about the office philosophy of compassionate care.

- Dentist`s desire to earn more money.

- Desire to treat only the patients who can afford the suggested full-mouth treatment plan.

- Staff desires to earn higher bonuses.

- Dental professionals expect compassionate care from other medical practitioners and will go elsewhere if they do not receive it.

There is a perceived lack of concern by practitioners (dentists and hygienists) to give back to the community by helping families who are in need and who are unable to afford dental care. Dental professionals would be wise to follow the lead of other local business owners who routinely, yet selectively, give away their services to those in need.

Probably the greatest lack of compassionate care occurs due to burnout. After years of grueling hygiene schedules, hygienists often just "go through the motions." Gone are the concerns to educate the patients so they can maintain healthier teeth and tissues. Life is reduced to living from paycheck to paycheck and getting patients in and out of the chair as quickly as possible. Because many offices are concerned about setting daily quotas and meeting daily production goals, practitioner burnout might occur quicker.

Remember the benefits of compassion

Patients who experience compassionate care appreciate it! We cannot fool the patients. They know when they are receiving compassionate care. They are more willing to comply with your suggested home care regimen, follow through on suggested treatment, and keep their next scheduled appointments.

In fact, as compassionate care increases, so do the new patient referrals. Patients` self-esteem increases, as does nearly all humans` self-esteem when treated in a kind, caring manner.

Imagine increasing your own self-esteem and self-worth on a daily basis because you are able to provide compassionate care. Isn`t that how it should be? Isn`t that what you had in mind when you entered the profession? If you have settled for less than a good working environment and are expected to compromise your standards, then it`s time to get back to why you entered the profession - even if it means changing jobs!

The short-term impact on the practice is that compassionate care boosts morale and helps people feel good about themselves. It also makes them proud to be part of such a group. The long-term impact on the practice is a decrease in cancellations and no-show appointments, a steady increase in new patient referrals, and better acceptance of treatment plans.

The continuity of compassionate care requires the following ingredients.

- Consistent sincerity.

- Commitment to quality care.

- Catering to the patient`s comfort level.

- Adhering to the practice philosophy.

- Actually practicing chairside compassion.

This consistency is often hard to accomplish if there are constant staffing changes, insufficient clinical skills, consultants changing how things are done, or inadequate time to compassionately deliver care. Also crippling are individual attitudes about, or resistance to, providing quality and compassionate care. A lack of patient cooperation and compliance will also send progress backwards.

Finding appointment lengths that are appropriate for each patient will further maintain the consistency of compassionate care. It`s about doing what`s right for your practice and your patients. Satisfied patients have more potential to increase your referrals and production than unhappy patients.

Take a few minutes today to consider your perspective of compassionate care. What challenges do you face in your work setting? How can you be more care-centered? Go share some tender-loving patient care today!

Colleen Reiter, RDH, MS is president of Business Success, Inc., a firm that specializes in management, education, and health care consulting in Atlanta, Ga.


How hygienists define it

According to hygienists, some factors affecting compassionate care are:

- Having sufficient time to provide the services scheduled.

- Possessing a strong work ethic devoted to quality.

- Focusing steadily on the task at hand without irrelevant distractions.

- Obtaining adequate training for performing procedures.

- Having adequate time for interacting with patients and developing rapport.

- Sharing a doctor`s mutual concern for patients.

- Having an awareness of patients` satisfaction with care, as well as their motivation level.

- Relying on a spirit of teamwork among the staff (at least a willingness to help each other during time crunches).

- Having dental equipment that functions properly and does not compromise hygienist`s physical health.

How patients define it

Let`s turn to patients` perceptions of compassionate care. Here`s what they consider to be compassionate care from dental hygienists:

- Gentle touch, yet thorough.

- Soothing, caring tone of voice.

- Clinician has pleasant chairside manner.

- Hygienist cares enough to speak audibly so patients can hear and understand.

- Minimal discomfort during procedure.

- No continuous bleeding or pain following a routine cleaning.

- No interdental papilla missing.

- Seated soon after scheduled appointment time, indicating that hygienist values the patient`s time.

- Clinician shows concern about patient`s comfort during procedures.

A warm smile in your comfort zone sets the stage for compassion

OK, maybe you feel that you are in a high-volume, DMO office and do not have time to consider compassionate care. Or, maybe it`s done in your office, but inconsistently. Here are a few tips on becoming more consistent. By the way, it is possible to let patients know how much you care - even in a DMO practice. Warm, caring smiles are still big-ticket items for most patients!

The practice owner`s behavior sets the tone for the kind of care provided. If a compassionate care philosophy is not visible during the job interview or the first month of your arrival, it never will be. Leave immediately! Often, new hires are told to do whatever they want to within the hygiene area. Then, after the "honeymoon" phase (one to three weeks) is over, they are told otherwise.

If you feel that you are expected to compromise your standards, keep job hunting! You must discover an office where the comfort zone permits you to deliver compassion.

Consider each patient`s age, needs, abilities, and treatment when scheduling care - rather than scheduling all patients for the same amount of time. Given the good oral hygiene of some patients, the schedule will balance out with those who need more time.

Want to enhance compassionate care? Take quick breaks to stretch and do some back, neck, and hand exercises to prevent repetitive-stress injuries. If you keep your body pain-free, it will be easier to focus on the quality of your patient care.

Perhaps you oversee the hygiene area and have input in the selection of new staff members. Identify job candidates who will ease into the established compassionate care philosophy. A new employee who is accustomed to racing through appointments might significantly decrease your patient base - not to mention your patients` trust in you.

To effectively utilize the technology available, you need to allow sufficient time to use it and to teach patients about your findings, so make sure that time is added in the appointment book if you will be using teaching tools. It makes sense that, if you wish to sell a large treatment case, the proper time should be allotted to explain all the details and benefits of doing it. Often, this is being done by the hygienist for restorative cases without additional time being allocated. Just add the extra time so you can maintain the expected compassionate care for that patient - and for the patient who is next on the schedule.

The dental hygienist should determine the amount of time to schedule for each patient - just as the dentist determines the amount of time to schedule restorative patients. Since no two clinicians work alike and no two patients have the same needs, it is just wise to do this.