There is a rising expectation for dental hygienists to increase their skills for comprehensive case presentations.
Can you see?How do you feel?Does that make sense?May I just explain? Would this be something you would like to do? Are you interested?Wouldn’t it be great?
Throughout the years, advances in science and technology have affected all types of businesses, including the dental industry. During past 10 years alone, the developments that have occurred in dentistry have surpassed those of the entire history of the profession. These changes have had a wonderful impact on the variety of services we offer patients.
One significant change that directly affects today’s dental hygienist is the impact of communication and case acceptance. Hygienists have never before had a role so important in affecting the case acceptance of patients’ comprehensive treatment plans. We are able to stay abreast of new advances in technology and science, and we have had course work in patient education. However, many of us have not had the opportunity to study advances in the science of communication.
A common obstruction to communication is the assumption that the communication we deliver is received and understood. The dictionary defines assume as “to take for granted.” Throughout The JP Institute’s 25 years of coaching dental offices, we have discovered the main assumption dental hygienists make is that they have patient’s acceptance of a treatment plan. The JP Institute has developed a process for case presentation skills using the science of communication that eliminates assumptions. The process refines and enhances your communication and case presentation skills, dramatically increasing patient case acceptance.
Have you encountered the following scenario?
You feel satisfied and confident as your patient leaves your operatory. You believe that you just presented your most eloquent case presentation, which reviewed the patient’s incomplete periodontal, restorative and esthetic procedures, and you still completed the patient’s hygiene appointment on time! You feel very assured of case acceptance.
As the treatment coordinator reviews the treatment plan and fees with your patient, your patient seems hesitant and says that she needs to think about it. This unexpected encounter leaves you to ponder ... What went wrong? There is not much else the treatment coordinator can do except to put the patient’s chart into the treatment pending file while determining the best time to follow up.
As a proposed checklist to your case presentation skills, review the following:
● Connect with your patient
The best presentation skills have been defined by many different authorities and in several different formats. The JP Institute coaches clients in a structured process that provides a format to review and refine case presentation skills. Ask yourself if you connected with your patient. Did you really listen to the patient during your social graces at the beginning of the appointment? Did your patient say he/she was under a lot of stress?
When you presented your treatment case to the patient, did you relate some of the variables that may affect his/her health and decision regarding the urgency of the treatment? Remember, if the patient’s treatment is already pending, there was not enough value for the patient to move forward with the treatment. One of the best ways to say “I care” is to listen. Talking about what the patient already told you is the first step to connecting.
There is an art to sprinkling open-ended questions throughout your case presentation. We must all practice the delivery of our case presentations until the open-ended questions feel as natural as our other styles of communication. Weaving questions into your case presentation also saves you time.
Check in with the patient, and check out how they feel about the communication thus far.
Hygienist: Mary, Can you see the fracture line on these fillings? (Visual)
Patient: Yes, I can.
Hygienist: How do you feel about fractures that size?
Patient: Are they large?
Hygienist: Yes, they are large enough for the toxins to seep under your fillings and cause a great deal of destruction to the teeth. Do you see the hemorrhage around the margins of these fractured teeth? (Visual)
Patient: Yes, I see that.
Hygienist: The bacteria that catches along the fractures above and below the gum line is causing that infection. Every time you chew and swallow some of that bacteria can enter your blood stream affecting your entire immune system. Does that make sense?
Patient: Yes, that does make sense.
Hygienist: How do you feel about getting the necessary treatment to bring these teeth back to their original structure?
Patient: I would like to do that, but how is it done?
Hygienist: Mary, before I explain the advances in dentistry to restore your teeth, the first thing doctor will want to do is get your gum tissue back to health. There is enough hemorrhage in your gum tissue that the supportive therapy appointment today (or periodontal maintenance) will not be enough to eliminate the infection. During your Risk Assessment Survey, we identified you to be under moderate stress. Many times when my patients are under stress, especially if it has lasted over a period of time, a smaller amount of the bacteria can cause more of inflammation. Then because the margins of the fractured fillings are so rough and harboring the bacteria the inflammation develops into an infection.
Because you are such a great patient and you keep your supportive therapy appointments regular, it should only take me one to two periodontal therapy appointments to get your gum tissue back to health. Now let’s review the superior restorations that are available with modern dentistry to restore your teeth back to their original structure. (Begin to review visually with a brochure, pamphlet, or your CAESY system. Visual.) Does the treatment make sense?
Hygienist: Do you see why it is so important to combine the periodontal treatment with the restorative treatment?
Patient: Yes, I do.
Hygienist: Mary, just for a moment, let’s switch gears to something fun. I was excited about you coming in today because I wanted to talk with you about some of the great cosmetic procedures that doctor has provided his/her patients. I have seen the doctor complete so many wonderful cases on my patients, I couldn’t wait to show you some of the things the doctor could do for you. I know I am presenting a lot to you today, but since you told me about your 25th anniversary party coming up, I got even more excited about what doctor could do before your party. May I take just two minutes to show you some of these advanced cosmetic procedures?
Hygienist: Let me show you a case that was similar to your teeth before she got her cosmetic work done. Here is the before and here is the after. Isn’t it beautiful? (Visual)
Patient: Wow, that looks great! This was what her teeth looked like before?
Hygienist: Yes. Dr. Smith does amazing work. That is why I chose him to do my work. When the doctor comes in for an exam we can discuss possibly combining the restoring of your fractured fillings with some cosmetic treatment. How does that sound?
Patient: Sounds great!
Hygienist: The doctor may choose to sit down with you and provide a consultation appointment so together the two of you can decide exactly what you would like your teeth to look like and not be rushed. Also if you do the treatment all at one time we can make sure we schedule you at a time that will not interfere with your work and get the treatment all done in two to three visits? What time frame works best for your work schedule? Lunch time, or possibly before work?
Patient: I think my lunch hour would work.
Hygienist: Great. Let me go ahead and provide your supportive therapy appointment today, and the doctor will confirm the diagnosis and what treatment plan would be best for you.
Patient: How much will all of this cost?
Hygienist: I am not sure until the doctor does the complete diagnosis. The advanced procedures the doctor provides are $1,200 per tooth. From what I see with your smile makeover and the fractured fillings, there are 16 teeth involved.
Patient: Holy cow, that is a lot of money!
Hygienist: It is a significant investment; however, it is an investment in you and your health, both in your mouth and your entire immune system, and the results are fantastic! Most of our patients choose one of our financial partners to work with and they can make it really affordable with low monthly payments. If we could assist you in making your treatment affordable, would this be something you would like to do for yourself?
Patient: Yes, if I can afford it.
Hygienist: I know you said you were really excited about your 25th anniversary party. Wouldn’t it be great to take this smile (pointing to the after picture) to the party? Most of my female patients say it is like having a face-lift. It can take ten years off your looks due to the changes in what is called your vertical dimension. (The hygienist then demonstrates what vertical dimension is.) I understand finances are of concern, but I’ve seen Julie work out some great financial options for our patients. She is the best at working with our financial partners. Pretty exciting, isn’t it?
Patient: Yes, it is! Wow, she looks great.
Hygienist: For now Mary, just sit back and relax, while I complete your supportive therapy today, and I will let Julie know you are interested in looking at our financial options.
The next part of the process is two-fold:
• Let the patient choose his or her own level of health.
• Present total treatment while still leaving the treatment open for the doctor to diagnose the full treatment plan.
The next critical part of the process is to provide a complete verbal synopsis of what you discovered to the doctor, what treatment possibilities were discussed, and what the patient’s feelings were about the treatment and whether or not he/she was interested.
The second part of this article will include the refinements for the science of communication during the hygiene/doctor exam.
There are many sources that can assist your refinements within the science of communication. It is fun to check out different styles of communication when there are several speakers at events such the RDH Under One Roof conference, or a local dental convention. Dental societies and dental hygiene societies also offer different speakers who study the art of communication. As an objective to The JP Institute’s Mastership Program, advancing communication skills is a key component of the curriculum.
Additionally, there are courses that study personality profiles systems, such as the DISC system. Personality profiles can help you understand the different types of motivating factors that prompt patients to say “yes” to optimum health. Continual learning from different sources will keep your communication skills fresh. Developing your own personal refinements to the science of communication is a journey. And the journey continues throughout your entire professional career.
As you begin your communication refinements a motivating factor to inspire you is to remember that case acceptance equals clinical results. Without the case acceptance, you cannot provide the optimum care you dedicated your hygiene career to provide. It takes practice, and changes within your routine and time management to develop these advanced communication skills.
The JP Institute is so proud of the advances within our hygiene profession, which is made up of intelligent, talented, and passionate clinicians. We applaud the professionals who have already embraced this level of communication to increase the opportunity for our patients to truly understand the amazing technology and services that are available today. For those of you who choose to embrace the advancement of your communication and case presentation skills ... a whole new world will open up for you. Enjoy the journey, it will be worth it!
Peggy Sprague, RDH, is a co-founder of The JP Institute, which has taught the most advanced clinical protocols, technology, and evidence-based science for the past 25 years. The JP curriculum emphasizes team support for comprehensive dentistry. JP specializes in analyzing and refining practice philosophies, strategies and business systems, hands-on implementation of clinical skills, and technology and product integration. Call The JP Institute at (800) 946-4944 for a complementary Practice or Career Profile to analyze your professional development, clinical protocols, technology and product integration, management systems, and profit potential. She can be contacted at [email protected].
Visuals, visuals, visuals
I say “visuals,” and you say “time management.” Understandably so! Everybody has a good idea of what we could put into our treatment time with patients that would make the appointment a bit more wonderful. Visuals are worth the time it takes to present them. It is best to plan your visual support and have it ready to expedite appointment times.
· Visual one - Have the highest priority of the treatment up on the monitor before the patient comes in the hygiene room. This is part of the room set up.
· Visual two - The intraoral camera tour should be the second clinical screening you do. (The first is the oral cancer screening).
· Visual three - A co-diagnosis occurs when you show the patient what you see in the mouth, (restorative, esthetics, and periodontal) and on the monitor to confirm the findings or show additional defects.
· Visual four - When you set the patient up to review your clinical findings, use a pamphlet or visual aid. It is important to individualize the pamphlet to the patient’s findings. It is a great idea to draw or circle what is pertinent to the patient’s problems right on the visual.
· Visual five - If you have a CAESY System, the patient can review as you document in your chart.
· Visual six - If you happen to have any of the work that has been presented in your own mouth easily visible, show it to patients. This works well for cosmetic treatment. The dental team member is the best testimonial patients can have to prove trust in the doctor’s work.
· Visual seven - When the doctor provides the exam, he/she will review visually on the monitor or in the mouth from the verbal synopsis the hygienist gave the doctor.
· Visual eight - After the doctor’s exam, the hygienist will review the diagnosis with the patient. The take-home pamphlet will visually confirm the patient’s understanding and value of the treatment presented.
· Visual nine - When you transfer the patient to the treatment coordinator, give the pamphlet to the treatment coordinator, not the patient. The treatment coordinator can use it to review the case financially.
· Visual ten - The treatment coordinator will give the patient the brochure as well a personalized treatment plan and investment options sheet.
With 10 different visuals, you may think that our promise for time management is short-lived. But we can assure you that with properly diagnosed hygiene services (not providing periodontal therapy at supportive or preventive appointments) you will have enough time to effectively use your visual support with patients.
The ultimate goal of the hygienist is to provide the best level of care. The time you spend using visual support will provide patients a good opportunity to understand why the treatment is the best thing for their dental health, immune system, and well-being.