The Doctor/Hygiene Exam Merged with the Science of Communication

Jan. 1, 2006
In the article titled, “Visuals and the Science of Communication” (December 2005 RDH), we discussed the opportunities to refine and develop the structure of the hygienist’s communication skills.

In the article titled, “Visuals and the Science of Communication” (December 2005 RDH), we discussed the opportunities to refine and develop the structure of the hygienist’s communication skills. Advanced communication refinement, along with the significant changes occurring within the dental profession, will directly affect the role of the dental hygienist in patient education. There is an additional impact for today’s hygienists that rely on advanced communication skills to achieve case acceptance. Hygienists have never before had so important a role in affecting patients’ acceptance of the comprehensive treatment plan. As hygienists, we have the necessary background to stay abreast of new advances in technology and science. We have all had coursework in patient education. However, many of us have not had the opportunity to study advances in the science of communication.

This article further addresses the hygienist’s role in the development of the science of communication with a specific focus on a refined structure of communication within the doctor/hygiene exam. These refinements can expedite your exams and increase case acceptance.

The hygienist’s verbal synopsis to the doctor

As hygienists, we know numerous patients listen to us. But, until the doctor confirms the diagnosis, they are not 100 percent convinced of the need for treatment. A complete and thorough verbal synopsis provided by the hygienist to the doctor is crucial to case acceptance.

When the doctor enters the room, the monitor should show images of the teeth with the most significant fracture lines. With a split screen showing quadrant images, the hygienist should also capture a picture of bleeding upon instrumentation around any fractured fillings, as well as whatever is the most significant change that will occur from cosmetic dentistry - for example, overlapping teeth, a “gummy” smile, etc. The images that are shown set the framework for the doctor’s exam. Remember, the doctor is coming from another patient (or two) and must instantaneously connect to the patient in the hygiene chair. Whatever we can do to provide that connection, both visually and verbally, will help expedite the doctor’s exam and communication to the patient. An example of a verbal synopsis from the hygienist to the doctor is shown in Exchange 1.

If you have chart notes written out to give the doctor a visual roadmap of what you just said, it will be much easier for the doctor to follow and confirm your recommendations. All of the communication during your verbal synopsis was for the doctor; however, it was for the patient to hear again as well. It is a lot of information for the doctor to remember all at once, yet very important to hear. The doctor would then provide the exam, confirm the diagnosis, and sit the patient up and review the confirmed treatment plan.

The next part of the process is to obtain closure of the treatment prior to any financial arrangement. You need to know if the patient is really ready to move forward with treatment or one of two things will occur. The patient will make the appointment and then cancel, or the patient will go through the process of the financial arrangement and say he/she will call you when he/she is ready to move forward with treatment. Exchange 2 is an example of the doctor’s communication.

The next most important part of the process is the absolute necessity for the hygienist to review the pending treatment during the periodontal therapy appointment(s). Bring up the fractured fillings again on the monitor, and the gummy smile or crowded teeth or whatever the reasons for the cosmetic concerns. Ask the patient if she had a chance to speak with her husband about her treatment. Find out what happened. Address any additional concerns, using, of course, visuals!

Repetitive communication

It is the hygienist’s responsibility to continue to review the restorative and esthetics within the structured process of the science of communication each time you see the patient. Each communication time is not as long; however, it is our responsibility to continue to communicate as long as the patient says he/she is still interested. The hygienist’s expertise is stimulating the desire for the patient to move forward with treatment. The hygienist’s confidence will increase as the patients schedule their treatment from the hygiene operatory.

Surveys indicate that it takes the average patient an average of three hygiene visits to say yes to treatment, if the hygienist is dedicated to reviewing the process of the science of communication each time. This is a very important point to the whole advanced communication process. In this article’s case presentation scenario, we did not get case acceptance today. However, the process was very different than the style of patient education that is common during a hygiene procedure. There was enough stimulation of desire for the patient to move forward and make a commitment to the consultation appointment with the doctor. The treatment coordinator is now scheduling an appointment with the doctor and all of the decision makers for the treatment to be accepted versus the patient going into the treatment-pending file. The hygienist also has the additional appointments of periodontal therapy to repeat the communication. The science of communication is a fun process once you learn the skills, and both you and your patients will reap the benefits of the successful outcome!

The first step to implementing the refinements of your doctor/hygiene exam is to have two willing partners - the doctor and the hygienist! Remember, your goal is to create a case acceptance team. (You cannot provide optimum comprehensive care without first having case acceptance to the treatment!) It is important to schedule time to sit down with your doctor and define the expectations that each of you has. You could start your meeting with the following questions:

• The hygienist asks the doctor, “What communication would you prefer from me prior to your exam?” Be specific. Role play, and be open to refining the hygienist-to-doctor verbal synopsis. Discuss your clinical findings during the appointment and the patient’s response. It is also important to define your visual expectations during the appointment to support his/her exam.

• The doctor asks the hygienist, “What communication would you prefer from me to support the hygienist/patient relationship?” Additionally, when the doctor is transferring the communication to the hygienist and exiting the operatory, what would be the best communication to support the hygienist’s final remarks with the patient to achieve understanding of the diagnosed treatment and increasing case acceptance?

The science of communication requires an understanding that refining your communication skills is an ongoing process during your entire career. There are many sources that can assist your refinements within the science of communication. We suggest you see how much fun you can have in checking out different styles of communication, and which ones best fit your own personality. There are great speakers you can model your skills after at events such as RDH Under One Roof, the ADHA annual meetings, or your local dental conventions. Dental societies and dental hygiene societies also offer different speakers who study the art of communication. As an objective of the JP Institute’s Mastership Program, advancing communication skills is a key component of the curriculum. Additionally, there are courses that study personality profile systems, such as the DISC system. Using personality profiles can help you understand the different types of motivating factors that influence patients’ decisions to say yes to optimum health. Continual learning from different sources will keep your communication skills fresh.

The faculty and consultants of the JP Institute have witnessed firsthand how refining the doctor/hygiene exam can be so rewarding for the entire team. You can expedite the time management of your exams while increasing the successful outcome of the case acceptance! It is important to remember, just like anything that you are passionate about, the amount of time and energy your team places in the commitment to work on the refinements will reflect the level of success you achieve.

The rising expectations of today’s dental hygienists require us to redesign our hygiene appointment and to first shift our own paradigm to recognize the monumental value the hygiene profession can offer our patients. We now know how periodontal disease and dysfunctional dentistry directly affect the health and well-being of patients and their entire immune system. We now can easily impact the patient’s self-esteem, which in turn affects the quality of their lives. The dental hygiene profession is instrumental in patients’ perceptions of today’s modern dentistry, and we must embrace the responsibility we hold.

There are many teachers, facilitators, consultants, and speakers that are among the dental hygiene professional colleagues dedicated to assisting hygienists’ refinement of their clinical and communication skills. We all are blessed with the opportunity to watch the entire dental team support the hygienist and the hygiene department like no other time in history. It is a time in our profession of which we can be very proud. But it must start with the fire within, and a passion to want to make the change. RDH

Exchange 1

Doctor: Karen, what were your clinical findings today?

Hygienist: Mary’s oral cancer screening was negative. There were no changes in Mary’s health history; however, during her risk assessment we noted that Mary is under moderate stress from work. Periodontally, Mary and I observed the hemorrhaging around teeth Nos. 2, 3, 14, 15, 19, and 30. We reviewed the treatment you had previously diagnosed in those areas. We discussed the rough edges of those fractured fillings harboring the bacteria, and the toxins that cause the infection in the gum tissue in those areas. We discussed Mary’s moving forward with the restorations to bring those teeth back to their original structure, as well as one to two periodontal therapy appointments to make sure we achieve perfect tissue before you begin to restore the teeth. She understands that is necessary to achieve the best clinical results. Mary is also interested in combining the posterior restorations of her mouth with some anterior cosmetic work. We discussed the possibility of 10 veneers. As long as we can work this into her budget, Mary is very interested in moving forward with both the posterior and anterior work. She loves the idea of not having to take off from work too much and getting the work done in as few appointments as possible. I also talked with Mary about the possibility of a consultation with you before you begin treatment if you feel that is necessary.

Exchange 2

Doctor: Mary, I would like to review with you the treatment plan that I feel would best serve you, but first I want to find out your level of commitment to the treatment. As long as we can offer you an option from our financial partners that meet your budget, are you ready to move forward with the treatment?

Patient: Yes, but do I really need all of those teeth to be fixed?

Doctor: Yes. I know Karen showed you the fractures and explained the urgency in restoring your teeth. What is it that concerns you about the number of teeth to be fixed?

Patient: I guess it’s just that I am not used to getting that many teeth worked on all at once. Will it hurt?

Doctor: Mary, I can assure you that most of my patients do not have any discomfort during the procedures. You may experience slight discomfort for the first few days after your treatment, but nothing more than Tylenol can handle. So how does that sound?

Patient: Sounds good.

Doctor: Do you need to discuss this with your husband before you commit to treatment?

Patient: Yes, I really need to discuss this with Jim.

Doctor: Karen, let’s schedule a consultation with Mary and Jim to review Mary’s treatment plan and to prioritize the treatment that Mary and Jim feel comfortable with. Mary, I know you are going to love your new smile, and as for the back teeth ... well, they are going to love you. Those fractures can really cause you a lot of pain and additional destruction of the teeth and gums as well as your jawbone support. Let’s schedule some time to discuss the treatment so you feel great about moving forward. Fair enough?

Patient: Thank you, Doctor.

Hygienist: Doctor, do you want Mary to go ahead with the periodontal therapy in the meantime?

Remember, the two of you are a case presentation team. If either the doctor or the hygienist misses a step in the process, one can prompt the other.

Doctor: Yes, Mary that is very important. You will need your gums and jawbone support to be in the best of health prior to your treatment. Mary, how do you feel about going ahead and getting started with the periodontal therapy?

Patient: That would be fine.

Doctor: You are in great hands with Karen. I would like you to schedule our consultation with you and Jim within the next week if possible. I do not want any more destruction to occur within those fractured fillings. Would that work for you?

Patient: I am sure we can work that out.

Doctor: Great. I will see you then.