BY Jannette Whisenhunt, RDH, BS, MEd, PhD
If you have been a hygienist for a few years now, it is hard to remember everything you experienced while in dental hygiene school. We tend to forget some things about that experience, either because we choose to remember only the really good or really bad things about that period of our life, or because it was a long time ago.
If you have not been out of school too long, then you are still in that "new learning phase" that happens to everyone once they start working in their new career. That phase doesn't really have a name or time frame, but it happens to all of us. It is when we get through that learning phase when we "start doing things our way." Sometimes this is very close to how we were taught in school, but many times it is a little less strict. We can all say we backslide some!
We rationalize our changes in infection control procedures, education, oral cancer screenings, or blood pressure screenings, and other items as a way we have to do it in order to stay on schedule. We maybe don't do as thorough of an intraoral or extraoral examination as we used to do. Intentionally looking for oral cancer starts to get a smaller amount of our time. Some of us start leaving it out altogether. Statistics tell us that oral cancer has only a 62.7% survival rate of five years or more; 85% of head and neck cancer (excluding brain cancer) are oral cancers.1
It is very hard to keep up those high ideals forever, and maybe it is not realistic to think that we can. I think we can do a better job if we are aware of what is happening. When we start skipping things that we used to do, we are cheapening our professional services and what our patients deserve. We can let ourselves get a little lazy. However, sometimes we need to push ourselves to be better and not slack off. We say that "we don't have the time to do everything," and that has been our crutch we use for cutting back on time spent on certain aspects of our duties. We are, though, the preventive professional in the office, and we are responsible for asking for enough time for certain patients that need it.
We also have to be sure that we are being productive and using our time wisely as we work. We can learn to give extensive oral health education to our patients while we are scaling, polishing and flossing. We are excellent at multitasking, and we can do that if we push ourselves to be efficient and discovering where we waste time. One or two minutes here and there can add up to those four minutes that you need to perform a thorough oral cancer screening or to wipe with the disinfectant a second time.
We need to use our wonderful skills to care for our patients, but we also need to make sure we are keeping the business end of the hygiene department accountable for everything that is done. Making sure that we are coding everything that is done and that it is coded properly is so important to the bottom line. If the patient has several periodontal pockets and bleeding on probing, are we coding that a D1110 as an adult prophy, or should it be a D4910 as a perio scale? Are you costing the office money by doing the work, but not coding it properly?
In 2014-15, several codes have changed and you might not realize it until the insurance company's rejection. Our reliable "Adult prophy D1110" is the single code biggest producer in an average office with about 90% per code.2 Do you think that maybe some of those could have been coded the D4910's Periodontal maintenance? Do we do more perio and bloody prophies than 10%? Are we counting the fluoride varnishes and other preventive things we provide? According to Dr. Charles Blair and Associates the rules are changing and we need to make sure our coding forms are updated every year. Take a few minutes to check out the requirements and look up the right code for what is being performed.
Costly mistakes are commonly made by improper coding. Your position and the financial health of the practice depend a great deal on the health of the hygiene department. According to a presentation given by Jeff Rice from Henry Schein Dental company, "On average, 33% to 35% of an office's production is the hygiene department and about 70% of what is done by the doctor is fed through from the preventive side."3 So, taking time to get those films that are needed, using equipment that is out there to detect oral cancer or decay can be very beneficial for your patients' oral health and it will also help you use your time how it should be used.
A great time saver can be as simple as using the appropriate disinfectant to clean your room. Make sure it is the shortest time available, because using a 5-minute kill time vs. a 1-minute kill time can save you four minutes a patient. When you multiply those four minutes times 10 patients, you have just gained 40 minutes to your day! Selecting the proper pumice to use so that you are not re-scaling stain off or using waxed floss on someone with tight contacts so that you aren't fishing broken un-waxed floss out of teeth can save a few minutes per patient. It can all add up, and wasted seconds and minutes will get you out of the "I don't have the time" feeling.
It can be very disturbing to stay in that "rush, rush, rush" feeling all day long. Before you know it, you can get tired, you are not as efficient, and it gets real easy to start a little slacking off here and there about your infection control, for example. It gets too easy to start leaving out the oral cancer screening, even on those high-risk patients that you know you should do.
We need to try to always push ourselves to do our best and that really means "pushing" yourself. I always tell my students this every year, "When I expect a lot, I get a lot. If I don't expect much, I don't get much." Your office, your patients, and your team deserve to have a time efficient hygienist. Strive to be the hygienist that does not use the same ole "time excuse crutch" that we have used forever.
Take your time back! Use your time wisely, and do the most important things first so they don't get left out.
When you think about the way you were taught in school about selective polishing, do you use that selectively or does everyone get a full mouth polish? You may say that "my patients expect this," and it is because that is what has always been done. Then you need to educate your patients about why it is not always necessary or recommended. You have to educate them why polishing is most of the time only cosmetic and that it removes the fluoride rich layer of enamel. It may take a couple of explanations, but they should respect your education and training to know that you know what is best for them. You can always polish a few teeth with toothpaste, if they really just want that fresh breath taste. Eliminating a full mouth polish where you can, can save you four to six minutes per patient at least.
When you stop and think about where you waste time, we can control a great deal of it on our own and take our time back. Working in a small business setting cost is something that we constantly have to be aware of. We don't want to be costing our office money because we are not being wise with our time, and we also don't want to be wearing ourselves out by doing things the long way around. It is always to everyone's best interest to work smarter instead of harder.
If you really take a few minutes to notice your procedure of how you are doing things now that you are out of the "learning phase," and see where your time wasters are, you can save more time than you think. It just takes some creativity and forethought to make it happen.
1. Oral Cancer Facts from Oral Cancer foundation. Website http://www.bing.com/images/search?q=oral/cancer+statistics&id=6187574CF940BA8326066C6F64302294C7D804ED&FORM=IQFRBA#a
2. Blair C. Coding with Confidence: The "Go To" Dental Insurance Guide Dramatically Cut Coding Errors and Boost Legitimate Reimbursement, CDT-2014 Edition. www.practicebooster.com, Charles Blair & Associates, Inc.
3. Rice J. from CE presentation from Henry Schein Dental Company in June 2014 at NC Dental Assisting Educators Association Annual meeting in Winston-Salem, NC.
Jannette Whisenhunt, RDH, BS, MEd, PhD, is the Department Chair of Dental Education at Forsyth Technical Community College in Winston-Salem, N.C. Dr. Whisenhunt has taught since 1987 in the dental hygiene and dental assisting curricula. She has a love for students and served as the state student advisor for nine years and has won the student Advisor of the Year award from ADHA in the past. Her teaching interests are in oral cancer, ethics, infection control, emergencies and orofacial anatomy. Dr. Whisenhunt also has a small continuing education business where she provides CE courses for dental practices and local associations. She can be reached at [email protected].