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The glue that binds

March 1, 2001
Your role in the comprehensive exam makes you the glue that bonds the patient to the dental practice.
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In many practices, the comprehensive examination is performed by the dentist with the assistance of the hygienist. In others, the examination is the responsibility of the hygienist, who then reports her findings to the dentist. In either case, the profession has recognized and acknowledged that the hygienist should and must be involved in the comprehensive examination.

There are many reasons for this, the most obvious being that the hygienist is the staff member who spends the most time with patients - especially patients who come to the office for continuing care. Through the hygienist's involvement in the comprehensive exam, patients see that this role in the practice is respected and important. Because they see that you have been entrusted with the important responsibility of performing the comprehensive examination, they know that they are in good hands.

When patients see that your opinions are respected and valued by the dentist, they respect and value your opinions even more. This respect and trust will translate itself into the patient being more receptive to your advice and recommendations. In essence, you become the glue that bonds the patient to the practice.

Step one

Your participation in the comprehensive examination is the first step of many that will create a relationship with every patient who comes into the practice. The most important aspect of this relationship will be your role as the primary educator of the practice. It is your responsibility to educate each patient about his or her dental condition and its consequences, as well as to follow up with an effective explanation of the appropriate treatment that will cure or correct the condition.

Once patients are made to feel that their dental health is important to you and to the practice, you have established an important bond. Your next step is to strengthen the bond by making your patients active partners. Begin by getting a pa tient's permission for that care.

When your patients agree that they want to maintain a lifetime of dental health, you can begin to present precise information about treatment plans and procedures. It is at this point that your active participation in the comprehensive examination is most valuable. A patient who knows that you are familiar with every aspect of his or her dental condition is a patient who recognizes that the information you present about recommended treatment is specifically tailored to his or her unique needs. Use the intraoral camera and radiographs to further personalize the information. Show the patient appropriate brochures, charts, or other visual aids that will help clarify the need for a particular treatment plan.

Most patients want to know what has been found during the comprehensive examination. They want to know about problems, solutions, and costs. Above all, they want the information presented in words that they can understand. To be an effective educator, you must keep all of these factors in mind.

Keep all descriptions simple and specific. Explain any existing problem and give reasons why it should be corrected. If at all possible, give the patient some options. This is especially effective if the patient is given brochures which outline each of the recommended procedures and if the patient is told how much each procedure will cost. Encourage the patient to ask questions. This gives the patient some level of control over what comes next. An informed and involved patient will feel more comfortable about making a commitment to a treatment plan.

For example, you might say, "Let's review my findings before the doctor comes in to complete the exam. "Tooth No. 3, your first molar, appears to have a fracture line right down the middle of the old silver restoration currently in the tooth. We probably should discuss with the doctor a more secure restoration for this tooth. The option would be a crown or an onlay. Do you have any questions?"

Restate and reinforce the information given to the patient when the dentist comes into the operatory to complete the exam: "Doctor Howe, I've shared with Mrs. Smith my concern about tooth No. 3. We know that the tooth would benefit from a more secure restoration. We've discussed the options available, and I've given her brochures describing these options."

When the dentist confirms your findings and conclusions, the patient will sit up and take notice.

It is equally important to end the comprehensive examination with a closing statement that asks for a commitment from the patient to accept the treatment plan. "Mrs. Smith, since you have no other questions or concerns about the treatment we have presented to you today, I see no reason why we shouldn't schedule you for the procedure, do you?"

At this point, you should again encourage the patient to ask questions. These questions can quickly turn into opportunities, because if a patient asks a question, he or she is showing some interest. If a patient says, "Gosh, that's a lot of money," she is not saying no, but is simply sharing a point of view that needs to be validated. Your reply should include a validation, an explanation of value, and a request for a commitment. "I understand your concerns, Mrs. Smith; however, $850 is a very wise investment to ensure that you have a lifetime of excellent dental health. Is the onlay the treatment you would prefer?" By doing this, objections or indecisiveness are handled effectively and efficiently.

Step two

Once the commitment has been made, introduce the patient to other team members who will be scheduling follow-up appointments, or taking care of financial arrangements. In a few brief sentences, wrap up the comprehensive exam visit, making sure to validate the patient for making a wise decision. Always leave the door open for more communication if the patient has other questions or concerns. For example:

"Mrs. Smith, if you don't have any more questions, I'd like Susie to discuss the financial arrangements and schedule you for treatment. Is this acceptable to you?

"Susie, Mrs. Smith has made a commitment to have an onlay placed on tooth No. 3. Would you please assist her with scheduling the time and also work out the finances with her. I have explained to her that the investment for the onlay is $850. She would like to utilize her insurance if she can; however, I have told her that many insurance companies do not pay a benefit for the more permanent restorations. She understands that if this is the case, she will be responsible for paying for the onlay. "Mrs. Smith, you have made a wonderful decision to have this permanent restoration placed. I have onlays in my own mouth and they are almost 20 years old now. They are just as perfect today as the day they were placed. If you have any questions, or if I can be of help to you, please do not hesitate to call me. See you soon!"

Your active participation in the comprehensive examination has a tremendous impact on patients; use the time to give them a good impression of you and the practice. Make certain that your clinical skills and knowledge of dentistry and dental procedures are excellent. Introduce patients to other team members in a way that makes them feel welcome and cared for. Encourage patients to ask questions and share responsibility for their oral health. Motivate patients to accept positive solutions to their dental problems. Using all your skills and talents wisely at this time will open the door for a life-long partnership

Cynthia McKane-Wagester, RDH, is the president/founder of McKane & Associates, a full-service management company servicing health-care practices. Her company's expertise is in developing excellence in staffing systems, working philosophy, and in ensuring that all team members - whether proven or inexperienced - adapt their skills to meet the ever-changing workplace. She is the author of Dental Hygiene, A Practice Within a Practice. She can be reached at her office in Maryland at (800) 341-1244 or by e-mail at [email protected]..

Instilling confidence in the practice

When patients come to the office for a comprehensive examination, they often are insecure and a little frightened of what they may find. You are the one who must set the tone for a comfortable examination and instill confidence in patients that they have chosen the right practice for their dental needs.

Begin by presenting your patient with a positive and enticing description of the practice. Your words must focus not only on the overall excellence of the practice, but on specific components of the practice that ensure excellence. Emphasize the commitment and passion of all the dental team members. Be sure to mention that continuing education is standard procedure in the office. Show pride in the excellent clinical equipment and technology that make the practice comfortable and patient-friendly. For example, you might say:

"Mrs. Smith, our team members are lucky to be part of a dental practice so committed to excellence. At our facility, we surround ourselves with the best in materials, team, and technology. We continually expand our dental education, always improving our skills to make every one of us experts in our respective fields. We do this because of our passion for our profession and our commitment to providing our patients with excellent service and care."

As the primary educator of the practice, you must commit yourself to the patient, to the practice. and to your own high standards. Put your practice philosophy on paper, memorize it, and remind yourself daily to remain true to the practice mission statement. Walk and talk the practice philosophy, sharing it in word and deed with each and every patient:

"Mrs. Smith, our practice is very committed to providing each and every patient with the very best dentistry possible. Our goal is to help patients be able to keep their teeth a lifetime."

When you tell Mrs. Smith this, you must do your utmost to convince her that you mean every word. To be believed and trusted, your delivery must be sincere and confident.