No more no-shows!

March 1, 2000
For patients to keep their hygiene appointment, you`ve got to have a carrot. Here`s some things you can do to create value.

For patients to keep their hygiene appointment, you`ve got to have a carrot. Here`s some things you can do to create value.

Gloria J. Anderson, RDH

In some dental offices, it is a daily struggle to keep patients in the hygiene schedule. The patients seem to bail out as fast as they are scheduled! The stress on the team generated from this daily scheduling turmoil is almost unbearable. The doctor is stressed from witnessing the schedule empty out one-by-one. The hygienist is stressed when her productivity is affected. The receptionist or scheduler is stressed from feeling the pressure to reach a goal that is never attainable.

Everyone in the office starts to feel a little more uptight! It`s not exactly the atmosphere we want to look forward to every day.

Why is there such movement in the hygiene schedule? Why do hygiene patients exhibit the same behavior whether they are in Oregon or Florida?

The answer, ladies and gentlemen, is because we have conditioned patients` behavior! We have not established what a patient`s perceived value or commitment should be to a prescribed appointment interval. (This phenomenon is even more ironic when you realized that, all across the country, a shortage of hygienists is perceived.)

To see where I am going with this, let`s now take a look at my own top 10 reasons why patients don`t keep their hygiene appointments ... or stick to their hygiene schedule!

Heard any of these excuses before? Do they sound familiar? Do any of these reasons sound like the dental hygiene appointment has any value to the patients? Not much, I`m afraid! It`s that perceived lack of value that is our challenge, our duty, and our responsibility to correct. We must promote the perception of value to our patients at this very beneficial and multifaceted visit.

This process must take place at the chair. The responsibility falls squarely on the hygienist and the doctor to elevate the importance of this encounter. Using this appointment time wisely and efficiently can make all the difference in the world toward enhancing the patient`s understanding, appreciation, and perceived value. At each segment of the patient`s visit, we must not miss an opportunity to advance awareness.

10 segments of the appointment

A typical dental hygiene appointment can be broken down into 10 general segments. Some steps of the appointment may not occur at all. Some may occur in a different pattern, and certainly others may be entirely different. Each office or hygienist may have a slightly different routine. However, I believe all of us are all familiar with these steps.

Bear in mind that, in no way, should the appointment time need to be increased. What I suggest can easily be accomplished within a normal schedule. We are not increasing what we do, so much as we are using the time we have more efficiently.

1) Familiarize yourself with the patient`s chart notes. This is the time to take notes about the patient`s history. The additonal personal information about them gives us insight into them as individuals. Our patients are not all the same. Communicating with them on a personal level will do wonders for motivation.

2) Meet, greet, and seat! Always remember the pleasantries. Welcome this patient back to your operatory just as you would welcome a guest into your home. Being gracious and friendly is so important, but don`t dwell on small talk. Know when to transition; after all, patients are there for a reason and you`ve got a job to do!

3) Health history review - Relate the significance of any changes that have occurred. The patient may be totally unaware of why we gather this information in such great detail. If they understand why we are so careful, it suddenly becomes important. Inquire about any problems that patients may be having. This is another great opportunity to show our concern for their oral health and our commitment to helping them.

4) Films - This often is a very sensitive issue with some patients. Your office should already have adopted a procedure on how to address the patient who is reluctant about radiographs. It always is wise to explain how this step enhances our ability to clearly and concisely diagnose. Without this important tool, patients certainly are not getting a complete examination. Comparing old films or actually pointing out calculus, bone loss, or decay on films is highly instructional and more interactive.

5) Assess the oral situation - Evaluate home care, deposits, bleeding, pocket depth, etc. Talk about what you are doing and what you are finding. How does what you are seeing today compare to the patient`s last visit? How does it compare to the norm? Share with your patient that you are concerned about the negative changes and that you want to introduce the necessary steps to remedy the situation.

6) Question patients about any changes in their routine. Ask them to demonstrate home-care techniques. If there is improvement, do not miss this opportunity to praise patients for their efforts. Chances are, if they had not followed your recommendations for home care and they had not been faithful to the proper recare interval, the situation would not have improved. Attribute their success to things you shared at their hygiene visit.

7) Plan the strategy for the rest of the appointment. This is an excellent time to discuss what you have found and what to do next. Always keep a dialogue going with patients, assessing their understanding, reading their facial expressions, and inviting them to ask questions. Based on the data you have gathered or what you have observed, explain your recommendations for proceeding. It may not be what a patient expected today. If you do not deal with patients` expectations, there is a chance you may really turn them off or even lose them altogether!

8) Instrumentation - Depending on how the appointment is going, this is most likely the next step, but not always. In the event that you are planning to scale and polish at this appointment, remember to keep the patient informed as you go. Explain how certain areas may need the benefit of root planing instead of scaling.

You don`t want to be accused of information overload. More than ever, you must continue to read your patient. Not every patient is a candidate for this type of demonstration.

9) The doctor`s exam - If the doctor is going to see the patient at this appointment, a few things have to happen first. The hygienist needs to inform the doctor about how the appointment has gone thus far. If periodontal disease has become an issue, the doctor needs to see chartings, films, etc. If the hygienist has made recommendations to the patient, the doctor needs to be aware of them.

Often, it works out best to share this information in the room with the patient. However, circumstances may dictate a brief conference out of the patient`s presence.

The main thing is to both know all the facts and be in agreement. Supporting and reiterating the hygienist`s findings and treatment recommendations for this patient is the single, most important thing that the doctor can do during this visit. If the doctor misses the opportunity to verify the hygienist`s findings and instructions, the vast majority of appointments` importance will be lost! If the doctor doesn`t even care what happened during the hygiene visit, how significant can it be?

10) Dismissal - Depending on the protocol of your individual office, a variety of things can happen at this point. It`s always a good time to check again for questions patients may have before they leave your room. It also is a good time for the patient to be informed about what will happen next, such as walking them to the front desk, scheduling the next appointment, etc. Remember to reinforce what the patient`s next visit should be and what kind of interval you recommend.

The recall system

I have yet to mention a recall system or whether it is better to preschedule or not. My feeling is that whatever policy you adopt, develop it thoroughly, utilize it consistently, and maintain it continuously. This way, you will train your patients to respond to whatever system you find works the best for everyone.

If your current system has been neglected or is inefficient, it may be time for a new approach. Do not incorporate statements into your system that give your patients permission to cancel or fail their appointments.

For example, a statement on a card or on the phone that says, "If you have to cancel this appointment for any reason, please let us know," is an invitation to cancel! A better phrase would be: "We are expecting you at 9 o`clock on Monday. If this appointment cannot be kept, a charge may be incurred."

I know that there are very strong feelings on both sides of the charging-for-missed-appointments issue. However, this statement allows you some flexibility and eliminates the "give us at least 24 hours" notion that is exactly what you are trying to eliminate! Make sure one individual is responsible for the recall system. You also want to ensure that the patient is informed about how this new system will work for them and what is expected of them. Keep track of missed appointments in the chart or on the computer. This history will help you develop a winning strategy with this patient.

Many consultants and practice managers recommend always prescheduling the next hygiene visit. However, if you try to preschedule someone six months in advance who really doesn`t want to be scheduled that far in advance, this policy will be used against you. You will hear all sorts of reasons why the appointment was not kept. I recommend always asking your patients for their preference. Some absolutely will insist that they be rescheduled at a certain time and day several months down the road. Try to have a system that is flexible enough to accommodate everyone.

Everyone gets into the act!

To reinforce the value of the hygiene visit, everyone must share in the responsibility. When staff members are supporting each other`s endeavors, the patient sees the priority of the situation. For instance, a patient is in the doctor`s chair for an unexpected procedure, and the dental assistant sees from the chart that this patient is past due for the hygiene visit. Taking the time to discuss the importance of this visit with the patient and offering to get this individual scheduled is another opportunity for reinforcement.

We all know our patients wait until they get to the front desk and no one else is around before they unleash all their questions and opinions. For that reason, the front-desk staff has to have special support and training to make sure each auxiliary is being consistent with what other members of the dental team said. Keeping everyone on the same "page" and comfortable with patient questions requires some in-house training and possibly even role-playing.

The perception of value and appreciation come from what patients experience in the chair. Value is not created when they receive a phone call telling them they are eight months past due for their hygiene appointment, it does not come from a postcard (no matter how cute it is!), and it does not come from a reminder call the day before. Value comes from the things patients experience while they are in your chair.

Gloria J. Anderson, RDH, BS, is the founder and president of The Anderson Group, a dental practice-management firm located in Enid, Okla. She has over 25 years of experience in the dental field, with combined experience as a hygienist, office manager, and a consultant. She also is part of the Linda Miles and Associates` Speaking and Consulting Network.

Top 10 reasons why patients don`t keep hygiene appointments

(1) I don`t remember making that appointment six months ago! No, I didn`t get a reminder!

(2) I already know how to brush and floss and that`s all they ever tell me anyway.

(3) It costs way too much and I don`t have that many teeth.

(4) If I go, the hygienist will just "yell" at me.

(5) My insurance will only pay for cleanings every six months, and you guys tell me I should come in every three months? I don`t think so!

(6) I have sensitive teeth and that scraping really hurts, not to mention the probe thing!

(7) I have been coming here for years, and now all of a sudden you tell me I have some special bone-loss thing and then charge me for a type of cleaning that my insurance won`t pay for! I think you are just trying to make more money off me!

(8) The hygienist is done with me in 10 minutes, and then I wait forever for the doctor. It`s a waste of my time!

(9) Something came up. I won`t be there.

(10) It`s only a cleaning!