Serious time issue

March 1, 2011
I have been a dental hygienist for over 20 years. Recently, I relocated to a different city and found a position in a very upscale group practice.

by Dianne Glasscoe Watterson, RDH, BS, MBA
[email protected]

Dear Dianne,

I have been a dental hygienist for over 20 years. Recently, I relocated to a different city and found a position in a very upscale group practice. There are six general dentists, four specialists, and six hygienists. The office is beautiful and has very nice equipment, I am well paid, and I feel I have integrated well into the practice. Sounds great, right? So what could be my problem?

The problem is having my schedule wrecked almost daily from having to wait excessively long for the doctor to check my patients. Twice this week I have left the office in tears at the end of the day from the stress of running behind schedule. It is common for me to be a full patient behind. I'm the last one to clock out, and the office manager is questioning why it takes me so long. I have never worked in a practice where I feel so disrespected by the doctors, plus, I don't like making my patients angry. I feel like I'm always apologizing for keeping them waiting. One of my female patients recently had to wait 30 minutes for her exam. When the doctor came in the room, she blasted him for making her wait and ruining my schedule. I have never worked in an office where getting the doctor to check my patient was such a problem, and this problem is stressing me to the max! I am normally very prompt. What can I do to get the doctor to check my patients so I can stay on schedule?

Brenda, RDH

Dear Brenda,

I can feel your pain! I, too, am a very prompt person, and running late for anything is a major source of stress for me. Without a doubt, the No. 1 complaint that I receive from hygienists is running behind schedule because of having to wait excessively long for the doctor exam. You are not alone in your frustration.

Consider the doctor's position. In some practices, the doctor is scheduled so heavily that there is no time in the schedule for hygiene exams. I've witnessed doctors literally running down the hall to do a hygiene exam. In one such practice where I consulted, the doctor told me that keeping hygiene checked was the most stressful part of his day. Consider what it would be like if you had to get up from every patient to go do something else.

There are two issues to consider: 1) schedule control, and 2) best time to summon the doctor. The primary problem causing your dilemma is poor schedule control. Simply put, there is no time in the doctor's schedule to examine your patients in a prompt manner. If you have 10 patients and it takes five minutes to perform a hygiene check, that's 50 minutes. In many doctor schedules, there's not even five minutes extra, much less 50. Even with a "normal" schedule, treatment does not always progress the way it is scheduled. Sometimes procedures take longer than expected.

While scheduling is a front desk function, the business assistants usually schedule according to the time requested by the doctor. Some doctors do not allow themselves enough time for procedures. For example, a doctor may feel he can do a three-surface composite in 40 minutes, but the reality is that it takes 50 minutes. Being too conservative on time allowance causes logjams in the doctor's schedule, which spills over to your schedule.

There may be a logistical problem as well, particularly if your building is large and your operatory is not close to the doctor's operatories. When the doctor has to walk a long distance to your operatory, that distance adds to the time issue.

The second problem is the timing of the doctor summons. In many practices, the hygienist waits until she or he is completely finished with the patient before summoning the doctor. If the hygienist uses all or almost all of the scheduled appointment time, waiting until the end to summon the doctor will guarantee the hygienist to run behind. You finish your patient, you summon the doctor, and then you wait … and wait … and wait. You feel bad if you leave the patient alone in the operatory, but eventually you run out of small talk and the awkwardness of dead air envelops the operatory. "The doctor will be here shortly," you say as you offer the patient a magazine and then pace the hallway and tap on your watch face. You can feel the tension building with each passing minute, and by the time the doctor arrives, you're 10 minutes into the next patient's time. It takes another 10 minutes to complete the check, dismiss the patient, turn over the room, and seat the next patient, who by the way, has been waiting in the reception room for 20 minutes. Nobody wins when you wait until you're finished to summon the doctor.

Here is what I recommend. Speak with the doctor privately and tell him that you want to treat your patients with excellence, efficiency, and most of all, respect. Tell him you understand that he is not keeping you and your patients waiting on purpose, but that his schedule is the problem. Ask him to consider your dilemma and the disrespect being shown to patients by making them wait excessively. Ask if it is possible to lighten his schedule slightly to allow time for timely hygiene exams.

Further, I would ask you not to wait until you are finished to summon the doctor. Incorporate an "interrupted exam" protocol. The sequence is:

a. Greet and seat the patient
b. Update medical history
c. Take blood pressure reading
d. Do a tour of the mouth
e. Take any necessary radiographs
f. Perform any necessary chartings
g. Summon the doctor

This gives the doctor 20 to 30 minutes to get to your operatory for the exam. Other than a chairside emergency, I know of no valid reason why a doctor would keep a hygienist waiting longer than that. If the patient has a heavy buildup of soft debris, polish first so the doctor will have an unimpeded view of the teeth. When the doctor appears in the doorway, say to your patient, "Oh look, here's Dr. X. I'm going to stop long enough for him to check you, and then we'll finish up."

Unfortunately, most people do not like going to the dentist. They know we use sharp, pointed instruments and needles in their mouths. Many have had painful, unpleasant dental experiences, and they walk in our doors unhappy that they have to be there. It seems the least we can do is be prompt and not show disrespect by keeping them waiting an inordinate amount of time. Their time is just as important as ours. If we disrespect their time, they will disrespect ours by being late or breaking appointments.

The fact that one of your patients recently admonished the doctor for the long wait should have been a wake-up call. Let's hope he is amenable to improving his schedule and changing the exam protocol before he loses patients. After all, good customer service is important!

Best wishes,

Dianne Glasscoe Watterson, RDH, BS, MBA, is a professional speaker, writer, and consultant to dental practices across the United States. She is CEO of Professional Dental Management, based in Frederick, Md. To contact Glasscoe Watterson for speaking or consulting, call (301) 874-5240 or e-mail [email protected]. Visit her Web site at

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