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Creating the Ultimate Doctor-Hygiene Patient Exam
By Karen Davis, RDH, BSDH
We’ve all been there. Frustrated! It seems as though the examination portion of the hygiene visit often lends itself to increased stress. See if any of these scenarios sounds familiar:
  • The doctor wonders how many times he has to ask his hygienists to please have intraoral pictures displayed when he enters the room!
  • The clinical assistant and hygienist both want to “wring the doctor’s neck” since it took forever to get the doctor in hygiene, and now it’s taking forever to get the doctor out!
  • The patient feels the tension from a feeling of being rushed, after waiting 10 minutes for the doctor to complete a two-minute exam!
  • The administrator’s neck muscles tighten as yet another patient complains about the fee for the doctor’s exam since, “She was only in there a minute, and besides, she said everything was fine!”
While there is not an easy fix to these common frustrations, there really are keys to make the doctor-patient examination more valuable and less stressful for all concerned. Warning, however, some of these concepts may take you out of your “comfort zone,” and some may require practice, in order to go smoothly and feel natural. Here is a brief look at a few strategies to create your own ultimate exam within the hygiene appointment.
1. Let go of the idea that a prophylaxis appointment is all the patient needs!

In practice after practice, hygienists are desperately attempting to educate the patient, change behavior, scale supra and subgingival calculus, remove all stain and plaque, perform and record periodontal evaluations, update radiographs, apply fluoride, identify restorative concerns, and so on, all in one appointment that lasts 40 to 60 minutes, if you get started on time!

Sound impossible? It often is. Even though most practices aren’t clear on the distinctions, the American Dental Association has done a great job defining the difference between a prophylaxis, scaling and root planing and periodontal maintenance. Ever wonder why the majority of adults have periodontal disease, yet the most common procedure provided in the hygiene department is still a prophylaxis? Perhaps it is because too often we are attempting to do too much in too little time, short of an actual diagnosis for what the patient really needs. Sometimes prophylaxis is just the beginning!

2. Don’t wait until the last five minutes of the appointment to have the exam

Time management is a challenge in any service industry where you are taking care of patient’s health needs, answering their legitimate questions, and providing treatments within a wide range of clinical conditions. In most busy dental practices, waiting until the hygienist is completely finished before notifying the doctor for an exam is almost a guarantee of running behind. Many times it is impossible for the doctor to immediately leave a tedious or technique-sensitive procedure to go examine a hygiene patient. The end-result? Everybody waits, and soon a “domino effect” takes place within the schedule.

Having a hygienist notify the doctor once data has been collected and potential treatment discussed will enable the doctor to look for a natural break in a procedure, interrupt the hygienist during his or her treatment, perform the examination, then both return to completion of their treatments. This approach requires hygienists get in the habit of notifying the doctor after the data collection and clinical discussion, but prior to beginning their instrumentation.

3. Use visuals to replace wordy descriptions

Patients will understand and retain information significantly better if audible and visual learning takes place together. Instead of us doing all of the talking (while working on the patient) and them doing all the listening, we should intentionally let the “pictures speak 1000 words” for us. Dental professionals have a tendency to use terms that are too technical and describe more detail than most patients really need when relying on our own verbal skills to explain the need for treatment.

Intraoral pictures, before and after pictures, educational pamphlets, radiographic pictures, etc., all assist in the co-discovery process necessary for patients to really understand and desire recommended treatment.

4. Sit the patient upright for communication

If ever you have been the patient in the dental chair you know what an uncomfortable position that is to carry on a conversation with someone who is seated above you. In fact, communication experts agree that as apprehension rises (as a result of someone with sharp instruments working in your mouth while lying on your back), listening ability diminishes. If you are willing to pause, sit the patient upright to describe conditions, discuss possible treatment, focus on the benefits to build value and use visuals, you will find you actually have to say less, because their ability to hear and retain information is significantly greater with the use of good eye contact and body positioning. Sitting upright also enables us to become a good listener, as patients feel more comfortable to discuss their true concerns.

5. Rise above insurance dictation

Patients all across the country tend to approach dental decisions much the same way: “If insurance pays for it, okay. If not, no thanks.” Particularly, if no symptoms are involved. In order to have an ultimate exam experience, patient’s questions concerning dental insurance should be consistently answered with a response that educates them about insurance reality. The reality is that dental insurance really is not “coverage.” That implies something that’s complete. Dental insurance is simply assistance to help defray costs. Most patients will never look at their own dental benefits any differently unless one by one in the dental office we are consistent in spreading the message that dental insurance was never intended to be complete coverage, and therefore shouldn’t be the only factor in deciding whether or not to proceed with treatment. It is simply a supplement, and wonderful when some assistance is offered, but all dental health decisions should be based upon need and desire, not insurance reimbursement.

Having an ultimate experience does require planning and forethought and may include change for some, but the rewards of being deliberate about how we approach this important time allotment in the hygiene appointment can directly lower stress throughout the practice, increase the patient’s understanding, and most importantly, improve case acceptance to achieve optimal clinical results we desire for all our patients.

Karen Davis, RDH, BSDH, is founder of Cutting Edge Concepts. Her 28 years experience as a practicing dental hygienist, and vast experience as consultant with The JP Institute, of San Diego, California, creates the context in which she relates, inspires, and challenges her audiences to “think outside their boxes”. Karen received her Bachelor of Science in Dental Hygiene from Midwestern State University, and since then has been an active participant in the dental profession. She speaks internationally, has authored numerous articles and has served on many advisory boards within the profession to share her passion for practicing comprehensively.
July 1, 2008