How to profit from . . . New-Patient Examination

July 1, 1997
A new patient`s experience is critical for the long-term relationship between the patient and "the practice." Although there are so many variables that influence this experience, both in and out of your control, the most important ingredient in a positive experience is the personal relationships that are built among the staff, doctor and the new patient.

Create a visual impact on first visit

Roger Briggs, DDS

Intraoral cameras keep new patients on same page with you during treatment planning

A new patient`s experience is critical for the long-term relationship between the patient and "the practice." Although there are so many variables that influence this experience, both in and out of your control, the most important ingredient in a positive experience is the personal relationships that are built among the staff, doctor and the new patient.

This goes back to the long-standing belief that the first few moments of contact with someone are when we form our opinions of that person. If this early sequence is "off," the new-patient experience also is affected.

In my practice, we think of our new-patient experience just like we were meeting Michael Jordan, Tiger Woods or Katherine Hepburn for the first time. These are people who we admire and respect, yet they all come from very different backgrounds. It is quite possible that they will have different needs based on our professional judgment, as well as their own needs and desires. We want to personally relate and appeal to all of the various personalities and people we serve.

A customer-focused approach

In my office, a new patient begins with a 12-minute, auto-play video in the waiting room. The video introduces and familiarizes patients with me and each of the staff members. It also explains our training and background, as well as some of our outside interests, by using both photos and graphics. We have pictures of each of us in our office setting, as well as taking part in hobbies and recreation with our families and friends.

The next step is a consultation meeting in a relaxed meeting room. In the hour-and-a-half that the new patient is visiting us on his/her first appointment, 15-20 minutes is spent in this room just getting acquainted with the person. We verbally go through each patient`s health and dental history, so that we can hear from the patient the experiences and reasons for coming to our practice.

Before going to the exam room, we conduct a brief tour through the office, introducing the patient to each staff person when possible. Once we are in the exam room and the patient is seated, I or my staff person (who will be gathering the data) will sit facing the patient and familiarize him or her with the equipment in the room.

The procedures that the dental team are going to perform during the periodontal exam are explained at this point. This helps put the patient at ease prior to putting the chair into a reclining position. Laying the chair back frequently makes patients feel more vulnerable. A thorough exam and records are the basis for good diagnosis and treatment-planning.

Intraoral cameras

A key instrument in the exam is an intraoral camera (IOC). The continual evolution of this technology has taken the complete exam and records to a new level of patient participation and codiagnosis. Even the most difficult and closed patient can become an active participant in the process through the use of the video images from an IOC.

As we proceed through the examination, my assistant and I interact using a "prompt and response" method. In other words, my assistant will ask questions during the exam in a manner that creates interest in the patient. My responses are the pieces of information that most patients are very anxious to hear.

The information that I give to my assistant is explained to the patient in terms that he/she can understand easily. It is important to create interest and an understanding of the conditions found in the mouth, both good and bad, so that the patient will want solutions.

The value of a comprehensive periodontal evaluation is reduced drastically if the patient does not understand the significance of what is detected. Communication, both verbal and visual, is critical. For example, if a patient (old or new) is not clear on the significance of his/her bleeding tissues, the acceptance of treatment is greatly compromised. This problem is alleviated by IOC images.

Today`s intraoral cameras provide the visual impact that helps patients recognize periodontal disease and other problems. More importantly, an IOC can impress upon them the need to proceed with treatment.

The latest intraoral-camera systems have a distally placed CCD camera and arc lamp-lighting technology that allows both better diagnosis and better patient understanding of periodontal disease - particularly in its early stages. The detection of early dental disease, even pit and fissure decay, helps patients recognize the need for early intervention and prevention.

For example, I quickly can show a patient a full-arch image followed by a close-focus image to illustrate a specific problem. I can compare images on a split- or multi-image screen, showing before-and-after documentation or just comparing what we are seeing in his/her mouth. The patient sees the diagnosis being made in front of his/her eyes and, in many instances, actively participates in the diagnosis. Thus, a patient can make an informed decision about his/her dental treatment.

Intraoral cameras do not replace the verbal skills of the provider, but they certainly increase the case acceptance of these early stages - as well as more complex needs and benefits of various treatments.

Treatment-consultation meeting

Once I have completed the exam and diagnosis appointment, the patient returns for a treatment-consultation meeting. At this time, I review the exam and provide the patient with specific treatment recommendations based on my diagnosis.

Part of this process involves revisiting images I have saved from the intraoral camera. The patient is shown images on the screen to explain what I have found and to better illustrate treatments and their results. I also can show case histories of previous patients to better illustrate what a procedure can do for them (or, what might happen if they don`t go ahead with a recommendation).

In the end, it`s the patient`s choice whether or not to act upon the suggested treatment. But, by creating a favorable impression of myself and my practice, and by dispelling the patient`s preconceived thoughts about dentistry, a greater number of patients do approve procedures at this point and are more likely to agree to recommended treatment in the future.

What this experience means

My experience is that high-tech equipment (intraoral cameras, micro-abrasive dentistry and lasers) makes it easier to be in a fee-for-service practice, which, in my opinion, gives me the most freedom. This high-tech approach has a very profound effect on new patients since the experience is so different from their previous dental experiences.

An open mind to treatment

I have found that new patients` minds are open to accepting the higher level of care that we can offer today, such as conservative cast-gold and porcelain inlays and overlays. This level of care can be presented in such a desirable prevention-based tone that most patients, at any income level, will want to make the transition into fine dentistry.

The infamous Reader`s Digest article certainly could lead a layperson to think that if his/her teeth could be "fixed" by one dental student for several hundred dollars, then a dentist who would recommend several thousand dollars worth of dentistry must not be trustworthy.

My experience has been that when patients are educated, understand their condition and are given treatment recommendations, they have power and control over their own dental decisions. This empowerment allows them to be more comfortable in our office, because they don`t feel like I "want to do something to them that is very expensive." This comfort factor leads them to more often choose my highest and best services of gold and porcelain.

For example, patients with a mouthful of amalgam can see the "tracks" of their past dental work. Therefore, they can see where they have had very few choices in the past.

With the enlightenment intraoral cameras can bring to the education and examination process, I believe that most people will begin seeing their dental health in a new way. Even existing patients can be educated more effectively on the benefits of quadrant or half-mouth rehabilitations and get out of the "crown-a-year" club. This is a win-win situation: Patients get the preventive dentistry they need by their own choice and you get to perform more challenging dentistry.

The bottom line

My new-patient approach, when combined with the intraoral camera, has made a significant impact in my practice. Since incorporating an IOC into my practice over six years ago, I have seen a 74-percent increase in revenue.

This revenue increase is not from a large number of new patients. In fact, I try to keep the number of new patients at a steady rate to ensure that I can perform fine dentistry on all my patients. I believe that if I see more than 30-35 new patients per month, it actually will lower my office production. The optimal number of new patients is more in the 20-25 per month range.

The combination of solidly-built patient relationships and the use of new technology create the framework for patient acceptance of fine dentistry and increasing practice productivity.

The author is a graduate of the Loma Linda University School of Dentistry and has served on numerous dental boards and societies in Arizona. Among his responsibilities include committee chairman for the Arizona State Dental Association Council on Public Health and a member of the House of Delegates of the Arizona State Dental Association.

The new-patient experience for children and their parents

The experience of a child coming into a practice can be a very nonthreatening one with the advent of intraoral cameras and micro-air abrasive tooth preparation. In addition, the intraoral camera is an effective education tool for both the child and the parent making the dental-health decisions.

Let`s take the example of a typical 10-12-year-old child with all four six-year molars and 12-year molars. While using the 40-power, close-focus magnification of the intraoral camera on the pit and fissures of an individual tooth, the parent and child have no difficulty understanding the susceptibility to decay of that part of the tooth. An IOC with close-focusing imaging can show things that just are not visible to the eye. It is explained that on the treatment appointment, the decay can be removed without the need of anesthesia and drills (in most cases).

In some cases, these patients can be seen the day of their new-patient appointment, since the actual treatment is quick and can be fitted into my treatment schedule. I have found that when we can accommodate a "soccer mom" like this, she certainly does appreciate how we have helped her with her busy schedule.

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