Staying on schedule

Sept. 1, 2004
One of the most frequently asked questions at my seminars, as well as when I am consulting on sight with a dental team, is the issue of time management for incorporating the hygiene exam.

Annette Ashley Linder, BS, RDH

One of the most frequently asked questions at my seminars, as well as when I am consulting on sight with a dental team, is the issue of time management for incorporating the hygiene exam. Here is how it typically plays out:

From the hygienist: One of the biggest challenges I have is staying on schedule. I often run behind because I am waiting for the doctor to do the exam.

From the doctor: How in the world can I stay on schedule when I jump up and down, and am interrupted all day checking hygiene patients? It is so stressful for me, disruptive to my work, and stressful for my assistants as well.

From the business team: We need to work on time management in this office. The patients glare at me (at the desk) when they have to wait to be seen. We run late much too often.

The periodic oral examination (exam during the hygiene/recall appointment) is a time-management challenge. Here are some ideas that I see working throughout the country. They are easily implemented when the entire team commits to the following minor changes.

1) Hygienists, do not wait until the end of the appointment to signal the doctor for the exam. The doctor should be notified once the preliminary data has been collected. This data includes a personal- and health-history update, oral cancer screening, the patient's dental concerns and a preliminary clinical assessment, necessary radiographs, periodontal assessment, intraoral camera tour, with at least one photo up on the monitor when the doctor arrives. This typically takes the first 10 to 15 minutes of the appointment.

The hygienist signals that the data has been collected. Ideally, he or she does this through an intra-office communication system, using the computer or another "silent" system that does not require leaving the treatment room and running up and down the office looking for the doctor. The clinical assistant is responsible for seeing the signal and now has 10 to 20 minutes in which to move the doctor to do the exam at his or her convenience. In other words, we build a "flex" period into the setting, rather than constricting the doctor (and the team) to the last 5 to 10 minutes of the appointment.

2) Doctor, perform the exam whenever you have a break in the schedule. For example, you have given anesthesia to a patient and leave the treatment room, turning that patient over to your incredibly skilled clinical assistant. The assistant cares for the patient to assure comfort, answers questions, reviews treatment, takes a shade guide to set the stage for a whitening procedure, turns the CAESY patient-education system on to the appropriate module, so the patient can "see" the possibilities for optimum oral health. Doctor, go to the hygiene patient now, when you have a break and it is convenient for you. In addition, if you have more than one hygienist, check both patients. If it turns out to be too early in the appointment, the hygienist will advise you.

3) In states where regulations allow for periodic oral examinations every 12 to 13 months on patients-of-record, some busy doctors have decided to identify those hygiene patients who may not need to be seen for an exam. (This is done with the understanding that this can change if the patient presents requiring an exam.)

One of the keys to successfully integrating these modifications into your practice is to allow and depend on the team to take responsibility for "coaching" the doctor. The chairside clinical assistant is responsible for being aware of the intra-team communication and for moving the doctor when appropriate to the hygiene room. Doctors who incorporate this strong team approach find their days are more efficient, productive, and less stressful. Huddle with your entire staff and discuss this approach to meet the daily challenge of staying on schedule.

Annette Ashley Linder, BS, RDH, is a recognized leader in the field and an award-winning speaker and consultant. Since 1989, she has presented more than 350 seminars and consulted in dental practices throughout the world. She is a featured speaker at dental meetings and provides in--office consulting services with her team of business and clinical consultants. She may be reached at her Web site at, via email at [email protected], or by phone at (804) 745-6015.

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