by Patricia L. Flanagan, RDH, BS, and Stephen L. Langlois, DMD
What would it be like to have a practice full of patients who continually move forward with treatment? Imagine your patients saying, "Hey, doc, what's next on my treatment plan?" What if many felt so good about their care that they continually referred other like-minded individuals to you? No, this is not a dream that you will awaken from thinking, "Boy, wouldn't that be nice!" It can be a reality if you are willing to slow yourself down and learn to really hear what your patients are saying.
In the October 2003 issue of Dental Economics, we discussed the value of adding the position of "treatment facilitator" to a practice in an effort to move toward a comprehensive-care model for all patients.
In this article, we will look specifically at the new patient experience and how the treatment facilitator can partner with both patient and doctor in ways that can help a practice achieve a 90 percent or higher treatment-acceptance rate. The new patient experience is a patient-focused co-discovery and goal-setting process that enables patients to make informed choices and move toward optimum oral health. The key is communication, and so much of communication is about listening. Many practitioners find that their busy schedules do not permit time to really listen with full attention. Unfortunately, if we do not hear the full message our patients wish to share, we miss great opportunities to help them make healthy choices.
The first phone call
This listening begins during the initial patient phone call to the office. When you think about how this all-important phone call is handled in most well-intentioned offices, it is no wonder that communication is difficult. Often the receptionist, who is busy handling other tasks, takes this call. It is difficult or impossible for her to give the new client the time needed to really have a conversation. The potential patient may feel rushed. In reality, there is no time to fully understand if the client will truly be best served in this practice. The key is a phone conversation that is not interrupted and not rushed. An in-depth interview should take place to insure that both parties' needs will be met.
Many patients make the initial call to an office with the expectation that they will have their teeth cleaned on their first visit. Most have never experienced a comprehensive examination as the first step to individualized care. Unfortunately, we often are asking our patients to accept this shift in thinking without helping them see how they will benefit. Through focused conversation during this initial meeting, both the patient and the facilitator can ask questions and explore possibilities. The facilitator helps patients see what might be gained through this process by first learning what is important to them and then sharing pertinent information about the practice in meaningful terms. This creates a win-win relationship, where the patient and the practice feel that it will work and be beneficial to both. If a decision is made to reserve an appointment, it is with a clear understanding of what will take place during this examination and how it is relevant to the individual.
In our practice, this process has become smoother with time. Initially, we found that many patients did not understand why so much time was needed for "just an exam." They previously experienced a shortened version of the exam during their periodic visits to other dentists, and did not understand the need for anything more comprehensive. What a difference it made when our facilitator listened to their concerns, heard about their values, and explained how our practice — by trying to learn more about them, their dental history, and their current oral-health condition — could contribute significantly to their unique goals for health!
The importance of having that first in-depth phone conversation has made all the difference. Yes, it takes considerably more time and it cannot be rushed or interrupted; but, when the expectations are clear, the payoff is great. Patients often end the call with a statement like, "This is what I have been looking for!" Every patient comes in to the new patient appointment with a clear understanding of what our practice is about, what will take place and, more importantly, how he or she will benefit.
Initial patient visit
When the day arrives for our new patient to be seen for his or her comprehensive exam, the practice is prepared because the telephone interview has been thoroughly documented. Approximately two hours are reserved on behalf of the patient. In our practice, this involves one hour of doctor time, with the facilitator present for the full two hours. The facilitator is expecting the patient at the appointed time and greets the individual by name upon arrival. Introductions are made to the front-office staff, and the patient is then escorted to the consultation room (an operatory or private office also could be used for this purpose).
Patients spend approximately one-half hour with the facilitator in a preclinical interview before the doctor joins them. Each initial appointment is unique, depending on the needs of the patient. Although certain clinical information must be gathered, no specific agenda needs to be followed. This allows the focus to be totally on the patient. The discussion that ensues centers around the patient's primary concerns, perceptions of oral health, barriers to care, and preferred communication style. In our practice, we send each patient an acquaintance form modeled after the one that Dr. Michael Schuster teaches at the Schuster Center for Professional Development. This form helps the patient begin to think about some of the issues that will be discussed and it provides a template for the facilitator to guide the dialogue during the initial interview. When the doctor joins the appointment, the facilitator provides a verbal synopsis of what was discussed. This accomplishes three things:
1)Helps the patient recognize that he or she has been heard
2)Offers the opportunity to clarify anything that may have been misunderstood
3)Affords the doctor the opportunity to learn critical information
The dentist's role in the dialogue
The dentist can continue the dialogue by asking clarifying questions. Jay Hislop, in his book, Designing Your Perfect Dental Practice, states "Effective clinicians get 80 percent of their information from listening to their patients, not from the clinical exam." This preclinical interview is an excellent way to focus more on the human side of the first visit, while being efficient with the doctor's time.
Patients transition from the preclinical interview to the clinical exam with ease because rapport has been established, and they know they have been truly "heard." They know what to expect and they have given the doctor and facilitator their permission to move to the next level of co-discovery.
The comprehensive exam also is patient-focused and provides learning opportunities for both the patient and the clinical team. While paying close attention to significant clinical findings, the dentist engages the patient whenever possible. The examination is a co-discovery process where both the dentist and the patient learn about the patient's health. Using an intraoral camera — or even a simple hand mirror — can be extremely effective at "bringing the patient along." While assisting the doctor, the facilitator offers guidance to either the patient or the doctor if he or she believes there may be an opportunity to create more value for the patient.
Avoid dental jargon — patients usually tune this out. If necessary, the facilitator can explain a term and share its significance with the patient.
Close the appointment with the understanding that the doctor will review all findings and make recommendations based upon his or her knowledge of the patient's oral health, desires, and values. The patient leaves the experience with a new awareness of his or her current state of dental health. A consultation appointment is reserved to complete the experience for each patient.
Creating your own reality
All practices have untapped potential to help patients move toward optimum oral health. The facilitator's involvement during the new-patient integration process is one of the most effective ways to actualize this. To hear the patient's desires and formulate a plan that addresses them, while maintaining sensitivity to the doctor's available time, is the key difference that the facilitator can make.
Now, once again, imagine your patients saying,"Hey, doc, what's next on my treatment plan?" No, this is not a dream that you will awaken from and say, "Boy, wouldn't that be nice!" This can be a reality — your reality! Take the challenge! Ride the wave!