Clear Up Communication by Dr. Bryan Laskin

Dentistry is moving at an insanely rapid pace, with new techniques and technologies being developed almost weekly that transform the way we deliver care.  

In addition to all of the dental innovation, the rest of our lives is also experiencing the same explosive change. The mobile environments we’re surrounded by, coupled with the ubiquity of social media, alter the marketplace that we work in, and quickly shift how our patients select their dental care providers.

We can place guided implants in five minutes within 500 microns of where they’re best suited to place the final restorations. Endo will soon be similarly guided. In my office, amazingly aesthetic CAD/CAM restorations are placed within 40 minutes of the patient’s butt hitting the chair.

In my opinion, though, none of this really matters to patients.

Patients aren’t great at evaluating the quality of their care, so it makes sense that the amazing improvements in quality that today’s dentistry provides would fly over their heads. I, like many of you, wish that I lived in a world where patients would truly value the quality of care we provide, but instead I’m in the same reality, where that’s just not the case. Quality dentistry is incredibly difficult to provide to our patients, who often seem to be doing their best to make our job near impossible, grumbling as they flop around in the chair.

So, from the patient’s side of the chair, it’s truly the quality of care that is the most undervalued service in dentistry. But I believe that there is a subject just as significant as the quality of our care that is as undervalued from the dentist’s side of the chair: communicating with your team.

The irony is that many dentists go out of their way to impress patients with things they can see, like the latest and greatest technologies or gadgets. Yet one of the most impressive tools—and most inexpensive, too—is something patients never see: good intraoffice communication.

Communication conundrum
Here are two statistics that illustrate the horrible state of communication in health care:

First, 50 percent of the time a patient is in the chair in a medical office, the doctor is looking at a computer screen. Keep in mind, in dentistry we don’t get much of a chance to talk to people, because we’re often “in their mouth.”

Secondly, one-third of all medical errors are caused by miscommunication. Have you seen the elaborate systems that most health care practices use? I think we in dentistry are probably even worse.

When you go to the physician, how many times do you have to repeat your chief complaint? My guess is it is at least three times: the receptionist, the nurse and the doctor all ask you the same questions. It makes them look less like a well-oiled machine and more like they don’t have their systems together.

We in dentistry do the same thing—and we have fewer variables. There is no reason in 2018 that we should not have all the extremely valuable information the hygienist had discussed with a patient before we enter the room. In my office we use a simple checklist through our practice management software that’s sent to me as soon as possible and includes, in this order every time:

• Patient’s name
• Changes in medical history
• Chief complaint
• Perio status
• Restorative needs anticipated
• Radiographs taken
• General notes (got divorced, just went to Aruba, etc.)

In this way, my team is all on the same page without having to chase each other down, or yell down the hall. There are enough bells and whistles built into all the software we use daily and, because of that, we often overlook just how valuable the most basic features—like intraoffice messaging and alerts—really are. The time it takes to craft a single, informative note about an incoming patient and make that note available to all team members will not only save patients from having to repeat themselves, but also give them the immediate impression that they were listened to and that everyone is working together toward a solution.

 It’s not enough to say that you are “ready for an exam” today. I, like most dentists, am a linear thinker so I want all the information sent like a pilot’s flight checklist, where it is easiest for me to read it. If you poke your head in the room and shout out this information, the patient who’s currently in my chair now thinks that my focus is on getting to the next patient. Plus, how can your team convey that Sally is frustrated today if you mention anything related to politics, and might give you an earful when you enter?  The “old way” is not acceptable in our office.

Operatory oratory
If you have to describe all the gory details of the patient’s lack of hygiene while I’m in the room, you are shaming the patient. This is because there are three people involved: the patient, the hygienist and the doctor.  It takes only three people to have a public forum, and I believe that all people over age 18 who aren’t under the care of someone else should obtain any negative feedback one-on-one, because being lectured is one of the top reasons people hate going to the dentist.

So, we send information about the disastrous state of the patient’s gingiva via intraoffice messaging before the doctor enters the room, then use a verbal cue to remind the dentist to support the hygiene instructions—something like, “We discussed how to keep things clean in the upper right.” I then can back the skilled hygienist’s previous conversation with the patient by stating, “I see what your fantastic hygienist is talking about. Your gums are angry up there, so be sure to heed her advice and use the tools she’s given you to improve the area. I’m sure she will be excited to see your progress next time!” 

This keeps the language at a level the patient can comprehend, validates the hygiene instructions and supports the previous conversation with the hygienist, who happens to be the fuel to your fire regarding case acceptance.

Even more powerful is the transformation you will have in case acceptance by leveraging complete intraoffice communication with your team regarding restorative care. Allow me to illustrate this with an example:

Bob enters your office for a routine hygiene prophylaxis and exam. Meanwhile, that tooth #3 (an amalgam with 12 pins) that you’ve mentioned would benefit for a crown finally broke but hasn’t caused him pain, so he thought, “I’ll get it taken care of next time I get my teeth cleaned.” 

He walks into your practice, hangs his coat and tells Mary at the front, “Yup, that tooth Dr. Jones told me about finally chipped. She was right!” This is about as common a scenario as any that we see in dentistry.  That makes this example powerful, because it could transform many experiences in your practice.

How is Bob’s situation treated in most offices today? Mary says something like, “Well, Dr. Jones is a genius, so you should have listened to her when she told you a decade ago and had the crown done,” or maybe, “We can get you taken care of soon.”

Fast-forward a few minutes when Jane, the hygienist, brings Bob back and asks, “How are you doing today?” Now Bob has to repeat his story about breaking #3 on a soft piece of bread. Then, after hygiene, when the doc comes to check on Bob, he tells the same story for the third time. Bob gets a treatment plan for a crown at the end of his visit but goes home with a broken tooth. The patient’s chief complaint is ignored three times and often, Bob doesn’t ever come back. This is not acceptable.

With good team communication, Bob’s initial discussion with Mary would be immediately passed along to the whole team. The hygienist, assistant, doctor and treatment coordinator would all be communicating throughout the hygiene visit to validate Bob’s condition, make financial arrangements and get the operatory ready to fix that #3 immediately—if Bob so chooses.  

When Dr. Jones walks in the room, all she needs to say is, “Jane told me you broke that tooth we’ve talked about since the day after the last mammoth died. Don’t worry—we’ll get you taken care of shortly after my evaluation.”

Behind the scenes in this example, the front desk and hygienist have the opportunity to share valuable information gathered from the patient and pass it to doctor, treatment coordinator, etc., through means every dental practice already possesses.

This may seem like a subtle change, but in the patient’s mind this is high-quality care.

Foreseen finish
As stated at the beginning, patients cannot easily or often evaluate the quality of our care. They probably won’t notice the latest and greatest technology that you broke the bank to bring into the practice, or be aware of the clinical mastery you showed on their case. Instead, patients primarily judge us on one simple concept: how we make them feel. Other than perhaps alleviating their pain, nothing feels better for patients than when they feel listened to and understood.

Think of all the greatest customer service experiences you’ve ever received, and I’d guess the vast majority of them come down to superior communication. The opposite is probably also true. Bad experiences come from bad communication. This is backed up by the fact that many bad reviews and lawsuits against dental practices are caused by poor communications at the front desk (not poor dentistry). With a better patient experience comes increased case acceptance and production. This kind of change can take place in any practice without having to pay a penny to implement it.

Keep everyone in the conversation, and the opportunities from communicating effectively increase exponentially. Whether you use the checklist I provided earlier or develop your own system—one better than yelling details down the hall—try the process of passing valuable information along the grapevine and just watch the positive impact of patients who feel listened to, and a dental team working off the same page.

As a whole, we in dentistry have ignored the reality of inefficient and redundant communication for too long. Elevate the care in your practice easily by treating team communication as the valuable asset that it is. Your team and your patients will immediately thank you.

Bryan Laskin covers more about patient information in a free e-book
Discover more about securing patient information and your reputation in a free five-page e-book. To download the publication, visit dentaltown.com/laskin-ebook.