Cathy Jameson, PhD
The role of the hygienist in today's dental practice is multifaceted. There is much to accomplish in every appointment. Often, a hygienist will express concern about being able to get everything done in an allotted time. When asked about educating patients about dentistry, the hygienist will often exclaim in exasperation—"When?"
Certainly, there are numerous areas where extended education could be beneficial to both the patient and the practice:
1)dentistry that has been diagnosed but not completed
2) new areas of concern since the last appointment
3) new opportunities, such as cosmetic alterations or implants.
In addition, educating patients who are periodontally involved and need further treatment, or patients who need additional home care instructions, assure health and well-being to the patient. All of these educational processes take time, skill, talent and "want-to."
Often, I will ask the following question when addressing an audience: "How many of you have dentistry sitting in your charts waiting to be done?" All hands go up. Then I ask, "How many of you think that you may have more dentistry sitting in your charts waiting to be done than you ever have done in your practicing lives?" Most dentists and their team members will acknowledge that this is probably true.
This doesn't mean that anyone has done anything wrong or isn't doing a good job. It means that almost every practice has an amazing opportunity to get the dentistry out of the charts and into the mouths of the patients. Most practices can double their production by nurturing that which they already have—their existing patient family. Supporting this growth in the hygiene area makes great sense.
Patients have a very special relationship with their hygienist. The hygienist helps patients to get healthy as well as helping to ensure the health of any restorations that person may already have received. The hygienist listens to patients as they express their joys and concerns. Patients see the hygienist as a concerned "third-party" and have a very personal and trusting relationship. Business tells us that a person will never purchase a product or service if there is not a level of trust and confidence. Well, here is a place and a person who has just that—the trust and confidence of the patients.
This is not to infer that the patient doesn't have a similar level of trust and confidence with the other members of the team, including the doctor. However, there is a continuous interaction that is healthy, gentle, supportive and informative between the hygienist and the patient. Plus, the hygienist usually interacts with the patient more than anyone else. Familiarity leads to comfort.
So, let's go back to the question about how much dentistry is sitting in the charts. Ask your hygienist this question, "How many patients do you see, on average, per day?" Then ask, "How many of these patients need or could benefit from something beyond today—periodontal therapy, restorative treatment or cosmetic alteration?" Our own surveys of these questions result in the following: the average percentage of hygiene patients needing something beyond a given day is 60 to 70 percent. Think of that. If your hygienist is seeing an average of eight patients per day, five to six of those patients need or could benefit from other treatment.
In the practice of my husband, Dr. John Jameson, we schedule an average of $3,000 to $5,000 worth of dental treatment from hygiene daily. We practice in a small rural community in southern Oklahoma, working with one hygienist. So consider the fee difference and the number of hygienists you may have in your practice. The numbers are substantial. We give our hygienist not only the time to educate patients in every appointment, but also the opportunity to help people make a decision to proceed with needed or desired care.
An educational system
The success of your practice is in direct proportion to the success of your systems. Synonyms for the word "system" are as follows: organization, arrangement, structure, coordination, method, orderliness. Consider the value and benefit of having systems in your practice that epitomize those words. Makes good sense, don't you think?
Your hygiene systems need to be organized in such a way as to provide for excellent care and to provide time and armamentarium for the hygienists to educate patients on any dentistry diagnosed but not completed, areas of concern, and also new opportunities for improved health or appearance.
Go through each of your hygiene appointment types—adult prophylaxis, child prophylaxis, all the periodontal appointments, sealants, bleaching—whatever type of appointments that are handled in your hygiene department. Analyze each appointment type to determine what is being done, how long each aspect of the appointment takes, and the total time needed to provide an "ideal" appointment without compromise. Next to each aspect of treatment, indicate how much time would be necessary. As you go through each appointment, look for areas where you could be more efficient and more effective, always paying close attention to time management.
Include time and space in each appointment for patient education. I am not just referring to educating patients about home therapy or co-therapy, although these are imperative. I also am indicating time to educate patients about other treatment. "How much time?" you may be asking. Do a time-in-motion study. See how much time you need, on the average, to do a good job. This would be the appropriate amount of time to include in each appointment.
When you add up the time that you need for the ideal appointment, you may be stunned to find that you need more time than is being scheduled at present. If so, ask yourselves, "Would we give up one hygiene appointment per day to give our hygienist more time per appointment, if this time were dedicated to patient education?" Put a pencil to it. Consider giving your hygienists the freedom and the respect to schedule the appropriate time for each patient. If you dedicate more time to introducing or educating patients about opportunities, this becomes more than a request. It becomes a required part of the appointment, just like necessary radiographs.
An adult prophylaxis appointment in our practice is valued at approximately $178: prophy, evaluation, bite-wings (when appropriate), and fluoride. "Wow," you might be saying. "Give up $178 per day?" Yes, since $3,000 to $5,000 comes from our hygiene treatment room daily. Would you give up $178 to generate $3,000 to $5,000 per day? Think about it.
In addition to the increased revenue, your patients will be better served. You wouldn't diagnose something unless a patient needed or wanted it. So, if a patient walks out your door not proceeding with treatment, both you and the patient lose. You would be able to do more of the kind of dentistry you believe in and your patients would be healthier or more beautiful, possibly both.
The American Dental Association surveys indicate that the main reason that people do not come to the dentist or do not say "yes" to recommended dental treatment is a lack of dental education, or no perceived need. Using deductive reasoning, it makes sense that if lack of education is the main reason people do not come to you or don't say "yes" to your treatment recommendations, then the greatest commission of dental professionals is to become better educators. And, by the way, great educators are great persuaders. They know how to communicate well enough to motivate people to "buy into" that which they are teaching or introducing.
Once you have outlined what you consider "the ideal" for each type of hygiene appointment, and you have determined the time you need to add education to your hygiene appointments, begin developing the system of education that you wish to incorporate into your practice.
Visual aids
My background is in education and psychology. For most of my life, I have studied how people learn. The more senses you use to educate, the better the learning will be. Approximately 83 percent of learning takes place visually. About 11 percent of learning is auditory. The remainder is a combination of the other senses.
Plus, repetition is the key to learning. Just because someone has heard something once doesn't mean that the person will "get it" or will "buy into" the proposal. Repetition not only answers questions, it also solidifies the benefits of the proposal. All behavior is driven by "what's in this for me?" It becomes essential that you focus repeated conversations and presentations about treatment recommendations on the benefits and end results of treatment. Be sure to outline and "show" the patient how your recommendations will enhance that person's health or appearance—or both. Stress the end results of treatment. Plus, do not hesitate to point out any risks that might occur if a person fails to schedule an appointment or even thinks about canceling the appointment.
My husband believes that if you stop reinforcing the need for treatment to a patient, the person begins to think that they are "miraculously healed." Some dental professionals stop talking about diagnosed treatment because of concern that the patient will think they are "bugging them." Unless a person specifically asks you never to review your recommendations, don't give up. Keep re-evaluating and reinforcing.
For example: Let's say that a person has come to your practice for a comprehensive oral evaluation. The doctor has diagnosed decay in two different quadrants and has recommended removal of the decay and restoration of the teeth with composite restorations.
But now the patient comes to the office for a hygiene appointment and it is noted (during the morning meeting) that the patient has dentistry diagnosed but, at this time, incomplete. The patient proceeded with one quadrant but not the second one. So the hygienist shows the patient a photograph of the area that has already been treated and what the teeth looked like prior to and following treatment.
Then, the hygienist goes to the next area of necessary treatment and takes or retrieves a photograph of this area, showing the patient the next area to be treated. The hygienist addresses the patient in the following manner: "Mrs. Jones, this is a photograph of the upper left area of your mouth that the doctor treated at your last appointment. How does that look to you?"
Listen. Then, go on. Show the patient the next area to be treated.
"Now, let's look at the lower right area of your mouth. You have two teeth that have decay in this area. Let me show you. We need to schedule an appointment to have the decay removed from these two teeth so they can be restored to health. Putting this necessary treatment off is difficult. It isn't going to get any better and you risk the decay getting much worse and needed treatment being more extensive. What questions do you have that I might answer for you?" A patient education video could be shown here for back-up support.
Video dentistry
There is no method of education better than visual aids and there is nothing better than video dentistry to show a person what is going on in their mouth. In addition, as you are showing a person their mouth, you can show them photographs of other situations—other people who have had a situation similar to theirs. Show the patient another situation so that he or she can relate to it. Then show the patient what you did to restore the mouth to health again or to change the smile. (Obviously, written permission from the person whose photographs you are showing is required.)
For example: A person has a fractured cusp. Show them the problematic area with your intraoral or digital camera. Then point out to that person someone else who had a similar situation. Show them the results of the treatment the doctor provided, stressing the benefits of the treatment. If you are taking photographs of every situation and are storing these photographs in the patient's record, which we recommend you do, show the person someone with a fractured cusp who did not follow through with the recommended treatment—and the resulting problem. Let people see the benefits of quality, long-lasting treatment but also let them see the truly negative possibilities of not proceeding.
In addition to video dentistry—intraoral and digital cameras need to be a part of almost every appointment—use patient education programming to let people see brief, patient-friendly instruction related to their particular situation. If possible, have this programming in all treatment rooms, in the consultation room, and in the reception area. This allows you to receive back-up support for your recommendations as well as introductory information about treatment possibilities.
Having written supportive material is also beneficial. However, don't just put brochures in the reception area and think that people are going to pick these up and get excited about treatment. Rather, let your literature be supportive of what you are teaching. There are patient education programs that can be placed in the reception area that are programmed to reflect the kinds of dentistry you are providing. Some of these individualized programs will also create a unique video about you and your team. Appropriate literature can be placed adjacent to the video player or television monitor so that patients can retrieve information of interest to them. Be sure to ask the patients about this when they come to the consultation room or the clinical area. "Mrs. Jones, did you enjoy the video presentation that was playing in the reception area? Was there anything that was of specific interest to you?"
In summary
At Jameson Management, we stress the value of patient education to not only improve the patient's hygiene health, but also as a part of helping every patient become comprehensively restored (whatever that might mean to individual patients).
• Outline your appointments. Define the "ideal" appointments.
• Determine how much time you need to include quality education in your appointments.
• Determine how you will incorporate visual aids, including video dentistry, into every appointment in order to get the dentistry out of the charts and into the mouths of your patients.
• Practice what you are going to do and how you are going to do it. The hygienist understands the value of education to the patients and to the practice. Support the hygienist in consistently adding this dimension during an appointment.
Does the hygienist have a valuable role as an educator? We think so.
