Reader question:
When I treat complex clinical situations, I often feel that I am so intensely involved with treatment that I do not communicate well with the patient. What are the best ways to overcome this challenge, inform patients about the procedure, keep them involved with treatment progress, and reduce potential anxiety and fear?
Answer from Dr. Christensen:
You’ve asked a very important question, and since I am a dentist/psychologist, I can offer some help. I am sure that, at one time or another, you or a family member were involved with medical procedures in which you were or were not informed either preoperatively or during the procedure about what was actually going on.
How did you feel in each of the situations? If you had been informed about the procedure beforehand and received reassurance that the practitioner was knowledgeable and competent to perform that procedure, you would have felt much more confident that all would go well.
On the contrary, if you went in for the procedure not knowing any details—including potential outcome, healing period, possible complications, and alternatives—you probably imagined innumerable potential challenges. You may have had questions about whether or not you made the right decision to move forward with the procedure, or you may have experienced anxiety or increased blood pressure and been afraid of the unknown.
My brief answer to your question will hopefully provide direction on what to do in the future and how to accomplish those suggestions.
Staff education
Knowledgeable staff are essential to alleviate patient fears and thoroughly address their concerns. Your team must be educated routinely on all procedures that you provide in your practice. I recommend in-service education sessions.
It is relatively easy to determine which procedures need more staff education. For example, can your front-desk staff educate patients about a simple or complex multiple crown prep appointment, an implant placement, a third-molar removal, or an endodontic procedure? What are the steps in a complex six-unit fixed partial denture prep? Can all of your staff members, both front desk and clinical, explain the steps of the procedure to a patient?
One scenario could include local anesthetic delivered by dentist or staff, making an impression as a mold for the temporary restoration, preparing the teeth for the crowns/fixed prosthesis, making an analog or digital impression, making a bite registration, cementing the temporary restoration, and sending the patient home with instructions.
There are more than 100 procedures in general dentistry that can easily be the subject of in-service staff education sessions. I suggest having at least one educational session per month, and they can occur anytime you feel would be best for your staff. I prefer scheduling these sessions before a typical patient day—i.e., from 7:00 to 7:45 a.m. and allowing 15 minutes at the end of the session for the daily huddle before the first patient arrives at 8:00.
Staff provides diagnostic data collection and patient education
During a patient’s first appointment, after diagnosing treatment needs and patient desires, offer an introduction to the procedures you plan to accomplish. Having well-educated dental assistants (DA) and dental hygienists (DH) accomplish the diagnostic data collection while you treat other patients is an efficient use of time, and it is financially wise. This approximately one-hour staff appointment includes all or some of the following, depending on the complexity of procedures needed:
- Informational forms
- Radiographs, panoramic
- Radiographs, periapical
- Radiographs, bitewings
- Radiograph, CBCT
- Casts
- Patient education
- Intraoral camera
- Periodontal pocket charting
- Charting previous restorations and endodontic treatment
- Charting missing teeth
- Charting caries
- Pulp testing
- Charting soft-tissue lesions
- Examining for occlusal diseases
- Other oral pathology
- Blood pressure
- Patient desire for treatment and apparent ability to pay
For typical noncomplex patients, I suggest that the dentist needs to be involved only for an introduction at the beginning of the appointment and for a short time at the end to develop the treatment plan or facilitate patient referral. This concept is primarily a staff appointment that is administered and conducted by a competent DA or DH.
How does the staff or dentist provide patient education?
These are proven and effective methods to educate patients, not only during the diagnostic appointment but also as needed on all subsequent appointments: radiographs, diagnostic casts, models of potential treatment options, intraoral camera tour of mouth, digital photos of previous patients showing potential treatment results, books, patient testimonials, and educational videos.
What is accomplished by patient education?
These educational methods should accomplish the following purposes:
- Patients receive relatively detailed information about the suggested procedures and expected outcome.
- Patients understand the procedure and acknowledge that understanding when questioned by the office staff.
- Patients have enough information to decide whether or not to undergo the procedure.
- Patients agree with you to have the procedure accomplished.
The components of informed consent
Dental informed consent has the following components (which can be provided primarily by staff members but all confirmed by the dentist): treatment alternatives; their advantages, disadvantages, costs, and risks; and what happens if treatment is not done.
It should be obvious that this type of thorough patient education requires time, an educated and motivated staff, and your ability to follow through with treatment or, if needed, refer your patient to a competent colleague. In any case, your staff should be the primary educators in your office.
Education during treatment
As previously stated, staff members can educate patients while the dentist is busy treating other patients. I suggest sending patients home with written information regarding what was discussed that day, because they cannot always remember everything you and your staff tell them.
We also continue verbally educating patients during their treatment. When patients know what you are doing as you actually provide the treatment, they are much less apprehensive about what is happening to them. During active treatment, either I or the staff are educating the patient much of the time. Patients also need to know what to expect after completing treatment and when they go home. Many of the forms we use in our office explain follow-up treatment and any possible complications that patients should be aware of.
Summary
Patient education is mandatory for practice success. You must first educate your team about every procedure your practice offers. Staff members should then be the primary educators in your practice. Upgrading this education is a continuing endeavor as new concepts, techniques, technologies, materials, and devices evolve in the dental profession. This article has explained how to best accomplish optimal patient education.
Author’s note: The following educational materials from Practical Clinical Courses offer further resources on this topic for you and your staff.
- Simple patient education for every practice—23-subject video series that is especially effective when used during diagnostic or hygiene appointments
- Dental documents booklet—more than 90 pages of informational patient instructions on most of the dental procedures
- All-access pass—full access to all of PCC’s CE educational videos, every new CE video release, and our international study club
For more information about these educational products, call (800) 223-6569 or visit pccdental.com.
Gordon J. Christensen, DDS, PhD, MSD, is a practicing prosthodontist in Provo, Utah. He is the founder and CEO of Practical Clinical Courses, an international continuing education organization founded in 1981 for dental professionals. Dr. Christensen is cofounder (with his wife, Rella Christensen, PhD, RDH) and CEO of Clinicians Report.
