Are Your Patients Going Through A “Phase”?
When presenting treatment diagnosis to patients, it is best to reinforce to your patients that your concern is for their overall health and total well being—after all, these are the main concerns of healthcare providers. Dentistry is important to achieving total well being and should not be downplayed to “watch it, and when it gets worse we will treat it.” So how do we translate evidence into billable, buyable services?
Often dentists are reluctant to think beyond the laundry list of procedures based on the diagnoses of evidence before them, but presenting the total treatment plan will absolve the dentist from not delivering all the information to achieve informed consent. Dentists often say that they feel responsible for giving a patient all treatment options during the initial visit or they will be liable for non-disclosure of important information. Yes, it is important for the dentist to comprehensively evaluate a patient prior to treatment and to report the findings in an accurate diagnosis explaining the appropriate course of treatment. However, if the patient chooses not to return to the practice, the dentist has little to do with the outcome.
When I look over many paper treatment plans and computerized treatment plans, I observe that the immediate treatment is blocked into appointments with everything that is to be done on the right side in the same appointment and everything happening on the left side in one appointment, whether it is scaling and root planning or crowns. Maybe the thought is to meet an hourly goal for production by doing as much dentistry at one time as possible. Sometimes this works but the patient doesn’t always understand the reasoning behind it. Plus, patients don’t care if you meet your daily goals.
By phasing treatment and explaining the system to the patient, a new understanding of where the patient is with a personal treatment plan will come about. Phasing of treatment is not a new idea but, because it involves monitoring the patient, it is often not implemented into the practice. For instance, all patients that have come in for emergency care are in Phase 1 and do not move out of this phase until no longer in pain and the immediate concern is under control. This phase includes necessary radiographs and may involve removal of infected teeth and antibiotic treatment. If this patient never returns to the practice after that visit, he/she remains in Phase 1. Actively marketing this patient for further treatment is often not pursued.
When the patient is free of pain, diagnosis is the next step in Phase 1. The remainder of the series of radiographs is taken along with diagnostic casts and intra-oral photos. The dentist may determine that the patient can go on to the hygiene department for assessment of their periodontal condition and preventive care. The dentist should monitor them through any periodontal care including scaling and root planing, the use of anti-microbials, desensitizers and topical fluoride treatments. That means coming into the operatory during hygiene visits to see the patient.
A satisfactory degree of periodontal maintenance must be achieved before a patient can move on to Phase 2 of treatment. The patient is educated to understand that the outcome of Phase 2 is dependent on the success of Phase 1.
Phase 2 starts when the hygienist and doctor determine that the patient has achieved an infection-free level of periodontal maintenance and is compliant with home care. This phase includes single- and multi-surface restorative on individual teeth. Endodontic treatment is performed in Phase 2.
Phase 3 includes single unit crowns, inlays and onlays. Teeth bleaching, if indicated, would be completed before the insertion of tooth-colored prosthetics. For children, space maintainers and orthodontic care is delivered while monitoring home hygiene care. Regular check-ups are required to warranty cast restorations and orthodontic outcome in this phase.
Phase 4 is the time for replacing removable prosthetics and the placement of implants. Fixed partials or overdentures are processed and delivered. Any additional periodontal surgery and other advanced treatment that is dependent upon the success of Phases 1 through 3 are performed. Phase 4 will also include further orthodontic care for children or adults. Compliance in maintenance and follow-up in the recall/hygiene department is again enforced to warranty all prosthetics, whether fixed or removable.
Phase 5 is achieved when the patient is placed into the recall system following the completed phases of treatment. The careful monitoring and follow-up of patients placed in recall is vitally important to ensure patient retention. Generally, patients appreciate letter reminders and calls in regard to scheduling their recall appointments; studies show that about 20–30% of patients that are overdue will schedule when called.
If treatment is phased, the patient should come to understand the necessity for continuing until treatment is complete and they can be maintained at a healthy level.
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