Show, Tell, Do
Communicating with patients can sometimes be a daunting task. We know that we don’t want to use overly technical language; but how do we convey a patient’s conditions accurately without it? We acknowledge that a patient will not commit to treatment s/he doesn’t understand; but how do we help him/her get the big picture? Our patients come to us with widely divergent dental “past histories.” How can we best address their fears and concerns? And what about explaining fees and insurance limitations? These issues often throw a roadblock into our patient’s accepting our recommendations.
One good method is the “Show, Tell, Do” system. This system provides for using an intraoral camera, or at the very least, a hand mirror, to show patients what we are talking about; a “script” we are comfortable with to explain what we are seeing and what might be done to correct problems, and then and only then, doing the service. Many dentists and staff skip the “show” portion and go directly to simply telling patients what they need. This can be a mistake. If staff skips the “show” segment, a patient may not fully understand why a service is needed; so he may decide to skip the “do” segment!
Let’s look at an example of using Show, Tell, Do. Joan is a new patient who was scheduled for a “cleaning” and exam. When she arrives, Shari, the hygienist, goes over her medical history, performs an oral cancer screening (to be followed by the dentist’s oral cancer exam) and gets the camera ready for photos. This is before beginning any type of “cleaning” service. As we all know, new patient cleaning and exam appointments bring with them many possible opportunities for misunderstandings. Why is this? Because until the patient is in the chair, we have no idea if she is going to require a standard adult prophy, a debridement, or is a candidate for scaling and root planing. In addition, we have no history with her so we don’t know what she has been accustomed to receiving in the past. Does she consider a polish with the prophy angle a “cleaning?” Has she ever had a periodontal probing and charting performed? The camera helps us introduce her to her mouth and lets her see what we see.
First Shari takes a photo of thick, heavy calculus on the lingual and facial of the lower anteriors, as well as a picture of 3mm recession on mandidular and maxillary bicuspids. She notices that #30 has a large MODFL amalgam restoration and a crack on the mesial surface. She sees that #19 has a large resin restoration, with recurrent decay around the margins. Both of these teeth are photographed. Tooth #3 has a large amalgam restoration, but appears to be in decent shape. A photo of this tooth is also recorded. Finally, she snaps a picture of Joan's chipped and worn front teeth.
Next Shari probes several areas of the mouth. She notices that the posterior tissues are inflamed and probing depths are 5mm around several teeth. She takes a photo of an inflamed area, as well as one of #22, which is not inflamed. Now she is ready for the “show and tell” portion of the appointment.
She sits Joan upright and brings the monitor close enough for her to see. Shari brings up the photo of the thick, heavy calculus on the lower anteriors and tells Joan what the picture means. She explains that this calculus is acting like a “splinter under your fingernail” and is a focal point for inflammation and infection. She shows the photos of the inflamed tissues around some of the posterior teeth, and the non-inflamed tissue around #22. Joan can easily see how different the tissues appear. Shari talks about periodontal disease and what it can do to the supporting structures of the teeth and how the mouth and body systems are related. She also tells Joan how different her teeth would feel if the calculus was removed and how much healthier she would be without the toxins that are currently affecting her mouth.
Next Shari goes to the recession photos, and describes to Joan what is occurring. When she gets to #30 with the large amalgam and cracked surface, she shows both #30 and #3 (as a “non-cracked” example). Since #19 has decay around an existing resin, these dark areas show up like the Grand Canyon on the monitor. The chipped and worn front teeth are displayed, with Shari explaining how these might be altered for better appearance.
Shari takes radiographs as ordered by the dentist, and after explaining to Joan what the numbers mean, records all periodontal probing depths and extenuating issues (mobility, furcations, and recession). Shari can see that Joan needs full mouth scaling and root planing. Since Joan was expecting a “cleaning” today, Shari tells her that she will remove the calculus from one segment of the mouth (the lower anteriors) but that this service is not complete. Often this is an important step, because patients can be very unhappy if their perception is that “nothing” was done today.
When the dentist comes into the treatment room he can go over all of the data collection that Shari has gathered, go over the photos and probing depths, confirm (or put a “watch”) on restorative recommendations, confirm the need for full mouth scaling and root planing, and then cause an estimate to be generated and presented by the treatment coordinator.
Although Joan is not happy that she needs periodontal therapy, restorative treatment on #19 and a crown on #30, because she has first been “shown” and then “told” about her conditions, she understands what is being presented to her. She agrees to “do” treatment, and schedules an appointment to begin.
Helping patients understand their oral conditions and treatment recommendations is an important function of a successful dental office. The Show, Tell, Do format can facilitate this.
Carol Tekavec RDH is the director of Hygiene for McKenzie Management. Carol can improve your hygiene department in just one day of training “in your office.” Interested in knowing more about how to improve your hygiene department? Email firstname.lastname@example.org.
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