Trust - The Most Important Element for Case Acceptance
Last month a friend called me in alarm with questions concerning her dental health and some recommendations her dentist had made. She had been seeing this dentist for several years and was on a six-month recall schedule. At her last recall appointment the dentist told her that she had serious bone loss throughout her mouth and would likely need to have several teeth removed, bone grafting of some type, and eventually implants placed. He recommended that she make an appointment with a periodontist right away.
Needless to say, my friend was shocked and upset. While she suspected that she may have suffered some bone loss over the years, she had no idea that her situation was such an emergency. She wanted to know what she should do.
First I asked if she knew what her periodontal probing depths had been over the years and had she ever had scaling and root planing. Then I questioned her about radiographs, any recession or bleeding, and had she noticed any teeth that seemed mobile. She wasn’t sure about any of these, and called her dentist back for answers. He offered to send copies of her records concerning these issues. As it turned out, full mouth probing and recording had not been accomplished in four years, and none were recorded at her last appointment. There were no notations concerning recession or bleeding. Her last radiographs were two bitewings taken last year, and prior to that there were two bitewings taken three years previous. There was no full mouth survey or even a panograph. My friend did say that #2 felt slightly mobile to her.
My advice was to seek out a second opinion immediately. She did this, and her new dentist recommended removal of #2 as bone loss was occurring that might affect #3. A bone graft was placed with a future thought to a possible implant. No other treatment was recommended as her perio readings were 3 and 4 mm with generalized 2mm recession and no bleeding. He recommended she increase her recall intervals to four times a year to be sure that no deeper probing depths were missed going forward.
While it might be easy to just write off my friend’s first dentist as not being a thorough diagnostician or adequate record keeper, there is more to discuss here. Presenting necessary treatment to a patient is not simply a matter of announcing what needs to be done. Information, data collection and detailed communication are key. Case acceptance is also predicated on basic trust. It is the most important element in helping your patients agree to the treatment they need.
• Information is often best presented in a “Show, Tell, Do, Re-Tell” format. For example: Current thinking on periodontal probing is that a full mouth recording should be performed at least annually. Show the patient the periodontal probe with an explanation of how it is used. Tell the patient what the readings might be and what they mean. Do a probing and recording, and either call out the depths during or show the results at the conclusion. Re-tell what the depths mean and what you recommend, if anything (home care changes, frequency of recalls, scaling and root planing, etc.).
• Further data collection in the form of radiographs and photos is also very helpful. When a patient can see what you are describing, it makes all the difference.
• Communicating what your recommendations are is the last piece of the puzzle. One good method is to set aside enough time for the dentist to present a treatment plan, or delegate this activity to a knowledgeable auxiliary. In fact, using a Treatment Coordinator or assistant might be the best choice. It may be easier for the patient to accept recommendations from an individual who will not be receiving direct monetary benefits from the decision. The following format can be used:
First, what a “normal” mouth or situation looks like can be shown, with radiographs and/or photos. Then the patient’s mouth can be shown, again with radiographs and photos. The differences between the “normal” mouth and the patient’s mouth can be highlighted – but keep in mind, this must be done in a non-judgmental and tactful way! A discussion of what may occur if no treatment is performed comes next. Finally, the treatment recommendations and details are shown, including how long the treatment will take and what the patient can expect during and after. The patient is given ample time to ask questions, and fees are presented.
• A written copy of the recommendations can be given to the patient, along with any documents concerning payment arrangements. This way everything has been discussed, questions have been answered, and treatment can proceed.
While this format is conducive to treatment acceptance, trust is the key. A patient has to believe that the dentist, hygienist, assistant, front desk staff and everyone connected with their treatment has their best interests at heart. This does not happen overnight. Trust is built day-by-day and appointment-by-appointment over a period of time. It is connected to patients seeing documentation, understanding what the data means, and having their conditions communicated at each office visit. It is being shown that recommendations are based on facts. It is also fostered by the patient seeing that the dentist and staff’s actions match their words…all the time.
If my friend’s dentist had built up trust with her over the years with actions and documentation, she would not have been alarmed by what she was told. It would have made sense and she would have been inclined to go ahead with treatment. But having serious issues thrust upon her all at once with no back-up documentation completely eroded her trust – and the dentist not only missed out on having his treatment recommendations accepted, he lost a patient.
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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