Continuity of Care
Bill comes into your office as a new patient, and is seen by the hygienist initially. The hygienist reviews the health history, performs an oral cancer exam, takes any x-rays the doctor has prescribed, charts existing, and probes. She discusses with the patient what she thinks may need to be done in his mouth before the doctor comes in to perform the comprehensive exam and determine restorative needs. She also has the patient co-diagnose the periodontal disease, and explains periodontal etiology to Bill. He is fortunate and does not need to have root planing, as his mouth is healthy. So, the hygienist goes ahead and cleans his teeth.
Bill has never had such a great experience at the dentist. He tells one of his friends about it and refers his friend to the practice. But when Bill’s friend comes into the practice he is seen in the dentist schedule instead of hygiene, and the dentist is only given a half-hour. The dentist does what he can in that time, probing quickly and doing a full mouth debridement. He informs the patient of restorative needs and goes on with the next scheduled appointment after telling the patient he needs to return for a prophy.
Bill’s friend did not have even close to the same experience as Bill did. The cleaning he received hurt and everything seemed very rushed. This make Bill’s friend think that Bill may not be a trustworthy source when it comes to future referrals. Even worse, Bill’s friend is not going to return to this practice, as he did not have a good experience. He is also going to inform Bill of his experience so he knows not to refer to the practice again. Actually, Bill is now considering not going back.
Now 6 months have lapsed and Bill has decided to go back to the practice once more to see if he has the same experience. This time Bill is scheduled with a different hygienist and she does not spend the time with him that the other hygienist did. This is because the new hygienist only requested 40 minutes to do her prophylaxis. She is rushed and not nearly as gentle. She also does not take the time to build patient rapport. Bill is in and out of her chair in no time at all.
Bill decides to not return to the practice again. There is no continuity of care - not only between doctor and hygienist, but even between hygienists. The person doing the initial appointment, whether it is the doctor or hygienist, has nothing to do with the care the patient receives.
The time allowed for the appointment is what made the difference to the patient and his perceptions of the office. Shorter appointments, allowing more people to go in and out of the practice in a day, do not necessarily lead to greater production. Patients that are rushed in and out of the office often do not accept future treatment or end up being lifetime patients in the practice.
That 40-minute exam and cleaning, rather than being $400 for the full mouth series of x-rays, comprehensive exam and full mouth debridement, may have been treatment planned for four quadrants of root planing, and three-month periodontal maintenances. At $200 a quadrant, that would be the potential of $800 generated in production that day, and putting the patient on a needed three-month periodontal maintenance equals more production, better quality of care for the patient, and less stress for the patient and provider.
This leads to quite a few good outcomes. The patient is impressed and comfortable while receiving the care, which may lead to better quality of care and even more referrals. There is less stress in the office because the schedule is not being over-booked with too much treatment in one appointment. This in turn will lead to enjoyment of doing dentistry for many years to come, not to mention a higher amount of patient retention.
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