11.2.07 - Issue # 295 Forward This Newsletter To A Colleague
Listening Skills
Recall Tools
Prophy before SRP

Anyone Getting a Fair Hearing in Your Practice?
by Sally McKenzie CEO
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The whir of the instruments, the ringing telephone, the chatter of staff and patients, the din of the dental practice can become something you just learn to tune out. Unfortunately, you may also be tuning out some of the most important “noise” in your office, the comments, conversations, and discussions among your team and your patients.

Sure, we’ve all been told to listen carefully, don’t interrupt, pay attention to what’s being said. But in the busyness of the dental practice, there’s simply so much to get done that taking the time to really listen is something we like to think we’re doing but often aren’t.

Most likely you’ve been a part of many “conversations” in which you’re busy telling your story only to have the other person jump in the second you pause to take a breath and seize control of the conversation with an account of something similar that happened to them, or to give you an unsolicited “solution” to your “problem.” Chances are also very good that you’ve committed the exact same offense.

Today, real listening is in scarce supply, a casualty of a culture that is perpetually on the run. Seldom do we stop to carefully consider what the other person is actually saying, ponder their situation, or really evaluate their concerns. We’ve substituted listening with “sprint hearing.” We hear the first few sentences of a conversation and think that we have all the information we need to sprint to the finish and leap in with a response.

At the first barely audible pause, we spill out all our knowledge on the subject, sure that we will blow the other person away with how quickly we were able to get to the crux of their issue and offer a solution. We’ve heard what we wanted to hear or expected to hear, but not necessarily what was really said.

How good a listener are you, really? Pick a day next week and try out the following listening tips. What you discover may surprise you.

  1. Shut up. You simply have to control your urge to speak until the other person is finished.
  2. Don’t think about how you are going to respond while the other person is speaking or you’ll miss important information that may prompt a completely different response than the one you’re rehearsing in your head.
  3. Look at the other person when they are speaking. Don’t straighten your desk, arrange the instruments, wipe down the counters, or anything else that distracts you or appears to distract you from what the other person is saying. Your eyes should be on the person speaking to you unless you’re looking down to take careful notes of what they are saying.
  4. Watch your body language. If you look away, raise your finger to make a point, glance at the door, peek at your watch, the other person will notice and feel you are not engaged in what they are telling you.
  5. Ask questions before you give answers. Make sure you fully understand what you’re being told. Seek clarification. Paraphrase what you believe you’ve heard, particularly if the person is upset or irritated. This helps the speaker feel you are truly listening to what they have to say.
  6. Stick to the subject at hand. If Mrs. Jones is telling you that her tooth started hurting during her son’s high school soccer match last weekend, resist the urge to chime in and ask her how the team did. Otherwise the topic can quickly get off track as Mrs. Jones digresses into talking about what a great match it was and may not remember or have the opportunity to convey important information about her symptoms.
  7. Separate your personal situation from the discussion. If you’re tired, not feeling well, upset about something else that is going on in the office or your personal life, it’s very easy to be distracted and not fully engaged in the conversation. Looking the person in the eye and note taking can be very useful tools in forcing you to be fully present in the moment.

Pay attention to how well you’re actually listening to others – your team, your colleagues, and especially your patients. Chances are that up until now, you haven’t heard the full story.

Interested in speaking to Sally about your practice concerns? Email her at sallymck@mckenziemgmt.com.
Interested in having Sally speak to your dental society or study club? Click Here.

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Belle DuCharme CDPMA
Instructor/Consultant
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Recall Tools to Improve Patient Retention

A dental office management operation encompasses mainly scheduling, billing, collections, insurance, delivery of dental care and the recall system.  As dental health care providers and managers of our patient’s concerns we can never stop educating our patients about dental diseases and how they affect total health.  How eradicating these diseases will benefit the patient by ultimately prolonging lives and improving the quality of lives. This education program becomes an integral part of the success of every dental practice.

 As part of the Advanced Business Training and Dentist’s Start-up Program at McKenzie Management we demonstrate a successful recall system based on sending a letter style recall versus a “cutesy” postcard message.  The important health care reason to return to the dental office cannot be visualized when the patient receives a cartoon character on a postcard making light of the request to call and schedule the professional cleaning or periodontal maintenance procedure.  The letter style recall system affords opportunities to communicate with the patient on a professional level and brings the recall appointment to a new height of urgency and importance. In the envelope we can enclose a message to call or a reminder card plus a message as to why the patient should return such as “we need to check the periodontal pocket on #18” or “we need to check the cracked filling on #2 and #29”.  We can also include in the envelope a prescription for pre-medication for the convenience of the patient.  Giving the patient a more urgent reason to return is most important but also in this envelope we can insert brochures about new services and products we now offer.  The brochures are small enough to enclose in the envelope and can be obtained thru McKenzie Management.  Some of the subjects include:

  • Reasons why a professional cleaning is necessary
  • Why sealants are recommended
  • The signs of periodontal disease
  • Information on composite restorations
  • Information about the different teeth whitening products
  • Information about crowns, inlays and onlays
  • Information about implants
  • Information about veneers and other cosmetic options
  • Pregnancy and dental disease

For patients who are late scheduling their professional periodontal maintenance procedure a brochure about periodontal disease can plant a seed that postponing this necessary appointment can have long-term negative affects.  The letter style is HIPPAA compliant whereas detailed information cannot be written on a postcard.

We all know that dental insurance companies scrutinize claims to make sure that the charges are part of the patient’s contract benefit allowances.  Recently I received a letter from Delta Dental of Massachusetts in regards to their program Healthy Mouths for Life oral health management program.  I was pleased to see that they have recognized the importance of continual education of the patient and the positive results of regular preventive care.  Using incoming claim data they can identify members experiencing gum disease or tooth decay and send them relevant informational brochures. Patients who have received scaling and root planning or osseous surgery receive a brochure that describes the cause and treatment for periodontal disease as well as suggestions for keeping gums healthy.  Patient who are under the age of sixteen and have a filling will have a brochure sent to the parents about prevention of decay and if applicable will receive another brochure promoting the benefits of preventive sealants.  To the benefit of the patient, Chlorhexidine mouth rinse following scaling and root planing and prescription strength fluoride toothpaste following periodontal surgery will be covered twice in a calendar year when dispensed by the dentist in his/her office. This is great news and I am sure other insurance companies are following suit as their research indicates keeping patients healthy benefits all. 

The evidence based data now linking periodontal bacterium to low birth weight babies has prompted some insurance companies to allow another prophy or periodontal cleaning to the frequency limitations.  Proper documentation is necessary to get the claim paid and a medical diagnostic code will have to be included in some cases.

Never assume that your patient “has heard it all before”.  Never stop promoting education as part of your daily dental operations. 

For more information about the Advanced Business Training and Dentist Start-up Programs for your educational benefit,  email training@mckenziemgmt.com, call 1-877-777-6151 or visit our web-site at www.mckenziemgmt.com.
Interested in having Belle speak to your dental society or study club? Click Here.

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Jean Gallienne RDH BS
Hygiene Consultant
McKenzie Management
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Prophylaxis Before or After Root Planing?

As hygienists, we have options of treating patients and are faced with decisions  to do what is right for the patient but still get the production required to run a business.

“Jean, I saw a patient this morning who was perio involved.  I did a full periodontal charting and found that he needed four quadrants of root planing.  I spent a full appointment time with him, and I didn't feel it was fair to only gett paid for the periodic evaluation. My question is, what would have been a better way to approach this appointment?”

It would have been better to do the probings after you explained what probings are and what they mean to the patient, so the patient is able to co-diagnose and give the patient the cleaning he expected to have. While cleaning the patient’s teeth, explain to him why the cleaning is not enough and it is just a “band aid” until he is able to get in for the periodontal therapy treatment that is needed.

This is doing three things:

  1. Your production is still as scheduled
  2. The patient got what they wanted
  3. The patient was treatment planned and educated about the treatment they really need.

Many times, if the cleaning or service the patient originally anticipated having done is not done at that appointment, the patient may leave upset without anybody knowing differently. Thus, even if he understands and decides to have the periodontal therapy done he may go somewhere else.

The trust that was starting to be established the minute the appointment was made with the scheduling coordinator might have vanished. He expected a cleaning and should have received what he was scheduled for and in addition he would receive an education about his mouth and periodontal disease.  

When it comes to doing the cleaning and then having the patient back the next day for root planning, most insurance companies usually pay for this. However, there will always be those insurance plans that the benefits are limited and they may not pay for it.

This is why, it is recommended that patients receive a written treatment plan by the financial coordinator and that the benefits are gone over with the patient and signed before treatment is started. Of course every treatment plan will have a notation that the amounts are estimated and that it is the patient’s responsibility to know their insurance benefits. This notation should also state that the patient is ultimately responsible for all cost accrued.

Now, the patient should have been given a treatment plan for four quadrants of root planing if that is what is needed and a periodontal maintenance in three months. There would not be the additional cleaning 2-4 weeks after the root planing because that was done before the root planning. Many offices see treatment plans like this on a regular basis because the new patient is scheduled into hygiene for a cleaning and more advanced therapy is needed.

In some offices, the patient sees the doctor prior to seeing the hygienist. An option for the treatment plan would be to do the four quadrants of root planing, a prophylaxis in 2-4 weeks, and then a periodontal maintenance three months after the prophylaxis.

Having a prophylaxis after the root planing in 2-4 weeks provides even higher quality of care for the patient. The hygienist will be able to concentrate all of her time during the root planing appointments on the 1-3 teeth or the four or more teeth that require root planing. Then at the prophylaxis appointment, the hygienist will now clean all of the healthy areas and polish if needed. If the patient has been on any antibacterial rinses that may have stained their teeth they will really appreciate being polished.

This appointment may also be used to determine the need for additional chemotherapeutic agents and placement of them where needed. If there is an area that has not quite responded the way it was anticipated, the hygienist may also want to retreat that area before placing a chemotherapeutic agent.

This is also a great time to describe the difference between a periodontal maintenance appointment and a cleaning. Seeing how a periodontal maintenance appointment falls between a cleaning and root planing and may be the next appointment they will have with the hygiene department.

Of course there is not one set treatment for all patients because all of our patients need to be treatment planned based on their individual needs. However, with the information provided this is one way that this patient may have been approached differently in order to be the most profitable for the office and beneficial for the patient.

Interested in knowing more about how to improve your hygiene department? Email hygiene@mckenziemgmt.com.

Interested in having Jean speak to your dental society or study club Click Here.

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