1.29.10 Issue #412 Forward This Newsletter To A Colleague

Why Shouldn't the Doctor Let You Go?
by Sally McKenzie CEO
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Attn: Dental employees, what have you done for your doctor lately? Some of you will read that question and say to yourself, “Well, I showed up for work today, lucky for him.” Others may quietly think to themselves, “I haven’t complained about a single thing … for at least an entire hour, even though the coffee is cold, and I really do not want to be here today.” And still others, will beam with pride and say to themselves, “I have done and will continue to do whatever she asks of me.”

I can assure you that even if your response was in line with the third one above, you’re not doing enough, particularly in the current economy. At this writing, the unemployment rate is 10%, and if you are fortunate enough to have a job, you want to do all you can to keep it. Now, more than ever, it’s time for you to take a good close look at yourself and what you are doing to help the dental practice you work in to not merely survive, but thrive - yes, even in these times. Ask yourself, if the doctor had to let someone go, why wouldn’t it be you?

Are you a whiner? There’s always some problem, some complaint, some annoyance on the tip of your tongue that you feel you simply must share with the doctor.  “So and so didn’t do this. Such and such did that. I’m not making enough money to put up with this stuff. Why can’t I have this? Why does she get that?”  There are few things worse than the high maintenance office whiner whose laundry list of gripes rivals Tiger’s extra-marital trysts. Certainly, the dentist may feel obligated to listen to your grievances and complaints, but today’s do-more-with-less dental practice needs low maintenance, positive, and proactive staff. 

Do you mix well or merely stir the pot? Gossip, backstabbing, and silly rivalries are best left on the playground. Don’t bring them into the practice. Regardless of your education, your experience, or your perceived social standing, you can torpedo your professional success in an instant with poor judgment, inappropriate actions, comments, and behaviors toward coworkers and patients. You must be able to play well with others. If not, you are a huge obstacle in the doctor’s ability to accomplish his/her mission.  And if tough decisions have to be made about who stays and who goes and you’re the practice pot-stirrer, why wouldn’t you be on the short list for a pink slip?

Do your promises go unfulfilled? You tell your teammates that you’ll take care of this or that, but time and again, it doesn’t get done. You promise the doctor that you will call the pharmacy for a patient. But you got busy, time got away from you, and so did that little task. You assure the hygienist you will confirm Mr. Jones’ appointment because he tends to forget frequently - unfortunately, so do you. You pledge to be on time for the staff meeting in the morning, but oops the alarm didn’t go off or the dog threw up on the carpet or you had to stop for coffee so as to be coherent enough to drive from point A to point B. The team is tired of your excuses. The doctor has let you slide long enough. The economy is the excuse the practice has been waiting for to show you to the door … finally.

Does your personal life take precedence over everything else? Certainly, most everyone has a life outside of work, but when it routinely encroaches on your professional responsibilities, you’re setting yourself up for poor performance. Your personal life is precisely that: personal. Your coworkers do not want to know all the details. Trust me. Limit your personal calls, emails, and text messages. If your 12 year-old is to text you when he gets home from school that’s one thing, but if you’re spending the next 30 minutes “thumbing” back and forth about his day, you’re taking advantage of the situation.  And while we’re talking technology, remember the office phones, computer systems, copiers, etc.  are there to help you carry out the responsibilities of the workplace, not run your side business. 

Next week, steps each team member can take to ensure you keep your job during lean economic times.

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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Jean Gallienne RDH BS
Hygiene Consultant
McKenzie Management
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Perceptions of The Periodontal Maintenance Patient

Converting existing patients that have been on a three month recall and have been billed out as a prophylaxis instead of the periodontal maintenance patient that they should be, is not an overnight fix. This will take some time and effort on the entire practice. Becoming a periodontal focused practice is a team effort. Let’s take a look at two different patient scenarios that will be basically treatment planned the same way.

The first patient has been coming in for years as a three-month prophylaxis recall patient, and has had root planing in the past. When the hygienist does six point probings, there is 4 and 5 millimeter pocketing, with bleeding upon probing in the upper right and upper left quadrants in four or more areas.

The second patient has also been coming in for years as a three-month prophylaxis recall patient and has had root planing in the past. However, this patient does not have any bleeding upon probing. He does have four and five millimeter pocketing in the upper right and upper left quadrant. The measurements have not changed at all over the years, however, there is no sign of the patients health improving. During instrumentation the patient has heavy hemorrhaging in both the upper right and upper left quadrant. We all know that healthy gingiva doesn’t bleed.

Both patients have been referred to the periodontist and refuse to go. They are aware of all the risks, benefits and alternatives and have decided that they would like to approach their periodontal disease treatment in a non-surgical approach. The hygienist has treatment planned two quadrants of root planing at this time.

The treatment plan should be given to the front office and the three-month periodontal maintenance appointment should be included in the treatment plan. This way, the patient is aware they are no longer going to be receiving a prophylaxis, and will be billed at a higher amount at future appointments. They will be made aware of the difference between a periodontal maintenance appointment and a prophylaxis. This should be explained to the patient not only in the hygienist’s chair, but the person going over the treatment plan and the financials should explain the difference to the patient also.

Here is the clincher. With an existing patient, you and the entire staff can explain and educate the patient verbally as much as you want, but unless the patient perceives something different being done at the periodontal maintenance appointment, you are still going to end up with patients on the phone complaining and mad at the front office, hygienist, and the doctor. This may cause a lot of patients to seek treatment elsewhere.

The important goals are to keep our patients happy and healthy, provide quality of care, and be paid the appropriate amount for the services rendered. We as dental professionals know the difference when it comes to the amount of work a periodontal maintenance requires compared to a prophylaxis. The sad thing is that you have been doing the work, and not getting compensated fairly by the amount paid by the patient or insurances, mainly because of misuse of codes to procedures actually being performed. 

Again, the patient doesn’t want to hear it - they want to feel a difference at all future appointments. Here are some ways to accomplish this:

  • Concentrate on most infected areas first.
  • Use an ultrasonic scaler in deeper pockets, diamond files.
  • Offer intra pocket placement of an antibiotic for sustained and slow drug release. (additional charge)
  • Start in the deeper pockets first with the ultrasonic scaler and then go back and hand scale the entire mouth, even the areas you used the ultrasonic scaler on.
  • Use chlorhexidine in the ultrasonic scaler or irrigation after the hand scaling with chlorhexidine.
  • Anesthetize site-specific areas.
  • You may or may not want to polish irrigate site specific areas with the product of your choice
  • Offer root desensitization (extra charge)

Many patients will not only feel something additional is being done, but the health of the mouth will actually start to improve. Of course, patient compliance has a lot to do with the overall health changes. When these patients are communicating with the office to make their next appointment with the hygienist, everybody needs to call the appointment by the correct name: Periodontal Maintenance. And remember, the office deserves to be paid for the work being done.

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

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