3.29.13 Issue #577 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Nancy Caudill
Senior Consultant
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The Perfect New Patient Exam
By Nancy Caudill

Step 1 - The Introduction (10 minutes)
Your assistant, Sue, seats the patient - sitting “eyeball to eyeball” with him in her dental chair. She makes an opening rapport-building statement, such as: “Mr. Brown, we are so pleased to have you here today. I see that you were referred by Mrs. Smith. We just love her. I promise that we will take just as good care of you as we do her! Dr. Smith asks that we have a baseline blood pressure reading for all our new patients. Is that okay?”

Keep in mind, it’s usually required by your state board that before a clinical team member can take any radiographs, they must be “prescribed” by you, the dentist. Your goal is to briefly introduce yourself to the new patient as soon as possible after your assistant has seated the patient, review the medical and dental history, and take a quick tour in the patient’s mouth to accurately prescribe the radiographs you need to make a complete diagnosis and treatment plan. Prior to your arrival, your assistant can be taking digital photos if you find them helpful, as well as intra-oral photos.

Step 2 - Radiographs (10 minutes)
Sue will now proceed to obtain the prescribed x-rays.

Step 3 - Soft and Hard Tissue Exam (10 minutes)
The order in which you conduct your exam is a personal preference. Remember to inform the patient that you are “performing an oral cancer exam, looking and feeling for lumps and bumps that are not normal.” This is added value to the appointment. The soft tissue exam would include TMJ evaluation, periodontal charting, etc. As you conduct your periodontal charting, explain to the patient that low numbers are good and high numbers 4 and above are signs of possible infection and disease. Then call out the probing depths to your assistant, as well as bleeding, etc. This helps the patient to “co-diagnose” their own health.

Consider having the doctor and assistant chart the existing restorations together. This is much quicker for the assistant, and also gives you an opportunity to brag on the patient’s previous treatment, as well as start preparing yourself for your diagnoses and treatment planning. (#1 is missing, #2 has a beautiful porcelain crown, #3 has an old silver filling with a crack on the distal-buccal, etc.)

Step 4 - Treatment Planning (10 minutes)
If your practice is chartless, treatment planning can be entered directly into the patient’s digital chart if your assistant is proficient. If not, she/he should write it down on the back of the routing form as you call out the treatment and it can be entered by the business team. It is more about being efficient than it is what “should be.” Your assistant will start entering the recommended treatment as you go through the mouth. (#3 will need a porcelain crown due to the large crack on the distal-buccal cusp, #6 will require an MO 2-surface white filling due to a cavity, etc.)

Step 5 - Visit #1 (10 minutes)
This is the important step. You have presented all the recommended treatment to the patient and it is charted. You decide where you want to start with the patient. Upper, lower, right or left? “Put out the fires first” is usually the first plan of action. At this point, the key is not to spend 30-60 minutes discussing ALL of their options. Discuss their options on the area that you want to start in. (Crown vs. filling vs. extraction vs. bridge, etc). Help the patient make a decision for their next visit based on your clinical review.  It is not mandatory at this time that you discuss the option for 8 veneers, orthodontic appliances and a sleep apnea appliance, unless this happens to be the patient’s chief concern.

In other words, eat the elephant one bite at a time to avoid your patient from running through the jungle and out the front door. Help guide them through the process, explaining that when they return for their next visit, you will discuss what area they would like to address next.

This scenario was 50 minutes. You determine how long it will take you. Keep in mind that you may have a difficult case that will need time to prepare and review with the patient. In that case, gather your information, discuss with the patient what they are expecting, and schedule them back for a consultation. Maybe it can be combined with something that is needed that is not extensive, like a filling. Don’t feel that you need to present 4 options to the patient that will take preparation and time at this appointment.  It will be apparent to the patient that their dental needs are complex.

Keep in mind that the patient only really listens to the first 5 minutes of what you say, so keep it short and to the point. Ask questions to confirm that they understand their next visit. Bid them good-bye until you see them again soon. Sue reviews the recommended treatment for the next visit and then escorts the patient to the hygienist, briefly reviews with her the doctor’s findings for the next visit, indicates that there was no evidence of gum disease and dismisses herself. All in less than an hour!

If you would like more information on how McKenzie's Consulting Coaching Programs can help you IMPLEMENT proven strategies, email info@mckenziemgmt.com

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