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  10.22.04 Issue #137

Return to the Annual Exam

Sally Mckenzie, CEO
McKenzie Management

       I bet you’re intimately familiar with those large cabinets you have in your office. You know the ones; they are most likely near the front desk area. They contain page after page of vital information about your dental practice, your procedures, and most importantly your patients. They are your patient records and chances are pretty good that they take up a very large space in your practice. Frankly, you could probably do a lot with the area they consume. But this is practically sacred ground, and those huge files with all those important records about all those patients who come to see you day after day, well those have

become a source of comfort and reassurance. Look at all of them! You must be the most popular dentist in town! Too bad you could probably gather up about half of them to use as kindling at the next autumn bonfire.

Of every two patients that walk in the front door there is a good chance that one of them will quietly slip out the back. It’s unlikely you’ll notice until there seem to be a few too many holes in the schedule or dollars are getting tight. Often the patients just fade away. That is unless you examine not only your patients’ dentition, but their documentation at least annually. It’s called a chart or record audit.

Here’s what we see happening in dental practices all over the country … I know, I know, you are certain yours is different. I wish it were, but nine times out of ten you’re in the same boat with the rest of your dental colleagues, and most of you are paddling up the same creek. … Doctors are often lulled into believing that they have a very active patient base. After all, there are oodles and gobs of charts. One look at the yearly sticker tells you at a glance how many of those patients are active. Unfortunately, often the yearly stickers are showing you only what you want to see and not the reality. During our onsite practice consultations we ask dental teams when they place the yearly sticker on the chart. The typical response is … “Well, Ms. McKenzie, of course the sticker would be placed on the chart the first time the patient comes in for any type of care that year.” Bzzzzz. Sorry that would be an incorrect answer. Here’s why.

There are any number of patients who are coming in when it hurts, but they haven’t had an appointment with the hygienist since the dawn of the new millennium. Place yearly stickers on the record when the patient comes in for his/her recall appointment. If the yearly stickers are placed correctly on records, charts can be pulled for inactivity based on the sticker. Most practices will keep a patient’s record in the file for up to two years, beyond that they should be pulled.

If you are assigning patient records to emergency patients stop that habit immediately. Emergency patients that have never been to the office for treatment should not be given a regular patient record because this lends to the illusion of a substantial patient base. Give them a smaller record until they purchase the comprehensive exam….then they can get a “big” person’s record.

Next week, why should you waste time on chart/record audits and patient reports?

If you have any questions or comments, please email Sally McKenzie at

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How Well Are You Managing Your Energy?

Dr. Nancy Haller
Executive Coach
McKenzie Management

Have you lost interest in your work?
Are fatigue and irritation a part of your daily experience?
Are you becoming more fixed and rigid with your patients? Your staff?
Is cynicism creeping into your communication?
Do you feel depleted, isolated, alone?

If so, you may be on your way to professional burnout.

Burnout consumes energy until your enthusiasm and motivation dry up. Knowledge and abilities remain intact, but the desire to perform, the spirit within is gone. Burnout is not an all-or-nothing phenomenon. Energy waxes and wanes – it’s never constant. Think of a campfire as an example. Depending on the quantity and size of the logs, the flames change. And if you don’t tend a fire, it burns out. So too with people and their work.

It’s always amazing to me how many high achievers act as if they have a bottomless reservoir of energy. Rarely do I coach executives who treat their wallet/budget the way they do their energy. Consider this – if you used your money the way you use your energy, you might be broke. You budget your money because you know there is a finite amount of it. Practice the same restraint with your energy. Replenish your energy regularly.

There’s a story in Steven Covey's book, The Seven Habits of Highly Effective People. A person sees a lumberjack struggling with a dull handsaw. Witnessing the slow and exhausting efforts, the person asks the lumberjack why he doesn’t stop to sharpen his saw. “I don’t have time; I’m busy sawing”, he replies.

To 'sharpen your saw', take an energy audit. This one was created by Tony Schwartz from The Energy Project. Rate each statement along a 5 point scale:

1=almost never; 2=infrequently; 3=sometimes; 4=most of the time; 5=almost always

I exercise at least three times a week.
I eat small, nutritious snacks every two or three hours.
I get 7 to 8 hours of sleep a night.
My level of energy is consistent and high throughout the day.
I eat a nutritious breakfast.

When I experience setbacks, I am able to recover my positive outlook quickly.
I feel relaxed and in control despite the pressures at work.
I have a good balance between taking care of myself and caring for others.
I feel secure and confident.
I am optimistic and forward-looking, rather than negative and blaming.

I focus well and shut out distractions at work.
I take time to think about long-term issues and strategy at work.
I set priorities and manage my time well.
I can step back and see the big picture even under pressure.
I am creative and imaginative.

I feel that my work makes a significant positive contribution to others.
I act in accordance with my most deeply held values, even under stress.
I am passionate about my work and highly committed to what I do.
I derive a sense of meaning and purpose from my work.
I have a mission in life that is bigger than myself.

I create clear boundaries between work and home.
I am able to leave work behind at the end of the day.
I take a break every 90 minutes to 2 hours at work.
I create time in my life for activities that I find enjoyable and satisfying.
I am still energized and able to engage when I get home at night.

Scoring Guide, by category:
22-25 On fire. You nailed this dimension.
17-21 Good energy management skills, but room for improvement.
13-16 Some energy management skills but this dimension needs attention.
10-12 Serious energy management deficits. Needs significant work.
Below 10 – Crisis-level deficits. Demands your immediate attention.

Overall Scores:
111-125 - You are a model of balanced energy management.
95 -110 - You have many strengths, one or two weaker areas.
75 - 94 - Moderate strengths, significant deficits.
50 - 74 - You are at very high risk for burnout.
Below 50 - It’s amazing you are functioning. Take action now!

Develop your ability to monitor your energy and keep it burning bright. One of the most effective ways is to find a mentor or hire a coach. It’s important to talk with someone who can help you to re-ignite the fire.

Dr. Haller is available to speak to your dental society or study club on subjects such as interpersonal communication, conflict management, and team building. If you would like information about any of her practice-building seminars, contact her at or 1-877-777-6151 Ext. 33

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From the Patient’s Perspective

         It may be the second most popular holiday after Christmas, but it’s number one in the amount of candy consumed. According to the National Confectioners Association, Americans are expected to spend $2 billion on sugary candy to hand out to trick-or-treaters this year, making Halloween the top holiday for candy sales. What’s

more, 90% of all children typically engage in this annual tradition. And the average trick-or-treater will consume 5,435 calories and more than 3 cups of sugar. YIKES! That’s enough to give any dentist a fright and it should be a hair raising thought for parents as well.

But All-hallows Eve wasn’t always this glutton’s gorge of dentition destroyers. Halloween's origins date back some 2,000 years to the ancient Celtic festival of Samhain (pronounced sow-in). November 1 was the start of the New Year, and the day marked both the end of summer and the beginning of the dark, cold winter – a time often associated with death. On the eve of this day, the Celts believed ghosts of the dead walked the earth. To commemorate the event, large, sacred bonfires were built, crops were burned, and a celebration was held in which the Celts wore costumes.

By the 800s, the influence of Christianity had spread into Celtic lands. In the seventh century, the Pope declared November 1 as All Saints Day. It is believed today that the declaration was an effort to replace the Celtic festival of the dead with a church-sanctioned holiday. The celebration was called All-hallows and, eventually, Halloween. About 200 years later, November 2 was designated All Souls Day, a day to honor the dead. It was celebrated much like Samhain, with big bonfires, parades, and dressing up in costumes as saints, angels, and devils.

While there’s no fighting a 2000 year old tradition like that, dentists don’t have to sell their souls or their licenses to the devil. In fact, Halloween is the perfect occasion for dentists to further the message of good oral health and moderation in candy consumption. Many dentists advertise in the local papers suggesting that this is the time for parents to introduce their children to the dentist for their first checkup.

One Iowa dentist gave children $1 for every pound of candy they brought to the office as part of a Halloween Health Day. Some dentists give out toothbrushes and floss at their homes and offices instead of candy. Children might not consider this a sweet deal but parents love it. What’s more, these tooth healthy “treats” also are excellent advertising venues, provided you have your name, address, phone number, and website printed on them.

The day also provides an excellent opportunity to communicate with patients and the parents of young children. Give them a list of suggestions during Halloween season of steps they can take to make the holiday a little easier on the teeth as well as overall health. The list might include the following:

  • Reduce the temptation to nibble on the way. Fix a healthy meal before children leave the house to trick-or-treat.
  • Wait until you are back home and all candy has been thoroughly inspected before digging in.
  • Eat only those items that are commercially wrapped.
  • Check the packaging and throw any suspicious items away. When in doubt toss it out.
  • Establish specific guidelines for how much candy a child may eat in a sitting.
  • Restrict candy to after meals when there's more saliva available to wash away food and help neutralize acid.
  • Consider making a small amount of candy available for the first few days after Halloween then either discard or freeze the rest for another time.
  • Encourage the younger trick-or-treaters to share with older siblings, so that the child does not consume all of the treats alone.
  • Allow the child to pick out their favorites and donate the rest to food pantries for the needy. This encourages both moderation and the value of sharing with those less fortunate.
  • Make sure kids brush twice a day and most importantly before bed.
  • Consider giving away alternatives to candy such as Halloween stickers, pencils, erasers, key chains and coins.

Halloween is great fun for children of all ages. Make the most of the opportunity to promote good oral health. Your patients will appreciate your helpful advice and their smiles won’t be looking like the jack-o-lantern’s.


I look forward to each new day with my team, and what we will accomplish today that will create the tomorrow that I want. I am happy because I feel in control again. I am happy because I understand my and my team’s role. I am happiest to have my feelings of fear, for the future of my practice, diminishing daily and being replaced by confidence.

I am looking forward to having my finger on the pulse of my practice again. Thank you McKenzie Management.


Have You Increased Your Hygiene Days Per Week In The Past Year?

Updated Version

How To Have A Sucessful Recall System
By Sally McKenzie

Unfortunately, patient retention is not guaranteed by preappointing, sending postcards, letters, or even phone calls. But an effective use of an integrated retention system can significantly improve your ability to keep patients returning. This step-by-step guide to the systems used by today's most progressive practices includes: letters that get responses, telephone monitoring techniques to ensure patient retention, tools to monitor your success, and scheduling tips for a productive hygiene department.

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Sally's Mail Bag

Hi Sally,
I am thinking about not accepting assignment of benefits from insurance anymore. Do you have any advice on guiding me in this direction?
Dr. North Carolina

Dear Dr.
I must warn you that it is not a wise business decision to “impulsively” decide to stop taking assignment. This very reason is why many doctors hire us as consultants, i.e., to evaluate their situation and advise them. You do need an assessment of how many plans you are presently accepting, how many active patients on the recall are on the plans, how much revenue has been generated and lost from active patients on these plans, how many new patients per month do you get from the plans, what is frustrating you to the point of wanting to drop the plans, how many dentists within 10 miles of your office take assignment from the plans you are presently on, how many people in your geographic area rely on your taking assignment because the socio economics doesn’t warrant them having available funds to pay upfront. Stopping assignment can be devastating to your business and your cash flow without proper planning and research. Let me know if we can be of help.
Best regards,


Office Managers
Financial Coordinators
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Treatment Coordinators
Hygiene Coordinators

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