Make the Fearful Patient Your Biggest Fan
What are your biggest fears? Insects? Rodents? Hanging from an airplane over open water? Being buried alive? A few years ago, the so-called reality show FEAR FACTOR exploited peoples’ fears, and contestants would actually volunteer to participate in this game of public traumatization for a mere $50,000. Fortunately, dental phobia was not ever featured on this program, but as dentists discover early on in their careers, many patients can be very anxious about the dental experience. There are varying levels of fear, but when fear reaches the point that it is irrational and causes the patient to avoid treatment, it becomes a phobia.
Patients who are extremely phobic typically have a history of negative dental experiences. However, those experiences aren’t necessarily painful. In many cases, anxious patients are as much or more afraid of embarrassment than they are of pain. They may start avoiding the dentist because of a painful experience, but they also often realize they need to return to the dentist. However, they can’t bring themselves to do so because they are afraid they will be scolded and belittled for their neglect.
In other cases, fears are learned vicariously through parents, family members, and friends. They may hear about Aunt Mary’s horrible experience 20 years ago and decide to take ownership of that incident almost as if it were their own. Typically there is not just one reason why people become fearful - it tends to be a cumulative effect.
Managing the anxious or phobic patient can be almost as difficult for the dentist as the experience is for the patient. Dentists frequently are targets of comments such as, “Don’t take this personally, but I really don’t like dentists” from patients, friends, or even family members. In other cases, it’s the question, “Why did you become a dentist?” as if such a decision surely must be the result of some early life trauma or closeted desire to engage in tortuous activities. Anxious patients are a common source of stress for dentists who receive very little training in managing and caring for them.
One of the most critical steps a dentist can take in handling an anxious or phobic patient is to listen to them. The fears of the patient will be as individualized and unique as the patient themselves. Taking extra care and time to build a relationship with the patient first and address their dental needs second is vital. It’s a process of gaining and keeping the patient’s trust. Give patients the opportunity to talk about their fears. Ask them if they have had any negative experiences in the past, if they have concerns about dental treatment, injections, anesthesia, or drilling. The answers to those questions can be every bit as important as the routine health history questions posed. Not only will the patient’s stress level go down, so too will the doctor’s.
Many anxious or phobic patients feel very helpless in the dental chair and this can be particularly traumatic. Helping them to feel that they have some control is critical. The most common approach is to establish a signaling system in which the doctor will stop if the patient raises their hand for any reason - perhaps to ask a question or because they might want to rinse. The key is to ease their fears by emphasizing they have more control of their circumstances.
In addition, it is vital that team members are sensitized to the special needs of this type of patient. Putting the patient at ease the moment they walk in the door will go a long way in improving the entire experience. Dental teams should tune into the patient’s body language such as breathing rates, perspiration, whether or not the patient is unusually quiet or particularly boisterous. How is the patient holding their body? Are they gripping their hands? Do you see muscle tension?
Dentists and dental teams that take the time to get to know and understand fearful patients often find that they become some of the most loyal patients in the practice as well as the doctor’s greatest source for patient referrals.
Next week, build long-term positive relationships with all your patients.
Dismiss or Not to Dismiss - That is the Question
To quote myself in my last article: “It is recognized that I am treading on philosophical territory.” I was correct, as I welcomed the reception of emails from our readers expressing their concerns about my “treading.” I recognize that my article was not intended for all dentists and hygienists. Many of you do have a very structured, organized and well-thought-out approach to manage your periodontal patients and I thank you for that. At the same time, there are others that need some assistance.
Supervised Neglect and Periodontal Disease
One e-mail I received expressed concern about supervised neglect in the profession. I am also concerned and at the same time, do not feel that any dentist or hygienist intentionally treats a patient with the thought that they are “neglecting” that patient. Dentists and hygienists are in the profession to treat patients, not neglect them. I have never witnessed a dentist in my career that intentionally neglected his patients or watched his hygienists neglect theirs.
Here is what I do see:
Would you consider this “supervised neglect?”
Importance of Having a Periodontal Diagnosis and Treatment Plan in Place
Here is what I see
I also see no clinical notes in the patient’s record indicating whether the patient has Type I, II, III or IV. In some offices, I see no periodontal screenings or charting, even though a D0150 for a Comprehensive Exam was billed. According to the ADA, the D0150 includes periodontal screening and/or charting.
Take the time to sit down with your hygienists to map out your “plan of attack” and write down guidelines to follow so there are no grey areas. Write clinical scripts to include in the patients’ clinical records that are thorough and complete, indicating the patients’ periodontal health.
Hygienists - It is NOT your fault!
It is your responsibility to educate them, after your dentist has made the diagnosis, as well as educate them on how they can help to prevent periodontal disease. At the same time, there are situations that are beyond even the patient’s control that can lead to periodontal disease. With education and cooperation, you can help them.
The Dentist’s Fear of Rejection
Informing the patient that they have periodontal disease is even more difficult when there are no indications in the patient’s clinical record that it has ever been discussed and there has been no periodontal charting or screening. “My other dentist never told me that I had gum disease!”
If you feel that you can “turn them around” and become compliant with additional education, then do that - making sure that you have documented, documented, documented. Does that still protect you - I don’t know. However, your other option is to dismiss your patient. It is your decision.
Dental Insurance is Changing
“Brian Watts, Vice President of First Dental Health and a featured speaker at the ADA’s 2010 Dental Benefits Conference, pointed out some interesting statistics. Dental PPO plans have grown 61% in the last six years and now represent 63% of the dental benefits market. In contrast, traditional (non-networked) fee-for-service dental plans have declined 55% and now only represent 17% of the market, Dental HMO plan have declined 40%, representing just 9% of the benefits market and dental discount plans have grown 30% and now represent 10% of the market.”
Dental discount plans are membership plans that allow the patient to get discounted dentistry if the dentist is participating in the program. There are no claims, no deductibles and co-pays, no maximums and no frequency limitations. In other words, none of the typical trappings of dental insurance that are necessary to know in order to determine the patient’s out of pocket expense. The patient joins and pays a membership fee, goes to the dentist and pays the discounted fee at the time of service. It is prudent for the dentist and the administrative staff to analyze the discount plan’s fee allowances to make sure that the practice can cover operating costs with these plans.
PPO plans have increased, but the standard for them has changed. With evidence based dentistry looming in the near future, we will no longer be able assume that there will be coverage for two exams per year, two prophys a year, or a yearly bitewing allowance. In the future, high risk individuals may get coverage for treatment not paid for in the past, and patients with no or few dental problems may qualify for fewer benefits at a reduced premium. Documenting risk factors and a formal diagnosis for the most basic procedures will be necessary to get paid by insurance companies. The cross-over to medical coding may include using a diagnosis code and a procedure code to be paid for some services.
No matter what products are available to our patients, we as dental care providers will have to be knowledgeable about the programs in the marketplace and know which ones will ensure practice growth and provide dental care according to the goals and philosophy of the dental practice.
If your practice decides to accept discount membership plans, remember that in order to be profitable you must manage these plans carefully. Do not offer any other discounts such as senior discounts or incentives to pay at the time of service. Accepting these plans stipulates that you are to be paid in full at the time of service. The patient is not to profit from postponing payment when they are already paying for discounted dentistry.
To be prepared, have a fee analysis performed by a reputable company to give you confidence that your charges are marketable as usual and customary for your demographic area. If your fees are in the low range, don’t assume that you will attract more patients. Most patients come to you by word of mouth and will assume your fees are fair. If you have further training and have great results in a given area of your practice, you may choose to charge more for your services based on your reputation and skill level. Market your special skills to patients who will be interested in these types of services even if you have to go outside of your immediate area. Purchasing a Community Overview Report every five years is a good idea to see how your neighborhood is changing in demographics and psychographics. It is recommended to have this valuable information before embarking on any marketing or advertising venture as it will help you identify buying habits and dental implications of the people that live within a ten mile radius of your practice.
With the technology available to check insurance eligibility and benefits for every patient prior to their visit to your office, there is no justifiable excuse to not be able to collect the deductibles and co-payments at the time of service. It is the patient’s responsibility to give you the correct subscriber information. If you have not been able to access plan benefit coverage and eligibility information before the patient arrives, the patient should be informed that they will have to pay for the service and you will have the insurance company reimburse them.
As the statistics show, dental insurance is here to stay but will be changing shape and scope over the next few years. Stay current and your practice will grow and thrive. Need more help with how to implement insurance systems in your practice? Call McKenzie Management today and sign up for one of our business courses.
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