This quarter’s e-newsletter looked at the concept of completing comprehensive exams for new patients and fitting this in to your practice philosophy and current circumstances.
Sometime in the past I think I heard that all “good” dentists completed a comprehensive exam on every new patient at the first appointment. In truth a rigid interpretation of this idea in a private practice setting can be overwhelming and a barrier to changing and improving your new patient experience.
Right after dental school in the 80’s I believed I gave a comprehensive exam to all of my patients, and it included dentition charting, necessary x-rays, and periodontal screening. As I went through more advanced continuing education, my comprehensive exam grew to include a comprehensive periodontal exam, joint & muscle exam and digital photography.
So have I figured out how to have all of my new patients accept a comprehensive exam? The answer is YES, but how I achieve that may surprise you. I have redefined what a comprehensive exam means and looks like, by individualizing it to each patient.
Many of you know that I purchased my practice two years ago. We are in a growth phase, with more open appointments spots available than we prefer. With this in mind I want the opportunity to meet every potential new patient that calls; therefore we put very few barriers in place. Requiring every new patient to have a two hour exam appointment with me can be a barrier for many. Once the practice has grown and I have more patients than time, requiring a two hour comprehensive exam for each new patient may be a very appropriate barrier to put in place, allowing me to spend my valuable new patient time with patients who have greater ownership and awareness of their current needs.
How do I individualize the comprehensive exam? The first step is handled by my team, who must be adept with particular listening skills during that initial new patient telephone call. Based on what they hear, they know to ask key questions which allow them to individualize the new patient appointment including hygiene if appropriate.
The next step to individualize the comprehensive new patient appointment belongs to the Doctor. The best way to illustrate what I do is to give you three different examples of real new patient appointments I had last week:
Linda moved here recently and was referred by her former dentist. She shared on the phone that she is very regular and committed about her dental care and is aware of no current issues or concerns. Based on this information she was successfully scheduled for an extended new patient appointment with hygiene. My hygienist completed a comprehensive perio exam, soft tissue exam and necessary radiographs as well as a pre-clinical interview. I was invited into the appointment whereby the hygienist introduced me to Linda and passed trust to me by sharing what they had learned together. I then completed my pieces of the comprehensive exam. As expected, Linda was healthy and well maintained so we completed her appointment with a prophy.
Whitney was referred to the office by her mother who was an existing patient. Nothing unusual was revealed during the initial telephone conversation, so a typical extended appointment with hygiene was scheduled. However, during the pre-clinical interview, the hygienist learned that Whitney was having issues with her joints and muscles so I was invited in to join the conversation and I performed an initial TMD screening exam. The screening revealed that there was something unusual going on and a complete TMD exam would be helpful for her. I discussed this with Whitney and invited her back for a separate extended evaluation appointment. I explained that we would have enough time to complete a clinical exam and discuss some next steps toward health and stability, which could include appliance therapy. After this discussion the hygienist completed her appointment and scheduled her for an extensive evaluation appointment.
Christina was referred by a local specialist. During the new patient phone call, her needs were clearly more complex than average, so the appointment was scheduled for an hour with me only. Christina and I spent the first part of our time together getting to know each other. She shared with me her understanding of her dental health and goals. We completed a comprehensive exam to gather all of the information I would need to help her understand her treatment options. Christina case was complex, so further thought and discussion will be necessary before specific treatment options can be presented. I asked Christina permission to take some time to think over what we had learned. We scheduled another appointment in a week to complete our conversation and develop treatment options.
For these new patient appointment scenarios to work, the office has had to become comfortable with several things. We should not try to squeeze everything into an appointment just because of the code in the appointment book, or rush or condense the process. We must be very comfortable inviting patients back based on what we learned at the first appointment.
Based on my practice philosophy and our currently schedule openings, having three patients with three individualized new patient processes works perfectly. It would not have worked years ago, we both myself and my practice we different. It might not work in the future as I will change and so will my practice. But we will reinvent the new patient experience from time to time as the practice changes. I encourage every dentist to have a new patient process that “fits” based on who they and their practice is today, and redesign it in the future when the time is right.
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