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Adding Technology to Patient Consultations
How to enhance case acceptance and office efficiency.
Jeffrey Ganeles, DMD
Dentists are generally regarded as trustworthy and caring, usually scoring well in public opinion polls. Many dentists, therefore, believe that if they tell a patient that he or she has a particular problem, the patient will obediently act on the information. The reality is that many patients need more explanation.
Typically, dentists resent scheduling consultations because they feel they are compensated to do procedures, not to talk. Dentists sometimes charge a fee for consultations analogous to other professionals who get properly compensated for intellectual work. Alternatively, the dentist may want to consider the consultation as a “loss leader” and waive the fee in anticipation of higher patient acceptance of greater revenue producing appointments in the future. A compromise between these approaches may be to charge for the consultation, then award a corresponding credit if the patient accepts treatment. Consultation appointments should be deliberately scheduled, rather than trying to cram them into the end of previously scheduled appointments or emergency time.
During the consultation, there are several goals to be accomplished. The doctor should carefully control the conversation and presentation to achieve these objectives.
The obvious objectives of the consultation include: educating patient about his/her condition in enough detail to understand treatment options and methods and the consequences of non-treatment; discussing sequence, duration of treatment, and how the patient will look and feel during and after the procedures; presenting fees and discussing financial arrangements; obtaining informed consent; and getting patient to say: “Yes, I want that!”
Additionally, there are a number of subliminal goals to reinforce. These are attitudes, emotions, values, and conclusions that the doctor would like the patient to appreciate as a result of their discussion. They include: confidence and integrity in the doctor and his or her staff; safety, accessibility, and genuine concern for patient; recommendations that are in patient’s best interest, not the doctor’s; evidence that the office is dedicated to quality and success, and that cleanliness, sterility, precision, and success are important values; an appreciation for the value of procedures; and to convert acknowledged dental “need” to emotional dental “want.”
Consultation communication tools and styles can help achieve or undermine both the obvious and subliminal goals. Ideally, consultations should occur in non-threatening, non-clinical rooms where the doctor and patient can have an eye-level conversation. Because many dentists do not have such a dedicated space, a dental operatory or treatment room may be used. Often patients are naturally anxious, so “scary” auditory and visual references should be or removed. In a treatment room this may mean uncluttered countertops without handpieces, gauze, or instruments in view.
Specific consultation materials may include radiographs, drawings, or photographs of the patient, customized brochures, or customized computer simulations. Often dentists illustrate problems by pointing them out on radiographs. In reality, this often just confuses most patients because they cannot appreciate what is being shown. Digital radiographs may be slightly more useful since they are significantly larger and can be “drawn” on to emphasize areas, but still are rarely instructive or motivating. Showing patients panorex radiographs or CT scans also completely fail to convey meaningful information, often causing more confusion.
Sometimes dentists combine drawings and radiographs by drawing on radiographs. While this could be a valuable communication tool between dentists, it is doubtful that patients get any meaningful benefit. There are also some computer software programs that more elegantly simulate treatment options based on scanned radiographs but suffer the same comprehension limitations by patients.
Some dentists use digital photography to create custom slide shows for patients. Several simulation software packages are also available to create digital mock-ups. While potentially very effective at satisfying the consultation objectives, these require a learning curve and significant preparation time. Further, it is possible to create unrealistic patient expectations if conditions do not permit ideal results.
During his consultations, the author combines digital photography with proprietary computer-based illustration software that allows instantaneous simulation of clinical conditions and treatment steps. Representative digital photographic images are taken during the previous examination appointment and stored using an inexpensive photo album. During the consultation, the digital photographs are often displayed to “introduce” the patient to his or her predicament. Next, the problem is simulated using the illustration software, showing the current difficulty and its development. Often, the “existing condition” screen is saved and printed for the patient so it can be referred to later in the consultation.
Next, proposed ideal treatment outcomes are created using the illustration software. These represent computer-sketched views of how the patient will “look” at the completion of treatment. Advantages and disadvantages of each option are discussed without clouding the conversation with treatment sequence or fees. Developing the options becomes a collaborative process with the patient as he or she watches solutions appear on a large monitor. Each option is saved and printed to create personalized take-home material. Speed, flexibility, and clarity in the computer program are needed for this consultation method. Once the final desired result is identified, the treatment sequence is illustrated, and treatment time, fees, insurance benefits, and financing options are addressed.
Directing this kind of consultation requires anticipation and active listening. Often, patients will want to shortcut to the question of cost long before it is advisable to discuss it. Patients are reassured that they will get this information after a decision is made about what will specifically be done and which methods will be used. It is generally difficult for patients to keep track of the subtle differences between multiple proposals, so the dentist should recommend appropriate discreet options including risks and costs of no treatment.
There are many advantages of orchestrating consultations with this method. Consultations are done on a scheduled basis so neither the doctor nor patient is rushed. Patients feel that they are respected, their time is valued, and that their problems are given serious consideration. The meeting is done in a consultation room to minimize the physical and psychological distractions promoting more attentive listening and a positive attitude. The concept of co-diagnosis with visual tools is a subtle but powerful method to include a patient in the consultation process.
The sum of these efforts is a greater appreciation for conditions, clarity for options, and recognition of value. Results include higher treatment acceptance rates, faster treatment acceptance, and fewer follow-up phone calls or questions following consultations. Patients get the treatment they need and want. Dentists schedule efficient appointments on informed, prepared patients boosting efficiency and profitability.
About the Author
Dr. Ganeles is a periodontist in private practice in Boca Raton, Florida, and an assistant professor at Nova Southeastern University College of Dental Medicine. He co-founded DentalImplan, Inc, which provides patient education software for office use.