Patient Communication in the Clinic
- Michael Ling
- Aug 16, 2022
- 11 min read
Updated: Nov 14, 2022
ONE SENTENCE SUMMARY
How to answer the questions we frequently get from patients in the clinic
1. Doc Intro
When the doctor comes into the room, you should introduce the doctor to your patient. If the spouse or parent is in the room, introduce them by name too. Assume that the doctor has no idea who this patient is, even if we just saw them recently or have seen them many times before.
Your introduction is a cue or reminder to the doctor so we can refresh our memories about who the patient is and what's happening today.
Your introduction should include:
What happened at the last visit?
What's happening at today's visit?
What's supposed to happen at the next visit?
EXAMPLE #1:
"Dr. Mattina, this is Mrs. Jones. This is Mrs. Jones' first visit with us today. She lives just around the corner and you met her neighbour Mrs. Smith last week. Mrs. Jones is here today because she broke a bottom molar on a chicken wing and it's feeling a little sore. We took an x-ray today and she's hoping you can take a look."
EXAMPLE #2:
"Dr. Bennett, this is Mrs. Jones. I'm sure you remember that Mrs. Jones was in for her new patient visit a couple weeks ago and you talked to her about strengthening some of her back teeth with crowns, fixing some cavities, and then making her a nightguard.
Today we are starting with the cavities and crown on the bottom right, and then she has another visit scheduled in a few weeks to do the left side."
2. Hygiene Check
For a hygiene check, the doc intro is the same as above, but the hygiene should add their concerns and recommendations.
2 important notes:
- If you have concerns, make sure they are not all negative. Find SOMETHING positive to say.
- Avoid dental terminology. Instead, use plain English that the patient will understand.
EXAMPLE #1:
"Hi Dr. Bennett, this is Tom. Tom has been getting some crowns and upper dentures done by Dr. Mattina. He's here today for his checkup and cleaning. No xrays were taken since they were just taken at his new patient visit a couple months ago. Everywhere looks great and Tom is taking great care of his teeth, but his gums are a bit sore on the bottom right from his crown appointment last week. I showed him how to care for it and I think he will be just fine. Tom is scheduled to come back next week to continue his denture steps with Dr. Mattina."
EXAMPLE #2:
"Hi Dr. Schneider, this is John. I saw John in August for his last cleaning, and then you saw him shortly after to fix some cavities on the upper right. Today John is here for his check up and cleaning. I've taken some xrays and just started cleaning his teeth. Great news - John's fillings feel great and he's super happy with them. Today I found a lot of buildup on John's teeth today, and the gums are very red with lots of bleeding. I don't think I will be able to get everything clean today, so I would love to get John back in a couple weeks to finish up."
3. FD transfer
In some situations, the same person will be with the patient the whole appointment from the exam right through to the financial presentation and check out. No transfer is required.
But if someone different will be involved with the financials, the patient must be TRANSFERRED from one team member to the next.
There are 2 types of transfer: Note and Verbal
The Note Transfer
If your patient has doctor treatment planned, the best way for you to transfer all of the necessary info to the next person is via note transfer.
Put yourself in the shoes of the next person who is going to talk to your patient. If they've never met your patient before, what would they have to know in order to pick up the conversation where you left off?
The "DDS Tx Plan" autonote has fields for all of the info required for a note transfer.
Tx Plan - What needs to be done?
Diagnosis - This is not a clinical diagnosis but a description of why the treatment needs to be done. Ex. Cavity, broken tooth, discoloured filling, sore tooth, infection, etc
BU Plan - This is our codeword for "backup plan", since we don't want to say "backup plan" in front of the patient.
FA - How much of the FA discussion have you had with the patient so far?
NV - What are the next steps? Which doc, how many units, and for what?
Do I need to do this note for ALL treatment?
No. Use your judgment. Remember to put yourself in the shoes of the next person who is going to talk to your patient, and who might have never met them before. Would this note be helpful for them or not?
For ALMOST ALL treatment, this note will be very helpful for whoever is taking over your patient.
If the patient doesn't schedule treatment for some reason, and then a month from now someone has to call them, it will be much more effective if they can say, "Hi Mrs. Patient, you saw Dr. Schneider last month about a sore tooth on the bottom right that Dr. Schneider said is infected. Is fixing that infection still important to you?"...... instead of saying, "Hi Mrs. Patient, are you ready to schedule that root canal?".
In reality, if the treatment proposed is a 46O filling, this note is really not helpful and you can skip it.
If in doubt, do the note. Too much communication is better than too little.
If I'm taking my patient up to FD, can't I just skip the note and tell FD everything in person?
No. A verbal transfer is not a replacement for a note transfer, for 2 reasons.
First, as you will see in the next section, the verbal transfer is really for the patient's benefit, not ours. So we use plain English and leave some details out. The note transfer is much more detailed than the verbal one.
Second, again - put yourself in the shoes of the person you are transferring to. They are not just sitting there waiting for you. They are usually in the middle of doing something else, and have their own long list of things to do on their mind. If you do a detailed verbal transfer with no note, they will be lucky to remember 50% of what you told them.
The Verbal Transfer
In addition to the note transfer, you should also verbally transfer your patient to FD. The purpose of the verbal transfer is to make your patient feel comfortable with the next person who is going to help them, and confident that we are all on the same page.
2 pieces of information required in a great verbal transfer:
What did you do today?
What do you need FD's help with?
2 tips for a great verbal transfer:
Remember that you are saying all of this out loud for the patient's benefit. We have everything in the computer, so technically we don't have to say anything at all to each other. We are only having this conversation to make the patient feel more comfortable.
Use plain English, not dental terminology, so the patient can follow along without worrying about codewords.
Example of a BAD verbal transfer:
"Hi Stacey can you talk to my patient about 46 endo/core/crown? He needs an FA and if he doesn't want to do it then 46 exo."
Example of a GOOD verbal transfer:
"Hi Stacey, this is Mr. Patient. We just finished up with his 6 month check up and cleaning and I entered all of that into the computer already. Mr. Patient has had a sore bottom right molar for a few weeks now and it's been keeping him up at night and getting worse lately. Dr. Schneider had a look and talked to Mr. Patient about fixing the infection to get rid of the toothache and at the same time strengthening the tooth so it doesn't break later on.
Mr. Patient, Stacey is going to talk to you about cost and payment and then get you scheduled as soon as possible."
If you're a hygienist, 99% of the time your job is done at this point. You've done your note, transferred your patient to FD, and then you will move on to your next patient. It is very unlikely that you will get into a detailed discussion about finances and payment with the patient, except for some common questions you will later in the "WHAT IF" section of this document.
If you're a dental assistant, sometimes you will transfer the patient to FD at this point, and other times you will continue with the financial presentation yourself.
When would you transfer to FD vs continue with finances yourself?
You don't have time.
You are getting out of your comfort zone. As you practice and become more and more comfortable, you will be able to handle more and more of these patients on your own entirely from start to finish, which is a HUGE help for FD.
4. "Does my insurance cover that?"
We have a whole separate training blog on how to handle insurance questions: CLICK HERE
5. "What did the doctor mean by that?"
(These answers also work for "How much is that going to cost?")
The patient might also ask similar questions like:
"What was that about?"
"Can you explain that to me again?"
"What's going on?"
The answer to this question comes in 4 parts:
Here's what's happening
Here's why we're concerned
Here's what we propose to do about it
Book the next visit
EXAMPLE 1: Patient has a broken tooth that is tx planned for a crown
Bad answer:
Dr. Schneider says that tooth needs a crown because it has previous endo and might break.
Good answer: Remember the 4 part answer from above
(Here's what's happening)
Dr. Schneider was pointing out that your upper molar - the one you had the root canal at your last dentist - it has a really big filling on it.
(Here's why we're concerned)
When teeth have this much work on them, especially when they are your grinding molars, they are at higher risk to break than normal. And when they break, they usually split right down the middle and then the tooth has to be removed. Since this is a really important chewing tooth, you'll probably miss it and want to replace it, which we can do with a bridge or an implant. Cost to do that is in the $5,000 to $7,000 range, and even the best implant we can do is still not quite as good as the tooth you have right now.
(Here's what we propose to do about it)
The good news is that we have materials now that can cover your molar like a helmet and keep it strong, minimizing the risk of it breaking in the future. Cost to do it that way is about $1,500.
(Book the next visit)
Dr. Schneider can see you next week Mon or Wed - which works better for you?
EXAMPLE 2: Patient has wear on his teeth and tx planned for nightguard
Bad Answer: Do you grind your teeth? Dr. Bennett says you need a nightguard and it costs $500.
Good Answer: Remember the 4 part answer from above
(Here's what's happening)
Dr. Bennett noticed that some of your teeth are quite worn down. That's why the spots HERE and HERE on your front teeth look flat, and it also might be why those filling keep breaking.
(Here's why we're concerned)
Almost everybody grinds their teeth at least a little, whether they realize it or not. It doesn't always mean making loud grinding sounds during sleep, so a lot of the time you don't even know you're doing it. But we can tell that you've already done some damage to your teeth, and if you keep wearing them down at this rate, by the time you're 50 or 60 or 70 years old they might be tiny little nubs. They can be very sensitive if you wear them down right into the nerve, or they can break because they get really fragile, or they don't look very nice. And then you're probably going to want us to fix that damage because it doesn't look or feel very nice, which means rebuilding your entire bite. We're happy to help you with that, but it's a major reconstruction job and can take months of treatment and cost tens of thousands of dollars.
(Here's what we propose to do about it)
The good news is that the wear on your teeth right now is not so bad that you're asking us to reverse it. If we can just keep your teeth where they are, and prevent them from getting worse, you'll probably be ok with this set of teeth forever. The best way to do that is by wearing a protective guard between your teeth when you sleep, so that when you squeeze together there's a shock absorbing layer there instead of grinding teeth against teeth. Cost to do this is about $550.
(Book the next visit)
The next step is to take some scans of your teeth, and then we can get that nightguard ready for you either Mon or Wed next week - which works better for you?
EXAMPLE 3: Patient has a whole bunch of cavities to restore
Bad Answer: You have 46 MOD, 45MO, 44DO, 35O, 36MOD, 38O composites to do and it costs $1000.
Good Answer: Remember the 4 part answer from above
(Here's what's happening)
Dr. Mattina noticed some cavities in your mouth. You can see some of them - these dark circles here and here on your x-rays.
(Here's why we're concerned)
When teeth get cavities, they usually don't hurt at first. Then they get deeper and closer to the nerve and they start to get sensitive. If the cavity gets too close to the nerve, the nerve dies and becomes abscessed. This is when people need root canals and crowns, which can cost thousands of dollars per tooth to fix.
(Here's what we propose to do about it)
The good news is that even though there's quite a few of them, at least we caught your cavities while they are small or medium size, and not huge. So hopefully we can fix these cavities before they turn into root canal problems. The cost to do all your repairs is $2,400.
(Book the next visit)
Dr. Mattina would like to get started Mon or Wed next week - which works better for you?
EXAMPLE 4: Patient has abscess tx planned for endo/core/crown
Bad Answer: Doctor says you need a root canal and crown.
Good Answer: Remember the 4 part answer from above
(Here's what's happening)
Dr. Schneider said that sore on your gums is coming from infection inside your molar. That's why it's been swollen and hurting you off and on.
(Here's why we're concerned)
When you get an infection like this, sometimes it's so bad that the tooth can't be fixed. So you have to get it removed, and since it's an important chewing tooth you'll probably want us to replace it. If that happens, we're happy to replace it with a bridge or an implant, but that's going to cost you $6,000 to $7,000, and the end result is still not quite as good as the natural tooth you have right now.
(Here's what we propose to do about it)
The good news is that your infection is bad, but it's still fixable. A root canal is the term we use for cleaning out the infection, and then we put a cap on the tooth to keep it from breaking. Doing it this way allows you to keep your natural tooth, and costs about $2,500.
(Book the next visit)
Dr. Schneider would like to get started Mon or Wed next week - which works better for you?
"Do I really need to do that?"
Remember:
1. Everything we do in dentistry is elective
2. We're here to help people get what they want, not to convince them they should care about things they don't care about
EXAMPLE 1: Patient has a broken tooth that is tx planned for a crown
Bad answer: Yes, because if you don't then really really bad things are going to happen.
Good answer:
No, you don't NEED to do anything. That tooth has been like that for several years. There's really nothing horribly wrong with it. But the doctor is concerned that it's higher risk for fracture than average because it has such a large repair. A lot of times we see these teeth come back cracked in half, and then we are doing extractions and implants for these people. You're at a point where, if you want, you can do something about it to reduce the risk of that happening.
But it's just RISK - the tooth has been like that for 20 years. It might stay the same for another 20 years, which is not likely, or you might go home for dinner tonight and break it on a chicken bone. All we can tell you is that this tooth is higher risk for fracture problems like that than any other tooth in your mouth.
So if that's important to you, and you can afford it, then go ahead and do the crown.
Dr. Bennett can get started with that repair next Mon or Wed - which works better for you?
EXAMPLE 2: Patient has wear on his teeth and tx planned for nightguard
Bad answer: Yes, because you grind your teeth.
Good answer:
No, you don't NEED to do anything. What we're worried about is that you've already done some damage to your teeth HERE and HERE. That's a lot more damage than we normally see from someone your age. So what we worry about is if this damage continues, you might have really sensitive, or short, or worn down teeth when you're in your 50's, 60's and 70's.
It's a pretty simple fix right now, vs really complicated and expensive to fix later on.
So if that's important to you, this nightguard will help slow down the amount of damage to your teeth so hopefully we can keep them the same forever.
Dr. Bennett can get started with that repair next Mon or Wed - which works better for you?
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