Dental Articles by Laurel Grantham
Click below to read the entire articles:
The following article was published in Woman Dental Journal in March 2006.
Put It in Writing, Please!
Even if your office uses paper less often – if it wasn’t in writing, it wasn’t done.
It’s a familiar scene in dental offices. The patient – we’ll call him “Bob” – has been reclined in the dental chair for an hour or longer and is a little stressed out while the dentist and assistant are performing a crown prep. The dental team is happily working away, and Bob begins to wonder if this dental visit will ever end. The procedure is finally completed and the assistant is quickly telling Bob all the instructions because they are running behind as usual. Poor Bob. Later while driving home, Bob wonders, “What did she say I was supposed to do?” Sure, he heard the assistant give the instructions, but because he was tired, stressed, and wished he were elsewhere, did he listen to the instructions? Not likely.
Why do we bother? Verbal instructions are like wind in the trees. You hear the rustle and know it is happening, but do we listen? Probably not. The same sit true for verbal dental instructions after dental procedures. These instructions are critical for good home care, patient compliance, and the reduction of phone calls after patients return home. I will never understand why the only postoperative instruction sheet in existence seems to be the one concerning extractions.
What other types of instructions are vital to good patient customer services? The following list includes several types of patient instructions that I use in my dental consulting program. These should all be customized with the doctor’s name, phone number, and address. The type should be large enough that even the most elderly patients an easily read and understand it. Instructions should be brief and to the point. I suggest writing these instructions on colored paper. Use a different color for each handout, and make sure the business office is double checking that each operative patient leaves with the appropriate ones. The number of phone calls will decline, patients will be impressed by your thoroughness, and you will be less likely to have postoperative problems. It all comes down to communicating effectively. I tell my clients, “If it wasn’t in writing, it wasn’t done.”
The most effective instruction sheets for your dental patients include:
Pre-medication instruction sheet – How many times has your schedule ground to a halt by a patient who shows up and has not taken his or her pre-medication? You called to confirm the need for the pre-med, reminded the patient, and might have even called in a refill. This is a common problem for both general and specialty offices. In this case, the office is partly to blame. Did anyone give the patient an instruction sheet listing the importance of the pre-medication and instructions on how to take it? Probably not. We just assume that because we know the importance of a pre-medication, patients should know as well. It doesn’t work that way – patients might nod and seem to understand. They even go to the pharmacy and pick up their pre-medications. But do they remember to take them on their appointment days? Why do they forget? They never really understood the importance and they received nothing in writing to reinforce what you told them.
Crown and bridge temporaries sheet – This is another important handout that can be used as an internal marketing tool. The last person to physically be with a crown-and-bridge patient is usually a dental assistant. He or she should hand each patient an instruction sheet while sitting the patient up in the chair and reviewing what has been done. You can take this one step further – have the assistant attach his or her business card to the top of the instruction sheet and tell patients to call directly if they have any problems. Patients will appreciate this personal service and remember your dental assistant’s name. The instruction sheet should be easy to read and convey all the usual instructions for the care of a temporary crown or bridge.
When checking out at the front desk, the business assistant should also ask patients if they received their instruction sheets. Customer services should extend from treatment rooms to your business office.
Dental pain instruction sheet – We usually recommend ibuprofen as an over-the-counter medication for dental pain. Patients seem to understand, but then they buy acetaminophen! Again, how were these instructions given to our well-meaning patients? Verbally. Why don’t we give them a written handout with the exact reason for our recommendation? It’s because we never thought about it before. Some offices give operative patients a few ibuprofen caplets before they leave. If your office does this, why not attach a one-dose packet to the instruction sheet? This way, patients have medication and instructions on one convenient sheet.
Root canal instruction sheet – The endo instruction sheet can cover many questions that patients ask when confronted with the need for a root canal, such as, “Will it hurt?” “Will my insurance cover this?” “Why not just pull the tooth?” You may give this sheet to patients when they are scheduling initial endodontic treatment at your front desk. This is where most of our patients want to ask questions and express concerns. It can jam up the flow of other patients waiting to check out and put pressure on your business office to answer clinical questions they may not be qualified to answer. Instead, your business assistant can touch briefly on the subject, then hand patients your in-depth information sheet on root canals.
Extractions sheet – You might already have this one in your practice, but what does it look like? Have you seen it lately? Is it a copy of a copy of a copy? Every piece of paper that goes out the door with a patient should be neat, spelled correctly, and reflect your office philosophy.
Any clinical handout should have your dental assistant’s business card attached so that patients can call if necessary. Some patients will not “bother” the doctor unless they have severe problems. Knowing the dental assistant will be happy to answer a small question gives most patients peace of mind.
Review your handouts periodically to make sure the instructions are brief, up to date, and easy to read. If you do not have a handout, type one and make sure it looks professional.
Denture sign-off sheet – Remember the old joke? “The denture that doesn’t’ fill well is the one that isn’t paid for!” You probably have that one patient who will never be satisfied with the look or feel of a new denture. Perhaps you even had to refund a fee because of total frustration with a difficult patient. The best way to handle the situation is to have all denture patients sign before their cases go to your lab for the last time. Have patients write their initials next to each item on the list, such as tooth color, tooth shape, denture fit, midline, etc. Include the following disclaimer on the handout. “If you choose to have changes made to your denture after it has been delivered, you are responsible for any additional lab fees.” Getting patients to sign and date the form will reduce the number who think they can change their minds after cases are completed.
Periodontal home care sheet – Once again, our hygienists give too many verbal instructions instead of providing them in printed from. Patients going through periodontal therapy are usually in the chair for long periods and do not receive verbal instructions well. It is much better to ensure patients are comfortable, briefly touch on what they need to do, and give them instruction sheets with your hygienist’s business card stapled to the top. This will build patient rapport and reinforce your customer service goals.
Patient consent forms – Patient consent forms are not just for sedation; they can be used for many reasons. If patients do not understand their treatment, the consent form explains it in writing. You can have your consent forms translated into Spanish or other appropriate languages so your non-English-speaking patients will understand treatment they need and can give consent. Consent forms should be written in large type that can be easily read, with terminology and concepts that patients can easily understand.
If you give any medication to relive anxiety before dental procedures, it is essential that patients sign a consent form and receive complete instructions. Merely telling patients that someone must bring them to their appointments and take them home does not relieve you of the responsibility for the patient’s safety. They need to see it in writing and know what else they should or should not do after their appointments. This form should be signed and dated, and a copy should be given to each patient. Never assume that patients should know what to do after dental appointments when they have received even moderate sedation.
X-ray sign-off sheet – If for any reason a patient decides to forego radiographs, it must be documented in the chart, and an x-ray release form must be signed and dated by the patient. If you merely ask patients and then write it on their chars, it can come down to you word against theirs if a problem arises. Also, if patients must sign a release not to have an x-ray taken, they seem to take it more seriously. Many times, the patient will say, “Well, if it’s that important, go ahead and take the x-ray.” If you have a patient who continually refuses all x-rays, decide if you want to keep this patient in your practice. If you cannot fully diagnose a dental condition, you might have a liability issue with this patient.
Periodontal refusal form – If you or your hygienists have diagnosed a periodontal condition that a patient chooses to ignore, you must have the patient sign a form in his or her chart. This form states that the patient has been informed of a periodontal condition, and he or she chooses not to receive treatment for the condition. If your chart entry merely states that the patient verbally refused treatment, this can be contested at a later date. How many of you have patients who say, “The doctor never told me I needed that,” after you spent 20 minutes going over everything in detail? Remember – anything verbal did not happen.
I cannot emphasize enough how critical it is to put important instructions in writing for your patients. They will appreciate it, your staff will save time by not having to answer redundant questions, and you will have addressed a risk-management concern. Think of all the procedures you do every day. I’ll bet you and your staff could come up with some interesting and helpful instruction sheets for your patients to take home. Put them on color-coded paper and keep them handy in a rack so that your staff can grab them during a busy day. Print and copy them professionally so that they reflect the excellence of your practice, and you can be proud to hand them out. Verbal instructions can be time consuming and frustrating. Let’s put it in writing and become more efficient and productive every day. Laurel Grantham
Grantham Consulting © 2006 |
