Have you an expertly delivered appointment routine – or does it often unravel into a mess?
Sally Goss suggests you answer a few questions to find out if you have key skills wrapped up
Hygienists work under private contract, NHS contract or within the community service with appointment times averaging between 15 minutes and 60 minutes. And every single hygienist appointment must contain certain elements in order to satisfy the patient, the GDC, the defence agencies and, of course, the person monitoring the income of the practice – while at the same time giving the hygienist a true sense of satisfaction with a job well done. So, is it possible to satisfy all of those elements every time? Let us examine the evidence:
Satisfying the patients
In the vast majority of cases, this is an easy outcome. It requires good communication skills (it is staggering to know that 70% of all litigation is related to poor communication), good clinical skills coupled with a desire not to hurt the patient, and enough time to educate the patients about good oral health.
Satisfying the GDC and the defence agencies
It is incumbent on us always to work within the GDC standards of dental practice and conduct and also to acknowledge the defence agencies insistence on good record keeping, clinical audit and good communication skills.
Improving practice income
The hygienist can be an enormous profit centre for the practice in a number of ways – by recommending products which the patients can then buy at the reception desk, by recalling patients at frequent intervals appropriate to their standard of oral health, by carrying out whitening treatments and supporting the dentists with Invisalign, Clearstep, etc.
Satisfying the hygienist
Can vary amongst different individuals.
Complete the questionnaire on the next page about your routine and see if these are the things that give you a sense of achievement. Give yourself one point for each action you do. Maximum score is 16 points!
• Do you get to the practice early?
To set up surgery and run through patients’ notes. Saves time and ensures no ‘surprises’
• Do you sharpen instruments?
Means less discomfort for the patient and reduces the chances of repetitive strain injury
• Do you see first patient on time?
If you run late on the first patient, you will be chasing yourself all morning
• Do you meet the patient at the waiting room?
Makes the patient feel important, especially if they are new to the practice
• Do you find out what the patient wants and ensure you deliver at least part of it?
If the patient has come for stain removal and you concentrate entirely on the periodontal condition instead, then the patient will be very unhappy
• Do you check medical history at every appointment?
To check for any change in medication. To advise on smoking/periodontal disease, etc. Stay updated on new research e.g. the link between bisphosphonates and osteonecrosis
• Do you make a note of oral health aids being used by the patient at every appointment?
So you can monitor changes, check on their technique and motivate the patient to use these aids daily
• Do you involve the patient in what you are doing?
To aid understanding, get the patient to hold a hand mirror while you show them colour of their gums, bleeding sites, areas of food packing, stain, etc. Use radiographs/intra-oral camera
• Do you complete measurement of sites/severity of any gum disease at every appointment?
BPE/pocket chart/plaque and bleeding scores ensure you can objectively let the patient know if they are better or worse than they were at the last appointment
• Do you find out how the patient wants the treatment to be carried out?
Ask if the patient prefers hand instruments or ultra sonic scaling. This gives the patient some control and builds up trust
• Do you carry out a pain-free scaling at every appointment?
Use sharp instruments. Use topical anaesthetic/local anaesthetic to keep it pain-free. Use Cavitron ‘blue zone’ or similar whenever appropriate
• Do you conclude the appointment effectively?
So that patient knows the next step e.g. more appointments required, recall date booked, etc
• Do you ensure the patient has sufficient oral health aids?
To ensure the patient has sufficient oral health aids to last until the next appointment. If they run out, patients may forget to buy more. To enhance practice income
• Do you stay current with the latest oral health aids that are on the market?
Don’t let the patients know more than you do! Be the first to tell them about revolutionary new products, such as Philips Sonicare Airfloss
• Do you take the patient to the desk?
Handing the patient over to the care of the receptionist will ensure they book their next appointment
AFTER THE APPOINTMENT
• Do you write up notes immediately following the appointment?
All clinical notes to be written at the time of the appointment to provide detailed information about the changing oral status of a patient
• Do you phone specific patients the next day?
To check patient is OK after local anaesthetic or to encourage and motivate new patients to keep on with the new oral health regime
• 16 points (maximum score): Congratulations, you have those hygiene appointment essentials
all wrapped up!
• 6-16 points: Make a note of any changes you would like to make and set yourself clear objectives for introducing them into your
day-to-day routine until you score a sweet 16!
• 0-6: Oh dear. Yours is a presence nobody wants – make it a new year’s resolution and remember, fail to plan, plan to fail!
Sally Goss has worked with periodontal and implant specialists for many years. She was president of the British Dental Health Foundation 1997-2000 and is a director of Practice Doctor Ltd. She was a member of the government task group NHS Dentistry Options for Change in 2001 and hygienist mentor to Boots Dentalcare until 2004. Sally also has a regular six-weekly slot on BBC radio, advising listeners on dental problems.