Dentaltown September 2016 - 86

hygiene feature The scrimmage line Physical positioning is probably the primary mistake teams make. It's important to know what your body language is saying to your patients. How do you line everyone up? A scrimmage-line scenario: It's time for the exam and the hygienist-to-doctor handoff. The doctor walks into the room and I notice my room is missing a chair. No big deal, right? I'll stand and the doctor can have the only chair. The doctor pulls his chair up to the 11 o'clock position and leans the patient back to thigh level. I think, "He knows we're supposed to be seated at 5 and 7 o'clock, but if he wants to hang out at 11... well, I'm not his boss." Moving on, I confidently stand at my 5 o'clock position and share information gathered from our appointment. The patient is interested in learning about Invisalign, the periodontal assessments were stable, and I noticed a "brown spot" where the patient is getting food stuck. The intraoral photo is blown up and onscreen so the doctor and the patient can see. "Nailed it," I think. The doctor diagnoses a cavity on tooth 4 and says the patient is an excellent Invisalign candidate. With the patient still lying back, the doctor asks if she has any questions. She shakes her head. Second, laying the patient back and standing over her puts her in a vulnerable position. Remember: Some people have a difficult time gathering their thoughts during an exam, especially if problems are found. If she's afraid or apprehensive, this will further inhibit communication. In the above example, the patient was immediately laid back and the hygienist, chairless, stood over her while sharing personal information. This closes off communication, and lost communication loses treatment-plan acceptance. Instead, start your handoff at eye level and share important information before the exam. Lastly, in this scenario you probably noticed that I didn't believe I had the freedom to tell the dentist where to stand or what to do. This is huge. All team members should feel empowered to help the team reach the ultimate goal. Dentists, please have the "it's OK to call me out politely" conversation with your staff. Coping with the quick handoff Gathering the tools needed for a great patient handoff is critical. In the hygiene appointment, information such as chief complaint, blood pressure, radiographs, cosmetic With time and direction, we are able to provide optimum care, have meaningful patient conversations and perform clinical evidence-gathering, all of which leads to handoffs with great information. The patient goes to the front. She doesn't want to schedule her filling or Invisalign right now, and asks the front office to give her a call. "What went wrong?" I wonder. "That was a rock-star presentation for the doctor." Well, yes, it might have been a rock-star presentation for the doctor, but body language wasn't helping the patient. First, the doctor diagnosing and speaking to the patient at the 11 o'clock position (or in other situations with a mask and loupes on) cuts off communication and doesn't really allow the patient to ask questions comfortably. When communicating at the handoff, all clinicians should have masks and glasses off. Ideally the doctor, hygienist (or hygiene assistant) and patient should be in a triangle of communication: the patient at noon, and the doctor and hygienist between 4-5 o'clock and 7-8 o'clock. This allows for open communication-the patient can comfortably make eye contact with both of us. 86 SEPTEMBER 2016 // dentaltown.com wants, intraoral photos of suspicious areas, missing cusps, recession, occlusal wear, bleeding points and probing scores should all be covered. In my experience, getting enough time to complete these duties for the handoff is critical to success. I'm not suggesting that anyone wink at poor time management-however, I've worked in an accelerated model and it's a special challenge to complete a decent handoff. In essence, the dental hygiene assistant is giving the handoff to the doctor, after getting a handoff from the dental hygienist. This game of "telephone" leaves a lot of room for error and confusion. For the purposes of this scenario, we'll review a one-hour appointment. The quick-handoff scenario: Patient Lucy is due for her periodontal maintenance, full-mouth series of radiographs, oral cancer screening and exam. In this one-hour appointment, Lucy is running 10 minutes late. This office's policy allows patients to be up to a half-hour late. I seat the patient, take Continued on p. 88 http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown September 2016