Case Presentation: Identifying Patient Types on the Initial Call

To discover whether the caller is a minimal or complex care patient, the receptionist needs to be curious — that’s a keyword — and ask about the patient’s underlying condition. These questions are best asked after the patient has had the opportunity to discuss what their main concern is. A way to invite that information is to simply ask as early as possible in the telephone call, “Nancy, what would you like the doctor to check first during your initial appointment?” This way, the patient is invited to volunteer the information that he or she is most concerned about.

Once you understand the patient’s chief concern, then a few simple questions will help reveal the patient’s underlying conditions. For example, an excellent question to ask is, “Nancy, I understand you’re unhappy with your smile. If you have another minute, I have a few questions for your medical record. Would that be okay?” It’s important to get approval to ask the patients these initial questions. One of the first questions I recommend asking is, “Nancy, are you missing any teeth, or have any been replaced with a partial or full denture?” The reason this question is important is that partial edentulism (the underlying condition) is a condition whose ideal treatment requires complex care, such as dental implants. Another good question is, “Nancy, are you pleased with the appearance of your teeth?” In this particular case, we already know Nancy is not pleased with her teeth, but if the caller does not volunteer that information, it’s a good follow-up question. If the caller expresses, “No I’m not happy with the appearance of my teeth,” chances are the enhancement of the appearance of the teeth will result in complex care (crowns, veneers, and tooth replacements).

Another question that will signal the complexity of the care the patient requires is the date of birth. Generally speaking, patients over age 50 are complex care patients. Keep in mind, these questions do not take a lot of additional time. And, all you need to have is one clue as to their underlying conditions. So, for example, if a patient says, “Yes, I’m missing a lot of teeth,” then your diagnosis of a complex care case is already made. One clue can yield a lot of information. If the patient is not missing a lot of teeth and they are pleased with the appearance of their smile, the patient is generally younger and doesn’t have any outstanding disabilities related to the teeth, chances are this is a minimal care patient.

Identifying what type of patient is calling and developing two distinctly different patient experiences will enhance your ability to help both minimal care and complex care patients get the level of dentistry that fits their conditions, disabilities, and lifestyle.

Two Types of Patients, Two Types of Processes

So how can your new patient process satisfy two significantly different patients? How do you make sure the simple and complex care patients are satisfied with their initial appointment? It’s simple. Have two different initial appointment experiences.

The minimal care patient’s appointment should center on efficiencies. The complex care patient’s appointment centers on effectiveness. Let’s talk about the difference. The minimal care patient responds well to patient education and efficiencies. Generally speaking, the minimal care patient is younger, has far less patience in treatment situations, and is not looking for deep relationships with healthcare providers. Younger people look at healthcare as a commodity. Thus, the visit to the dentist is best managed in an efficient manner. Minimal care patients can be seen first by a hygienist, who cleans the patient’s teeth and initially assess and identify issues that should be looked at by the doctor. The doctor then has a short discussion with the patient about his or her needs and recommended care. Then, the financial coordinator would make financial arrangements with the patient and set the next appointment.

The emphasis on the new patient experience for the minimal care patient is on efficiency and delegation. The new patient experience for the complex care patient, however, focuses on relationships. Here, I recommend that the complex care patient be seen first thing in the morning or first thing in the afternoon, without a lot of other competing procedures going on in other rooms. In other words, block out an hour of time to focus on that complex care patient. My recommendation is this patient first is seen by the doctor in a confidential, comfortable area of the practice, not the clinical operatories. That way the doctor can discuss and discover the patient’s conditions, their associated disabilities, and most importantly, the life events the patient is currently experiencing that will affect his or her ability to accept care.

After the doctor and patient are able to have an open discussion about the patient’s experiences with dentistry and life circumstances, an examination should be conducted to verify the dental needs. Then, a second discussion should take place, again in a private and comfortable area to review the patient’s diagnosis and treatment plan recommendations. In this discussion, the doctor and dental team need to acknowledge the patient’s life circumstances and relate them back to their emotional need for better dental health. By doing so, the patient experiences your willingness to be there for them when they are ready – either now or later.

The differences between the complex and minimal care patient’s initial appointment are significant. Consequently, it is ideal if you can determine which type of patient is calling during the initial phone call. The big secret to managing the differences between minimal and complex care patients is being able to appropriately identify them on the telephone.

Here are two quick examples of how quickly you can classify the patient care type:

MINIMAL 

Ring, ring, ring.

Good morning, Dr. Homoly’s office. How can

we help you?

Yes, I’d like to make an appointment to get my teeth

cleaned, please.

Sure. We’d love to see you and I’m sure you

will love Dr. Homoly and our practice. Can I

have your name, please?

My name is Debbie.

Debbie, thanks for calling our office. May I

ask how you heard of our office?

Sure. I was just transferred here and a co-worker

recommended you.

I’m so glad. Be sure to let us know who

recommended us so that we can properly

thank them. Before we make an appointment,

is there anything you would like Dr. Homoly to

look at or be aware of first?

I just need to get my teeth cleaned.

Debbie, we’re happy to do that for you.

Debbie, if you have another minute, I have

a few more questions for your oral health

history. Would that be okay?

Sure, that’d be fine.

Debbie, do you have any missing teeth now,

or any teeth that have been replaced by a full

or partial denture?

Oh no…I have all my teeth. I had my wisdom

teeth taken out in college, but besides that, I have

all my teeth.

Debbie, are you generally pleased with the

appearance of your teeth?

Yes, I think so. I had braces when I was younger, and

they’re still pretty straight.

Debbie, do you have any difficulty chewing or

opening or closing your mouth?

No…everything’s fine.

Debbie, for your medical record, may I have

your date of birth?

Sure, it’s September 15, 1981.

Okay, Debbie, our first available appointment

for an exam and cleaning is next Tuesday

at 2:30. When you come in you’ll be seen by

Rita, our hygienist, will talk to you a little

bit about your dental concerns, she’ll clean

your teeth and take some initial x-rays. Then

you’ll meet the doctor and the two of you will

discuss your treatment needs, if there are any.

How does that sound, Debbie?

The answers from Debbie revealed that she had minimal conditions in her mouth and minimal disability. This is a minimal care patient who will respond well to efficiency, which means getting her in, getting her out, and making her happy.

In my case presentation program, Making it Easy for Patient’s to Say “Yes!”, we train on communication and confidently presenting treatment through dialogue. The intention of the advocacy dialogue is to reassure that patient that we’ll look to find a way to fit our treatment recommendations into their life circumstances. This dialogue opens the conversation about whether some, all or none of your treatment recommendations will fit into their lives now.

When you’re ready to train your team on presenting treatment and patient dialogue, I can help.