[ Read Part One ]
An Inside Look at the National Survey of Public Perceptions of Dentistry
The Crown Council was given the opportunity to help fund a significant study meant to identify public perceptions of dental health and the role dentists play in providing dental health services. We jumped on the opportunity because we felt it was time to see what was really on people’s minds when it comes to the dentist.
What we have attempted to do is translate the scientific data into a practical, easy plan for your practice in the form of understandable survey findings and some associated solid suggestions for your practice. Some of the results will not surprise you. Others may expand your vision of what you should be doing. Yet other results may be a little unsettling.
Survey Finding #2
“Tell me more about periodontal disease.”
When survey respondents were asked to rate the importance of different dental procedures, 85% said that checking for periodontal disease was important. Only one other procedure outranked checking for gum disease in patients’ minds, and that was checking for cavities which came in at 88%.
Perhaps because of the media attention over the last ten years that has focused on the systemic link between periodontal disease and other health related problems like heart disease, the public is coming to the realization that what is going on in their mouth is important. Dentistry seemed to score higher in this area when it comes to addressing and treating periodontal disease as roughly 85% of patients indicated that their dentist was checking and treating it. At least that is the perception. Keep in mind that a survey is only as accurate as the way questions are asked.
The good news is that patients seem to be increasingly open discussions about periodontal disease. In fact, over 80% expect you to address the topic when they come into your office.
Here are some questions for discussion and action with your team:
Team Discussion Questions
- How much are you really diagnosing and treating periodontal disease in your practice?
- How many units of scaling and root planning did your hygiene team really do in the last thirty days?
- How many units of antibiotic did they place?
- How many perio maintenance appointments or 4910’s did you have in your practice in the last thirty days?
- How does that compare to the number of cleanings you are doing?
- When you look at those numbers, how do you know if that is reasonable and what those ratios should really be?
One of my mentors, Dr. W. Edwards Deming, the father of the quality movement around the world, once wrote, “How many dentists do magnificent work? The question is impossible to answer, for the simple reason that there has never been a definitive study of quality in the dental profession; nor is there likely to be one. Partly because they tend to work alone, dentists resist the idea of being evaluated, or ever observed, by others. And because inferior dental work may not be discovered until years after it is performed, patients are seldom in a position to make informed decisions.”
Great progress is being made in this area by a group of forward-thinking dentists who are comparing and discussing their clinical performance on a monthly basis in order to improve the quality of care they are providing. Each month, practices who are involved in the ToPS Institute’s “Total Practice Support Program” submit their clinical results, including important data in the area of periodontal diagnosis and treatment. Their results are analyzed, compared and shared so that each can better understand the level of care they are really providing their patients, and learn what they can do to truly improve their practice.
So what is the periodontal protocol in your practice? By that I mean, how do you diagnose and classify the different levels of disease and what is your treatment protocol at each level? Are you, as the dentist, totally clear on the answer to that question? Is it in writing? Have you had a discussion with your entire team about your clinical philosophy in the area of periodontal disease and why identifying it and treating it is so important? Our experience has been that there is a lot of opportunity for improvement in most practices in this area.
Once you have your periodontal protocol defined, how do you know if it is really being followed? How do you really measure adherence to what you believe in clinically? One dentist who recently started measuring his clinical results in the program was amazed at the difference in the results his hygienists were getting. Were their patients that much different? By working together to clarify clinical protocols and establish a uniform system in their practice, results improved for both hygienists. Hence, the patients benefited from better quality care and the practice benefited as well. That’s why we say, what is good for the patient is usually good for the practice.
There is a very personal sideline benefit from this entire process — peace of mind and integrity.
Years ago we had an advertising executive attend one of our seminars. He was unhappy in his professional and personal life and was considering a change. During one of the sessions, we encouraged each participant to write out their core values or what really mattered most to them and then compare that list to their daily task list of what they were actually spending their time doing. He took on the challenge. Several weeks later, he called and said that he had fired his therapist! He had discovered the root of his problem. As he considered the values and the things that were most important to him in his life and then compared that list to how he was spending his time, he discovered that the two lists were miles apart. He was doing little if anything that really mattered to him. He started making some changes in his daily activities personally and professionally to bring his actions more in line with his values. Within a very short period of time, his personal life improved and his professional results had skyrocketed.
We are finding the same thing in the dental office. Much of what is wrong in dentistry starts with your philosophy of care and making sure that it is being executed with your patients.
One last word in this area: If you are not accurately measuring your clinical results, you don’t really know what is going on in your practice or if you are really walking your talk. The cumulative results of your daily activities may surprise you. They do most people.
So, once you have clarified your clinical philosophy of care, put it in writing, and educated your team, then it’s time to work on how you are communicating with your patients. That is the main message of the survey, how your patients perceive what you are doing and receive what you are saying.
How are you educating, presenting and discussing periodontal disease in your practice? Is everyone on your team using a uniform way to communicate with your patients using verbal skills that you have trained and retrained on a regular basis?
I was recently presenting a workshop with a group of “veteran” dentists with whom I have worked and trained for many years. We were doing what I thought was a “review” of some case presentation skills that the group had heard many times before. As we went into the practice section of the workshop, I stopped to listen to what was going on in the room and was surprised that many were struggling with the skills. Now maybe that is a sign of a poor instructor! But what I was reminded of is that having heard it, does not necessarily mean that you know it. You have to know it, to do it. But you have to do it many, many times before it becomes a part of you.
How you communicate with your patients can always use more attention and training time in the office. How your patients perceive what is going on depends on it.
Once again, periodontal disease was ranked as one of the topics of most importance by patients in the survey. How you diagnose it, communicate it and treat it is one of today’s highest priorities.
There is a general conclusion to these first two survey results on the importance patients are placing on oral cancer and periodontal disease: Patients are coming to realize that what is going on in their mouth can and is affecting their overall health. They also realize that what is going on with their overall health can show up in what is going on in their mouth.
While patients get the connection, dentistry may not! Survey respondents indicated that only 51% of the dentists they visit are addressing the connection between oral health and overall health. The difference between their perception of the connection and what they expect from their dental office is another wake up call.
There is an open invitation that is gradually evolving into a patient expectation that the dental teams start addressing whole health issues that are affected by, or visible in, the mouth. They don’t just want to talk about their teeth. They want you to address the big picture. The two most obvious areas to start are with periodontal disease and oral cancer which have clear whole health implications.
I was recently in for my routine hygiene visit. During the appointment, Melissa, my hygienist, asked me how much sleep I was getting. Now that is an interesting question for a hygienist to ask, I thought. It just so happened that I was on the tail end of a particularly busy time where I had been burning it on both ends. I shared with her what was going on in my life and then asked her how she was able to tell. “Fatigue,” she said, “shows up early in your mouth. In fact,” she said, “many symptoms of a lot of health problems show up in the mouth.” You see, Melissa gets it. She understands that, as a patient, I look at her as a member of the larger healthcare team. Patients don’t expect you to be the family practice physician, but they are now expecting you and asking you to make them aware of things that their physician might need to address more carefully.
One area where dentistry does a good job of addressing a whole health issue is in the area of high blood pressure. In most dental offices, every patient’s blood pressure is checked at every visit. It is just one way you screen for a whole health issue that your patients may or may not be aware of. But when was the last time you checked for diabetes, for example? Millions of people have diabetes and are being treated for it. Millions of others have diabetes but have never been diagnosed or treated.
Some of the symptoms of diabetes show up in the mouth. Do you know what they are? While your job may not be to diagnose a whole health problem, patients today expect you to know what you are looking at, address it with them and point them in the right direction.
- Pay more attention to information on the medical history form.
- Using proper communication skills, address oral and overall health and the connection between the two.
- Patients expect this, they are leading the way.
- It is time dentistry started leading the patient in the direction they are asking to be lead.
- It is the right thing to do as a member of the healthcare team. It is t he right thing to do for the patient.
Additional findings from the Crown Council-funded survey on what dental patients really want will be excerpted on this blog. They are described in full in the FREE e-book, What Patients Really Want, by Steven J. Anderson, available here.
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