The Problem With Standard Charting

When we chart a patient in the standard way, we can be inadvertently creating problems. Most dentists spend a lot of time examining the mouth carefully and calling out all the treatment to a DA in language that the patient doesn't understand.

Then they sit the patient up and give them a diagnosis.

Most dental conditions are painless. Think of things like periodontal disease; imperfect restorations that need to be replaced; worn teeth. I would guess that at least 80% of what we diagnose is unexpected to the patient. It's also more expensive to treat that the patient expected.

So, this scenario is not just's the norm.

You should understand that when you hear the words "but it doesn't hurt!".....that's more than an idle comment. It's an objection. You are now dealing with someone who has lost a little bit of trust. They want you to be wrong.

Psychologically, the patient is now in an oppositional mode which puts the clinician in a somewhat defensive position.

Unfortunately, as the clinician tries to educate the patient this can now sound like a justification for a sales agenda. The more the dentist educates, the more it sounds like 'selling’. This shifting of the patient's emotions into a negative state can snowball, lead to cancellations and damaging reviews.

The other problem dentists face is patient apathy. It's very difficult to get apathetic patients to commit to treatment...particularly for complex or expensive treatment. These people need to be quickly convinced that a problem really exists.

For many years, my solution to all of this was to conduct my exams using a technique that I called the Eavesdrop Technique. I didn't chart using dental jargon because that caused the patient to 'tune out'. I was careful to convey the diagnosis to the dental nurse in a way that was designed to make the patient curious. It involved verbalizing the charting in plain English.

The problem with the Eavesdrop Exam is that it is a very nuanced technique. If you really knew how to do it well, it worked, but it's difficult to master and it can easily become a farce. The verbal skills I now use have been simplified. We've moved past using the Eavesdrop Exam as the main communications tool.

Today, we can use a combination of techniques and technologies to solve these communications issues. Each situation can offer different solutions based on having enough room and enough staff. The options include the use of New Patient Coordinators; the use of the latest photographic technologies where cameras are tethered to screens in other rooms; instant annotation software and post-treatment simulation can all be employed.

The stakes are only getting higher and we cannot afford any miscommunications. Most practices have more than one clinician. As facilities are being re-developed they are usually larger. Typically, we have a mix of newer graduate dentists along with more experienced dentists. If one dentist causes a patient to post a negative review it affects all the practitioners at that facility. And if the practice is part of a larger corporation, that review can ripple across many practices.

Defining the problem clearly is the first step in finding a solution. In future articles, I'll be detailing out the various solutions.



Dr. Michael Sernik
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