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, so many patients are surprised that there are problems and it's common to hear "but it doesn't hurt!"

This now puts the clinician in a somewhat defensive position. They now try and educate the patient which can, in turn, also sound like a justification for a sales agenda. This shifting of the patient's emotions into a negative state can snowball, lead to cancellations and damaging reviews.

The other problems dentists face is patient apathy. It's very difficult to get apathetic patients to commit to treatment...particularly for complex or expensive treatment.

The system I use causes patients to be more engaged and more motivated to want a solution. It removes all doubt that there is a genuine condition that requires attention.

Interactive Charting

Most of the charting happens with the patient sitting up while you look at a series of high definition images on a monitor.

When you 1st look in the mouth, just call out to the DA anything that would not be visible if you had a high definition photo of each arch. This shouldn't take more than a few moments. You'll now be sitting the patient up, but before you do so, look for the most significant condition that is visibly obvious and describe what you can see in very plain English that any patient can understand.

For example, say to Helen the DA: "Helen, please note that the lower molar on the right side has a filling which is around 80% amalgam filling.  There are two 3mm cracks on the outside. They run down under the gum. If they split the tooth it might not be possible to save this tooth."

Then take photos with a DSLR camera and some anterior shots. Sit the patient up. Display the enlarged photo on your monitor that clearly shows what you just described. The monitor needs to be visible to the patient from the dental chair. Point to the area and say to the patient something like: "I'm wondering if you can you see what I'm looking at here."

Chances are the patient will easily see what you just described to the DA. They now understand that there is at least one specific problem.  This is not the time to discuss solutions. If they ask for options, just say, "I understand that you're interested to know the solutions. We'll go through all the options in a moment. I'd like to first note anything else that is visible, because I imagine you'd like to see the full picture. Is that OK?"

Now from the monitor, continue the charting, calling out the conditions to the DA. How you do this is up to you. You could use standard dental charting jargon for efficiency or use plain English if you are trying to reinforce a particular message. You are not addressing the patient directly at this stage. They are passively overhearing what you are saying to the DA.

When you've finished, lie the patient down again and just check again that nothing was missed such as periodontal conditions or occlusion issues etc.

Before discussing treatment options, you'll need to review radiographs and any other diagnostic tools or techniques. The next step is to sit the patient up and begin a discussion regarding treatment choices. There is a very specific sequence and method to how you discuss treatment options. (This will be discussed in other articles.) 

This charting method has 2 significant psychological advantages.

Instead of you telling them what you can see, you were able to get them to tell you what they can see. People believe what they say, more than what you say. By holding back on the solution, you have also sequenced the process into PROBLEM-SOLUTION. This sequence transforms the apathetic patient into an interested motivated patient. 


Dr. Michael Sernik
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