Managing patients’ expectations

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patients' expectations
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The job of managing patients’ sometimes unrealistic expectations, whether of digital consultations or orthodontic and cosmetic procedures, is easy when you know how. Nicole Azzopardi reports

Dr Rhonda Coyne is used to last-minute appointment changes and contingency plans. 

Having spent more than 20 years building her orthodontic practice in Far North Queensland, she’s dealt with decades of volatile weather and the tyranny of distance between her and many of her patients.

But when her presentation at the Australian Orthodontic Congress was cancelled in March this year due to the outbreak of COVID-19, hearing more about how she manages patients’ expectations during digital consultations became that little bit more topical.

“Communication is everything when it comes to managing any client’s expectations about the work we embark on together—but now that digital technology is so possible this also means we are adapting our clinic to suit our patients and learning how to bring them along with us,” Dr Coyne explains.

From assessing cleaning levels and identifying broken brackets to spotting tooth trauma and decay, dental monitoring using artificial intelligence and digital technology has more than 100 checkpoints that Dr Coyne can rely on to assess her patients from a distance.

“A lot of my patients are out of town and live remotely,” she says.

“They get rained in and would otherwise have to cancel. Digital appointments, aka tele-orthodontics, is the way we have been going for a while. 

“You’ve got to be flexible, adaptable and resilient and now with coronavirus, you’ve got to be that and more.” 

But despite the uptake in digital technology, on her side of the chair Dr Coyne is highly aware that her clients need to be stepped through the process of how it’s going to work if they choose treatment with her. 

“Managing expectations and communicating across the different generations is interesting,” she says.

In the digital world where you may not have the same non-verbal cues, you need to be on the money with good communications skills and having a really thorough process of finding out what their expectations are.

Dr Rhonda Coyne, orthodontist

“We now have the gen Zs who are really different to other generations. They want to video chat, so digital appointments just make sense to them. Whereas our gen X like email and text and the previous generations prefer face-to-face appointments. But in this current environment FaceTime is likely to be the new face-to-face.

“In the digital world where you may not have the same non-verbal cues, you need to be on the money with good communication skills and having a really thorough process of finding out what their expectations are.”

For Dr Coyne, one of the biggest hurdles is explaining up-front that she alone will not be delivering an end-to-end service when it comes to caring for a patient’s teeth.

“I want the patients to understand that everyone has a role to play and the patient does not dictate that ‘Dr Rhonda is going to do everything’,” she explains.  

“It’s a collaboration and they need to understand that.

“I always do the first 15 minutes of the first consultation to set the scene and explain how the staff come in and when. Then it’s not a drama moving forward.”

Vice-president of the Australian Dental and Oral Health Therapists’ Association, Nicole Stormon, says that most roads when managing a client’s expectations lead back to thorough consent procedures. 

“Part of professional practice and the code of conduct we follow is to manage expectations and follow appropriate consent processes,” Stormon says.

“With any cosmetic dental work there can be high expectations. Part of that is that we have to be able to provide information that adequately describes the limitations and the advantages as well as the potential outcomes for treatment.”

Dental therapist Natalie Cowan sees many parents who not only have high expectations, they are at times confused about her role in their child’s care.

With any cosmetic dental work there can be high expectations. Part of that is that we have to be able to provide information that adequately describes the limitations and the advantages as well as the potential outcomes for treatment.

Nicole Stormon, vice-president, Australian Dental and Oral Health Therapists’ Association

“I understand when parents are paying $8000 -$15,000 for their child’s smile, they want to be seen by the most senior person in the team, namely the orthodontist,” she says.

“However, there is a general misconception that an orthodontist is required to do every last bit of the work and that dental therapists are not up to the task of performing intricate orthodontic procedures like attachment placements, removing a CBJ appliance or de-banding.”

To overcome this, Cowan believes first impressions are paramount.

“If our staff are able to put the family at ease with a friendly smile, an introduction and verbal welcome, and address them by name when they walk through the door, this goes a long way toward providing reassurance that they’ve come to the right place,” she says.

A thorough series of introductions also serves to smooth the path to boost parents’ confidence in all staff members as the family’s long-term relationship with the practice develops.

“The orthodontist introduces me and explains what my role will be at their child’s future appointments. Often, I will carry out simple tasks such as photography or impressions to display to the parents showing that the orthodontist stands by my capabilities as a practitioner,” Cowan says.

In addition, expectations become clearest when a treatment plan is descriptive, contains pictures that explain the process and is written in language that’s easy for the whole family to understand.

With the plan now thoroughly stepped out and crystal clear for the parents and their child, Cowan believes her chairside manner then makes the difference between a difficult or simple appointment.

“You need a nurse on your team that is gentle, reassuring, emotionally supportive, approachable and most of all, cares,” she says. 

“Be creative and fun. Make them feel safe. Managing parental expectations is important but never forget focusing on the child—your patient—is ultimately paramount.” 

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