#847: Co-Diagnosing: Pre-Game Strategies

What Would Doctor Do?

Tiff and Dana educate about how to set up doctor’s diagnosis with some pre-gaming strategies. It’s as easy as 1-2-3:

1. Calibrate the language and focus

2. Set clear expectations

3. Doctors, empower your team

The consultants give examples of how to go about this, plus insight on why this’ll improve how your practice functions.

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Transcript:

Tiffanie (00:01.732)

my goodness. Hello, dental A team listeners. We are so excited to be here with you today. I have Dana, my, my fave podcast gal with me today. You guys know that Dana, thank you so much for being here with me. we've got some fun things in this one today. I cherry picked you for sure for this way back in the day when we created these newsletter topics because we're going to talk hygiene. So,

Doctors, teams know we're going to talk dental assistance and hygiene. But first of all, Dana, how are you today? How's life?

Dana (00:34.165)

Doing good. Life is, you know, it's winding into summertime. So things are starting to, like sports are slowing down, school stuff is slowing down. So it's a good space to be in. How about you?

Tiffanie (00:41.412)

Yah!

Tiffanie (00:45.764)

I agree. Lacrosse, like banquet was last week and that was our last lacrosse thing until fall. And I was like, my gosh, I don't know how Dana does it. I had one kid, one kid in one sport. And I was like bananas this spring. So you are super mom, you are super consultant, super everything. So thank you from us and from your family for everything you do Dana, cause I think it's wild.

Dana (01:11.604)

Bye.

Tiffanie (01:14.468)

When my life gets chaotic, I'm like, I think about you. I don't know what you're doing over there with the kids. And you're just always, always being the best mom ever. So kudos to you. And that honestly, like, I think that's just how you personify yourself in general. You're just constantly like, on the next thing with a smile on your face and like, this is what has to happen. So this is what's going to happen. And you just get it done. And I think I can probably.

accurately guess that that was you in hygiene as well. So I think it's kind of cool to pick your brain on these. You guys know that Dana is my go -to systems lady. Like systems are her jam. She does see freaking fantastic at them. And one thing I wanted to look at today were some systems that we could put into place in practices or that we actually do work with a lot of practices on to help doctors get more diagnosis from their dental assistants and hygienists. And I think -

I think we do our team a disservice by not allowing them to play a bigger part and a bigger piece in that aspect and really feeling like they are giving more to our patients than we ever realized we could. And I think this is a good area, Dana, where we can take some of those simple systems and implement them so that anyone can use them. But first, how did that go for you?

Chair side, when you were a hygienist and you've got a doctor coming in, like how did you do that? And then how do you take that and implement it into your consulting now?

Dana (02:40.084)

Yeah, sure. I think that as a hygienist for me, the biggest thing was working for a doctor who like, he gave me the open space and actually said like, I honestly I know you're coming from hygiene school where like, you can't diagnose you can't do the things like you're not the doctor and he's like, I want to set the expectation that you have that space. And no matter.

what you say, right? I will always have your back when it comes to patients and patient care. And so I think the biggest thing is knowing that he truly wanted me to do that, right? Gave me the confidence to go in and have the conversations with patients. And his biggest push was you spend so much time with them. And then I have so little time with them. And there's so much that you can do to make my little bit of time that I have with them, be more efficient, be more effective. And you know me to

I think this is something we share like I don't want to waste one minute. So if I can pre -do all of these things and just kind of be like here it is, right? That's a wing for me. And so I think the first thing is and doctors this is for you. Let your hygienist know that you want them.

Tiffanie (03:35.144)

Yes.

Yes, yes.

Tiffanie (03:46.724)

Yeah.

Dana (03:53.844)

to do these things and give them the space to do it and set clear expectations that I want you to take the photos before I come in and I want you to talk about those photos and I want you to take scans before I come in and I want you to talk about them. I want the patient to see them. So I think one is giving the space and the next is truly creating a flow of what do you want your hygienist to do.

Tiffanie (04:03.204)

Mm -hmm.

Dana (04:16.34)

before you come into the room so that they have very clear expectations of what conversations they should be having and when they should be having them.

Tiffanie (04:25.636)

I love that. I'm always taking so many notes. Thank you. I hope everybody's taking notes unless you're driving, then stop replay and take notes. So I love that. I think that's great. Like that your doctor said that you're with your patients way longer, right? Than the doctor is. And I think that's just the way of life. I think our dental assistants are there longer than our doctor is. Our doctors are in and out and our doctors, we've got them in a lot of different rooms. So to expect them to do all of those pieces every single time they're walking into a room.

feels absurd to me. So I love that you said that. And some key parts that I pulled out that I think is huge for everyone to understand is that this isn't something that you can go in on Monday or Tuesday or Wednesday or whatever day is tomorrow in your practice and say, okay, guys, we're going to do this thing called co -diagnosing now. Like we're going to do this thing where you're going to tell me what you think the patients should need, because that's like a giant, I think of like clouds, right? I've said this before, like clouds, and you're trying to pull raindrops out of the cloud.

And it doesn't work like that. Like you've got to have, you've got to start small. You've got to start with clarity. So I think what you said was beautiful where you're calibrating. We like to call it, what would doctor do? Right? So what would doctor do if they saw this piece? Right? So we're calibrating on what that might look like, what doctor may say, because you guys, they're the support team, the dental assistants and the hygienist, you guys are preheating the patient to what

may be diagnosed. I'm gonna make a huge caveat here on co -diagnosis. Okay, I know the word diagnosis is in there. That's what it's called, co -diagnosing, but you're not actually diagnosing treatment. You're not saying you will need a crown here because you're not licensed or educated right in the laws of you to do that. Do you know what the doctor's probably gonna do?

Absolutely, because you've worked with the doctor, you can see it. You see what's on the x -ray, but you've not actually been trained, quote unquote, to read the x -rays. So you can't legally diagnose, but what you can do is you can say, hey, what I've seen happen before when I see something like this is. So you're prepping the patient. I always like to say prep for worst case scenario because anything is better than that. So if you see a fractured filling and...

Tiffanie (06:46.276)

you're like, gosh, you know, this, this is pretty big. Usually what I see when something like this happens is we might need to put a crown on there. And have you ever had your have you ever heard of a crown before, right? If they don't have a crown. So you're preheating them to something that the doctor may say. The idea there is that doctor, I don't believe and Dana, I think you probably agree with me here. I don't believe that the doctor should be the first person to tell a patient if we can avoid it, that something is wrong.

that shock value, like Dana said, you have more time with the patient, you have a better relationship, but time, you have more time with the patient. So you shock them with the information, have the conversations, kind of get them used to the idea that something is wrong. And then when doctor comes in and confirms it, they're like, okay, got it. Now, you guys, my dental assistants and mostly my hygienists, this is huge for your exams because...

I think the biggest complaint I get from my clients, from my hygienists and my clients practices, and Dana, I think you probably see this too, is my doctor's always running late. His exams are too long. She doesn't get to me quick enough and then I'm into my next patient because her exams are too long. Exams are too long, exams are too long. We're spending too much time talking. My exams are too long. That's all I ever hear and I'm like, great. So then I think...

I always train on, okay, awesome, his or her exams are too long, that's passing the blame. That's saying that's out of my hands, it's their problem, they're issued, they need to fix it. But if we took ownership in this situation and we said, what can I do to help this situation for me? This is my appointment, like I'm stressed out that my next patient's ready, I'm not done here, how can I take that control?

of this situation and I think co diagnosing is one of those spaces. What information can I give the patient to preheat them to make the exam shorter? You guys, when the doctor comes in and is like, my gosh, you're getting a new crown and they're like, what? What is a crown? How does this work? And doctors like, awesome, let me tell you. How much time Dana do you think could we even be safe there? Like I just, it blows my mind that that's not something I think that we think of in the chair, right? That's like that bird's eye perspective we get to see it. But when you're in,

Tiffanie (09:05.7)

in it, you don't see it. But Dana, how much time? I mean, you don't have to quantify it. But like, in general, did that save a lot of time for you, Chairside, when you started operating that way with your doctor?

Dana (09:16.884)

absolutely. I mean, I remember when I first started and yeah, I took some calibration, right? I kind of had to learn through through listening to him do exams, like really what he would treatment plan. But I do feel like it made 15 minute exams into five minute exams. And that is huge when it comes to a 60 minute appointment.

And it's always funny because we always hear, you know, well, when doctor says it, like patients believe it and that's for sure true, right? Like we can, as a hygienist, we can talk about fluoride. So we're blue in the face, but when the doctor backs that fluoride up, like all of a sudden it's like, wait, is it too late for me to get that fluoride? I turned down. But I think understand that the relationship there also is a flip side. And I think every hygienist myself included has had that patient where the doctor leaves and they turn and they whisper like, do I really need that? Right. And so.

Tiffanie (09:50.82)

Yeah.

Dana (10:07.238)

So that it's there for hygiene too. And I feel like the more that we can take those barriers away of yeah, absolutely. Right? Like we talked about it, Dr. talked about it. Now it should be super important and you should trust as a patient that you truly need it because we're aligned and we both said round about the same things.

Tiffanie (10:28.612)

Yeah, no, I totally agree. I think that's huge. I think that's huge. So I think what would doctor do, right? Calibrate on what that looks like. And Dana said it exactly how it goes, right? You calibrate by seeing the exams, by seeing the diagnosis, but you guys can also calibrate by setting aside time to review x -rays together, review case studies, review treatment plans, and allow people to ask you the questions of, well, why did you diagnose that? Or doctors, you're not gonna love me for this.

Be super consistent with your diagnosis too, because I've had a lot of hygienists come to me and say, Tip, I would love to co -diagnose, but I honestly have no idea what he or she is gonna diagnose in the moment, because sometimes this similar or same situation is a crown versus a filling on another patient. And I do understand doctors, I'm not saying that it's black and white, it is a very gray situation and I totally get that, but there has to be some sort of consistency so that they're comfortable preheating, even if you're not,

going to do the crown every single time, what do you want them to talk about if they see that situation? What do you want their conversation to look like? Calibrate, make sure your diagnosis is as calibrated as possible so that it's super simple for everyone, including your patient. If your hygienist is confused, your patient's probably confused, put that caveat in there. Calibrate that, get that super in line, but then calibrate what would doctor do? What do you want your hygienist to say to your patient?

when a certain situation comes around, do you want them to say, hey, this might be a crown, let me walk you through that. And when you come in, it's either a crown or a filling, but what did you want he or she to say in that moment? Dana also, you talked about photos, x -rays, scans, making sure that those are all up. I love intraoral photos. I have been a huge advocate for that since, I don't know, they started like 20 years ago, right? And I remember trying that first camera and it was so big.

It's so ridiculous. But they're huge. And I love doing a good tooth and a bad tooth, a good filling and a bad filling and really just looking for staining, looking for anything that might be an issue today or later. And I think your scans, those are freaking fantastic. The scans, the internal scans of the whole mouth are going to show.

Tiffanie (12:42.276)

Movement it's gonna show all of those pieces as well and making sure that you're reviewing those with your patients before doctor comes in and that you're like wow, that's kind of that looks like a crack right there I'm gonna have them double check that because if that's the case We want to make sure we tackle that really quickly so that it doesn't fully break Those are the conversations that you're having you're not saying I see I got some stick here from my Explorer Looks like you have decay may or may not could just be staining How many times have we gone through that right like my gosh doctors like I think it's just staining

Got it. Okay. Fantastic. Worst case scenario is, wow, you've got some staining here. You've got some discoloration on your teeth. I'm hopeful it's just staining, but in the event that it is decay, it could look like this. Because when doctor comes in and even if it's just staining, doctor comes in and is like, no, it's fine. It's just staining. We're like, thank goodness. I was really worried it was something different.

we need to probably ramp up our hygiene care at home to ensure that this doesn't happen again, because the staining can lead to decay. You've just now bundled up a simple diagnosis and your hygiene care. Like you, you scared the patient and then brought it back to great, let's continue preventing that with ramped up hygiene care. So making sure those photos, x -rays and you guys, those, the scans, everything you guys are calibrated on that as well. I think Dana and I probably,

overuse the word calibration sometimes, but it's huge. If you guys aren't on the same page, if your hygienist or dental assistant doesn't know what you want them to say in the co -diagnosis, what would doctor do? They're not going to say it. If they don't know what you want up all the time, it's consistent every single time, they're not going to have it out and they're not going to take them, right? If I know you're not going to look it into oral photos or we're not going to use them with the patient, I'm not taking them. Dana, is that crazy? Is that me?

Dana (14:35.3)

Nope, that's not you.

Tiffanie (14:39.364)

I'm not taking them. I'm not gonna, I'm not gonna waste my time, right? Dana, you are 100 % true. They're right on the time thing, right? And I think that comes from working in a dental practice. I tell my family all the time, like, I know exactly when I'm gonna get somewhere. I know exactly how long dinner is gonna take me to prep and make. Even if it's a new recipe, I will have it done when I say it's gonna be done. Because dentistry, being on the minute, right? I work in 10 minute increments because for -

25 years in the chair, that's what I worked off of. And I can time things down to the minute. And it's beautiful, but it's also stressful on the other side when things get a little chaotic. So help them time those, help them get your time back, help them get their time back, calibrate on what you want them to say, calibrate on what you want up, use it. And then you guys, Dana, I think you spoke on this, but I think maybe some more.

about just like your doctor backing you up to really drive it home. I know my doctor always backs me up as a dental assistant, always said, gosh, Tiff, like great eye. Even when he didn't see that something needed to be diagnosed, he'd be like, great eye, I'm really glad you caught that. Let's put a watch on there because there is some significant staining there. Today it's not decay, but I want to make sure we check that again when they come back in. He leaves and my patient is like, okay, well, that's great, but what do I do so that it's not decay next time?

And I'm like, great question. Let's walk through that. So Dana, how did your doctor really truly back you up? Because I think that is, I think that's honestly more important than the calibration, because then a doctor comes in and says, nope, you're wrong. It's not that. We are like, I'm never saying that again. I'm not going to feel, I'm not going to feel this again. So I'm never saying that again. So what did your doctor do to truly back you up as a hygienist in your practice?

Dana (16:18.932)

Yeah.

Dana (16:32.34)

Yeah, I agree with you, too. I feel like the biggest thing that I hear when it comes to barriers of that is confidence that like what happens if I'm wrong, right? Like, you want me to tee these things up and and I can be as calibrated as I am to you and still make a mistake with that, right? Still think that that staining is decay or still think that that filling is a crown.

Tiffanie (16:38.084)

Yeah.

Dana (16:51.508)

And so he just did such a great job of, you know what, Dana, typically you're right. Like this usually is that in this case, I think it is. And he would just steer the patient in the right direction. He never used the word wrong. He never used the word like, no, that's not it. Right. He never, he always just navigated the conversation and the patient actually got the diagnosis that he truly diagnosed for them without making it seem like the things that I talked about weren't important or weren't true.

Tiffanie (17:14.468)

Yeah.

Dana (17:20.116)

And so I think it is finding that line of, I'm going to steer the conversation where I want it to go and the treatment that I really truly recommend, but I'm not going to step on my hygienist's toes and make it look as if she made a mistake and the things that she talked about weren't the case. Because dentistry isn't always black and white. There is gray when it comes to diagnosis. You can look at doctors diagnosing, you know, I mean, it can be all over the place sometimes. And so I think it is just giving your hygienist that same grace that you wouldn't associate in that like, it's not wrong.

It's just this is this is what I want to do or this is what I'm diagnosing.

Tiffanie (17:55.748)

Yeah, I love that. I think that's beautiful. And it's, I wrote down the word empower, because I think your doctor was using very empowering verbiage and just words specifically to make you feel empowered to do it again, because no matter what, right, there's that line of allowing us to feel empowered or allowing us to feel defeated. And it's very easy to feel defeated when you think something is going to go one way, and then it's totally different and we get in our heads. And we've got a lot of time to sit and think about the fact that we diagnose that.

co -diagnosed that wrong. So allowing that empowerment and really getting on board is going to be huge. And I think doctors, your action items today are go figure out the kind of verbiage that it's going to take to empower a team. If you don't, if you don't feel that you're already empowering a team, go learn some of that, go dig some of that up. And even just kind of in the mirror, I would say in the mirror verbiage to yourself, like talk to yourself and see how did that

feel how did that land because I know you're saying it but you're watching yourself say it and it's gonna make you feel a certain way I promise you that so go figure out how to be super empowering maybe even ask your team how you know how do I how and when do I empower you how do I instill the sense of empowerment in you and when do I make you feel like you're not empowered that will help you kind of steering guide those conversations as well then schedule some meetings calibrate on what would doctor do if you're not calibrated already

If you are and you feel like your hygienists are there, they're top notch, your dental assistants know what you're going to do, fantastic, then freaking just tell them to go co -diagnose. They might just be holding back and they're like, gosh, I knew he was going to do that. And that's a cool feeling, right? As a dental assistant, I was like, haha, I knew it. I knew that's what he was going to do. But like being able to talk about that over the patient is really cool too. So calibrate on what would doctor do? What does that look like for your team? Calibrate on what you expect to have up, photos, scans.

x -rays, all of those pieces, what do you expect to have up? Use it and figure out how you're gonna best empower your team. Those are gonna be your three action items from today and I think they're super valuable, super important. I would love to hear and Dana would love to hear, I know we have practices actually track this for us when we're working on calibrating and we're working on these types of things because we use this often, both of us do I know, to decrease that exam time, to decrease the amount of time that your chair side.

Tiffanie (20:19.3)

and increase the relationship build with the patient, I promise you, it increases the relationship build, it increases the stickiness and it actually will increase your case acceptance. So start tracking your amount of time, chair side in an exam and start tracking your diagnosis or excuse me, your treatment acceptance if you're not already. If you are, then start tracking the difference after co -diagnosis compared to prior. So.

How can your dental assistants and hygienists help you diagnose? It's called co -diagnosing you guys. And if you need to re -listen to this a couple of times, if you need to take this to the team, I implore you to do that. Dana, remember, was and is a hygienist by trade. She did it for many years and it sounds like her doctor was just super empowering and super fantastic in that way. As a dental assistant with my doctor for years, he was very much the same and I always felt like no matter what, he was gonna stand behind me and it was okay even if I wasn't spot on with what he wanted.

So calibrate, calibrate, calibrate and empower. Go do the things. Dana, thank you so much for being here. I love being able to pull from you because of your experience in the hygiene field, but then also your experience with your practices that you coach on the daily. Because again, I know you work on this stuff a lot to help decrease that time and help increase that case acceptance. So Dana, thank you so much for being here. I appreciate you and I value you. Everyone go do the things.

Leave us a five star review below if this was super helpful for you. Let people know what you implemented, what worked really well for you, and if you have ideas of your own, we'd love to hear them. You guys, hello at thedoll18 .com, or if you have more questions regarding this, please reach out. We are always here for you, and we'll catch you next time.