The short version: When the hygienist reviews findings with the patient before the exam, the doctor confirms and diagnoses instead of starting treatment conversations from scratch. Exams are shorter, patients are more prepared, and everyone stays on schedule.
As an RDH, it’s not lost on me how frustrating it must be when your hygienist interrupts you, just as you've started a procedure, to ask for a hygiene exam.
I have to assume that when you went to dental school, you didn't picture stopping procedures multiple times a day,. That has to be one of the bigger surprises once you're in practice: wait, I need to do what?!
So you step away from your patient, walk into hygiene, ask how things have been, review the X-rays, find areas of concern, and start explaining your findings and recommendations.
YIKES.
Your time away from your own chair is disruptive. But you can't rush the exam, because those are your patients too. They're also the ones who will later fill your restorative schedule, so the periodic exams needs to be comprehensive.
So how do you streamline it for you, your hygienist and your patient?
Introduce Co-discovery
In my practice, we use a co-discovery approach. Before the doctor walks in, I've already reviewed my findings with the patient, shown them what I've seen, explained what I suspect the doctor might want to address, and answered their initial questions. When the doctor arrives, I’ve filled them in on what we've covered, and the doctor diagnoses and creates a treatment plan without having to explain every finding starting from scratch.
How it works
Triage from the start. As I review the medical history, any chief complaints, the X-rays, and what I'm seeing clinically, I keep a mental list of what the doctor will want to look at.
Talk with the patient first. If I see something I suspect the doctor will likely address, I start the conversation. I explain what I see and what the doctor will be evaluating. This is a tremendous service to the patient. Patients want to know right after X-rays whether there are any areas of concern. Sharing my initial impressions means they don’t spend the rest of the appointment wondering.
Show them. Patients understand what they can see. I'll take intraoral photos, or pull up last year's radiographs side by side with today’s, so they can see the changes themselves. Showing them does far more than any description ever will.
Keep the handoff quick. I work in an assisted model, so for brief findings, I leave a note that the dental assistant will share with the doctor. However, when something needs more explanation, I'll pop over from my next operatory to fill the doctor in on what I saw and what we discussed.
Examples in practice:
A periapical radiolucency. Let’s say I see a periapical radiolucency. I’ll show the patient, "Do you see this dark area here?" I'll explain that it can be a possible sign of infection, and where I’m able to, I pull up a previous PA to show them the comparison. Then I'll let them know that when the doctor comes in, they’ll evaluate it and let us know what their recommendations are.
That conversation takes me about a minute. The biggest time saving may be that the patient isn't processing all of this for the first time with the doctor during the exam. They've had time to sit with it and think of their questions, so by the time the doctor walks in, they're engaged and ready to hear the recommendations.
Would it be nice if the doctor could walk every patient through every finding from start to finish? Maybe. But that only works in a world where the doctor doesn't need to get back to their own patient and isn't pulled into hygiene many times a day. For most practices, that’s simply not the reality. And, in many practices, the hygienist has been treating these patients for years, so there’s already a level of trust. Patients appreciate having the insight of another provider they trust.
Wear and grinding. So many patients have some degree of it and don't realize it. I'll show them the wear on an intraoral photo and talk about possible contributing factors. I explain that grinding is a recognized possible sign of sleep-disordered breathing, and that it may be the body's way of trying to keep the airway open. Then I'll ask about their sleep and snoring. In our office, when a patient shows signs that may be associated with sleep-disordered breathing, our protocol is to send them a sleep screening to assess their risk for OSA.
I also explain that grinding can be a side effect of certain medications, such as SSRIs. They may still need to take them, but it's important that they understand the side effects their medications can have, and they can talk with their physician if they have concerns. By the time the doctor comes in, the patient understands what we've seen and why it matters, and the doctor makes the recommendations from there.
These conversations fit within the time I already have with each patient. I work in an assisted model and spend about 30 minutes with each patient, and I don’t need to add time for these conversations. I just use my time differently. If these discussions fit in my 30 minutes, they can fit in a traditional hygiene appointment too, and they often save time at the end, because the exam itself goes faster.
The hygienist isn't diagnosing
This is the most important part. In co-discovery, the hygienist shares what they're seeing, and the doctor is still the one who diagnoses and treatment plans. That's why I always say to the patient, "the doctor will let us know".
Owners sometimes ask, "What if my hygienist tells the patient something I don't agree with?" It's a fair question, and of course this happens in my office! I describe my findings and what I expect the doctor will evaluate, not what treatment the patient needs. When the doctor comes in, they might agree with my findings, they might find something I didn't note, or they might say everything looks fine.
I'm not offended when the dentist isn't concerned about something I pointed out. I work with some incredible dentists, and I trust their judgment. When no treatment is recommended, patients are thrilled! They've had a thorough visit, they understand what's happening in their mouth, and they aren't upset that nothing needs to be done right now. And my ego doesn't take a hit. On the periodontal side, I’ve been fortunate. My dentists and I agree on how we assess perio, so we’ve always been on the same page. But on the restorative side, I'm not a dentist! Dentists know a heck of a lot more than I do about whether a tooth needs to be opened up or not.
Why it works for everyone
The doctor spends less time in each exam and gets back to their own patient sooner.
The patient hears about a finding twice, from two providers who are clearly on the same page. They understand it better and feel more comfortable moving forward with the treatment recommendations.
The hygienist gets to use the full skill set they were trained for, instead of spending their time standing around waiting for a doctor to begin an exam, sit through the entire exam for the doctor to discuss their findings from the beginning, and there’s less possibility that the hygienist’s schedule will run behind when the conversations occur this way.
How to start:
You don't need to restructure anything to try co-discovery. I'd recommend starting with a conversation between the doctor and hygienists:
Agree on language: what you want your hygienist to look for, what you want them to say to patients about their findings, and how to communicate it to the doctor.
Ask about their concerns. Many hygienists tell me they've discussed periodontal findings with a patient, only to have the doctor come in and say everything looks great. Ask your hygienist whether there's anything you could do to better support them during the exam.
Use what patients can see: intraoral photos and radiographs.
Agree on the handoff: when a note is enough, and when a quick summary is better.
Doctors, back up your hygienist in front of the patient. When you need to adjust a finding, do it in a way that keeps the patient's trust in both of you.
Taking it a step further
Co-discovery works in any practice. But in an assisted hygiene model, it goes even further. Because I don't need to stay in the room for the exam, I can move on to my next patient while a hygiene assistant stays with the doctor. If you're curious what waiting on the exam costs your schedule, I wrote about that in "What Is the Doctor's Exam Costing Your Hygiene Schedule?".
If you're wondering where your hygiene schedule is losing time, including during the exam, the Hygiene Assessment is designed to find out.