A consultation can vary hugely between clinician to clinician and it is important that you identify what works for you in your practice. Some dentists are offering virtual consultations, some will oﬀer an initial conversation with their Treatment Coordinator. Many dentists will offer free consultations and others will apply a fee. Time is also a varying factor – some consultations last 30 minutes and others over an hour. In short, there is no rule when it comes to what a consultation should look like, as long as the outcome is that the patient is aware of all their options and feels excited about starting treatment.
For me, there are two main aims of an initial consultation which are very simple and important to keep in mind throughout:
- Give the patient relevant information about all options available to them, in a way they can understand.
- Build a rapport with the patient.
Here, we will focus on what can help make a face-to-face consultation successful. I hope lots of the advice shared will be relevant and applicable to virtual consultations, shorter consultations, and initial consultations with the TCO.
First Impressions Count
It’s cliche but it’s true! First impressions really do matter. We know a person forms an opinion of someone within seconds of meeting them, so it’s imperative that we do everything possible BEFORE the patient meets us to ensure that the opinion is positive. This process starts before the patient attends the appointment. Creating a positive first impression is a team approach. Here’s what you can do to help:
- If it’s their first time visiting you, ensure information is sent out to the patient about the practice, where they can park, how to find you etc.
- I would also recommend sending out information about yourself, this could be in the form of a link to your biography on the practice page, your own personal website or professional social media pages. It’s nice for the patient to see who they are going to meet ahead of time.
- Ensure the team is engaged – a huddle each morning is really helpful, even if it’s just with your nurse, to discuss who’s coming in. What do we know about each new patient already? They may have given valuable information when they called to make the appointment such as what prompted them to make the appointment or how they heard about you.
- Be organised and on time. An obvious one but try not to keep your new patient waiting for their consultation too long! Ring ahead if you’re running very late, and make sure the surgery is prepared when they arrive, have your camera and equipment ready, the scanner set up if you’re planning to use it, your Invisalign models and photos at the ready to help the appointment run smoothly.
- Practice your introduction! Introduce yourself and your nurse confidently and outline what the appointment is going to entail, for example: “Hi, my name is X and I’ll be the dentist looking after you today. This is my nurse X. Welcome to the practice. Today, you’re booked in for a consultation as you’re unhappy with aspects of your smile, is this what you’re expecting?”
Pictures Speak a Thousand Words
I would highly recommend taking photos of every patient you do a consultation with. This will help you in the consultation and also in the planning phases behind the scenes. If you don’t yet have a camera you can use a mirror in this section.
It’s really helpful to display the photos on a screen so you and the patient can both see them. an iPad, laptop or a TV screen is fine, personally I couldn’t work without my iPad and apple pen which is great for annotating the photos.
With the photos in front of us, the first thing I will ask is “what do you notice about your smile?” this is the time to get as much information from the patient as possible about what they are unhappy with, what they like, what they dislike. At this point, it’s great to let the patient speak without interruption, and to listen actively whilst your nurse is taking notes, quoting the patients exact words where possible. Once they’ve finished I’ll ask “is there anything else?” often there is, and we want to elicit as much information from the patient as possible. This will help with your overall treatment plan.
Next, it’s helpful to find out what they would like their smile to look like. A simple question you can ask is: “If you could wave a magic wand and have your dream smile… what would this look like?”
You’ve now got a good idea about what they want to change and what their ideal smile looks like. This is so valuable as it ensures you’ll be on the same page as the patient and have the same vision for their future smile, you could even write down their smile aims. You can let the patient know why this is important: That the plan will be formed with these aims in mind – we take in to account how they want their smile to look not just what we think it should look like, cosmetic dentistry is not one size fits all.
Patient & Motivators
Before delving in to complex explanations of malocclusions and the pros and cons of aligners vs fixed braces, spend some time finding out the patient’s WHY and ensure the patient feels listened to. Some questions you could ask are:
What prompted you to make this appointment?
You’ve lived with this smile for years, what is it about now that’s making you want to change your smile?
How does your smile aﬀect you day to day?
What impact would having your dream smile have on your life?
Do you have a date in mind for when they would like your dream smile? Do you have a budget for how much you’d like to spend?
Discussion of Options
When discussing the options with the patient, the following can be really helpful to have in your surgery:
- Models of clear aligners and fixed braces for comparison
- Photos and videos of patients wearing their braces so the patient can see how they look when being worn
- Before and after photos – preferably of your own work
Photos to illustrate things such as IPR, attachments, black triangles, composite bonding. Most people are visual learners and will respond best to seeing examples rather than just listening to you explain them.
Practice your explanation of different orthodontic treatment options along with the advantages and disadvantages of each option and relevant costs, this part can almost run like a script, I encourage patients to ask questions as we go but generally I will say the same thing to all of my patients to make sure i’m not missing anything out. To begin with you may find it helpful to have a prompt sheet or a comparison table for the different options, patients will also find this useful to follow along. Practice makes perfect and you’ll be much more relaxed if you are confident with what you are explaining. Remember we need to offer the patient all options available to them, including what they may wish to have further treatment after orthodontics i.e whitening and composite bonding.
You may choose this point to discuss fees – if you include whitening and retainers don’t forget to mention this as can add value to the treatment plan.
So far we have welcomed the patient to the practice, taken photos, found out what they dislike about their smile, we have a good idea of what their ideal smile looks like and what’s motivating them to proceed with treatment. We have discussed options and they’ve told us their preference. This could all be done virtually which would mean a much shorter clinical appointment, or you may have chosen to have longer appointments to do all of the above face to face. Either way, many patients worry that there’s nothing that can be done to help, or that their expectations can’t be met. At this point, it can be very powerful to reassure them that you absolutely can help them with their concerns. This is true – even if you’re just starting your journey in to cosmetic dentistry and may not be able to treat the patient yourself, you can help them by referring them with all this valuable information to a clinician who can.
This is the stage where I carry out an examination, orthodontic assessment, take relevant X-rays and possibly a scan. This will vary of course, depending on how you’ve set up your consultations and if you have a scanner available – it’s a great tool to use and complements the photos well. You can also use the simulation feature which will give an indication in seconds of how things can look. Very exciting for patients to see!
Treatment Plan & Summary
Once you’ve finished your examination and discussed your findings with the patient, it can be helpful to summarise their main concerns to ensure they feel listened to and give them a chance to correct you if you have misunderstood anything. Next, you can recap the aims outlined earlier and remind them of their ‘WHY’. If you are confident that you can treat their case then feel free to confirm you can help them with their concerns, and ask if they have any questions. I think it is important to note that If you feel like you need to get a second opinion or spend some more time planning the case you can explain that you need to do some panning and careful assessment of the photos and x-rays and invite them back for a second appointment to confirm the treatment plan.
You could now ask your patient for a commitment: What would they like to proceed with? Or, what would they like you to put on their treatment plan? Once you’ve agreed aligners is a sensible treatment plan for them you can run through the appointment schedule and finance options. If you have a Treatment co-ordinator at the practice this is where they can take over. If you don’t have a TCO, could your nurse or a receptionist help with this?
A Final Note: Don’t Forget Non Verbal Communication
A huge proportion of communication comes from body language, tone, etc. It’s important not to forget this when carrying out any consultation, and hone your skills in how you can get non verbal communication to work for you.
I would recommend that you’re not interrupted during the consultation. Focus and concentration is key and things like nurses popping in and out, music, phones going off can break this concentration for you and the patient – studies show that it takes 23 minutes to get back to the level of focus you were at before if you were interrupted… so make sure you won’t be disturbed!
Article by Lydia Sharples