Exceptional Dental Practice Management

The Hardest Thing

    It's easy to be nice to the nice.  A sweet patient is a delight.  A pleasant co-worker is like a gift from heaven.  Everyone wants to be around them and that just reinforces their niceness and the positive response they get.  But, what about the curmudgeons, the surly, the shy, the nervous or the just plain grumpy?  Who's going to love them?
    It requires more from us to be nice to the complainer, the criticizer, the whiner, or the person who's hard to talk to.  We have to try harder to have a relationship with them or to get through an hour with them.  If we wrap our arms around our own compassion, insight, desire to help, or generosity of spirit and hold it tightly to us, we will always have to "put up" with these people, rather than developing a relationship with them.  If you tell yourself, "It's their own fault" and grimly go through your encounter with them with your teeth gritted, you lose as much as they do.  If you plan on telling your story of woe at lunch rather than sharing insights you've gained into this patient, everyone misses an opportunity to be better. 
    The first thing to realize is that initially, you'll have to meet them more than halfway.  Some may seem so insulated that you wonder if you have the right to try to penetrate their bubble.  Maybe you don't, but that shouldn't stop you from being kind and compassionate.  You never know what's getting through, and you may be making a difference that makes all the difference in a lonely life or in someone's recovery from grief or endurance of pain.  That's the point, we don't know what's behind their demeanor, we can only respond.  I once asked a patient if he was very apprehensive, because he always seemed tense when he was in the office.  He looked shocked at the question and I thought I'd made a mistake in asking.  He said, "I deal with severe depression every day of my life.  It's all I can do to get up and do anything.  It has nothing to do with anyone else."  I was glad that I asked and from that day on I make an extra effort to be nice and kind to him.  He knows I know and I feel the weight of that confidence. 
    We all have patients that make the staff groan and even do a pretty dramatic death scene when they see them on the schedule.  Even the doctor may droop at the thought of an hour in their mouth.  They are invariably hard to work on and seem ungrateful for what is being done.  You can't control the way they are, but you can decide to bring all you've got to the challenge.  Even if they never show you that it means something to them, they may tell others.  Even if they don't tell others, you have the personal satisfaction of knowing you did your best for them in every way.  The team sees that, too.  Anyone can be nice to the nice and love the lovable.   The hardest thing is being kind and loving to the curmudgeon.  Doing the hardest thing is a true sign of character.  It's something I expect from in myself and encourage in our staff.  It's what makes a team exceptional.

Couldn't Have Done It Without You

    Who doesn't like to hear that?  There is nothing like gratitude to keep a good thing going.  When a dentist says something like that to a manager, it becomes the wind beneath her wings.  On days when things seem frustrating or just plain aggravating, remembering those words is not only uplifting, it is a bar to rise to.  Knowing that someone feels that way about what you do makes you determined not to disappoint them.
    If you really think about it, no matter how things are at work, they couldn't be exactly that way without the people involved.  So, good or bad, I couldn't have done it without you, is a reality.   I've worked with all kinds of people in my 18 years in dentistry.  Some were wonderful, some not so much.  Some were endearing, some were infuriating.  Some worked hard, some as little as possible.  They all made their mark. 
    The worst group I worked with were insulated, selfish, and catty.  Their main concern was for themselves, they talked behind backs and they didn't care that they caused misery and division among their co-workers.  They almost drove the practice we worked in into the ground.  When anyone tried to make things better, they became threatening and abusive.  We couldn't have been as miserable or unproductive without them.  On the other hand, I also couldn't have learned what an office manager needed to be if I hadn't worked with them. 
    The best group I ever worked with is the group I work with now.  They care and the patients know that.  They get along with each other, so the culture of the practice is healthy.  We couldn't be the way we are without them.  Could it be better?  Sure, there's room for improvement, there always is.  When you decide that you're good enough and stop trying to get better, you start losing your edge.  Even if someone leaves or someone new is added we will become what we will be because of who is with us.  Since that means we could get better or we could get worse, it is important to pay constant attention to the mindset and attitudes of the staff.  It's the kind of thing that requires careful and timely redirection to keep us getting better and better. 
    Are you getting the idea that being exceptional takes work?  It's not just luck, it doesn't just happen.  You can't get lazy and ignore a slip in attitude or stop paying attention because things are going well.  It's a work in progress and as a manager, it's something that couldn't be the way it is without you.  So, make sure that what it is, is good.

Emerging Personalities

    Human nature is interesting.  We all present our best self whenever we're meeting someone new or when we're in a situation in which we know that the other person's opinion of us will affect what we want.  Think about a job interview.  How many times have you hired a person who seemed to be just what you were looking for, only to wonder where she went and who showed up in her place on the first day of work.  I'm always amazed when that happens.  It seems like a lot of work for someone to fake being what they obviously know an employer would be looking for, only to drop the act once they've gotten the job.  Then everyone has to go through the pain and aggravation of a new person who isn't going to work out.
    When I think about an emerging personality, I'm talking about the types of things people do that either hurt or aggravate others.  Managers tend to see these behaviors and then wonder what, if anything to do about them.  For instance, everyone has worked with someone who seems to work hard and be a real go-getter...in front of the boss.  Left unchecked, this person can cause resentment among the staff that is picking up her slack.  She's often one of the more pleasant personalities in the office.  Why wouldn't she be, she's getting a lot of credit for a little work.  She'll also make a big deal of lending a hand...when the boss is watching.  Otherwise, she can be counted on to be off in the restroom touching up her makeup or staring at the computer screen as if she's making a concerted effort to find patients to fill holes in hygiene when in reality, she's looking up recipes on Food Network. 
    Another personality that we'd all like to see restrained is the person who blesses your heart while she stabs you in the back.  It's incredible to watch this person.  She can poor on the compliments and as soon as the person is out of earshot her true feelings emerge.  Why bother with all the sugar if your going to top it with vinegar? 
    There are beneficial emerging personalities.  The receptionist who can flash a smile even though she's feeling miserable or dealing with stress at home is highly desirable.  The dentist who can disguise his frustration with being over-scheduled and focus on his patients needs has a special talent.  A staff member who can push back her frustration with a co-worker and look for the good is mature and will always be in demand.
    We all have emerging personalities and we know it.  We know when we unleash them, too.  When you manage to pull uncommon compassion and understanding for others out of your heart, you know you've done something special.  Keep pulling that out, it makes you and others happy.  Sit on the negative personality traits that struggle to emerge.  You know you're going to do it, make the right choice and get through to the other side without setting that free.  It's all about self-discipline and, as usual, choices, all of which are under our control.  I think managers have a responsibility to address negative emerging personalities.  The culture of the practice depends on it.   Each person and their emerging personality is individual and your approach should be, also.  If you can help a staff member recognize the damage  they do to their relationships with the rest of the staff and help them make corrections, you may  change the course of their career experiences for many years.  If you approach the situation with care rather than anger, you can earn respect and influence. Draw out the  good traits and help them learn to control bad impulses and everyone succeeds and benefits.

Teach Thinking

    Have you ever noticed what a thinking rut people can get into?  Some people seem to have a natural ability to see solutions and ways that will make everything work better.  They usually end up managing something or someone.  That's good, it uses that natural talent in a productive way.  What about the people who don't think outside the box very easily?  Is it something that can be learned, or are there two groups, the leaders and the led? 
    Do leaders encourage those they lead to be dependent on them so that they feel more secure?  Do they give up and just see it as their cross to bear?  Maybe those that are led like having the burden of seeking solution placed squarely on someone else's shoulders.  Sometimes people worry so much about making the wrong choice in an unusual situation that it paralyzes them in indecision.  Maybe they've tried to do something out of the ordinary in a pinch and got reprimanded when it didn't work out.
    So how can you get staff members to stretch outside their comfort zone?  I've even seen people squirm when a suggestion takes them into unfamiliar territory, even though any possible negative consequences are pretty benign.  We want what we know and we resist what is different.  Maybe the answer is to lead them through some possible dilemmas and see what suggestions they come up with.  Encourage them to think wildly outside the box.  Come up with some exaggerated worst case scenarios and let them figure out how they'd deal with those consequences. 
    If staff members can believe that it's safe to try to come up with solutions on their own, you may see the confidence they develop show up in other ways during the workday.  You may have to bite your tongue sometimes if you do this.  The thing about leaders is that we like to come up with answers.  We like to feel needed.  We have to be careful not to send mixed messages.  We can't make the staff feel like we want them to come up with solutions, but only if it's exactly what we would do.  If, as a leader, we can see growth in this area as a win-win for all of us, we might have just learned a new way of thinking ourselves.

You Can Do Anything

    If you think that there is something you can't do, check out my friend, Ed Brenegar's post Yes, You Can, on his Leading Questions weblog.  When you're there, take the time to view both of the videos he has posted. 

    They are about Rick and Dick Hoyt who compete in the Ironman triathlon.  The thing that makes them exceptional is the fact that Dick's son, Rick is physically disabled and confined to a wheelchair.  The spirits of both the father and son drive them across the finish line with Dick providing the physical power.  I've never seen such an amazing example of will and determination.  The sheer love that drives Dick and the faith that the son places in his father is inspiring. 
    There's not much I can add to Ed's post.  If there is something that is defeating you, or stopping you from trying to reach your goals, watch the video.  After that, you may say "I don't want to do this", or "I'm not interested enough in changing or improving", but you won't be able to say, "I can't do it."

Raving Patients

    Everyone wants raving patients; as long as they're raving about the great treatment and exceptional service they received at your office.  Let them rave all they want.  Because, rave they will, whether it's good or bad is up to you and your team. 
    It's been proven that a disappointed patient often won't bother telling you about the problem.  But they will tell everyone else.  Nothing spreads as fast as news so make sure all news about your office is good news.  People also like to be the one who finds something great.  Let it be you.  They'll tell their friends all about the great new dental practice they've found and they'll want them to go and see for themselves how smart they are.  What impeccable taste to be discerning enough to find this wonderful dental practice.
    So, how do you plug your practice's name into that?  You begin by taking a good look at yourselves.  What are your strengths and weaknesses as a team?  As individuals?  Build on the strengths in a way that benefits your patients and enhances the care you provide and the manner in which you provide it.  Assess the weaknesses. Can they be improved enough to make them neutral?  Can they be eliminated?  Can people who are weak in one area apply their strengths somewhere else and let someone who is strong where they are weak take over something? 
    Can great customer service be taught.  Definitely.  Sometimes just becoming more aware of providing better service will start a great idea inspiring discussion.  There are great books about customer service that can help.  Think Disney, who better demonstrates the benefit of paying attention to the customer experience.  When your team starts paying attention to the patient experience, great things may happen when they see that it benefits everyone and makes the day much more pleasant.   And those raving patients make life in the practice so great, everyone will want more and more of them.  Once you get started, you'll wonder what you were waiting for. 

The Weight

    Are you still carrying that around with you?  You know it's worse than useless, it's destructive.  There's not one positive thing it can do for you, rather it can only cause you pain and hurt others, as well.  If you give in to the temptation to open the door and take a peek at it, it will fling the door wide and obliterate anything productive you have done to deal with it.  It wants to keep you involved with it, because without you, it is nothing, it's powerless.  It can have a hold on you and even though you know it has nothing good to offer, it's pull can be so strong that you can find yourself drawn back over and over even while you tell yourself you will regret the indulgence.
    Grievances and hurts of the past are the useless weight that can destroy perspective and stunt our personal and professional growth.  It's as if you spend your life sitting in front of a screen that distorts everything that happens in the present with feelings and impressions of unpleasant events and interactions from the past.  If you can't leave your feelings about the wrongs that were done by others in the past, you deny yourself the opportunity to enjoy the better person they may have become in the meantime.  Ironically, you torture yourself more than you bother them.  They go happily about their day while you remain mired in useless resentment.  If you are foolish enough to give into the desire to make sure others know how someone once hurt or cheated you, you further diminish yourself, while they continue to enjoy the peace of moving on.
    You may reason that of course you are still living it, you were the one who was wronged.  It's easy for them to move on, of course they want to let it go.  Ok, let's imagine they wanted to join you in reliving the past.  What would it serve?  Maybe they could admit their sins daily, fall all over themselves making it up to you and beg forgiveness over and over.  Wouldn't that be great!  And what would your response be?  You'd tell them to forget it, don't worry, we all make mistakes.  So, get on with it.
    Aristotle and many great thinkers and philosophers believed that our main purpose was to seek happiness.  We can't even begin to do that if we hold on to old problems.  If we want to find happiness we must allow happiness to others.  We can't do that if we look at them with vision that is clouded with resentment.  Resentment is wasted and only turns back upon the beholder.  After writing about Galba Bright's passing and encouraging others to look at others with kind eyes only yesterday, I found myself allowing resentment over past events to not only intrude on today, I gave into the shallow desire to share those memories with someone else.  The words are out, they won't ever come back and now I'm sorry for it.  I'm worried that the person I talked to will think less of me. I feel guilty about the words that would have never been uttered if the other person had been present. I'm impatient and frustrated with the weakness in myself that allowed the useless sentences. And new life is breathed into the almost dead problem of the past.  And the weight is uncomfortable.  As it should be.

In Memory of Galba Bright

    I never heard a bell ringing, but certainly an angel got his wings a few weeks ago.  I found out today that Galba Bright who wrote the Emotional Intelligence weblog passed away unexpectedly and much too soon.  I only knew Galba by corresponding through our blogs and emails, but he had a profound effect on many people through his thoughts about how we could see and treat each other. 
    Galba was quick to find good in others and to give credit.  He was humble and gentle and inspired respect and admiration.  When I read his emails I could almost see his kind eyes and happy smile in his words.  He made me feel that I was better than I thought I was.  The thing I'll remember always about Galba is his determination that there is good in everyone if you choose to see it.  His death at a young age reminds me that there is never too much time.  The best time to start to look for good is right now.  In his memory I urge you to go about your life tomorrow finding the good that he believed is in every one of us.  Then do it again and again until you don't have to remind yourself anymore. 
   
   

First Reaction

    When there is a crisis in your practice, what is your first reaction?  Do you panic or think clearly?  How about your staff, do they run in circles in response to a critical situation or do they become a well-functioning group of responders?  If you've been lucky enough not to have faced a crisis yet, don't rest too easily.  Sooner or later you probably will.  If you've already dealt with an extremely stressful situation, you know how unexpected these things are and how people react if they've had no preparation for facing something out of the ordinary and frightening.
    Let's talk about an unruly person in the practice.  I've had this experience with a patient and also with a staff member's boyfriend.  In both instances the angered person did not feel that they were getting what they wanted and did not want to accept the fact that they wouldn't.  In both cases the other person became somewhat threatening.  I found it was best to remain in control of the situation, to keep other staff members within sight and aware of what was happening, and finally, to be willing to call the police if the situation did not resolve within a reasonable time.  Once the situation gets disruptive, repetitive or unreasonable, it's time to end it by escorting the offending person to the door or by calling the police.  To do less is to expose the patients and staff to undue stress and unreasonable risk.  Hopefully, most practice won't deal with this type of situation, but it does seem like many people put less restrictions on their behavior so the odds are higher that you will.
    Another dreaded experience is a patient or staff member with a health crisis.  I think most people's first reaction is to take themselves out of the situation, especially if they feel unprepared to deal with it.  People tend to react fearfully and are likely to panic which can turn normally pragmatic people into helpless, not to mention unhelpful individuals.  I have seen normally reasonable, intelligent people scatter and become almost incoherent in this situation.  Kind of a deer in the headlights scenario.  The way to avoid this is with preparation.  If this hasn't happened in your office yet, you're lucky, chances are it will to some degree.  Prepare your staff by spending time discussing the types of emergencies that may occur.  Figure out which staff members would be best able to help with CPR and which just wouldn't be able to stay calm enough.  Some of the less composed staff members should be assigned to call EMS, clear the reception area and wait for the responders.  Everyone can take part in helping, just make sure they know what their part is and feel comfortable with it.  Don't always count on the dentist to be the one to administer CPR, he could be the one who needs it.  Have at least two other staff members who are comfortable with and capable of administering life support until EMS arrives.
    Being prepared in advance takes away the unknown to some degree.  Remind the staff that their first reaction may be to panic, but encourage them to recognize it as a response that can be challenged and overcome.  It's easier if they have had a chance to practice and know what is expected of them.  Hopefully you'll never face this kind of stressful situation, but don't count on it.  It's better to practice and never need it, than to face a crisis a wish you did.

The New Patient Examination

    I believe that the new patient examination sets the tone for everything that comes after that initial visit.  This appointment tells the patient whether or not you are serious about dentistry.  It can show them that you want to understand who they are and what they want and need. 
    In our office we do a Pankey style new patient exam.  That means we really try to understand our patient.  When the patient arrives, I take them into my office to get to know them and to help them understand our philosophy and who we are.  If handled correctly, this part of the exam can give you valuable information about your patient's fears, anxieties, expectations and desires.  You can find out what they liked about previous experiences and what they hope never happens again.  In turn, it is your chance to present the staff and dentist in their best light and to let the patient see how much your practice has to offer to them.
    Once you move into the examination operatory, you will not only chart existing restorations, you have an extremely important opportunity to educate the patient about their oral health.  Many times, no one has ever bothered to explain the conditions in their mouth or explained what treatments are available. Often patients comment that it is the most thorough exam they've ever had.  Some even express a certain amount of annoyance that their previous dentist did not take the time to do the same thing.
    Finally, once the prescribed diagnostics are completed, you have the opportunity to fill the doctor in on any information that you have received from the patient that will help him connect quickly and understand what they are hoping for from your practice.  By this time, not only is the patient much more aware of their oral condition, they are anxious to meet the dentist because you've spoken so highly of him.  The meeting is much less awkward than usual and the patient much more relaxed. 
    Finally, by recording all your findings, both clinical and personal, the staff has the advantage of knowing more about the patient at their first encounter.  When the hygienist sees the patient for the first time, it is much warmer for her to be able to say, "I see you have a 13 year old daughter, so do I.", then to ask her again, "How many children do you have?" 
    It's more personal and it tells the patient that your practice is special.  This is a practice that patients tell their friends about.  You can build systems into your own practice to make this type of exam fit into your day.  We set aside 90 minutes on our schedule for this exam.  The doctor spends anywhere from 20-30 minutes with the patient.  You will need to identify a dental assistant or hygienist that has a good knowledge of operative dentistry to perform everything but the diagnostic segment of the exam.  In practices that have a lot of downtime in hygiene, this can be a very good solution.  Designating an assistant to be your patient care coordinator is another great option.  It's an initial investment in each patient that has inestimable value.

Take This Job And Shove It

    I'm going to approach this first from the employee's view and then from the employer's.  Do you wake up in the morning and feel your heart sink when you realize that it's time to get up and go to work?  Does Sunday evening find you dreading the week ahead?  It's pretty miserable isn't it?  And life is too short to spend a lot of it being miserable.  Maybe you work for someone who demands high performance, but is incapable of giving positive feedback.  Maybe the culture in the office just isn't healthy.  If you've tried to make it work, but year after year things stay the same, you should think about finding a job that allows you to grow and feel satisfaction in your progress. 
    Maybe you're a dentist who has given up on finding staff that will perform well and treat each other and the patients with respect and kindness.  Does it seem like you're the only one who cares about how the practice is going?  Are the demands endless?  Do you have a staff member who sets your teeth on edge?  Do you feel like a victim in your own practice?  If you can say yes to any of those questions, you need to make a change. 
    Whether you're the employee or the boss, you may not believe it now, but things can be wonderful.  You don't have to dread walking in the door to work, or come home griping and complaining.  You owe it to yourself and your family to figure out a better way.  When you stay in a dysfunctional situation, your life loses balance.  It affects everything else and becomes pervasive and unrelenting.  Misery multiplies and spreads out. 
    There's hope.  You have to look at your situation, evaluate the chances of making things better and face the facts if there's no way to make it work.  No one situation is right for everyone, so it's ok to admit something just won't work and find something that does.  If you find yourself thinking you'd like to take this job and shove it, or if this post makes you wonder how I could possibly know so much about you, you may have some soul searching to do.  Make your life what you want it to be and start living and stop being miserable. 

Inspiration + Appreciation = Influence

"Leadership is based on inspiration, not domination; on cooperation, not intimidation."

~William Arthur Wood~

   

As you may have noticed from previous posts in the last week, I have a new boss.  He's about to turn 35, and while I would've had to have started pretty young to be his mother, I could have been his babysitter.  I obviously had a great deal of respect and admiration for my former boss, Jeff Price.  He was a mentor and teacher for me, as well as a boss.  So, were you wondering, just a little, how I'd adapt to a new, younger boss?  Well, if you weren't, I sure was.
    I really felt like I was at the top of my game, you know?  Here I was, managing the practice of the best restorative dentist in the area.  He is respected by dentists far and wide, and assisting him was like working with one brain and four hands.  We didn't have to say a word, it just happened.  So what would I do with Dr. Nigel Morgan?
    The first few times I assisted Dr. Morgan it didn't feel like one brain and four hands, it felt like no brain and all thumbs.  He felt it too, and we were both anxious about it.  I didn't want to disappoint and I began to feel like maybe I was a good assistant only because Dr. Price had it all together.  I worried that I'd miss the satisfaction I got from assisting Dr. Price.  Well, time is all we needed.  We've gotten used to each other and it's back to one brain, four hands.  Whew! 
    The other thing that concerned me was this; Dr. Price has known me for nine years.  He knows what I can do.  Was Dr. Morgan going to plunk down a pile of cash for a practice and hand it over as willingly for me to manage as Dr. Price did?  He has done so gratefully.  Whew, again!  So, now I'm starting to like the new guy more and more.  Of course the fact that he has an easy smile and a good sense of humor doesn't hurt either.  He's fun to be around.
    Finally, would I be able to accept leadership from him and share leadership of the staff with him?  Remember, I could have been eligible for diaper duty with this guy a few decades ago.  I need not have worried.  He has the right combination.  He inspires us with appreciation.  Verbalized appreciation of our skill and for what we give.  His own generosity of spirit allows him to praise and thank his staff.  Last week was his first week owning the practice.  At the end of the last day, he gathered us all in the hall and thanked us for making it a great first week.  I looked at the faces of the staff and saw pure joy, but I saw something else.  In that one sentence, he earned influence with them.  Now they will do anything he asks, not just because they want to keep their jobs, but because they want to do it for him.
    Earning and keeping influence is the secret to becoming a great leader.  For some people it comes easily.  I suspect it does for Dr. Morgan because he seems at ease with himself.  It can be a developed style though.  You may have to be more conscious of what you say and do if giving those things doesn't come naturally to you.  I think that the results will inspire you to keep doing it, though. 
    If you go home at the end of every day feeling stressed, beaten up and used up; think about this.  I'm sure that Dr. Morgan feels a certain amount of stress in the evening.  He's a brand new owner, so it would be natural to assume that he has a lot of new worries to think about and new things to adapt to.  But, I feel comfortable saying, I don't think he goes home feeling distress.  I doubt very much that he goes home and worries about his staff.  He knows we are going to be there every day, helping him and making his practice a success.  In just one week, he earned that.

Pot Stirrers Not Welcome

    There is nothing more detrimental to a happy work environment than a pot stirrer.  You know, the kind of employee that makes little digs intended to start some drama.  Once the trouble starts, she is the first one running around trying to see how everyone feels about it.  In the event that she is confronted, she will cry to the boss about how mean everyone is to her when she only wants to help.
    I've seen more workplaces ruined by this kind of behavior.  Even the happiest, healthiest office can not survive intact if this is tolerated.  The best employees will either leave or become frustrated and resentful.  The tension will destroy the culture of the practice and the reverberations will be felt by anyone walking in the door.  Faces that were once open and pleasant will become stressed and drawn.  Laughter will turn into exasperated sighs.  Harmony will melt into discord.
    Employees should  be urged to confront this behavior and let the pot stirrer know that their antics are not appreciated and will not be entertained.  They should understand their responsibility for maintaining the healthy relationships and should not be drawn into this drama inciting behavior.
    Managers and dentists have a responsibility to the team and patients to recognize a pot stirrer for who they are and the damage they are capable of.  The only response to this behavior is a serious confrontation with the promise of dismissal if the behavior continues.  Pot stirrers tend to be manipulators and can turn the situation every which way to try to continue their behavior as well as their employment.  For the sake of the team and the health of the practice it is imperative to recognize the behavior, confront it and follow through with dismissal if it continues.  Anything less is detrimental to the team, the patients and ultimately the health of the practice. 

The Front Line

    Dental hygienists spend more time looking at the patients teeth than anyone else in the practice.  They basically go over the teeth with a fine-toothed comb, examining every pit and groove and checking margins.  If the dentist is the captain, they are the lieutenants  when it comes to patient education and treatment acceptance. 
    It's great for the hygienist to talk to patients about what they are seeing while they are performing the prophy.  As a matter of fact, at least 60-70% of the appointment time should be spent talking about the patient's oral health.  You have to achieve a good mix of personal relationship building and patient education.  During the time you are scaling, you have a captive audience.  Use that time wisely.  Rather than talking about your love life or your cute cat, tell the patient what you are seeing in their mouth and how it can be improved.  If they have absolutely great oral health, congratulate them and encourage them to keep it up. 
    It's important to develop relationships with our patients and there are times when it's easy to get so involved in talking about our lives that we can forget that part of our jobs is to educate our patients.  Everyone in the office should be ready to do that whenever the opportunity arises.  Spending as much time as they do exploring the mouth, hygienists are the front line in treatment presentation and acceptance.
    Talking to the patient about what you see and what can be done to improve conditions is an important step in being an educator and treatment presenter.  The next step is letting the dentist know what you talked about with the patient, what treatment was discussed and how the patient reacted.  Then, it's basically a matter of the dentist coming into the room, doing his exam, and confirming the conditions and giving his recommendations.  Hearing both the hygienist and dentist express the same opinion, helps the patient understand and appreciate the need for treatment.   A hygienist that can do that is a true partner  in providing care for the patient.