A day in the life.  

A question that every patient asks is “How long is this going to take?”  You always answer with: “You are booked for x amount of time” . But when your office manager, or a staff member, asks you how long is the procedure going to take when they are booking a patient or when they are setting up your schedule you better have a better answer.

Do as much as you can realistically do.

In BC a unit of time for dentists is defined as fifteen minutes.  Starting out it is a challenge to know how much time each procedure takes, and as always the more you do, the faster you get.  One piece of advice I got when starting out was do as much as you can realistically do, there is no harm in rebooking the patient.  

This means for me that if the patient is only booked for an hour, I am not going to be doing four surface restorations on the entire quadrant.  That being said, my office manager and front desk staff seem to love giving me a challenge and push me to be a better, and faster dentist.

Just keep the hygiene side on schedule.

The biggest challenge has been remembering to get to the checkups in order to keep the hygienists on schedule.  This is especially difficult when you have two or more patients in your own chairs and you know there is an emergency walk in as well. It is best practice to just keep the hygiene side on schedule, they don’t have assistants to help set up and take down the ops, and they are doing a lot in their one hour booking.  On your side you are generally able to stack patients a bit and have some overlap. Not so for the hygienists.

The Hygiene Side

In our practice we have two hygienists, one dentist, and two certified dental assistants working most days.  The hygienists have one column each, under the titles Sandra and Daniel.  They have two different types of appointments: The first is a perio only appointment (Labeled Perio and is light blue), where there is no requirement for a dental checkup. I can ignore these on the schedule unless the hygienist requires a specific exam on that patient where they noted something that needs diagnosing.

The second type is a checkup or ‘Recare’ appointment (Labeled Recare, and is dark blue). These I have to keep an eye on. Every patient seeing a hygienist, who isn’t 365 exempt, requires a dentist checkup once a year at least.  During the appointment the hygienist will take radiographs as needed, perform periodontal probing, as well as a debridement, and then the dentist exam. Our hygiene columns are generally booked for four units of time. Generally after the first half hour the radiographs have been taken and the probing completed so I can sneak in anytime after that for the checkup.

What is the checkup? First check in with the patient see if they have any concerns, maybe make some small talk to build some rapport, then review radiographs, review Perio charting, extra oral exam, intraoral soft tissue exam then go through each tooth to check restorations and for cavities.

365 Exempt?

If you are in British Columbia you are going to hear the term 365 exempt being thrown around a lot.  What it means is that there are hygienists who have taken further coursework so they are able to work independently of a dentist, and the patients do not need to have a dental checkup every 365 days.  They are able to open their own businesses or work while there isn’t a dentist in the dental office.

The Dental Side

My two columns are labeled A1 and A2, but we don’t assign specific chairs to the columns or specific CDAs.  In our office we have six operatories, two for hygiene and four for dental use. We do have some days where we have two dentists working but generally with one dentist working we still end up using all the four bays.  

In scheduling this way we can have overlap where a patient comes in while I am still finishing a restoration or doing checkups, and be seated by the second CDA, I can pop over and administer local anesthetic and go back to a different patient to finish the restoration, do a checkup or an emergency exam while the anesthetic takes effect and the CDA places rubber dam. In addition we often book deliveries, impressions, and emergency exams in the side column.

It took a few months to get used to this system, and there are still appointments where I get stuck into things and the hygienists have to come and grab me for checkups and my CDAs have to prod me to keep on schedule. I am nowhere near as efficient as one of my colleagues who has been working for five or so years.   

At first I had to ask the front desk staff to slow down my bookings as I didn’t feel I was keeping up as I wasn’t that fast. Over time we have perfected the shedule and the reception knows how much time I really need to do something, although they like to squeeze it just to keep me on my toes.

David mentioned in his post “It’ll fall into place” about stress and that he uses washing his hands as a mini break to gather his thoughts, I do the same with checkups.  Sometimes you just “need to give the patient’s jaw a break” and go over slowly to do a checkup. Coming back to the restoration or extraction after a few minutes can really change your perspective.  Other times you may just need to fabricate that someone needs your attention to get you out of the operatory.

What it looks like

Here is a typical day sheet at the end of the day.  Things never start out this way but often end up this way.  We have NP, or new patient exams sprinkled throughout the day.  One endo where we knew I would be finishing up was split into the second column for the last bit of time as I knew I would be giving anesthetic for the extraction while my CDA took the final radiograph.  A second Endo patient is in the 2nd column but that appointment started as an emergency exam and I ended up having to do an extirpation with doing a 17MOD on the side. We have a policy in our office dealing with SP exams (specific problem exams): When patients are booked for this they understand that no treatment is guaranteed to happen at that appointment. We book them some time for a specific exam as soon as we can in order for them to at least be diagnosed and ranked for severity. If we have time, or it an urgent case we will of course provide some stabilization treatment or definitive treatment if possible.

Overall running on schedule is important.  It reduces your stress, in reduces your colleagues stress, and most of all it keeps patients happy.  Some days of course you run behind, and if you are way behind it may be better to offer to rebook someone to buy yourself some time.  

David is a recent graduate dentist working in private practice in regional NSW, Australia. Read more at www.dentalheadstart.com/meet-david/

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