Ep: 83: The 4 Steps To Improve Diagnosis Percentage

One of the key numbers to improving case acceptance is diagnosis percentage. In today’s episode, we dive into what diagnosis percentage is and why it’s not level all the time.

We’ll also discuss why having a thorough and consistent diagnosis process is key to improving case acceptance. This is a big challenge with practices that have multiple hygienists and providers who will give. We also show you the 4 steps to increasing diagnostic consistency so that you have consistent treatment plans to improve the health of your patients.

You’ll learn…

  • Why improving diagnosis percentage is key to improved case acceptance
  • The main factor that causes doctors to lower their standard of care
  • The 4 steps to improve diagnostic case acceptance (and you should NEVER diagnose more than you think is right for the patient)
  • What causes inconsistencies in diagnosis for the same diseases in the mouth and how to fix it
  • The one tool you need to be using to improve your diagnostic standards
  • Why you’re not seeing and diagnosing patient problems that are right in front of you and what to do about it
  • What to do when hygienists and doctors are at odds with each other when it comes to patient diagnosis and treatment
  • The one word is key to make sure everybody is playing on the same team


Dr. John: Welcome everybody to this edition of the double, your production podcast. I'm Dr. John Meis and here with the amazing Wendy Briggs. How are you doing Wendy?

Wendy: I'm great. Dr. John.

Dr. John: Awesome. So our topic today is really, we're going to be talking about how to increase one of the key numbers in case acceptance and that's diagnosis percentage.

So when we think of diagnosis percentage, Wendy, how are we measuring that?

Wendy: Yeah. I think we have a lot different ways of measuring it and that's one of the things that causes confusion. What I think most people look at is the total dollar of treatment presented and the total dollar of treatment that's accepted from that. So from that we, we figure out, how effective we are at gaining patient acceptance. But then again, that number can sometimes also be confused with case acceptance. So the whole time, yeah, the whole purpose of today's call is to give people a little bit more clarity, what we're actually talking about when we talk about diagnostic percentage.

Dr. John: Very good. So when we think about the whole diagnostic case, acceptance spectrum, First of all, you have to diagnose something, and then the patient has to accept it. Then they have to accept paying for it. There's this spectrum. So I want to start out at the very front end of that in that is how we're diagnosing.

Now, let me tell you that. I think everyone should diagnose to they're under level of understanding. And their definition of the standard of care, nobody should be doing diagnosing more than they think is right for the patient ever. That's just a matter of integrity. So that's not what we're talking about here.

So let's talk about what we are talking about here. So first of all, I have noticed that doctors diagnosis percentage or diagnosis, assertiveness is not level all the time now. Here's what I mean by that. I mean by that, is that when a doctor comes in for an exam, they may diagnose slightly different.

If they have lots of time to talk through the treatment with the patient, versus they're behind schedule. They're looking at the patient. Oh, it's not that bad. It'll wait till next time. There's going to be a difference in those two situations, the fatigue level of the doctor at that moment, just, how they're feeling in general will make a difference.

So there's all these things that kind of affect how assertive doctors are in their diagnosis. And so what we want to do when we talk about improving this, we want to, first of all, improve our consistency. So let's talk about some of the ways to do that. Shall we.

Wendy: Absolutely. Let's talk to our four steps we really have four steps. To improve our diagnostic percentage.

Dr. John: First one is having clear standards. So one of the things that all new dentists struggle with is, as they're looking at a particular case, they're trying to decide this versus this, and after you've been doing it for a while, that comes very quickly. But the ability to have certain set standards is such a great tool for new dentists and older dentists alike. That when you see this is what we're going to do, and we're going to do it that way consistently every time. So that clear standards is step number one. So next step number two, I actually learned from you, Wendy. And that was the use of risk assessments. Do you want to walk us through those?

Wendy: Yeah, you bet. So we often do risk assessments internally, which means we're, you're, we're evaluating risk factors looking at the level of disease in the mouth. And we may have some of those conversations in our own heads, but there's power in actually having a systematic process where you use a tool where you have the conversation with the patient and they're involved in the process.

So when we're looking at each individual patient. We need to be identifying why they get disease. I think that's something that we have missed as a profession. And I read a really interesting article published in the journal of comprehensive dentistry in 2017 that said as a profession, we've missed an important step.

We need to, instead of just diagnosing the solutions to the symptoms that we see, take a step back and figure out why the disease. Started and risk assessment can help us do that. So as a profession, as a whole, we've gotten into this pattern of, we see a problem. We diagnose a solution instead of trying to figure out why the disease started in the first place and has the patient mis-diagnosed with an actual disease.

So by doing the risk assessment and bringing the patient into those conversations, we actually empower the patient to know why they're having disease, why they have chronic infections happening again. And again. Why they have made investments in restorative dentistry that continue to fail. And we find that they're much more involved and we end up partnering with the patient because we do that risk assessment.

So instead of doing the risk assessment in our brain and identifying, Oh gosh, this patient has rampant disease. We really should begin that process at the earliest warning signs. And we can't do that if we don't have a systematic process for doing the risk assessment in the first place.

Dr. John: Yep. And what's magic about it is when you do this risk assessment with the patient, right? The patient is getting an understanding of their condition. Without you saying anything, the risk assessment lays it all out for them. And so it's one of the magic things that. Can really transform case acceptance is when you have risk assessments that the patient is, right along with you, th the term co-diagnosis used to be bandied around a lot, and this is a good example of that is that we're looking at it together and it's such an awesome tool.

And the two that, that, you've shown me to be the most powerful. Are the two most common diseases that we dentist treat, right? So the caries risk assessment and the periodontal disease, risk assessment, they're valuable tools, right?

Wendy: And we could go on and on about a whole variety of other risk assessments, but those are the two foundational principles that I think every practice should be doing consistently.

We see other practices embrace, a diabetes risk assessment or sleep apnea, risk assessment. There's a whole variety. Of tools, but the beginning at the very beginning, at least do the caries risk assessment, at least do the perio risk assessment. Those are the foundational I guess conversation starters that we see needed desperately in dental practices.

Dr. John: Yeah. So step number two is risk assessment. Step number three is additional training. I have a story to tell that I'm embarrassed about saying but this is this is what re what I said one time. I was at a Dawson center lecture. And I went up to Pete Dawson and he was talking about all these, full mouth cases.

And this was my first meeting with them. So I was just starting to learn some of the concepts and I said to him I really don't see a lot of full mouth cases. And he said, you see them. You just don't see them. And once I understood all of the principles that he taught and many people have taught after him he was absolutely right, because I didn't recognize the problems that were happening.

I didn't, I, you don't know what you don't know. And so getting, additional training is really helpful in seeing things that you wouldn't see. Otherwise, for instance, implant training. Once you have implant surgical training, you look at every space differently. Every single one, you look at it differently.

Is this a good implant site is it's not a good plan implant site. If you don't have the surgical training, you're not even thinking that way. So getting additional training and for, young dentists that are coming up and dentists that are building there. There are clinical tool belt. We always like to see the complex restorative training come early in their career.

After that, maybe implants after that, maybe cosmetics, but every time you take one of these courses, you see what you didn't see before, which helps drive your diagnosis percentage.

Wendy: Love that, it's so amazing when we do see dentists, I guess invest in additional training and expand their tool belt, how it often lights a fire, not only in them, but in the entire team, right? Because we have new services on the menu we can be offering consistently. And all of a sudden the whole team gets a fire lit under them and everybody improves in identifying those things. So it's an awesome journey to be a part of.

Dr. John: We have so many clients who were starting to lose their passion for dentistry, because it was starting to become repetitive and not very interesting. And they learn a new skill and all of a sudden their passion returns, they're really excited about dentistry. And so there's this learning helps you get more years of really enjoying the craft of dentistry.

So the last step that we have for improving diagnostic percentage is using our team case acceptance process. You want to start describing that Wendy, and then I'll fill in some color here.

Wendy: You bet. I can't tell you how many times I'll have a doctor in a hygienist a little bit at odds, right? The doctor will come and say, gosh, I wish you could get my hygienist to help drive restorative dentistry. And I'll have the hygienists come to me and say, gosh, I wish we could get our doctor to stop pushing us to sell restorative dentistry. And I find that there's a reason for the disconnect, right? We don't take the time often to work on this important partnership. In fact, we've long said that this is a gap in hygiene, professional education.

We go to hygiene school and we're graduated to be clinicians. However, there's a tremendous gap in our education. We really don't have any courses designed to prepare us, to discuss restorative dentistry with patients. And know we look at the average is 70% of all restorative dentistry is referred from the hygiene department.

But we graduate professionals, woefully, unprepared to have any of these conversations. So what we found is missing in many practices is consistency on developing some of these skills. Hygienist had been in the trenches a long time. They may work for several years with the doctor before they really feel like they're on point and sinked up and can accurately predict what the doctor's going to say for restorative needs.

In my opinion, that's way too long. We can facilitate that process. And we say you should have a system for consistency with that diagnosis and case acceptance a standard. If you will, that your team knows. You will uphold and we can develop those processes in about 90 days. So 90 days after you hire your new provider with the right tools to establish consistent processes, you and your new provider should be on-point and thinked up and successfully partnering up to help patients understand why they need the restorative dentistry. They do what the urgency looks like and being willing to accept it and move forward. And that's often missing in practices. So there's a variety of strategies or skills that we have practices work on to develop that level of consistency.

Dr. John: When we have that level of consistency, then the doctor can walk in and know that the team has already talked about, different situations or issues the patient may be having, has already talked about potential solutions. And when that team member tells the doctor, then she knows. What, she knows what they've already talked about. She doesn't have to say it over again, saves a lot of time and increases consistency. So that's why it's so helpful to have this team approach. It does not happen quickly. Unless you make it happen quickly. And that's what we help practices do is to make that happen more quickly so that we can onboard a team member and have them be fully functional in that 90 day period.

Wendy: I love that Dr. John and what's awesome to see is when the entire team understands what their role is. And of course, we're talking about necessary dentistry, right? We often talk about, you mentioned this at the very beginning, we're never in a position to have to talk about unnecessary dentistry. That's, what's wonderful, understanding that, doing the right thing for the patient, trumps any desires we have to grow the practice or whatever it may be. If we focus in on helping the patient understand why they need what they need.

Dr. John: We have that team-driven approach. It's amazing what can happen overnight. I, when we've seen it literally happened overnight, which is a really exciting thing to witness. Yeah. We really have, and just focusing on doing the right thing for the patient at the right time, every time that's the only thing that creates sustainable practice, progress and success.
So this is one little piece of it.

Wendy: Yeah, exactly. And what's interesting is I want to take just a minute because there's four steps to increasing diagnostic effectiveness on the restorative side. Also applied directly on the hygiene side. So I wanted to speak to that really quick. Having clear standards is often what's missing on the hygiene side.

Especially if we have multiple providers, multiple doctors under the same roof. Many times we don't have tools or processes or systems in place so that there is no gray area with hygiene standards as well. So we often teach that we talk about non-negotiable standards that need to exist for the preventive therapist role, the periodontal therapist role and the role of a patient treatment advocate.

The second thing was risk assessment, which we talked about a little bit on the caries side, but we mentioned the perio risk assessment as well. And hygiene to increase their diagnostic effectiveness. Absolutely should be using some time type of risk assessment or tool to evaluate where the patient is right now.

Today. And what do they need to return them to a state of health? If they're not there already risk assessment on the hygiene side absolutely helps to impact our diagnostic percentage on the hygiene side. The third thing was increasing the tool belt, right? And increasing training, same thing on hygiene.

If you're not certified to give anesthesia and it's legal in your state, get it done. If you aren't familiar with how to utilize lasers and advanced technologies and your periodontal therapy, get that done. There's so many opportunities for us to also expand our tool belt in regards to our roles in the practice, hygienists should be doing so much more than just cleaning the teeth in today's world, but you can't do those advanced therapies.

If you haven't received the training and have the knowledge. And just like Dr. John mentioned. Once, you know what to look for. And once you see those opportunities, you can't unsee them and you'll find that you have opportunities to utilize lasers at a higher level in your practice. You just don't know that yet.

So the fourth step was systems for consistency. The same thing, hygienists benefit from this. Tremendously as well on the hygiene side, as well as the restorative side. So having a process for how we utilize intraoral images, having a process for how we utilize cavity, detecting lasers having scripted out conversations to help increase urgency and create awareness with patients, all of these benefit, the doctors diagnostic percentage, but also hygiene team.

You can affect your own diagnostic percentage by using the same four steps in improving diagnostic effectiveness.

Yup. Fantastic. Very good. Anything else you want to cover, Wendy?

I think we could go on a whole nother conversation about practice models and practice styles, because again there's a lot of different ways to practice dentistry successfully.

But I would say one of the things that we share in common is our vision for what a dental. Practice really can be. And the most successful practices we work with have dialed in on how to really utilize the team-driven approach in all areas of their practice, but in this area specifically, if you focus your time and attention on developing some of these processes, the return will be massive.
And I think it's super important to, to focus on some of these things today, especially because you have articles that always come out, the reader's digest article of a few weeks ago created a whole bunch of chatter, and the article was, Hey, dentists are dishonest. And we went to several dentists that got different plans.

And in reality, those articles are. They can be damaging to our profession because you have people that really don't understand how the industry works, writing them. But what we have seen is the best way to overcome some of the questions or concerns in that article is to have some of these things dialed in.

Right to be focusing on building trust with your patients, using the technology, following these four steps to improving your effectiveness is going to help everyone, even the patients understand why they need what they need and be willing to move forward and take action.

Dr. John: Reader's digest every 10 years ago runs the same article.

They just have they write it again. But it's the same story about every 10 years. It's not an uncommon model in the media in general. And so the key is if patients understand the why, if we make things visual so that they can see that we use these risk assessments and other tools.

That's when we get the magic of they, they understand where you're coming from. The trust level goes up and his trust level goes up, case acceptance goes out so you can catch it on the next episode of the double, your production podcast.

Wendy: Thanks for joining us today.

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