Two Primary Reasons the Second Consult is Bad for Your Practice

We recently did a survey asking periodontists about the efficiency of their practices.

Much to our surprise, one of the main points covered revealed a startling yet common problem. 

On the day of the initial new patient examination, patients aren’t being scheduled for their treatment. 

Most of the periodontal practices we surveyed are booking a second consultation and others are having to call and follow up with the patient after the patient has left the office.

If this sounds like your practice, I would like you to think about a few very important questions.

On the cases that didn’t schedule, what was the purpose of the initial examination? Was it exclusively just for data collection?  Was it simply just a meet and greet?

Maybe your goal is to schedule the patient for treatment as soon as possible and it just doesn’t end up happening that way.  Maybe, you felt like you were missing too many puzzle pieces in order to develop a clear diagnosis and treatment plan.  Maybe the patient was “not ready” for one reason or another.

Certainly, there are going to be some very valid reasons why any provider may not opt to rush a patient into surgery right away.  However, there are several components to consider like how much time you spent vs what you billed out.  When lost production time is not taken into consideration, there may not be enough revenue left to provide the exceptional care that the patient truly needs.  After all, this is a business, and time must equate to income.  You spread yourself too thin when you waste time, and this decreases your value.

If you are not booking patients routinely straight out of the initial exam, you face some serious consequences which could have been avoided.  The hour you book for an examination (non-production) time, affects more than just your bare minimum baseline.  Appointments can only be made if the patient is well prepared, ready for the next step and offered to schedule.  The odds decrease if you wait for them to ask for an appointment.

Here are a few points to consider…

The hour you spent on the initial consult doesn’t just end with that one hour… 

Ask yourself these questions:

1. How much time are you really accumulating on visits that do not contribute toward production?
2. Whose time is being wasted?
3. Did you think of everyone involved?
4. Do you think the patient really wants to come in twice?
5. Does your staff really have time to chase the patient and call to follow up?
6. Maybe your referring dentist wants to “get that crown seated”.

Getting a patient scheduled eliminates extra “busy work” and adds to your profit potential.

Think about production time vs busy work time.  Often periodontists think that there is no way around “busy work” such as completing unfinished charts and addressing the needs of referring doctors and or staff.  There is only so much time in one day, so, inevitably something has to give. 

What happens when you spend time on “busy work”?  You compromise your own self-care and your personal relationships suffer as a result.  If you are not thinking of ways to minimize wasted production time, it will not only affect your bottom line financially, it must ultimately affect your well-being and spill over on to others.  Those others are staff, patients, referring doctors, even friends, and family.

A case sitting in limbo affects the perception of the competency of the provider…

 Ouch!  Like it or not, your practice is a business and it’s all about perceptions.

Think of it this way; what happens when you see someone who is unable to make definitive decisions on a topic in which they should be an expert?  Did it leave any doubt in your mind about their competency not necessarily in their professionalism or level of expertise, but rather about the specific and appearingly unique situation with which they were faced?

When you appear undecided, you also obliterate any sense of urgency in those around you.  Of course, you probably have a logical explanation, and you know what you are doing.  However, if you're hesitant, it makes it appear “OK” for the rest of us to hesitate.  I'm talking specifically about the staff and the patient.  Hesitation also leaves patients feeling like “Maybe I don’t really have a serious problem…”  After the patient leaves the practice they will often conclude “if it’s not obviously broken, then why fix it?”

The result… lost case, lost production.

How you can prevent lost time and wasted production and by default, avoid second consults. 

The key to efficiency is to anticipate the needs of the case BEFORE the patient arrives.

Of course, you wouldn’t begin performing surgery before the patient is ready.  So why do you book out an hour of your time when you don’t even know for sure if the patient needs a Periodontist?  How do you know if they are even emotionally invested in getting the help they need?

Does the patient come to you prepared?  If not, solidify your screening process.

Most likely, over half of the things that you establish with the patient during the initial consultation could be standard questions asked during the initial telephone call and preliminary data collection process.

With a good screening process in place, you will gain clarity and insight into both the patient's needs and readiness for the procedure to be performed, as well as for a full hour of your time. 

Moreover, you and your entire team will better learn how to help patients holistically and address their perceived needs.  Instead of just shuffling them through the door expecting them to accept care they may not even be interested in, you will find out what they can do, can’t do or are even ready to do.

The more information you have in advance the more control you will have over the case.  It follows that the patient will be managed much more efficiently.  Positioning is everything.

Teach your referring doctors how to better prepare periodontal cases before they refer them to you. 

Your referring practices should have a clear understanding of what takes place in your practice, so they feel included in the overall process.  Knowledge is power, and your referrers will love this level of mentorship from you. They will feel more in control.  They will also be delighted to take on some of the things that really, they should be doing anyway.  So upon the patient’s arrival, you can literally “cut” to the chase, well, at least by the next visit.  (Pun fully intended)

Eliminate redundancy, your time is valuable, don’t waste it. 

Repeating the same routine periodontal treatment scenarios over and over like a broken record doesn’t serve you well.  Develop a clear system so that it’s easy for your entire team to help you pick up the pace.  You don’t need to reinvent the wheel as if it’s some unique epiphany every time.  Sure, there are subtle details that you and only you can decide and must be the sole proprietor of.  However, stick to what should be your expertise and leave the conundrum out of your daily task list.  PANDA Perio provides an easy to follow, and consistent process for your entire team utilizing templates and checklists. PANDA was designed exclusively for Periodontists taking into consideration their various levels of unique styles of expertise.

A well-run practice leads to increased case acceptance ultimately giving you less stress and more free time.