A Treatment Co-ordinator (TCO) can hugely benefit practices for many reasons, especially when it comes to phobic patients. The patient’s first visit to the practice does not need to be in a surgery, and in some cases, does not need to be an examination for their first appointment.
One of the main reasons for patient’s feeling nervous, is because they do not trust the dentist not to hurt them. Therefore, having a consultation with a patient can help to build rapport and help to build trust before proceeding to the next appointment – whether that be another consult or for the first exam.
Last week I had a patient visit me for her first consultation. To say this patient was nervous is an understatement. She had been an NHS patient for years, and was referred to hospital for any dental treatment required so that treatment could be carried out under sedation. Even so, she only ever visited the dentist when she was in pain. Her NHS dentist could no longer refer her for treatment under sedation, so had told her that she would have to start with a private dental practice. This patient was not just terrified of dentists, but was terrified of anything to do with mouths. She said that if she thought about it too much then she would panic and wouldn’t even be able to brush her own teeth. She didn’t know why she had this fear, but could always remember being this way.
I spent that first hour appointment just talking with her and finding out more about her current dental situation. There was no charge for this appointment or the next consultation I booked for the following week. During the next visit, I asked if the patient would be happy for one of our dentists to come in during the appointment. Not for an exam, but just to meet him before the next step. Only once I had her permission did I request for the dentist to come into the room. The dentist introduced himself and then took a seat next to the patient.
Dentists or TCOs should always sit at the same level as the patient during the first consultation. Sitting above the patient can cause intimidation and make the patient feel uneasy.
I gave a debrief of what the patient and I had discussed and the problems she was experiencing at that moment. This patient could tolerate having a mouth mirror in her mouth, and if need be could have x-rays taken, but a probe was out of the question. If we wanted to carry out a full exam with pocket charting then the patient would need to be under sedation.
The dentist advised that we could give an idea of what treatment was needed with just the use of a mouth mirror and x-rays. He promised that he would not use any other instruments. The patient was still apprehensive because in the past, another dentist had promised the same thing, but had still used a probe. On that occasion it took the patient over 30 minutes to calm down and she never returned to that dentist.
The patient was still so nervous that she requested that I went in for the exam with her. The exam revealed that some work was needed just to get her mouth to a healthy standard, including a thorough cleaning by the hygienist. The thought terrified my patient, but we can offer treatment under sedation so planned for all work including two fillings, hygienist clean and full exam to be carried out during the first session.
Another part of my job is to make sure that the treatment is affordable for our patients. At our practice we can offer some very useful finance options and I was able to go through these options with this patient. She has booked for her appointment and is happy that she came to visit us. She said that if she could not have had sedation then she would have really struggled to ever see a dentist again.
By being a TCO I feel that I am helping each patient that comes to see me and I do find helping an extremely nervous patient very rewarding. There are so many pre-conceptions and horror stories circulating regarding dental treatment and dental experiences. One of my responsibilities as one of the first points of contact is to break down these stereotypes and build trust and confidence in the treatment offered and the in the dentist him/herself.