by Glennine Varga, AAS, RDA, CTA
Dental Sleep Medicine (DSM) is a therapy that thrives with team interaction. Don’t get me wrong – I’ve seen successful offices function with only two people. All the same, Talking, Educating, Assessing and Marketing (TEAM) is the way to spring Sleep forward in your practice.
There is a great article: Sleep Medicine: A Team Sport, that was originally published in Practical Neurology and is reproduced in its entirely in this issue of DSP. The authors sum up the spirit of collaboration that is needed to maximize patient success with sleep medicine. Dentists (and their teams as an extension) are major players on that roster as Durable Medical Equipment (DME) suppliers and consultants. It’s so great to see that dentists are becoming more recognized as true provider partners within our medical community. This means it’s time for us team to step up and help facilitate our role in sleep medicine.
The role of any dental team member is to help enrich a patient’s understanding of his/her oral health including airway health. This is my opinion and the opinion of the American Dental Association (ADA) as well. In the recently released statement from the ADA, all dentists should be screening for sleep breathing disorders in both children and adults.
Since team is so vital in sleep medicine, let’s look at some specific techniques that will create opportunities and make an impact on patient experience.
T – Talk (Ask Questions & LISTEN)
E – Educate
A – Assess (Document to Maximum Medical Improvement MMI)
M – Market (Communicate with physicians & document success)
T – Talk
I’ve had the honor of being selected to teach for Dr. Dick Barnes of Arrowhead Dental Lab. I believe that the TEAM structure is the key to presenting comprehensive dentistry, which blends perfectly with sleep breathing therapy. There are many points to TEAM but I feel the fundamental fact of allowing your patients to contribute to their experience is key. Talking with patients means asking questions and listening to answers – and that makes all the difference. Many dental offices screen patients by handing them a clip board with an Epworth questionnaire or STOP BANG. Some patients take screening forms and draw a straight line down declining any sleep issues. I’ve seen the most effective way to get your patients engaged in conversation regarding sleep is to ask the right questions based on medical history, signs and symptoms, and risk factors. Give your patients an opportunity to communicate in their own words their feelings about their dental or airway health. The most minimal way of doing this is to change your existing medical history to ask: “Have you ever been diagnosed with Obstructive Sleep Apnea? Have you ever been told to were Continuous Positive Airway Pressure CPAP or PAP therapy? Do you snore?” If you want to take it to the next level, instead of handing your patient’s medical history on a clip board, sit down with them eye to eye, knee to knee and interview your patient. Once we can gather patient’s relevant information while listening with intent to repeat, we team pass along our interview findings to our doctors. If you would like to really impress your patients, report what the patient has told you in their own words to your doctors after introductions. You will see how this one tip could change the entire dynamics of your practice – I’ve seen this happen over and over.
Many times, educating patients is a long-term process. We want to take every opportunity we have to give our patients enough information to make educated decisions toward therapy. The best time to educate is while the patient is in the office. However, I’ve seen successful teams spend a lot of time on the phone with patients upfront to help manage their therapy journey. Educating patients on your website, Facebook page, reception monitor, treatment/consultation rooms and in your community should be being done at all times. If you offer sleep breathing therapies to your patients, bombard them with sleep breathing facts. This will get patients to ask questions and start talking about sleep. I’ve learned how important it is for patients to co-discover their deficiencies and take ownership for improvement. Educating patients on what ideal sleep breathing is and where each patient is on the spectrum is relevant to separating the decision to do something about it versus problem solving how to pay for it. Most patients are used to being told there is a problem, given a therapy option and follow all the rules necessary to have insurance “cover” it. This starts the downward spiral of “I will only do what my insurance covers.” Instead, help your patients discover for themselves the impact their sleep breathing condition is making on their chief complaint or issues they have expressed concern about.
I’ve heard the statement that Dental Sleep Medicine is a thinking person’s game. This is because it requires us to assess every patient about where they are on their sleep medicine journey. Sleep medicine is a team sport because it can modify many areas of life and physical functions. Evaluating patient progress, tracking management and communicating with your sleep medicine team is integral to prosperity. We team can help with this by completing patient’s subjective intake, documenting and transferring information correctly and most importantly following up on required actions. Assessing patients starts at intake, gathering risk assessment and signs/symptoms information for non-diagnosed patients. If patients need to obtain a diagnosis, help facilitate the testing for them. When working with diagnosed patients, collecting a copy of the base line sleep test report and physician intake notes. This will start the assessment process in your practice. Many offices use their dental software system to store documents and notes. However, to be more organized there are some great dental sleep medicine systems on the market you can invest in that will keep you on track like DS3, DentalWriter or SleepConnect. I’m most excited for the latest addition in this arena ImagnSolutions which has full integration with Dentrix for those dentists that do not want to separate medical from dental ledgers. Regardless if you use a system or not it’s imperative to keep track of your patient’s progress and encourage their efforts to reach Maximum Medical Improvement (MMI). When patient success happens, be sure to Celebrate!
A verb in this example, marketing is to advertise or promote. You can spend time marketing in the traditional sense of the word and purchase radio time or put up a billboard to spread the word. Most offices I’ve had the honor working with attribute most new patients to internal patient and physicians referrals. Promote! Everything we team do to interact with patients gives us an opportunity to promote our services. There should be a balance of listening to patients and promoting our services when the opportunity presents but we first must learn to recognize these opportunities. When patients call in for the first time, help to ensure their decision to take action by saying things like “I’m so glad you called, in my opinion you’ve called the best!” or “Thanks for calling us, if anyone can help you with _________ (enter patient’s reason for calling- snoring, excessive daytime sleepiness, getting elbowed by bed partner) our office can!” Strengthen your patient’s decision to choose you by personalizing their experience and promoting their success during therapy. Take every advantage to communicate with your medical team. This is by far is the biggest complaint I’ve heard from physicians regarding dentists and oral appliance therapy (OAT). Physicians say they’ve worked with other dentists that do not communicate so they move on to find those that understand their need to be informed of patient therapy. This is a perfect opportunity to promote. As patients reach MMI create a spread sheet of before and after sleep vitals that can be marketed to your medical team.
Editor’s Note: This Sleep Team Column will be dedicated to the team and provide practical tips and resourceful information. Let us know your specific issues by email to: SteveC@MedMarkMedia.com, while we can’t respond to every individual. Your feedback will help us create the most useful Sleep Team Column we can!
- Thank you, Dr. Kevin Kwiecien!