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Volume 54, Issue 6
Special Report on COVID-19: Winning back patient trust. Dental professionals offer guidance about how to handle getting patients comfortable and alleviating anxiety about returning to the practice after the COVID-19 pandemic stay-at-home orders.
Patients might feel hesitant about coming back to the dental practice after the stay-at-home orders are lifted and the Centers for Disease Control and Prevention (CDC) advises that routine dental appointments are allowed once again. We spoke to dental professionals about how to handle getting patients comfortable about returning to the practice and winning back their trust.
Madi Bullock, head of public relations for Weave, says getting back to work will take time and be different for everyone. Remote work strategies and tools practices are using now are here to stay, such as working from home, texting patients, curbside pickup, wellness forms, and email marketing.
“We’ve seen businesses get creative in how they can safely ‘stay open.’ That has created new channels for businesses to communicate effectively with their customers that we hope to see continue even after stay-at-home orders are lifted,” Bullock says.
Rebekah Pryles, DDS, an endodontist in White River Junction, Vermont, says that they have been seeing patients on an emergency basis during the COVID-19 pandemic. To bring comfort to the staff and patients, they have been carefully following the guidelines from the American Dental Association (ADA), Occupational Safey and Health Administration (OSHA), the CDC, and local dental societies. They also continue to monitor what those guidelines are to keep up with their rapid change.
“At the beginning of this, the guidelines were changing every single day. We make it our best effort to read them every morning and implement things immediately. So, the staff knew that we were taking things incredibly seriously, and our patients knew that we were doing what we could based on the best evidence,” Pryles says.
Pryles says that the “best evidence” included many things. Early on, they learned that N95 masks were the most appropriate and made the switch. Also, Vermont recommended creating partitions between operatories to create a closed space, so their practice did that.
“We implemented all disposable PPE for the staff, and we explained these things and the reasoning behind them to our staff and also to the patients, to show them what we were doing to keep them safe in the practice setting,” she says.
Regarding the personal protective equipment (PPE) changes, the practice made them early enough that there weren’t shortages at the time. They could obtain some of their PPE equipment as they usually would. However, once the state of Vermont designated their practice as an ER diversion site, they were also able to obtain PPE from the state as well.
Set the Proper Expectations About What is New Upon Returning
Katrina Sanders, RDH, a practicing dental hygienist, dental hygiene educator, and international speaker, says that for patients, there has always been a fear around dentistry. Moreover, patients don’t like surprises, especially when it’s about something of which they are afraid.
“There’s always been a fear about dentistry. There are smells and sounds; it’s a 4D experience going into the dental practice. And now, let’s add on the extra layer of uncertainty around COVID-19,” Sanders says. “The more that we can support our patients and educate them about the things that will look and feel or smell different, the more prepared they can be to step back into the operatory.”
Some of the changes Sanders anticipates will begin before the patients arrive. Sanders says patients should get a phone call before their appointment, screening them for exposure and symptoms of COVID-19. This questionnaire will delve into any inflammatory conditions the patient might have, and for a good reason.
“We have noticed that there are certain types of inflammation that have elevated the individual’s risk for propagating or potentially losing their life to SARS-CoV-2,” Sanders says.
Also, Sanders says that practices should communicate all the new limits patients can expect. In the past, patients might be used to showing up early and getting coffee or leafing through magazines. However, practices need to limit congregations of people, so there may be fewer patients allowed in the waiting area, or, in some cases, no patients in the waiting area; they will come in directly from their cars.
“A lot of people are doing a texting service saying, ‘I’m in spot number one.’ When your hygienist is ready, they retrieve you from your car to limit the number of interactions within the dental practice,” Sanders says.
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Pryles says one of the most important things they have implemented in the practice to make patients and staff feel safe is the heavy screening of COVID-19 symptoms and exposure ahead of appointments. Patients that don’t pass the screening or present febrile are not treated.
“We are at a point now where patients don’t even come into the office,” Pryles says. “They call when they arrive, and a staff member meets them on the front porch to take their temperature.”
The Vermont clinician sees these safety measures continuing in the short term until vaccination or widespread testing becomes available. Recent ADA guidance supports the early steps Pryles and her partner, Brook Blicher, DMD, made to keep everyone as safe as possible from the start.
“But I don’t think this is permanent in dentistry. I should make that very clear,” Pryles says. “These are temporary fixes for a short-term problem, and once COVID-19 is managed, I hope and foresee that these things get taken away.”
Once you get to the operatory, Sanders says all dental professionals should perform impeccable hygiene, especially hand hygiene. They should also encourage patients to do the same. Sanders says patients often stick their hands in their mouths to show the team where the pain is.
“Now, we may be asking them not to stick their fingers in their mouths and instead describe where the pain is coming from,” Sanders says.
Sanders says that dental practices also may provide mouthwashes before dental visits to reduce the viral and bacterial load of the patients’ mouth before arrival.
The operatory will also look different, with more plastic and disposable things and less paper. Display units will likely be put away, along with samples, because they will get contaminated from patients’ aerosolized mouth droplets.
“We have taken the time within the dental community to examine what those risks are and ultimately are working to remove them so that we don’t have to sanitize or sterilize them in between every patient,” Sanders says.
Also, the staff will look different with larger masks, like level 3s or N95s, and maybe even plastic shields. Staff will also probably wear disposable or laundered garb with hair coverings like bonnets or surgical caps. All of this equipment is hot to wear. Sanders says you might tell the patients that the dental office might seem cooler than in the past in an effort to help keep the dental team comfortable.
Finally, Sanders says you should warn patients that you might need their patience. Appointments might run a little late. Sanders says that turning rooms, wiping them down with hospital-grade disinfectants, and changing PPE between patients could delay appointment starts more often.
“We anticipate that may take a long time. And so if you’re looking at your watch, waiting for us to bring you back, know that we’re not sitting in the backroom eating chicken fingers and enjoying a soda,” Sanders says, laughing. “We are working around the clock to be very sterile, sanitized, and very clean.”
Winning Back Patient Trust Takes Consistency and Communication
Bullock thinks a significant obstacle to getting patients back into the office will be a lack of trust and a sense of security. She says it’s hard for consumers to know if it is the right time or if it is safe, or even necessary, to get back into the office for routine or elective appointments and surgeries. To overcome these challenges, Bullock recommends frequent and effective communication.
“This lack of trust can stem from a lack of information communicated, which, in turn, can exacerbate the problem and spiral into fear and the unknowing,” Bullock says. “Knowledge is power-arm them with that.”
Lynne Slim, RDH, is a dental hygienist writer and speaker has practiced for 40 years. She says her patients have a tremendous level of trust with her based on her background, experience, and active role in the industry as a writer and researcher. However, she thinks it is also based on predictability. When people and practices become erratic, that can erode trust.
“Trust is also cumulative. Whatever you have promised people, they have certain expectations. When they come in as new patients, it’s like being presented with a blank check. It’s like deposited money, and you have to treat it like that. Do what you say you are going to do over and over again. Patients counted on us to do that,” Slim says. “In my practice, where I was for 12 years, I was confident, so my patients felt safe.”
Bullock recommends opening new communication channels to connect with customers and share with them the practices you’re putting in place to keep communities and people safe while serving them. For example, you can let patients schedule appointments and make payments over text. Reduce paper by completing wellness forms online and increase communication through email marketing about all the changes in the practice day-to-day. Practice analytics can come in handy here, as well, Bullock says.
“Similar to grocery stores, we’ve seen success in targeting business hours to customers with impacted immune systems and with the right tools that can be done easily and efficiently,” Bullock says.
When it comes to alleviating anxiety about infection zones in the office and rebuilding trust, Bullock thinks careful attention to the tone of your communication, and a message of togetherness is essential. She also thinks open lines of authentic and empathetic communication are crucial, as well as being responsible for the infection control practices put in place. Following these guidelines will help people understand and empower them.
“This may be a waiting game, but it is also a creative game; how creative can a business get to serve safely,” Bullock says.
As far as dealing with patient anxiety, Pryles says so far, most of their patients are grateful the practice is open to relieve their pain. Pryles says they are comforted also to see the practice is following the guidelines. However, if a patient were reticent to come in, the conversation about precautions you are taking is a critical one between doctor and patient to make them comfortable getting the care they need.
“Some may still not feel comfortable, and that’s something we have to recognize as practitioners. We can’t make everybody comfortable in a pandemic setting, and that’s okay,” Pryles says. “We need to do our best to keep everybody safe.”
Many practices might ask for payment before you even come in to eliminate stopping at the front desk on the way out. Or they could be going paperless or using epayments to become touch-free. Plus, moving forms online can be daunting to less tech-savvy patients.
“If they don’t feel comfortable going out to all the platforms to complete a lot of this content or they need help or support with that, we want to be able to help our patients with that,” Sanders says.
Sanders says it is also vital to communicate to patients that before opening the practice, the team has been “working around the clock” researching information from the CDC, OSHA, the Organization fro Safety Asepsis and Prevention (OSAP), the ADA, and the American Dental Hygienists Association (ADHA) about what guidelines they need to meet to be safe.
“We are not opening our practices until we can promise that we are as safe as possible,” Sanders says. “We have been working tirelessly as an industry to ensure that we are aligning with what those guidelines are to protect our patients best.”
“Honest and open communication has always been important in dentistry, and it remains incredibly important now-even more so than a non-pandemic setting. So, the more you can explain to staff and patients why you are doing what you are doing, as well as the guidance that you are following to make your decisions, it will go a long way in making people more comfortable,” Pryles says. “Transparency in dentistry has never been more important.”