Do You Need a Parachute?

A dentist I used to work with once remarked that when he came into my hygiene room to check a patient he felt like he had been dropped out of an airplane without a parachute.

He described what it was like to work with his restorative patient, loops on, narrowly focused on precise preps. He would then walk into my room where he was expected to be outgoing and expansive in his thinking, embracing the complete history and future of the patient in my chair.

He felt like he was asked to jump right in to a relationship I had been building with my patient for almost an hour. We decided to create a parachute to bring him more gently into that conversation; a simple four step process we eventually used throughout the entire practice.

As I was preparing recently for a workshop about the Continuing Care System (Click here to learn more) I remembered this story. I laughed to myself as I thought of how often I was impatient with the dentist for not showing up when and how I wanted him to for those hygiene checks. Until that conversation I had never really thought about what it was like for him to leave his patient to see the person who was there for a hygiene visit.

To be honest, I had not thought much at all about the way in which the Continuing Care System intersected with all the other systems in the practice. My focus was primarily on my schedule and my patients. Today I understand the importance of those intersections; those times when we are responsible for passing on the relationship we have been building with a patient to someone else in the practice. I see those intersections now as precious moments, ripe with opportunity. Every single time we pass the relationship to someone else, we pass the trust that goes with it.

In a social situation when one joins two others who have been talking, one of the two would be expected to include the third person by briefly bringing him or her up to speed. Likewise, our “Parachute” included a brief introduction, a bridge in the conversation to invite the doctor in and allow him to join us gracefully.

We were aware that the doctor’s time was limited. He wanted to greet the patient warmly and join the relationship without intruding. The sooner he knew what we needed from him that day the more effective and efficient he could be.

Since I had more time with the patient I could pay attention to what was really important for the doctor to understand about him or her, personally or professionally. I also would have done a clinical assessment and had a sense of what the doctor needed to know about the conditions present. Often I had talked with the patient about treatment options, either based on what we discovered together or on what had been discussed in the past. The doctor wanted to be as informed as possible as early as possible in the process.

Our ‘Parachute” was a brief summary which consisted of four points I would convey to the doctor when he entered my room. The doctor agreed he would not start a conversation with the patient until he had heard these four items. They could come in any order, except for the last one.  Here’s how it worked:

They Said: I was expected to tell the doctor something specific the patient had said to me that day; to summarize or offer key points I thought were important to the patient. This part of the process was designed to make sure we heard our patients, and that they knew we heard them.

I Said: This was my opportunity to let the doctor know how far I had taken the conversation with the patient; what information I had given them, suggestions I had made, questions I had raised. This was designed to make sure we did not waste our time and the patient’s time repeating the same things over and over. The goal was for the doctor to take the conversation to the next level, not start all over again.

We Saw: This was where I conveyed the clinical findings; what we saw in the mouth, on x-rays, photos, etc. The language was specific here: not “I saw” but “We saw.” This statement helped me hold myself accountable to co-discovering conditions, not just reporting what I discovered to the patient and doctor.

We Want: I always ended with this statement because this was the cue to the doctor that it was time for him to enter into the conversation. This was designed to let him know what we needed from him that day and if I had promised anything on his behalf.

This summary could be brief:  

“Susan said she loves the crown you did for her and finds it so easy to floss in that area. We did not see any bleeding on probing there like we had in the past. We just want you to celebrate with us and also admire the pictures of her new grandson!”

Or it could be much more in depth:

“Mary said she feels some sensitivity on the lower left molar area when she bites down. You remember the second molar on that side had two root canals and three crowns before she came to us so she’s a little nervous about it. She also felt some tenderness when I palpated the muscles on that side. She thought I was pressing hard until she touched those muscles gently herself and it was uncomfortable. I told her the two things could be related and we wondered if you could check and see what you think might be going on or how we could figure out what is causing her sensitivity.”

Do you need a parachute? Try this one. Practice it with the chart of a patient you saw recently to get comfortable with the process. Use it in hygiene — or in any other situation where you want to pass the trust you have built with a patient to someone else so they can gently, gracefully, parachute into the relationship.