Extreme wait loss

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wait300The portrayal of a Californian public hospital in Peter Nicks’ apolitical documentary The Waiting Room is sobering. Wait times stretch into whole days; cots line hallways; anger and disillusion are etched on the faces of patients and doctors alike.

While Australia’s dental surgeries are a far cry from America’s overstretched medical system, wait-room frustrations are no different. In fact, given patients are waiting for a service for which they have made an appointment and are perhaps already anxious about, any discontent or frustration is intensified.

“A person’s anxiety may be related to their fear of pain,” explains clinical psychologist Sally-Anne McCormack, author of Stomp Out The ANTs (Automatic Negative Thoughts). “This is not going to decrease if they are left by themselves waiting outside and listening to noises, smelling odours or having their imaginations run wild.”

For some people, she goes on to say, memories of a previous appointment is often skewed, most frequently towards the negative, and being made to wait only heightens it. Erica King has guided dental practices for the past 25 years-first across 585 practices around Australia before becoming director for the six currently under the DCA Dental banner-and has seen her fair share of anger in the waiting room. Medicare’s ill-fated Chronic Disease Dental Scheme, which allowed GPs to refer patients, resulted in some challenging waitroom antics. “Medicare patients would turn up with no appointment and expect to be seen right then and there,” remembers King. “When we couldn’t, they would yell and become extremely unpleasant. We’ve had people put bricks through the window, staff threatened-even hate mail. We have panic buttons under the desk, which summon police immediately.”

Thankfully, this kind of behaviour in the average polite waiting room is rare. That said, frustrated waiting patients can quickly escalate into aggressive ones, leading to unpleasant experiences not just for staff, but for the other patients in the waiting room. “There can be serious negative consequences,” warns managing director of Momentum Management, Toni Surace. “People can say, ‘This is ridiculous, I’m taking my records,’ and leave forever. And that person can spread the word to many other patients.” King agrees: “Why should a dentist’s time be more important than a patient’s. Everyone’s time is important-thinking otherwise is rude and arrogant.

The days when any medical personnel could think 45 minutes to an hour in a waiting room is acceptable are in la-la land. When I was growing up patients all went to the same dentist forever. Patients have a choice now; they have plenty of options, and they can and will explore them.” Ultimately, in most cases the fault lies back at base. The most common culprits are underestimating procedure-times, emergency patients and double booking appointments. “Dentists are notorious for underestimating the time a procedure will take,” says Dr Surace. “We get dental assistants to time the dentist on a particular procedure, without the dentist knowing, six times, then take the average, and use that to book appointments. Often the team will know it will take longer than what a dentist will tell you; they don’t like to admit to it.”

Dr Angelos Sourial, principal dentist at Brunswick East Dental, might beg to disagree. He’s at the frontline of the issue, dealing with patients and their different needs daily. “I think most patients understand that there’s an element of unpredictability when it comes to providing healthcare of any kind and so a wait time of approximately five minutes is generally well accepted by patients in most cases. We all know how stressful dental procedures can be, especially if there is a tricky case or a particularly anxious patient.” Dr Sourial cites a recent example of one such trying situation: a patient mixed up his appointment dates, but on arrival was adamant he had to be seen right away. A proffered coffee and (recent) Time magazine went some way to mollifying the distressed patient, who agreed to wait for Dr Souris to squeeze him in. Dentists need to try their utmost to give quality care “to give patients a sense it was worth the effort”, says King.

She and Dr Surace have the same advice on how to do this best: plan, and plan some more. First, ensure your appointment book has a mix of short, medium and long appointments every day-back-to-back short procedures leave you more open to potential delays. And ensure that if you can’t physically book an emergency slot into the day, at least be aware when in the day you could best fit one in, if the need arises. “Also,” adds Dr Surace, “teams need to act with a triage mentality, determining whether an emergency is a true emergency-not a tooth that has been bothering the patient for six weeks, and they have only just now decided to do something about it.” Practices may need to look to themselves, too: Lack of tone in email or text reminders often comes across as harsh, and circumvents the cornerstone of a good relationship. When dealing with a new client, choose to phone them; try and book them in first thing in the morning-first impressions count. Sometimes, though, delays are inevitable: tricky extractions, anaesthesia-resistant patients, time-sensitive emergencies.

So what can you do about it when it happens? Communication is key. Both dentist and the front desk need to know exactly what’s happening that may impact other patients. “If you’re running more than five minutes late, 10 at the most, a patient needs to be told and offered to reschedule,” asserts Dr Surace. “If there’s no way of knowing how long the delay will be, do everything you can to make patients comfortable. Inform them, tell them how much longer things will take and offer refreshments. Some practices will tee up with a nearby coffee shop, so they can offer patients a free coffee card and call them when the dentist is ready.” Keep an eye out for signs of restlessness: sighs, grunts, frequent watch checking, repeated exits from the waiting room to talk on the phone-these are all indications that a patient is reaching the end of their tether. Try and catch them before they do… but if you can’t? “My strategy is to immediately try and remove them from where everyone is listening,” says King. “If there’s nowhere to remove them to, lower the volume and tone of your voice, and slow your speech down, to try and calm that person into a less aggravated state. Remain calm, and for goodness sake don’t yell.” Remaining calm, and creating a soothing environment, is key, says McCormack. “When I was young, nearly every dentist had a fish tank which was a pleasant distraction to help calm waiting patients.

Ensure your waiting room has a calm atmosphere through the use of colour, music and orange or lavender essential oils.” And Dr Surace’s final piece of advice is perhaps the most straightforward-but might result in the biggest attitude shift. “Actually, we should stop calling it a waiting room altogether,” she says. “We should call it a patient lounge or lounge area. We are effectively telling patients that they will be waiting.”

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