Communication in the Dental Office: Part II—Effective Telecommunications

The dental staff receives and places a myriad of telephone calls each day. The dental professional speaks with a variety of people both inside and outside the dental practice to transmit information, place orders, schedule and confirm appointments, manage travel, or perform one of many other tasks common to the dental office. The dental professional must use proper techniques when answering or placing calls either by landline or by cellular phone. In addition, the dental professional must be aware of the constantly changing forms of telecommunications and be able to assess their applications for the dental practice.

In a realistic sense, telecommunications in the dental office refers to the different types of telephone systems and communication tools that are commonly used. These may include standard line systems, cellular phones, hands-free phones, conference calls, answering machines, and pagers.

Telecommunications refers to the process of transmitting information, over significant distances, to communicate. Modern dentistry utilizes a variety of telecommunication systems, including but not limited to various types of telephone systems, such as key systems, cellular phones, hands-free telephones, answering machines, pagers, and facsimile machines (fax). Such systems have provided endless communication capabilities to enhance patient care. With such systems, however, patient confidentiality must always remain constant.

The most used form of telecommunications in the dental office is the telephone. A myriad of telephone calls are received each day. The manner in which these calls are received can impact the success of the practice. A telephone call that leaves a patient uncomfortable or unhappy can result in the loss of patient rapport. The opposite occurs when the patient feels he or she has received professional courtesy. This patient will look forward to future contact with the office.

TELEPHONES

An array of telephones is available for the dental practice. For a modest price a dental practice owner may purchase a sophisticated telephone system that will aid in productivity and profitability. It is important for the dental team to decide the number of lines required for proper phone and facsimile operation and the types of features needed on the telephone. Functions can include call waiting, speakerphone, hands-free phones, conference calls, answering services, speed dialing, music on hold, and data storage for telephone numbers.

Cellular phones have had a significant impact on telephone networks. Today most dentists and staff have mobile phones and these have become vital in situations where there are satellite offices.

TELEPHONE USE ACROSS THE COUNTRY

It is important to maintain a network with other dental professionals and entities. The ability to contact fellow dentists, research facilities, dental suppliers, and cosmetic dental laboratories across the country is very important in today’s dental marketplace.

The United States is divided into time zones. Time zones are regions divided vertically by longitude all around the globe. The divisions are not necessarily straight and some states in the United States are divided. The states of Alaska, Florida, Idaho, Indiana, Kansas, Kentucky, Michigan, Nebraska, North Dakota, Oregon, South Dakota, Tennessee, and Texas are split between two different time zones (Figure 1).

All time zones are set from the time in Greenwich, England, which never observes daylight savings time (DST). DST is observed in many areas of the country to take advantage of more daylight hours during the spring and summer months.

The states of Arizona (with the exception of the Navajo Nation) and Hawaii, and the territories of Puerto Rico, Virgin Islands, Guam, and American Samoa are the only places in the United States that do not observe DST but instead stay on “standard time” all year long. The reason these areas do not observe DST is due to the fact that their residents believe their hot and sunny climates do not necessitate more sunlight each day.

Time zones are abbreviated with the following letters:

EDT—Eastern Daylight Time

CDT—Central Daylight Time

MDT—Mountain Daylight Time

PDT—Pacific Daylight Time

AKDST—Alaska Daylight Time

HST—Hawaii Standard Time

There are free, downloadable applications that tell the current time anywhere in the world. One example can be found at: http://www.online-reference-tools.com/app/worldclock?camp_id=4824&gclid=CNX6zsDSj7ECFcHRKgod4Vwc1w.

CHOOSING A TELECOMMUNICATON PLAN

Cost is generally the primary factor in selecting a telephone plan for the dental practice. Flexibility is also important, as it will be necessary to expand or update the telephone system as the practice grows. To include a multitude of phones in this course would not be appropriate because there are constant changes. However, the dental team should be certain that the system purchased is from a reliable source that will provide support when required.

The telephone market is cost-competitive, but costs can vary considerably. Before selecting a system, examine the specifications carefully to determine the cost of the standard features and the cost of each of the optional features. Also, be sure to consider the cost of operating and maintaining the system. A reliable system often saves money in future maintenance. In some areas suppliers provide maintenance contracts.

TELEPHONE FEATURES

Conference calls are often required in a dental office when the dentist or other staff member needs to speak to several people in various locations simultaneously. This type of call is arranged through a conference call operator, or via a call center, when given the names and telephone numbers of the persons to be included in the conference call. The participants are called at the assigned time and all of the callers when connected can hear and participate in the call from their own location.

A hands-free telephone allows the administrative assistant to work on the computer, access records, or perform some other task while talking on the telephone. This time-saving device is becoming very popular in clinics and private dental offices. The concept of a hands-free system can be carried into other methods of communication (eg, pagers and walkie-talkie types of systems), allowing staff members to obtain messages from other areas of the office without using a keyboard or dialing system.

Call holding is frequently used in a dental office. This enables the first caller to be placed on hold while the assistant answers the next call. This is especially helpful when several calls are received in rapid succession. Care should be taken to extend courtesy to each of the persons placed on hold.

Speed dialing is a convenient method of dialing other offices or business contacts that are frequently called. Commonly called numbers can be stored in the telephone memory and assigned a one- or two-digit code. Using short codes saves time when later dialing this source.

Music on hold is a system that provides the caller with music or a narrative about the practice while the caller waits. This system can be personalized for the office and offers a variety of options for the user.

Caller ID is a caller identification function that displays the phone number of the incoming call on a screen location on the handset, phone base, or even a computer screen. This feature may also include the name of the account holder if they are listed in a phone directory, address list, or caller contact list.

Cordless telephone is a feature that provides an extended mobility range in the office. This range allows staff members to leave the base station and perform other tasks while on hold.

ANSWERING SYSTEMS

Voicemail messaging is the system whereby a message is left on the phone when no one is available to answer the phone. This can be done during busy times in the office or after hours. A legal obligation exists to inform patients how they can make contact in case of emergency when the office is closed. The telephone number for the dentist or substitute dentist must be provided to the patient in cases of emergency.

It is important to establish office policies with the patient. The office must convey telephone policies concerning appointment cancellations. If the office will not accept these cancellations by message, it must be clear in the message that the caller must call during business hours to cancel and reschedule an appointment.

If the office utilizes an answering machine during busy daytime hours, the messages must be checked frequently. Patients must have calls returned to them quickly to provide quality of services and the proper standard of care.

In many cases, voicemail boxes are used to direct messages to the dentist and other members of the dental team. The dental team is responsible for checking their mail boxes often to obtain messages and transmit the patient’s needs accordingly.

If a voicemail system is utilized, it is wise to follow a few basic courtesies:

• Be sure to turn on the answering machine before leaving the office.
• In the outgoing message, indicate that the caller has reached an answering system.
• Give the name of the dental practice to ensure that the caller has reached the correct office.
• Give clear information about daily office hours.
• Give the telephone numbers for contacting the dentist or the emergency dental practice.
• Ensure that the answering message includes specific information about emergency contacts.
• Make sure the caller has adequate time to record a message.
• Arrange to have messages checked periodically by the dentist or a staff member if all team members plan to be out of the office over a period of time.
• Upon returning to the office, check the calls on the voicemail or recorder as soon as possible.
• Take care of any necessary follow-up to the recorded calls. Most systems allow the user to access the answering machine or voicemail box to receive messages even when off site.
• Update the outgoing messages regularly.
• Do not leave unprofessional messages that are distracting to the caller.

Adapted from Finkbeiner and Finkbeiner. Practice Management for the Dental Team, 7th ed. 2010, Mosby Elsevier.

In some offices, such as an oral surgery practice, an answering service is used with an operator who answers the calls after office hours, weekends, and scheduled days off. The operator then informs the patient where the dentist may be reached for emergencies or takes the information from the caller and notifies the dentist.

Follow the policies of the local professional organizations. In some instances, such as an emergency dental clinic, a message may instruct the caller to hang up and call “911” if a person’s life is in danger.

TIPS FOR EFFECTIVE TELEPHONE MANAGEMENT

The following lists represent the DOs and DON’Ts of effective telecommunications in the dental office.

DO the following:

1. Answer a call promptly. If the person does not identify him or herself, ask the caller, “To whom am I speaking?”

2. The person answering should identify him or herself to the caller and use the caller’s name throughout the conversation.

3. Practice good listening skills and avoid interrupting the caller while he or she is speaking.

4. Speak clearly and maintain a smile. Callers are known to “hear” a smile in a telephone voice.

5. Always use a friendly congenial tone when speaking.

6. Commit to returning calls in a timely manner.

7. If the caller speaks in a language that is not understood, ask for someone who can interpret the information.

8. Learn how to manage multiple callers at the same time with ease and courtesy.

9. Always make collection calls in private, and away from public areas.

10. When concluding a telephone conversation, make certain the caller or person called hangs up first.

11. Keep notepaper readily available for taking notes during the telephone conversation.

12. If making a long distance call outside the office’s time zone, be certain to check that the person being called is likely to be available.

DON’T do the following:

1. Do not argue with a caller in a public area of the office. If a dispute arises, ask the caller to hold so the conversation can be resumed in a private area of the office, or suggest the caller come to the office for proper clarification and resolution in person.

2. Don’t say “This is Dr. Bronner’s office calling.” People call, not offices. So a better example would be, “This is Stephanie from Dr. Bronner’s office calling.”

3. Avoid using slang terms when addressing a caller.

4. Avoid referring to the caller as “hon, sweetie, or dear” or any other personal pronoun; use the caller’s name.

5. Avoid eating or chewing gum while speaking on the telephone.

6. Avoid keeping a caller on hold too long. Ask the caller if they can be placed on hold before doing so, or ask if a call can be returned if expected to be for a long time. If they prefer to have a call returned, obtain the best phone number to make the return call.

7. Avoid making and receiving personal calls in the office.

8. Avoid giving an impression that the call is an interruption during a busy time. If extremely busy, ask the caller if the call may be returned so undivided attention can be given to the caller and their situation.

9. Do not leave a specific message with someone else or on voicemail. To avoid a Health Insurance Portability and Accountability Act (HIPAA) violation, the patient must sign a permission form upon their registration that permits messages to a person or an answering machine.

10. Do not call a patient before 8:00 am or after 9:00 pm.

11. Do not make threats to a patient regarding delinquent accounts or for any other reason.

When answering the telephone there are phrases that should be avoided during the conversation to eliminate a poor image or misunderstanding on the part of the listener. Figure 2 provides a list of words or phrases that are appropriate to avoid and suggestions for a replacement word.

When conversing with a patient it is often necessary to spell out terms or names for them. This may happen when referring the patient to another physician or dentist whose name is difficult to pronounce, or when certain letters or words sound similar and could be confused. Therefore, a list can be kept of the letters with identifying words that will enable the person to understand how to spell. Figure 3 provides some words that will help to identify letters.

OTHER FORMS OF TELECOMMUNICATIONS SYSTEMS

Within the dental office, communications can be improved from one area of the office or clinic to another through the use of pagers or an intercom. It is possible to incorporate this into the telephone system or purchase separate systems for each of these functions. It is wise to select a system that will allow for people to be contacted quickly. It is also prudent to select a system that can be answered without touching the phone if it is to be used in a clinical area. However, when using an intercom system, HIPAA privacy and security rules must be followed to protect all patient protected health information (PHI).

CELLULAR PHONE

A cellular phone (cell phone) is a mobile telecommunication device used by a large portion of the population today. According to Mike Snider in USA Today, more than one in four US homes (26.6%) had only a wireless phone as of June 2010 and showed no signs of decreasing. Low-income families, renters, and young adults are more likely to have a cell phone versus a home landline.

An office-dedicated cell phone is especially helpful when a dentist or staff member needs to maintain contact with a central location while driving from one place to another. Many dentists with satellite offices provide a cell phone for all staff members who are engaged in working at one or more satellite sites.

Dentists may also use a dedicated, professional-use only, office cell phone exclusively for on-call or emergency calls from patients on an after-hour basis.

Depending on the practice management software and the downloaded phone applications, the dentist can securely access patient records and medical alerts without violating HIPAA regulations.

Rules for office cell phone usage include the following suggestions:

• Record a courteous and brief introductory message, similar to that of the office message.

• Speak at a normal volume. For some reason, people feel the need to raise their voices while on their cell phone. In reality, the phone’s microphone has adequate amplification to carry a voice.

• Do not interrupt a face-to-face conversation to take a phone call.

• Use a 10-foot rule as the appropriate distance to talk on the cell phone when others are present. When answering urgent calls, move away from others and maintain a 10-foot distance.

• Set the phone on vibrate when in other offices or meetings.

• HIPAA regulations must be observed. Do not speak about patient matters in public.

Additional rules concerning professional use of the office cell phone:

• Avoid inappropriate conversations in public.

• Do not use the phone for personal reasons. An office phone should not be used for private matters.

• Avoid novelty ring tones. Some tones can be very annoying to others in public.

• If allowed by state law, use a hands-free telephone in the car.

As with a telecommunication plan, cellular phones have many features. Certain features such as the ability to receive text messages, voicemail messages, and electronic mail are very popular. With patient consent, dental professionals can use these communication features while still observing HIPAA regulations.

Because so many people of all ages have these cell phone features, dental offices use them to set and confirm dental appointments, make follow-up calls, and even offer general information messages about insurance-related information or nearby road construction that could delay a patient’s arrival.

Texted, short messages are meant to reach patients easily. Because they are limited to 160 characters, they must be brief and concise. Short Message Service (SMS) subscription services have been established to help dental offices begin this new process. These service companies state that automated messages are more effective and cost less than the traditional phone call process, which involves busy phone lines and manpower to complete. A tracking report can be received to show all successful and failed messages that were sent and delivered daily.

Automated voice messages can also be used to communicate appointment information to patients. Voice messages can be sent to confirm appointment date, time, and office location. These voice messages can be set to run at specific times of the day and at the preferred time of the patient.

While electronic mail (e-mail) is not necessarily a form of “tele”-communication, some cellular phones have applications that allow users to receive e-mails on their phone. Should the patient prefer this, the office can draft and send an e-mail pertaining to many types of messages.

Additional information regarding the use of extended cell phone applications:

• Permission to contact the patient via their cell phone must be received.

• The office should make a note of the preferred method(s) of contact to the patient and follow it.

• Just as patient addresses change, so will their cell phone number and plan. Be prepared to make changes to maintain effective patient communication.

• As prohibited by law in many states, NEVER text while driving.

• Do not use the texting option while talking on the phone to another person.

FACSIMILE (FAX)

The facsimile (fax) machine is a scanning device that transmits an image of a document over standard telephone lines. The machine actually operates like a photocopy machine that sends an image by wire. At the receiving end, a similar machine accepts the call and creates a print of the document. The original message may be handwritten or sent directly from the computer as a keyed document. The cost is the same as a telephone call. A cover sheet accompanies the document with directions as to who is recipient and from whom the message is sent as well as the number of pages being sent.

While many offices still utilize this technology, other offices have purchased scanners that operate with the office’s computer system. Once a document is scanned, it can be transmitted via computer to other dental offices, dental laboratories, and specialized dental practices.

Care must be maintained to ensure that a message appears at the bottom of the cover sheet to maintain confidentiality. An example of a confidentiality statement could read as follows:

“The information contained in this facsimile transmission is privileged and confidential and is intended only for the use of the recipient listed above. If you are neither the intended recipient or the employee or agent of the intended recipient responsible for the delivery of this information, you are hereby notified that the disclosure, copying, or use for distribution of this information is strictly forbidden. If you have received this transmission in error, please notify the sender listed above immediately by telephone to arrange for the return of the transmitted documents or to verify their destruction.”

MAINTAINING CONFIDENTIALITY

There are times when private matters must be discussed with a patient, such as the results from tests that were performed or financial matters about their account. Be certain before beginning any such conversations that the location is away from others and privacy can be maintained. This may mean moving to another physical site such as a private office.

In addition, it is important that when leaving messages on the person’s telephone that these are not an offering of confidential information, even an appointment confirmation. Only leave messages with another person who is named or on the answering machine, if permission is obtained on the patient’s registration form. Not all forms are designed with such a question, so be certain that permission is granted somewhere on the initial patient registration form.

SUMMARY

Communication is very important in today’s dentistry. The telephone system maintains a connection between the dental team and their patients, dental suppliers, and their local and national dental community. Many telephone features including caller ID, a hold feature, and a hands-free option exist that can aid the dental team in providing productive, quality communication. As impressions about the dental office can be formed by telephone technique, it is important to be professional at all times. Proper grammar and appropriate dental terminology will convey the proper image to a patient, dental laboratory, or dental supply company. It is very important to preserve all private healthcare information to maintain confidentiality.

REFERENCES

1. AT&T Phone Information. http://www.att.com/esupport/article.jsp?sid=52254&cv=820#fbid=faWCrOrEcLP. Accessed on June 27, 2012.

2. Daylight Saving Time. Infoplease.com. http://www.infoplease.com/spot/daylight1.html/#ixzz22zkgLkkA. Accessed on August 7, 2012.

3. Finkbeiner and Finkbeiner. Practice Management for the Dental Team. 7th ed. 2010; Mosby Elsevier.

4. Jablow M. Smart phone, smart practice. Dentistry IQ. http://www.dentaleconomics.com/articles/print/volume-94/issue-9/features/smart-phone-smart-practice.html. Accessed August 8, 2012.

5. Snider M. More people ditching home phone for mobile. USA Today. April 21, 2011. http://www.usatoday.com/tech/news/2011-04-20-cellphone-study.htm. Accessed August 8, 2012.

6. World Atlas. Time Zones. http://www.worldatlas.com/webimage/countrys/namerica/usstates/timezonelarge.htm. Accessed June 27, 2012

ABOUT THE AUTHORS

Betty Ladley Finkbeiner, CDA-Emeritus, BS, MS, is a Faculty Emeritus at Washtenaw Community College in Ann Arbor, Michigan, where she served as chairperson of the dental assisting program for over three decades. Betty began her career as an on-the-job trained dental assistant for the late Joseph S. Ellis, DDS, in Grand Rapids, Michigan, and later became a CDA and an RDA in the state of Michigan. She received bachelors and masters degrees from the School of Education at the University of Michigan. She has served as a consultant and staff representative for the American Dental Association’s (ADA) Commission on Dental Accreditation and as a consultant to the Dental Assisting National Board. She was appointed to the Michigan Board of Dentistry from 1999–2004.

Ms. Finkbeiner has authored articles in professional journals, authored several continuing education classes, and co-authored several textbooks including: Practice Management for the Dental Team; Comprehensive Dental Assisting: A Clinical Approach; Review of Comprehensive Dental Assisting; and a handbook entitled, Four-handed Dentistry: A Handbook of Clinical Application and Ergonomic Concepts. She has co-authored videotape productions including Medical Emergencies for the Dental Team; Four-handed Dentistry, An Ergonomic Concept; and Infection Control for the Dental Team, and lectured to University of Michigan dental school classes and many dental meetings. Currently retired, she continues to write, lecture, and provide consultant services in ergonomic concepts to practicing dentists throughout the country.

Wilhemina Leeuw, MS, CDA, is a clinical assistant professor of dental education at Indiana University Purdue University, Fort Wayne. A DANB Certified Dental Assistant since 1985, she worked in private practice for over 12 years before beginning her teaching career in the dental assisting program at IPFW. She is very active in her local and Indiana state dental assisting organizations. Professor Leeuw’s educational background includes dental assisting in both clinical and office management. She has received her master’s of science degree in organizational leadership and supervision and is also the continuing education coordinator for the American Dental Assistants Association.