I’m thinking of doing longer examinations, but what do I talk about?


Following my last article on the benefits of extending consultation and re-examination times, several Update readers contacted me saying, “Yes, I like the idea, but what do I do with the extra time?”

Well, the first thing to say is that not all re-examination patients need a longer appointment. You will (hopefully) have a group of patients who are dentally well with either no perio disease or a stable perio condition that is being maintained by your hygiene team. You will have dealt with their restorative needs by supplying long term restorations which your patients are looking after. These type of patients need a regular 15 minute re-examination appointment.

The group of patients who need longer are the patients who are either new patients or patients who, for whatever reason, are still needing active treatment and, therefore, each time you see them for a “check-up” you have to prepare them for (and sell them) the next phase of their treatment in order to achieve dental wellness.

These patients, together with your new patients, need what we call a co-discovery appointment.


A co-discovery appointment is a mixture of clinical prowess and theatre. The purpose of the appointment is to entertain the patient with the good and bad aspects of their mouth and, also, to gently educate them with knowledge (not preventative dentistry tips) about their anatomy and physiology which fascinates them.

Two thirds of this appointment is likely to be gloves off and at least half is concerned with agreeing a way forward with the patient. So this is not the usual “How are the kids?”—re-check medical history—“Any problems since last time?”—intra-oral examination—load treatment onto software—write up notes—tell patient what they need—nurse drops them back to front desk… (The patient may or may not book treatment with this routine, or may book treatment and cancel it later on…)

A co-discovery appointment divides the appointment time into something like: 20 per cent establishing rapport and gathering soft facts, 30 per cent examination, 50 per cent discussion of options and agreeing the treatment plan with the patient.

The appointment splits like this:

  1. Co-rapport building
  2. Co-discovery examination
  3. Co-treatment planning
  4. Co-fee development
  5. Co-acceptance
  6. Co-book the treatment appointment

The “co” prefix means that each stage is delivered by the patient and the dentist working together and in agreement as to the next stage.

Co-rapport building

The initial minutes of the appointment are best spent away from the dental chair, somewhere comfortable and somewhere easy to chat. We all have a version of the small talk required to move on to a more meaningful conversation and, once this is done, the objective is for the patient to divulge and for the dentist to assess the patient’s dental needs and wants and any issues that might hold them back from accepting treatment. The juiciest bit of knowledge a dentist can hope to ascertain from this conversation is what difference the treatment would make to the patient.

Co-discovery examination

This is the pivot around which the co-discovery appointment turns and, if done well, it virtually guarantees treatment uptake by the patient. During the co-discovery examination you, your nurse and the patient take part in a leisurely, exciting journey around the patient’s mouth and discover together all the healthy areas along with any pathology (still) present. This is the art of helping the patient discover what’s good and what’s not so good about their mouth and the dentist and the nurse, like the good actors they have to be, entertain and inform the patient using: explanation, mirrors, cameras, models and photographs.

Co-treatment planning

At the end of co-discovery, it’s time for the dentist to summarise in layman’s language what has been found in terms of pathology (don’t offer solutions yet). At this stage it’s important for the dentist to pause and wait for the patient to ask something along the lines of, “What’s next?” or, “What do I need to get sorted first?” or similar. This is known as a buying signal and is the green light for the dentist to develop the treatment plan, offering choices and, importantly, a recommendation of treatment together with the likely fees.

Co-fee development

This is the time to agree that the patient is comfortable with the treatment and, in particular, the fees. If not, look at what other options the patient might have to upgrade or downgrade the fees. It’s a good time to stress the value and the longevity of the proposed treatment together with the outcomes and benefits. The dentist and the patient work together to find the right solution at the right fee.


At this point the dentist and the patient agree that the proposed treatment is best for the patient and that, if compromises in treatment planning have been made, the patient understands the likely effect of these.

Co-book treatment appointment

The dentist and the patient go to reception together and the dentist explains to the receptionist what the next appointment is for, its duration, how soon it needs to be and the fees due today and on the next visit. Then they hand the patient over to the reception team to make the appointment(s).

So, there you have it. A co-discovery appointment. The results from many, many practices that have implemented this technique are:

  1. Larger treatment plans
  2. Higher levels of patient acceptance
  3. Fewer objections
  4. Fewer cancelled appointments
  5. Increased average daily gross fees

Pretty good, eh?

If you would like some help introducing co-discovery appointments to your practice, contact me for a chat:

e. simon.hocken@breathebusiness.co.uk

m. 07770 430576

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