FIELD NOTE 004

Question: Does every patient leave knowing the next step on their Path to Health?

Health Path: Patient + Team

Status: A simple discipline we are actively trying to strengthen

From the field

Dental appointments can be pretty harrowing.

There may be local anesthesia, injections, drilling, water spraying, suction, unfamiliar sounds, and—perhaps most challenging of all—dental dad jokes.

I have always tried to maintain a connected dialogue with patients and provide as much comfort as possible. But even when we do everything we can, a dental appointment can still be a lot to go through.

For years, I routinely ended appointments with the same line.

I would put down the drill, bring the chair upright, and say:

“That’s all the fun for today.”

It usually earned a smile, or at least the polite acknowledgment patients give dentists when they are relieved the appointment is over.

I meant it as a lighthearted way to close the experience.

Unfortunately, it also sent a message:

We are finished. You can go now.

The patient was ready to leave. The team could sense that readiness and did not want to slow them down. If another appointment was needed, everyone assumed someone else would explain or schedule it.

Sometimes that happened.

Sometimes the patient left without scheduling the next step.

What is worse is that I—the person who was supposed to be leading the patient toward health—often had not clearly stated what that next step was.

I had completed the procedure.

I had not always completed the transition.

The Health Progress question

Traditional dentistry tends to organize appointments around procedures.

The filling is finished. The crown is seated. The tooth is extracted. The cleaning is completed.

From the practice’s perspective, the appointment is done.

But the end of a procedure is not necessarily the end of the patient’s need.

Active disease may remain. The patient may need another part of a multi-step treatment plan. The emergency may be resolved, but the patient may still need a comprehensive evaluation. Immediate disease may be controlled, but function and long-term health may still need to be rebuilt.

When we focus only on the procedure completed today, we can unintentionally leave the patient without a clear understanding of tomorrow.

That is where progress often stops.

The patient may have heard several clinical explanations during the appointment. They may be tired, numb, uncomfortable, or relieved that the difficult part is over. They may remember that we told them something else was needed, but not understand its urgency or how it connects to their larger health goal.

Then we bring the chair up and say, “That’s all the fun for today.”

The team receives the same signal as the patient: the encounter is over.

No one clearly reconnects the patient to the larger journey.

The last minute matters

Now that I am more focused on Health Progress, I have begun to notice how much the final minute of an appointment matters.

That last minute should answer three questions:

1. Where are we now?

2. Where are we going?

3. What happens next?

A simple closing conversation might sound like this:

“We made good progress today by completing this part of your care. We still have active disease on the other side that can continue to grow if we leave it untreated. Our goal is to get all of that disease under control. The next step is to schedule the upper right side. Is that next step clear to you?”

The exact words will change based on the patient and the situation.

The structure should not.

First, acknowledge the progress made today.

Second, remind the patient what remains and why it matters.

Third, reconnect that next step to the patient’s larger health goal.

Finally, confirm that the patient understands.

That conversation does not need to be frightening, dramatic, or long. It also does not require pressure.

The patient may still decide not to schedule. They may need time, financial information, or another conversation. Patient progress always includes informed choice.

But even “not yet” should be clear.

If the patient is not ready, we should understand the concern, document it, and agree on what should happen next. Ambiguity is not the same as autonomy.

What we’re trying—and learning

We are working toward a simple operating discipline:

No appointment is complete until the next appropriate step is clear.

That next step may be:

• Returning to complete active treatment.

• Scheduling a comprehensive examination after an emergency visit.

• Reassessing healing or disease control.

• Meeting to better understand a larger treatment plan.

• Exploring financial options.

• Scheduling appropriate maintenance or prevention.

• Completing a referral.

• Pausing care while establishing a specific time to reconnect.

• Returning for routine recare because the patient is healthy and stable.

Sometimes the next step is simply to continue protecting the health the patient has already built.

The dentist does not need to manage every part of scheduling or finance. But the dentist should clearly establish the clinical direction.

The team should not have to guess what the doctor intended. The patient should not have to reconstruct the plan from a printed estimate. The next team member should be able to continue the same conversation without starting over.

That requires three things:

Say it. Clearly state the next appropriate step to the patient.

Confirm it. Ask the patient whether the next step makes sense and address remaining questions or concerns.

Document it. Record the next step so the team can schedule it, support it, and follow up consistently.

We are still working to make this reliable.

Time pressure gets in the way. The team may already be behind. The doctor may be thinking about the next patient. The current patient may be halfway out of the chair.

But those are exactly the moments when a repeatable closing discipline matters most.

A few seconds of clarity can prevent weeks, months, or years of stalled care.

One question can change the handoff

I still like humor, and I will probably continue making questionable dental dad jokes.

I may even occasionally say, “That’s all the fun for today.”

But it cannot be the final message.

The more important closing question is:

“Is the next step clear to you?”

We can make that question even stronger by asking the patient to explain the plan in their own words:

“Before we finish, tell me what you understand the next step to be.”

That is not a test of the patient.

It is a test of our communication.

If the patient cannot clearly describe what comes next, we should not assume we communicated it successfully.

The final minute of the appointment is where today’s transaction either ends—or becomes part of continued progress toward health.

Try this in your practice

For one week, ask the treating provider to close every appointment with four statements:

• Today, we accomplished…

• What remains is…

• The next appropriate step is…

• Is that next step clear to you?

Then make sure the next step is documented and handed off to the team.

At the end of the week, review 20 appointments:

• Was a next step documented?

• Did the patient schedule it?

• If not, was the reason clear?

• Does someone own the follow-up?

You may discover that patients are not rejecting treatment.

They may simply be leaving without enough clarity to continue.

Compare notes

How does the clinical conversation end in your practice?

And what question helps you know that the patient truly understands what should happen next?

—Josh