Running a dental practice can be quite a stressful business.
It’s not just that patients don’t really want to be there and are fearful of what may happen to them, it’s also that the systems under which we work push us to work to strict time schedules. So that if a patient is delayed arriving there is an added dilemma; should we re-appoint them or is there enough time left for me to get the work done without disrupting the rest of the schedule.
Sometimes, the temptation is to turn the patient away and get them back another day but then we wouldn’t have wanted that to happen to us – especially if the delayed arrival was not our fault but due to circumstances outside our control. I can remember being rather late for an appointment with a consultant surgeon because there was an enormous traffic jam. I kept ringing the hospital to explain and apologise. When I arrived he saw me but was not too gracious about it even though I apologised to him personally. However, at all subsequent appointments he kept me waiting each time I attended. He did the same with all his other patients – so it wasn’t just revenge, and muttered a brief apology for his tardiness. We, the cannon fodder in the piece, were expected to accept the delay with good grace. He seemed to be exercising a sort of divine right of consultants.
But to return to the point: for us, as dental practitioners we require our patients to arrive on time and the whole financial process is predicated on the assumption that all will be right first time. If not,
we risk losing time and consequently, losing money. The other major factor is that, in general practice, we need our patients to attend or we do not have a business and so we need to satisfy their demands politely and in timely fashion. As a rule, this is not the case with most hospital based consultants, they are paid a salary, so they do not really care if we attend or not. Should we fail to attend we merely reduce the pressures on them.
That brings us to the business aspects of running a dental practice: we have to make a profit, or we will have no funding to pay all the expenses and will be unable to invest in new equipment, décor and furnishings. All these things are extremely important in the modern world where progress moves at considerable pace and we have to be seen to be abreast of the trends. The days when you could invest in a chair and a drill when you first set up and continue with the same equipment, possibly with the re-cover of the chair (though this was rare as they were leather covered so would withstand much more abuse than today’s chairs), for your whole career have really gone. Now we have to be seen to be up-to-date in every aspect of practice life. I recently visited a practice which aspires to be largely private where money has not been spent on the décor for a considerable period of time and it is looking rather tired and fairly dated.
None of us can afford to look left behind! This applies to the techniques we use which need to be up to date also and in this regards CPD has made great strides in keeping us aware of new methods. This is not only good for us but good for our patients who are the recipients of the latest thinking in treatment techniques. They have benefitted from the, once disparagingly regarded, obligation to attend courses for CPD purposes. Now guided CPD can be even more helpful in keeping us up to date with current thinking. In days of yore, it was not uncommon for a dentist to never attend a post graduate lecture in his working life; unless there was a social event attached. And, as recently as a couple of years ago, I had a dentist tell me that the use of a particular material was entirely justified because that was what had been taught some 15 years previously. If I had adhered to that philosophy, I would still be lining cavities with Zinc Phosphate cement. But things move on and keeping abreast of the current evidence based changes is essential.
In recent years the emergence of therapists who can do quite a lot of things that fully qualified dentists can do is starting to change the ways in which we work. If the dentist does the examination and the diagnosis, a part of the treatment which a therapist is not qualified to do, then much of the treatment can be carried out by a therapist.
Obviously, the services of a lesser qualified therapist will be less costly than those of a fully qualified dental practitioner and this will be even more so with an orthodontist.
This then, opens doors for the innovative deployment of therapists to carry out the majority of less complex work and reserving the more complicated cases for the orthodontist / dentist to undertake. This will also apply to a slightly lesser effect in routine general practice. Some of the problems which I have encountered are basically due to the dentist not building a comprehensive treatment plan but just pointing the patient in the direction of a therapist without clear, decisive instruction. This can easily lead to the patient having lots of his time wasted as he shuffles back and forth between the two to resolve some of the treatment problems. It also wastes lots of the therapist’s time which reduces any financial advantages their deployment should bring.
A proper treatment plan would have prevented this.
The fly in the ointment is that all diagnoses and treatment planning must be made by a fully qualified dental practitioner.
What a Shame! Or we could have operated the practice from a beach in Spain.
The other aspect which must be considered is that the work of the therapists must be under prescription from the dentist / orthodontist and should really be checked to ensure that there is no misinterpretation. I think it would be very difficult to defend if anything went wrong due to lack of supervision.
So, the call of the beach full time must remain a pipe dream for the present. But, there is no reason why the judicious use of therapists cannot reduce the need for the Orthodontist / Dentist to be present in the practice or, should this be your desire, to enable you to run multiple practices using innovative techniques which enable you to keep a close handle on what treatment is being undertaken by your therapists and even be available remotely for consultation. Using the image techniques which have been developed by Oralign it is quite possible for the supervising dentist/ orthodontist to log into the system and review the case progress, offer advice or even arrange to intervene if that is felt necessary.
This is where some innovation can help.
Oralign has developed a system which can enable the dental practitioner / orthodontist to review the work of the therapist using intraoral images which can be transmitted on a closed, secure web platform and securely stored so that a complete case record can be maintained and recalled almost instantaneously. Because these records are encrypted and date stamped they cannot be manipulated to our disadvantage without this becoming evident. Once the data has been transmitted to the server it is no longer held on the surgery computer. Effectively, this make the records acceptable for evidence should that necessity occur. Any other information, queries or instructions transmitted via the platform are also similarly recorded, encrypted and date stamped which gives a comprehensive record of the case. The other aspect which makes them particularly suitable for orthodontic cases is that all the images are sequentially ‘galleried’. This means that you can look at any single view, several are normally used in orthodontic cases, these can be followed to review the progress as treatment moves on. It also means that if there is some unplanned deviation from the desired pathway it can be seen early and can be corrected whilst this is still a minor discrepancy and before it has the opportunity to develop into a much more difficult problem to correct.
The key to success
As every Government department knows, data protection is paramount. Sadly, often honoured more in the breach than in the substance. This is also the case with our patient data and whilst we, as dentists, rarely have data of great significance sometimes we might have. I recall attending a complaint by a patient that the practice he attended had been careless with his medical information. He had honestly confessed that he was HIV positive (at that time it was rare indeed for it to be admitted) but the Practice had written on the front of his record card in large red letters ‘HIV +’ which any other patient at reception could easily see. Not unnaturally, he was quite upset about this.
It is extremely important that patient data is fully protected and to this end we, at Oralign, have taken advice and a lot of trouble to ensure that our system meets the requirements of the new legislation which will be introduced in 2018. This is already operative in both USA and Canada and breach of these rules leads to a severely punitive fine. This becomes an area which is not to be ignored or taken lightly.
New ways of working are emerging all the time but, if we are willing to embrace some of the new technology (I know, another learning curve!) we can improve the efficiency and the profitability of our practices whilst at the same time improving our work/life balance – if we wish — or by expanding what we can accomplish and the number of patients we can deal with either on 1 site or multiple sites.
Food for thought.
Lester Ellman Jan 2018.
Please Note Oralign has moved to:
ITAC 13, Daresbury Sci-Tech, Keckwick Lane, Daresbury, Cheshire, WA4 4AD