Dental Tribune Indian Edition

5Dental Tribune Indian Edition - July 2013 World News The filter principle: Is every patient a finals patient?Simon Hocken UK “Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you belie- ve is great work. And the only way to do great work is to love what you do. If you haven’t found it yet, keep loo- king. Don’t settle. As with all matters of the heart, you’ll know when you find it. And, like any great relationship, it just gets better and better as the years roll on. So keep looking until you find it. Don’t settle.” Steve Jobs, CEO of Apple Inc. in 2005 You remember finals, don’t you? Of course you do. Your examiners ca- refully selected a patient(s) for you to examine and diagnose and for whom to present a treatment plan. The finals patients were unlucky enough to have more than one dental problem and you were marked on finding all of them and your ability to determine a set of solutions for the patient. Afterwards, most of us headed off into practice, where a series of finals patients are paraded in front of us on a daily basis. Now these patients wil- lingly pay us to make our professio- nal judgements, offer our best solu- tions and suggest a fee for doing the dentistry. However, that’s not always what happens, is it? There’s something that happens in general dental practice (be it pu- blic like the National Health Servi- ce [NHS] here in the UK, mixed or private practice) that is rarely spoken about in dental magazines, online fo- rums or even at the bar at dental con- ferences. And it’s this: many dentists consult with, examine, diagnose, and treatment plan their patients, not in the way that they did for their finals patient, but by applying some sort of filter—a filter of which the patients are completely unaware. Such filters have several elements and in my 25 years of being a dentist, followed by ten years of coaching dentists, I think I’ve probably heard or seen them all, or at least their effects. The filter may have some or all of these components: 1. Will the patient like me if I tell him about all of this? 2. Will the patient come back if I tell him about all of this? 3. Will the patient think I am overpre- scribing? 4. (For returning patients) If I tell the patient about all of this now, will he wonder why on earth I haven’t mentioned it before? 5. Will the patient be willing to pay for all of this? 6. If I persuade the patient to have the big treatment plan, what happens if it goes wrong? 7. As long as I make a note on the re- cords, I am keeping myself within the legal rules. The enemy within here is fear, and not the patient’s but the clinician’s. And so the filter is applied and the pa- tient is offered the treatment plan that the clinician believes is absolutely ne- cessary or the one he feels the patient needs. Presumably, he leaves the rest until such treatment becomes (as he deems it) necessary or needed. An ad- ditional filter, of course, is the one that pushes the dentist towards offering treatments that are well paid or earn the most number of units of dental ac- tivity. Let me run this analogy past you. Imagine taking your three-year- old, £25,000 car in for a 30,000-mile service. During the course of this, the technician discovers that as well as the regular service items needed, your car also has two sets of worn brake pads. In addition, the front brake discs are warped, the rear dampers are leaking and two tyres are nearly at their worn- tread marks. As a customer, which of these pho- ne calls would you like the garage to make? 1. The call that lists the faults, your options and the costs for having everything put right? 2. The call that tells you about the faults they think you will want to hear? 3. The call that tells you about the faults that you will be able to see? 4. The call that tells you about the faults they think you will be willing to have fixed? 5. The call that tells you about the faults that will earn them the big- gest margin? And what will the garage do about the faults they don’t tell you about? Perhaps, put a ‘watch’ on their records and consider telling you at the next service? Duty of care I know that some of you will be wincing already at my comparison between a clinician and a mechanic but there’s more mileage in this ana- logy still to come. After paying for just the service, you drive off from the garage with the faults left un- reported. A child runs out in front of your car and you fail to stop in time because of the worn tyres/brake pads/ discs/dampers. In the investigation that follows, these things come to light and spark a witch-hunt. A good garage owner dare not risk this and the inevitable damage to the garage’s reputation. He takes his duty of care seriously and must tell you exactly what the garage has found wrong with your car. So what’s really going wrong when a patient leaves a dental surgery with half a treatment plan? In my opinion, this happens because we’ve lost the simple, straightforward, trusting relationship between patient and clinician that we had as a final-year student. Exter- nal circumstances, such as insurance companies, the economy, the practice finances and, probably most impor- tantly, our lack of confidence and self- esteem have filtered our behaviour so that we agree to compromise our professional skill set and integrity in order to be liked, keep the patient or stay within our comfort zone. So, how does that sound? Not so great from where I’m sitting and let’s not tell the national newspapers. When I left the NHS in 1992, I deci- ded to get rid of all the filters I had acquired, and simply show and tell my patients what I could do for them as if they were one of my family and money and time weren’t an issue. I’ve used exactly the same approach in my coaching practice. I was lucky enough to be mentored by some great coaches on the idea that you often do your best coaching just before you get fired (for telling it like it is). And that’s what I do for our clients. In my view, you have to decide what sort of dentist you want to be: either an anxious single-unit, one- tooth-at-a-time dentist, forever de- stined to gross a thousand pounds a day, whilst complaining that pa- tients don’t want your treatment; or a dentist who communicates clearly and straightforwardly with your pa- tients about what you can see in their mouths and the best way to fix it, the- reby giving them back their responsi- bility for their health and leaving the decision about whether to proceed with them.DT “We agree to compromise our professional skill set and integrity in order to be liked.” Simon Hocken is Di- rector of Coaching at Breathe Business, a business-coaching con- sultancy based in King- sbridge in the UK. He can be contacted at info@nowbrea- the.co.uk. Contact Info DTI BERLIN, Germany: Several mor- phometric studies have proven sexual dimorphisms in human teeth, for example that women’s teeth are smal- ler than men’s teeth. The German Society for Sex-Specific Oral and Maxillofacial Surgery recently repor- ted on a study that found no obvious differences between male and female teeth. Headed by Prof. Ralf J. Radlanski from the Centre for Oral and Ma- xillofacial Surgery at the Benjamin Franklin Campus of Charité Univer- sitätsmedizin Berlin, the researchers explored whether the sex of an indi- vidual could be identified if only the front teeth were considered. This was tested by having participants evaluate 50 images of the anterior oral region of men and women aged between seven and 75. The lip area was not shown. The participants included dentists, dental technicians, dental students and dental professionals, as well as 50 people who had no professional dental background. The results overall demonstrated that sex could be detected in only about 50 percent of the images. Al- though there are anthropological stu- dies that claim to prove measurable morphometric differences, the study proved that those are not even visible to experts’ eyes. While some tooth positions were correctly assigned by 70 percent of the participants, others were wron- gly assigned by the same number of participants. The assumption that women tend to have rounded teeth and men rather angular ones could not be confirmed by the study. Fur- thermore, contrary to what was ex- pected by many of the participants, shape, size, and colour of the cani- nes were not meaningful indicators of sex. “In everyday practice, it is relevant whether the restoration fits the pa- tient’s face but not whether the patient is male or female,” Radlanski said. “Recognisable typical male teeth or female teeth do not exist.” DT Teeth equally perceived by dentists General dentistry has undergone major changes during the last 20 years, not just in the way clinicians treat their patients, but particularly in the way patients request tre- atment and their increased expec- tations of outcomes. In particular, the practice of restoring patients’ compromised teeth has become less complex in some ways, yet more challenging in others. Tooth replacement is increasingly being performed through the use of re- storations supported by dental im- plants, and numerous elegant and predictable clinical approaches to this have been developed. The increase in the use of dental implants is also partly due to the developments in the design of the implants themselves and of the com- ponents available to complete the re- storation. All of these advances, however, would be of little use without well- defined decision-making criteria when considering treatment in the context of either damaged or missing teeth. Accurate diagnosis is essen- tial, and the clinicians involved must always have the aesthetic aspects of the treatment foremost in mind when dealing with sites located within the appearance zone. DT Prof. Urs Belser Switzerland Prof. Urs Belser is professor at the University of Geneva’s School of Dental Medicine. He can be contacted at urs.belser@medecine.unige.ch. Contact Info The way forward