Archive for May 2012 »

Amazing story about Lucy and how she influenced development of teeth

Lucy, officially named as Australopithecus afarensis is the name of pre-human or creature that lived 3.2 mil. years ago. It was founded in Ethiopia in Hadar region in 1974.

You can find very interesting data about her, but there is something that especially attracted my attention. Well, today we know that Lucy was oldest known human or pre-human individual that walked erect. What initiated that transition? Contemporary scientists think that there was a problem to find food in trees. Perhaps it was a good reason to think about descending to the ground. The ground was very dangerous because it was covered with high grass (savanna) and was populated with predators. Lucy was only 1.1m (3ft 7in) tall and the grass was definitively taller than she was. That initiated the idea to stand erect to be able to see above that grass. Other reason was the fact that you spend less energy if you walk on two legs rather than on all four.

But how that influenced teeth development? It was not easy to stand upright because without any adaptation erected creature would look straight to the sky. To overcome that head should be flexed to the front and that was not so simple because in that case there would not be enough space for soft tissues which would in the and cut the airway. The evolution resolved that issue by descending the larynx. That opened much space in the posterior and enabled normal breathing and influenced development of speech.

That new space in the rear enabled also a great change in swallowing. Before that, every swallow included protrusion of the tongue between anterior teeth. That is the reason many animals have small incisors and/or open bite. With that additional space the tongue was able to go to the back and in the act of swallowing its tip was touching hard palate. The outcome was greater teeth in the anterior and closed bite for the first time.

Why the nature produced upper position of the larynx at all? Because it could be a dangerous and even deadly accident if food goes to the airway. That upper position of the larynx facilitated separation of digestive and respiratory systems. When erect body changed that separation wasn’t so effective like before and because of that we cannot drink water and breathe in the same time. In humans, that ancient type of swallowing is normally founded in babies, but before the end of the first year of life in normal development it changes to adult type of swallowing. If that does not occur, it is very likely that we will have open bite in the anterior.

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Giving information or advertising?

Many people do not understand the difference between informing and advertising. Even some regulators are trying to mix things up because then they can play as arbiters guided with rules that are not clear.

Giving information is “emission of related data about requested subject”. That means that if you want to change your cable provider and go or call one of companies that should be considered as informing and not advertising. But, if you get information about some product or service without your initiative, that is advertisement.

In the Internet, having a website is considered generally as informing because people have to enter correct address or to search for your firm. But what happens if you search for a word “water” to find information about chemical properties or pollution and you get water prices and pages that offers you to buy their bottled product? Now you can see that it can be legally complicated.

To solve that issue guide yourself with a simple rule that if your website is indexed by third-party search provider without payment for “special position in the index”, then you do not advertise, but inform.

It is good to be available for information about your products or just about things that you do. The best advertisement would be one that is seen when the customer needs it, but that is not possible. Because of that avoid spamming people with your offers and instead attract them to follow you. That creates much better satisfied customers that are interested and well informed about you.

You should never forget that satisfied customer is the best advertisement you could get!

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How do you know when to start using outsourcing? Where is the line?

I have been with my students in one dental laboratory today. Dental laboratories are some sort of outsourcing in dentistry which is: “the process of contracting an existing business function or process of an organization to an independent organization, and ceasing to perform that function or process internally, instead purchasing it as a service” (used from Wikipedia).

We have many students that are dental technicians, so they know procedures and how to “make something” in dental laboratories, too. Because of financial crisis it is very hard to start dental business in these days, so they asked me how to know where to draw the line between doing something by yourself in dental practice and sending it to a dental technician’s office. That is the same question in every outsourcing, in every business.

To facilitate thinking, you have some parameters regardless of business type.

First one are legal issues. There are some jobs that you can and others that you cannot do. For example: if you have need for biochemical laboratory you cannot do blood sample analyses because you’re not certified and that procedures are protected by the law. This is not the case in dentistry. Dentists can do nearly everything in dentistry in mostly all countries around the world.

After you have passed legal restraints you have to carefully choose procedures that are well candidates for outsourcing on economical basis. How? You have to calculate a ratio between costs and earning. Many entrepreneurs forget to calculate all costs and that tricks them to bring wrong decisions. It is easy to understand that you have to include costs like material, needed equipment and complicated education, but it is easy to forget to include production time. That last is important that distinct a dentist from dental technician. Dentists have much higher salaries on hour basis than dental technicians.

I have good contacts with my recent students that have finished dental medicine and are working for some time now. When they have problems, their problems are closely linked to the idea that “you have to use outsourcing as much as you can”. That is correct only if you have a lot of patients so in effort of saving time you can select “expensive” procedures for outsourcing. Under “expensive” I mean that if something is complicated, takes a lot of time, needs expensive equipment and cannot reach a high price it is a good candidate for outsourcing.

What do they choose for outsourcing? Great example are orthodontic retainers or plaster casts. In the beginning I teach them to do everything they can do because in first months they will have a small number of patients so it is not good to outsource something what is not needed. They can make plastic orthodontic retainers in dental office. The same thing are plaster casts made for analyses. The cost of plastic orthodontic retainers is around 100$ (for dentist) and they take 45 minutes of production per pair. The same procedure is for teeth whitening trays. If a young dentist has two patients in a day he cannot be feasible with doing of whitening with dental technician. Especially if he want to lower price to attract patients. Do not forget that one important factor is that young dentist has a lot of time to do anything so in the pause he can make simple not demanding procedures that technicians do.

Why this is all important? Because when you are a dentist or you are managing any other business you have to understand that you have the same goals: lowering the costs and production times in the same time with raising the quality. That will present you as a good and desirable service provider and in the end that will increase your earnings.

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How to start a first interview with a patient?

Students and many colleagues often make mistakes in first contact with a patient. You have to know that every patient has some positive or negative experiences with doctors. Because of that I have learned from the best ones that you have to smile and to have dosed humor in every contact. That fights their anxiety and in the end that prepares a patient for normal conversation. We do not want patient that approves everything that we say and few hours later asks himself/herself why haven’t he/she asked this or that or why have he/she approved something.

In the first sentence after: “Hello, my name is Dr. Strujic” and talks about how they traveled, etc. I ask them what is the reason they came today. Well, the main error is to “spoil” their complaints with our observation. Of course, our experience can lead us to find their problems accurately in the first minute, but why not to use that moment and before talking to just ask them that? In the most cases they do not surprise me, but there are some patients that have done that. There were situations with great problems and patient say that he/she has problems with something much less noticeable from my perspective. That’s why orthodontists do not like open bite: it is hard to treat ti, it takes much time, it needs their attention, but the biggest problem is that for many patients it isn’t “a big deal”. In that case they came because they have one rotated lateral incisor.

In the general, main complaints we are receiving from patients are linked with esthetics. I learned from my mentor and from my experience that those patients that have complaints correlated with esthetics are the best ones because they will be well motivated. If anything we need that is patient motivation.

There are patients that came with sentences like: “My mother is unsatisfied with…” or “My general practitioner has seen my… and he wants to…” or the worst one: “I do not have problems with esthetics but with function”. The main reason that occurs is because they thing that esthetics is not enough reason for an intervention or really someone forced them to do something. In both cases our outcome will be limited because of their motivation. I do not say that function is not a good reason for doing something, but they do not understand it. In my experience nothing creates such motivation like esthetics and we are lucky because major part of problems are closely linked to problems with esthetics.

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How to develop usable software? Forget your ego!

Many people think that the main issue with software development is about how to make it. OK, that is hard, but can be learned. But what about users? In my experience many systems were developed to satisfy IT department perspective or to accommodate developers view and that can lead us to bad UI experience. Why? Because something logical for IT professional isn’t often logical for others.

As chief architect I have been examining diverse systems. Some of them were very user friendly (lay people user friendly) and some of them were not. When I tried to correlate that to the price there were many non-logical conclusions. Unfortunately, there are many systems that try to force users to accommodate their logic. Somewhere it goes OK, and somewhere they have great problems. That occurs specially in heath software that has to be created to help medical professionals by giving them good tool for producing medical data and to quickly retrieve it for making medical decisions and conclusions. If they have to loose time to find something in the software, we haven’t done a good job in development.

How to avoid such problems? My way is to spend more time with users. For example, I have been developing software for university admissions. After first version of software was in release I have been sitting in the reception desk and trying to do all jobs as a new one in the reception. I have entered data to the system as a user and talked whole day with others in the reception. What was the outcome? I wrote several full pages of seen non-logical procedures, bugs, and needed software extensions. Every day after working in admissions reception I was trying to change software to be ready for the next day. The result was very usable software, satisfied reception workers, satisfied management and dramatically lowered error in processing in the same time with time shortening. The same job that have been doing in few days, now is done in one-two hours.

You ask why don’t developers do that? Well they are engineers and they do not want to mix themselves with reception desk workers. I am orthodontist with PhD and certified professional developer, but when I do development the main goal is to make better product and to succeed in that mission I am ready to do whatever is needed. In development you have to forget your ego and to focus on making good and usable software. That is the reason why I have earned such great respect both from top management and the lowest wage workers. I assure you that that approach is a winning one.

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What is most influenced factor in doing business? Misunderstanding with IT!

Have you ever had problems in your business? I have many friends among medical and dental professionals, but also among business managers and other professionals. When you evaluate their business as a third-party you can easily find that the major part of their business is often limited with misunderstanding with IT. They growth speed is equal to growth of IT support efficiency.

Nearly all IT schools educate their students how to perform specific tasks, but they forget to tell them that they will not work with other IT professionals. It is most often scenario that they will work with other professionals, but a lot of them will not be IT professionals. That is the greatest error in education because we have to educate “working” professional and not professional that will not be able to integrate himself to prospective firm.

You have to understand that the same problem is in other education programs. In everyday lecturing in School of Dental Medicine I emphasize importance of creating a “user interface” in every dental professional. I learn them many subjects, but in every topic I try to help them gain experience that will allow them to function. They have to know how to do a triage of problems, to learn how to plan and how to use available time with patient and the most important to take good “problem history”. By talking with their client, in this case a patient, they have to know how to meet patient expectations and how to give an advice to the client what is needed and perhaps to correct their expectations.

Contemporary IT professional have to be able to do the same thing: to talk with colleagues and others in the company and to adjust his language to every person’s technical knowledge. For example: accountants and managers do not know what is better to do in networking IP v4 or v6, or is it better to use ASP.NET or Python or Visual Basic or Visual C#. If they know, it is OK, then you can advice them, but if not you have to make that decisions for themselves. The major task is better productivity and nothing else.

All noted is one of reasons that forced me to start programming. I have had the same problem with my IT professionals. They knew every topic and every piece of technology better than everyone possible can know. But they cannot employ that knowledge to help other systems. They expect someone to draw to them what to do and by using what technology, and that is not acceptable in doing modern business.

I remember one occasion when I have selected one Database Developer to start organizing one of last parts of our library that is organized only with book identification cards. And after three weeks I asked him what is the status of “our project” and he told me that he cannot do anything because Director of Library does not know “what data types to use in some data fields”. That example can demonstrate the chief problem. He had to invent a solution, to adjust all systems to accept that data and not to expect that from “lady chief of the library”.

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Customer relations program or how can you help your effectiveness

If you are serious businessman, you should already know what is Customer Relationship Management CRM. Customer Relationship Management is a way to keep our customers in thinking that they are special and that we are taking care about their problems.

What is the chief problem? When customer contacts us we have to make an impression that we have been thinking on his/her problems all the time and not only when they are present. That give us good reception and our customers are more satisfied with our performance.

The best implementation practices are to use it in everyday basis and to enter data in every contact with a customer, in every job done or request from customer and in the end whenever we think something about customer. It has to be used both by top management and reception desk. You do not need to use something too complicated. You do not even have to use computerized version, but you have to be aware that doing business without CRM can destroy your rating and finally leads us to a disaster. Customers do not like when they have to repeat things to us and that leaves an impression that we are bad and not-caring business. Perhaps you can think that it is only a first impression and that they will see your valuable product, but that’s not the case. Do not forget that customers don’t know much of our work, because if they do our services wouldn’t be needed.

I have received many questions about CRM. There are businesses that want to start using CRM and were asking me where to start. After few questions, I see that they have organized something. One client told me that he creates notes on every customer in his archive. Data including birthday, marriage status, attitude, potential relationship problems, etc. If that isn’t CRM, what is? He needed only to have that data properly organized and available to all firm personnel.

Finally, if you have customers, you have to have some level of CRM. It is best practice when a customer arrives and after hello you ask him/her: “How is your leg?”. Of course, that can happen only if you have done homework writing specific data after last session. Person will have a feeling that we care about him, and will transfer that positive attitude to all his friends. In my experience, that sort of relationship does not make you only better person, but it makes you money, and if it is not main objective doing a business, what is?

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