Searching Excellence

If you are a professional, you have experienced the scenario when someone is doing your job instead of you. Here we are not talking about others with equal credentials but about those that do not have them. Good model to explain the issue is relation between general dentists and orthodontists/dental surgeons in which first party plays a role of outsourcer and last one is outsourcee.

Yesterday I attended a meeting of General Assembly of European Federation of Orthodontic Specialists Associations EFOSA. That body is top organization in Europe that represent orthodontic specialists. Among other topics, we have discussed about dealing with General Dentists that are practicing orthodontics. We have heard that in Czech Republic orthodontic therapy is protected by the law, but this is not the case in other countries. There are countries where insurance companies do not want to pay orthodontic therapy to others but orthodontists and also those (like UK) where insurance will pay wherever patient finds a therapist.

We are witnessing that in modern times we are deregulating many things. Perhaps we must not deregulate this issue, but to put it in the protected list you have to find a good reason. In USA, American Association of Orthodontists have done a survey where they wanted to show that the result of therapies done by general practitioners statistically differ from those done by orthodontists. The result showed difference, but without accepted significance. But that does not mean anything because in USA anyone that does orthodontic therapy is very careful because of the American legal system. Doctors that are not officially educated in residence programs are very careful: they choose only simple cases, they invest large sums to their education, they follow scientific literature and they are counseling with orthodontists. All because of fear of mistake and in the end because of legal and financial consequences. We can see that effective legal system protects patients in this matter. In other parts of the world it is more complicated to determine doctor’s responsibility.

My opinion is that there is no legal instrument that can solve the problem. You can try to solve it by fighting its roots: to care about feasibility.

Why/where/when general practitioners are practicing orthodontics or dental surgery? After profound consideration you will see that in every case it is well linked to price levels. Everyday we can see more and more simplified approaches to medical and dental procedures. That is forcefully introduced by sellers of dental materials and equipment because they want to extend number of their customers to a larger group so they want to include general dentists to the business. New procedures help doctors to be quicker and to have better results in the end of any procedure. But, they also help general dentists to perform tasks previously reserved to specialists not because they are mean, but because they want to decrease their costs and to increase income, too.

In my experience, general practitioners basically do not want to do procedures reserved for specialists, otherwise they would finish a residence program. They only want to have excellent interdisciplinary team and not to lose money in vain. Specialists have to be aware that their services are required and that they have to be realistic and to adjust their fees. If your procedures simplify and/or your costs decrease, you have to consider changing of your prices, especially in the time of crisis. You have to be more reasonable and to offer good prices which will satisfy yourself, but which will not attract other dentists to start this unwanted behavior.

Be quick and well-informed. Be ready to make suitable deals for yourself, for patient but also for general practitioners. If you let them do easy procedures reserved to specialists, they will do more and more. That happened with dental implants and now everyone is inserting them. It is hard and very demanding to be a specialist. Specialists were educated to do complicated procedures and because of that they are recognized and well paid. But if they start to be overpaid, their dominion will decrease or in the extreme they will seize to exist.

The same story can occur in every other profession. What will happen if changing the wristwatch strap will cost you 100$ or if newspaper delivery 50$ daily? You know the answer: watch repairers and deliverers will be out of business!

Whatever you do or sell you will have somebody unsatisfied with your performance or product. That complaint must not be on real basis, but you should know how to react. What to do specifically after customer tells you that he/she is not satisfied with your performance or your product?

Prevention is the most helpful thing. You should not think: “I will promise everything and I will deal with problems in the end”. When you take the order, you have to detect what a customer wants and that must not be equal with what customer says he/she wants. To deal with that, learn from the best and try to practice it in every occasion. Do not force customer to take what he/she does not want. Instead, try to develop a need for something in customers perspective. That is a good practice.

If a customer comes with a complaint, first do not panic! At first, listen carefully all that other party is trying to say to you. You should detect is there objective reasons for a complaint. Sometime you will find it, sometime you will not.

The worst thing you can do is to argue with a customer. Even if a customer elevates his voice you should rest calm. Why? Because if you adjust your voice with a customer you help development of the affect inside his head and the main reason to even talk with a patient is to decrease or to eliminate that affect. In psychology, affect is short-term emotion caused by something. People think much different in the state of affect and are ready to do many things that they will not do without it.

If a customer has no objective reason for a complaint, you have to try to explain whole process and to try to find potential other reason for that complaint. We can see often that after we do our business correctly, our customer tries to avoid paying or to get lowered price. Of course, if you have done your job professionally the only reasonable time for price negotiation initiated by customer is before any procedure. If you are forced to negotiate price after procedure it should be only damage control negotiation because it is better to get anything rather than nothing.

If a customer has objective reason for a complaint, first tell that you will try to investigate what happened. If it is your fault or not, next thing you must do is to apologize and to say that you will do anything possible to quickly correct the problem and if it is not possible that you will find the way to compensate him/her. In this case you should think about something. This customer is not satisfied with your performance because you have done something wrong. Here you should try to decrease negative advertisement and not to be tight on compensation because customers love to see that if it was your fault you are ready to play fair. It was your fault and it is cheaper to pay slightly higher compensation then to have person that will share his experience wherever he/she can.

One additional thing: In whole conversation you have to take care on many nonverbal messages you are giving. If a customer does not want to feel your sentiment he/she will send you a written complaint. But you will see that among all complaints oral ones are the most frequent. Why? The customer is trying to detect whether you understand his/her problems and how you will take it seriously. If you succeed in that interview you will leave good impression toward a customer and that will be the strongest impulse that will cancel any further problem.

Do not misunderstand me: you must not be a good man if that is not your style, but this kind of behavior is good for a business and positive cash flow which is in the end very important!

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.

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.

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.