Tuesday, January 27, 2015

Fire, Fire!

“They call me the Fireman, that’s my name.”

That’s the first line from George Straight’s song “Fireman. I haven’t been able to get that out of my head since recently having a string of “fires” to put out. Unfortunately, or perhaps not, they haven’t been the types of fire he refers to in the song.

We probably all have experienced cycles in our practices when everything runs smoothly and others when there seems to be an unusual amount of dental emergencies, post-op flare-ups, appointment cancellations, or staffing interruptions. A couple weeks ago, a retired dentist friend stopped by and asked how things were going, and all I could say was that I had been spending my time “putting out fires.”

I began to evaluate each of the situations to see how many of them I could have prevented. Were they the results of poor planning on our part? Could some have been prevented with early intervention of a minor problem? How many were the result of the patient’s own neglect, procrastination, or lack of knowledge? And, how about the possibilities of some being natural disasters or acts of God?

All of this “fire control” made me think of two books I read last year, on the recommendation of an AGD friend. It’s interesting the similarities you’ll find between forestry management and fire fighting to dentistry. The first book, “The Big Burn: Teddy Roosevelt and the Fire That Saved America,” by Timothy Egan, told the story of a tragic fire in Colorado that gave the impetus for expanding and reorganizing the U.S. Forestry Service. The second book was “Young Men and Fire,” by Norman Maclean. This is a true story, horrific and heroic, about a failed fire fight that lead to the death of several smokejumpers. My love of analogies went into high gear and I found there to be some interesting parallels. I won’t give all the details of the books because they are good reads, but I will try to illustrate the basics.

In “The Big Burn,” key points were the need for excellent communications, organization, and leadership. These attributes were lacking in many areas when the fire broke out, and this resulted in one of the largest and deadliest forest fires in U.S. history. These three things—communication, organization, and leadership—are extremely important in a dental practice. Many dentists, including myself, find these more challenging than the clinical skills required to be successful.

Communication needs to be bidirectional. We must keep our ears open and mouths shut more often. When we communicate with patients and staff, we need to be certain that we use language they understand and then ask if we are clear. I actually have had new patients tell me that we were the first office to actually listen to what they wanted or expected before we told them what they needed.

Organization is, for me, the second most difficult function of running a dental practice. Written job descriptions and procedures are very important to help the staff have a clear and secure feeling about their functions. I’m kind of old school—tell me what to do, show me how to do it, and I’ll do my best to get it done. But this works great if you only have to do this for one assistant one time, and he or she never leaves. But, in reality, it’s better to have written procedures and policies in place; then it’s much easier to start new staff and maintain consistency.

Leadership is the hardest for me and a lot of other dentists. I think, by nature, many of us who pursue this career never thought about having to lead a team of people to accomplish our goals. That is why there is abundance of courses available for leadership development, and these should be some of the first courses taken by the new dentist soon after dental school.

In the second book, “Young Men and Fire,” the importance of good planning—which also involves contingency plans for possible complications—was the significant parallel I found to dentistry. A comprehensive treatment plan for ideal treatment is needed. Sure, often we see patients for an emergency situation as their first encounter. We should put out these little fires, and then try to get the patients to allow us to present a plan for ideal treatment. Even if they cannot do everything right away, they deserve to have the opportunity to understand what they need, and then we can make a staged treatment plan to achieve the desired goal.

I can’t count the number of times in the past that I have seen beautiful porcelain crowns or veneers on anterior teeth and then discovered that the posterior teeth have advanced breakdown from decay, attrition, or advanced periodontal disease. Excuse the cliché, but this definitely is not seeing the forest for the trees.

I’ve decided the best way to handle “putting out fires,” is to approach them as opportunities rather than irritations. I will strive to learn from any unexpected post-treatment events so as not to repeat them in the future. I will use emergencies to make the patient comfortable, find a solution to the immediate problem, and educate him or her to help attain the health needed. When I find a fire too big to handle alone, I will call upon my interdisciplinary team of specialists to help me.

Thanks for letting me share, 

Terry G. Box, DDS, MAGD

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