The Paradigm Shift Expanded: Part 3

This is not a zero sum game. When you raise your responsibility level, every participant in that game can raise his or her responsibility level. Once the less able general dentist gets a glimpse of what can be done, and is not capable of doing it, that opens the door to his saying, Why don’t we refer it to the prosthodontist.  And the more able general dentist? He or she feeds on the challenge and grows. Who wins? The patient, of course.

Having been trained in the above under the direction of Dr. Paul Robertson at the University of Connecticut and having always taken the lead role in sequential treatment planning, it becomes second nature the more that you practice it. And it then puts you, the periodontist, in the leadership position, something that patients need, something that is in dire need within the dental profession.

Having taught perio residents and having worked directly with young periodontists, I do see a change in both the training and the assumption of responsibility from the time when I was trained. “Finding out what the restorative dentist says,” while valuable, is a step below the responsibility of full and sequential treatment planning. There are some patients who need cross consultation before the treatment plan can be created, but such patients are in the vast minority in my experience. Sometimes, what we do out of professional courtesy results in patient confusion, reversal of patient motivation, and consequent lack of treatment acceptance.  The goal of the periodontist in my opinion should be to treatment plan nearly every case without the need for cross consultation. The patient receives one treatment plan from one source, even if others will ultimately be involved in the treatment. With good communication with the other participants in treatment in advance, this goal can be realized.  Acceptance rate for treatment will go up.

That does not mean that the restorative dentist does not have input and can’t modify the full and sequential treatment plan that the periodontist designs. But lack of sequence, lack of agreement as to what the sequence should be before execution of the treatment plan nearly always creates unnecessary steps and sometimes errant steps. If the sequence is created by the periodontist, it can always be modified. But if the periodontist does not make a sequential treatment plan, it often is not done. This creates a tremendous amount of confusion and extra time spent in correcting that confusion. Patient care suffers. It is much better to set the plan and let it be modified than to never set a plan to begin with.

Thinking takes a primary role over doing. We hire architects to create a full plan for our buildings. Architects create the entire plan first, develop the sequence, suggest contractors, and we get a great building. Lack of such planning results in repeated steps, redo’s, and cost overruns.

We shall, in the not too distant future, have to make a choice. Do we follow the prescription of another or do we create the prescription? Or in current terms, who is the “quarterback” of the case? Our position as the primary or secondary doctor for the complex and periodontal case is determined by how we answer that question. There is nothing wrong with second position as long as we are comfortable and maintain our integrity within that position.

But if we want to reassume the lead position, the  periodontist can and should be prepared to be the architect of the mouth. Such is a necessary tenet under the category of “expertise” of a Director of Dentistry. Such was and continues to be our responsibility. Such is the substance that will create the Paradigm Shift to allow patients with periodontal and complex needs to seek us for diagnosis and treatment planning. That’s the way it used to be. The only difference today is that those patients can bypass the initial step of referral. And from this perspective, that is a beneficial change not only for periodontics but for the patient.

Want to advance yourself further in your practice? When you examine the patient,  envision and plan the entire case, even if you aren’t doing all of the procedures. Think about the whole case with the endpoint in mind.  Conceive each step, and sequence it to completion. It will be easier for some than for others. But for those who choose to make this exercise a part of your New Year’s resolutions,  you will advance yourself in your profession. You’ll add to your thinking skills, your diagnostic skills, as well as helping your patient see the whole picture.   When the patient sees the whole picture, he or she is not only better prepared to buy that picture, he or she appreciates the artist who creates that picture.

And once you accomplish this on a consistent basis, you are in a better position to help the restorative dentist create cases that he or she never dreamed of. And you then make sure that the restorative dentist has the tools to pull off a great result or agree to refer the patient to someone who can.

The next step is to plan the entire sequence while the patient is in the operatory at the first visit. When that happens, watch what happens to your treatment acceptance rate.

If it ends there, then you have preserved the best that dentistry has to offer. But in that time, you are not only honing your treatment planning skills and your business skills, you are creating teams of dentists who elevate the profession as you do.  You create cooperative relationships,  you create alliances. You succeed together. So if the inevitable happens, if the impingement of the corporates,  the squeeze from dentists that keep everything in house, as well as the economics of purchasing all of the best technologies require that you too be a part of a group, you have already created that team of superb doctors that now are allied together.  And you’ve created business systems that are strong and that allow you to expand. You then assume the reins of what you created, as the Director of Dentistry for that group practice.