How to manage a dental practice and get out alive

author

"This book is dedicated to Carlo Guastamacchia,

my first and foremost mentor."

TIZIANO CAPRARA

PREFACE BY

FABIO TOSOLIN

HOW TO MANAGE A DENTAL PRACTICE AND GET OUT ALIVE

THE DENTIST BETWEEN PROFESSIONAL AND PRIVATE LIFE

HOW TO MANAGE A DENTAL PRACTICE AND GET OUT ALIVE

Copyright © 2015 Tiziano Caprara

All rights reserved

Preface

It is indisputable that the problem of clinical quality is relatively easy for the competent dental professional to solve, because it is relatively easy for a trustworthy, motivated dentist to keep abreast of new developments and organise things in such a way as to offer his customers attractive treatment prospects or good clinical support to maintain their oral health over time.

The problem with modern dentistry is, in fact, no longer the need to assist a plethora of suffering patients who, without other alternatives and fundamentally devoid of critical capacity, thronged the waiting room of the dental practice. This image, more and more relegated to a distant past, at least in the more culturally and economically advanced areas of the country, is destined to remain fixed in the cartoons of the 70s, when the patient placed his blind, uncritical faith in his dentist, and the dental auxiliaries were so auxiliary that they were almost totally inconsequential in procuring the loyalty and trust of the patient. Loyalty and trust were not goals to achieve, but the point of departure with the customer.

In periods in which a set of dentures was uncritically judged to be excellent only because it was able to ensure mastication for some (few) years, it was easy for the dentist to appear adequate or more than adequate in the patient’s eyes for his immediate needs. Any contingent failures were attributed by the patient to fate or to his own biological inadequacy, and he would not infrequently apologise to his dentist, whom he held in awe, for such failures. Unfortunately, weak gums run in our family, Doctor; in spite of all your efforts, there was no way… was an expression that indicated a form of quasi-medieval causal attribution and made it clear that the patient would never have questioned the therapy or the professional, but rather himself and the structure of his own mouth.

The future of Italian dentistry is not, however, made up of the stuff of intimidated patients in the face of actual or alleged errors of dental professionals. On the contrary, more and more frequently, well-educated patients, uninhibited and convinced that they are the guardians of unreal rights to good health, demand – not ask – to receive efficacious treatment. Efficacious even regardless of the objective conditions necessary to obtain the results they demanded. Or efficacious with regard to details which have very little to do with clinical practice and a great deal to do with human relationships.

Tiziano Caprara’s book, in its colloquial tone and novel format, deals with subjects that are topical and compulsory for all dentists, beginning with how to manage interpersonal relations with his staff and his patients.

Being punctual; listening to patients; interpreting needs that are expressed but also unexpressed; managing appointment time frames, delays, communication both vocal and non in the dental unit; handling complaints, financial negotiations, debt collection and treatment plan presentations are aspects that are no longer considered accessories of clinical treatment. The contemporary patient sees them as customary prerequisites, the conditions at which he will accept that treatment and grant his compliance to that dental practice. Caprara reminds us that the patient does not deal with the dentist alone, but with a pool of individuals in whom he expects to find unity of purpose, language and mission as well, or even of missionary spirit. And the author also reminds us that the making of such a team is not the work of some weird fate, but of premeditated action, strategies, tactics and techniques that very few know, but which are accessible to all.

While prioritising the need for motivation and mission on the part of the team, the book does not neglect other technical aspects, such as work organisation, economic profitability and marketing. In fact, acting as a counterpart to the new social and cultural situation underlying patient relationships, the perspective of a continuous erosion of the gross margin looms ahead on the horizon of Italian odontology, placing the dental practice in an unprecedented competitive situation, to be tackled not with the power of motivation alone, but also with the instruments of organisation and efficiency which are suggested by the book.

The Author undeniably and explicitly delineates the feelings and anxieties that pertain not only to his own life experience, but to those of the vast majority of his readers as well, and he expresses them most explicitly. More than a few of us will not fail to identify with the problems of management, organisation and relations with patients and staff encountered by his Dr. Normalini, not to mention those arising within the family, too.

The reader is guided, step by step, from the definition of the problems to the search for their solutions. Without claiming to write a treatise on the subject, the Author deals with all of the major themes one by one: work management, motivating collaborators, organising the practice, economic management and marketing. There are perhaps several affirmations that some readers might find excessive or maximalist. Tiziano  puts these words in the mouth of his role model, Dr. Eccellenti: Modifying our work environment can positively influence our character, a statement that sounds provocative, yet all of the discoveries made in the field of behavioural sciences agree, with supporting data and no provocation intended,  that human behaviour can be evoked, developed, shaped and maintained by means of appropriate contingencies. The text further supplies references to evidence-based methodologies of proven effectiveness, such as behaviour management through positive reinforcement or the acquisition of new behaviours through shaping, without being weighed down by ponderous theoretical in-depth analysis.

The book, in fact, continuously proceeds from the concrete everyday problems of the dental practice to the equally concrete and accessible solutions to the same, which makes it a treasure trove of tips, not an exhaustive manual. One of the undeniable merits of the book is precisely the very readable yet persistent style which guides the peruser through topics that in other works could easily become ponderous, highbrow and complicated to the point of causing him to give up reading it or trying to change his life. Because it is nothing less than a change in lifestyle that Caprara proposes to the reader, encouraging him to ask himself what he really wants from his work and his family life, before planning any changes or adopting any new management strategies. Indisputable.

Fabio Tosolin

Introduction

If you have purchased this book, you are definitely dental professionals who have already attained superior levels, but want to improve further.

You probably wish to optimise not only the clinical sphere, but also the management area of our profession. You, too, have realised that this aspect can affect not only our work at the dental chair, but our personal lives as well. Work and life are not two separate and distinct sectors, but only two faces of the same coin.

Unfortunately, there are very few books that deal with these topics, while countless volumes address clinical matters. Rarely, however, have I seen colleagues despair because their root canal therapy did not reach the peak of perfection, while I’ve seen many whose stress levels had driven them to the point of retiring their white coats to the peg. The management sphere can ensure that our profession is a pleasant and enjoyable one or make it into a nightmare, the sheer thought of which makes us hate getting up in the morning.

As I said, I’ve found very few books that help us in this area. Carlo Guastamacchia (to whom this book is dedicated, and whose name – Carlo – has been given to the character Dr. Eccellenti) was one of the first in Italy to deal with these topics, and his works still represent the gospel truth among reference books. Apart from said author, the number of volumes published in this field is quite limited, and, in many cases, getting past the second chapter of some of these tomes is a veritable feat.

For this reason, I have attempted to present the topics in a new form, that of the novel, simpler and more comprehensible. The aspects dealt with constitute a compass for the reader who wishes to modify the way he conducts his practice.

This book will not only speak to you of management, but can change your relation with the profession completely. Some of the topics analysed are rarely expressed publicly, but are to be found exclusively in conversations among colleagues: the uncertainty of their future, the problem of motivation in an increasingly complicated profession…

With almost 20 years of experience in the front line, I have hired and trained many dental assistants, but I’ve also suffered several resignations; my economic management is good, but in the past I’ve had to deal with major financial problems; I’ve established excellent relationships with my patients, but I’ve also wanted to get rid of some of them. In all these years, I’ve learnt that the quality (and the profitability) of the profession depend on one thing alone: the motivation of the dentist and his employees. Being convinced of this is already a first step towards success.

We are very much alike and this is our book.

Dr. Tiziano Caprara

Chapter 1

It was a beautiful Monday morning. I was on my way to my dental practice, in a leafy residential area of town. The day was so pleasant that it was almost a shame to have to spend it indoors at work. I parked the car and went in through the side door, which led straight into my private office. I’d barely set my bag down when Raffaella came in.

Do hurry, Dr Normalini. We’re running late.

Raffaella was my dental assistant. I’d hired her when I opened the practice, about fifteen years ago. It felt like ages now.

You have Mr. Peruti in Room 2. He doesn’t have an appointment, but he insisted on see seeing you about a problem. You must hurry, Doctor – your first patient, Mr. Rotti, is already in Room 1 and you know how he hates having to wait.

The day was off to a great start. I hadn’t even got changed and problems were already beginning to pop up. Mr. Peruti was the type of patient that no dentist would ever want to have. If I’d only known that beforehand… I changed into my scrubs slowly, gazing at the sun through the window, resisting a powerful urge to take the day off.

I went into Room 2. Mr. Peruti didn’t even wait for me to say hello before starting to complain.

Doctor, we’ve got a problem here. A big one!

He pulled out his dentures and continued to speak, waving them in front of my nose.

"This tooth here seems to stick out too much, this part here keeps rubbing and the top part is too thick. I know you warned me about all this, but you should’ve made things clearer. If I’d realised that it’d be like this, I’d have stuck with the four teeth