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Problem:
Every restorative dentist has experienced circumstances when a laboratory produced product is disappointing (wrong shade, open contacts). This is a common issue which leads to patient frustration, dentist embarrassment, the need for additional chair time and a reduce level of patient satisfaction.
Questions:
How can we improve our communication skills to better manage our patients and what changes should we consider as clinicians to mitigate lab inconsistencies or improve outcomes?
What to say:
Before the start of treatment, dentists need to set realistic parameters to achieve more reasonable patient expectations. Generally, it is a mistake to promise specific timelines or an exact number of visits. For example, let’s review a common problem where a simple crown takes three visits instead of two and then compare two different scripts.
Script A: “Mrs. Smith today we will be starting a crown. Generally, this takes two visits and at times a third visit may be needed to modify shape or to obtain the perfect fit. In terms of color science, proper shade selection in dentistry can be complex depending on a number of patient specific variables. Color is an art/science and is impacted by each material, light transmission and other factors. I will only complete this restoration until everything is done at a highest level because I want this to look and feel great, I want you to be happy and I want this to last for many, many years. So this will be completed in either two or possibly three visits.
Script B: “Mrs. Smith today we will be starting a crown and at the next visit, we will be finished”
In Script A: The patient was educated properly and instead of failure and disappointment that the crown was not finished in two visits, they will feel as if they have an excellent dentist that more completely explained the process and simply needed more time. They will know they are with a doctor that truly cares.
What not to say:
What do you say when things go wrong?
-“Please never say that the lab made a mistake or the lab did not do this correctly or the lab did not follow my instructions”
-“Never blame the lab because if I am the patient, I do not want that crown in my mouth fabricated by that lab.
-Often patients will say, “Can you use another lab?”
-Rather say, “the crown fits fine but to get this perfect I need one more quick visit to modify the contact or shade”
-Often the patient will also say, “why does that not fit or why are we not finished?”
-Response: “Dentistry involves many variables and something called the “distortion equation” which means there are many little factors that need to be addressed that lead to the fabrication of a restoration. It is a complicated, imperfect process and it is simply amazing how well things generally fit. I just need to modify this one aspect to make this perfect”
-Clinical Pearl: An extra visit should be turned into “how thorough you are and not that the lab is not good or made a mistake”.
-Remember, often the difference between a good and an excellent dentist is “that one extra visit”!
-An extra visit should be perceived that you are an excellent dentist, willing to put in the extra time and effort to produce an excellent service. “I am glad you are my doctor”, not the opposite.
How can a clinician improve lab products?
-Everything in dentistry is “personal and about relationships”. Establishing a good relationship with your lab tech is no different
-Introduce yourself: Let them know who you are and what you are looking for (ie, I would like broad wide contacts and small embrasure spaces)
-Be more involved with the fabrication process- “can you send me a photo of the wax-up?” This will not delay the case and will take only a few minutes
-It takes extra organization and a minimal amount of time to check the steps along the way.
-If you choose not to do this, then expect lab outcomes to be more unpredictable. It is that simple.
-Provide the lab with excellent impressions and records. If you don’t like an impression, take another one as it will save you enormous time in the long run. They are techs and designers, not magicians
-One of the key elements of a successful clinician is to understand “prosthetic control” and a little extra time will go a long way. Personally, I would rather spend this time looking at a digital design as opposed to doing extensive adjustments at the chair.
Summary and Conclusions
-What we say, how we say things and what we choose to omit or include are among the most important aspects of proper patient communication and management
-When we need to rely on lab support, we need to spend more time to educate our patients so their expectations are more realistic
-We need to develop more personal relationships with our techs
-Always under promise with time and then over deliver
-Understand how an apparently negative event can be turned into a positive one
-The bottomline is that the patient “feels” that they are in the right place with the best doctor who explains the process and is doing the right thing!
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