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- Team DentalReach
Abstract
The idea of combining the efforts of dentists of narrow specializations to solve complex patient problems is not new. It is embodied in different forms that have their own functional characteristics and boundaries. Both these are discussed here in detail, explaining how to respectfully handle dental consultants of an in-house dental dream team, in a way that they also benefit the private practice. Other types of dental consultations are also discussed.
Consilium and its metamorphoses
Consultation (extended consultation) is a form of cooperation of narrow specialists, which aims to develop a collegial understanding of the diagnosis, methods and plan of treatment or rehabilitation, which will then be carried out by one or more doctors.
Types of dental consultation include:
- An in-house dental team of specialists - most appropriate
- Inviting a colleague for a consultation
- Doctors' industrial conference/meetings
- Thematic training conference of doctors/study clubs
Characteristics of dental consultation in an in-house dental team
A properly organized consultation has clear characteristics:
1) Appointed as soon as possible when combined complaints of the patient are identified, in order to ensure the prompt provision of dental care.
A well-trained administrator, listening to the complaints of a patient in a clinic, may understand that he has several limitations that require the participation of different dental specialists. Usually, based on the complaints and wishes of the caller, it is clear that say, a therapist, periodontist, surgeon-implantologist, prosthetist is needed. It is quite reasonable to suggest that the patient immediately visit the consultation with the participation of the necessary specialists, explaining that it will give him the opportunity to understand his problem as a whole, get a complete recommended treatment plan, save time at the preparatory stage of treatment.
In some clinics known to us, the proposal of a consultation with the participation of trained administrators is being successfully carried out. This testifies to the competitive advantage of clinics and the availability of a well-organized medical service. One of its functions is to provide an early solution to the patient's problems.
Many doctors object to administrators offering potential patients a consultation at the stage of informing them about the clinic's services by phone. This is usually due to a lack of trust in administrators and their lack of training to perform such a function. It is customary to invite everyone who called for a consultation with a therapist who launches a traditional conveyor: "You need to go to a consultation with a periodontist, surgeon ...".
The transition to new forms of customer service is an indicator of teamwork, depending on the maturity of management and front-line personnel.
2) The clinic immediately appoints the first narrow specialist to whom the patient came for the initial consultation.
This means that the specialist who gave the first consultation must continue the treatment. This also brings us closer to the standards of medical service, however, in order to implement it, doctors need to be assigned an appropriate duty and plan the time for consultations in the schedule.
3) The consultation is conducted according to a scenario in which a number of aspects are revealed, which in turn determines the patient attitude.
The attitude of patients towards doctors of the consultation and the results of treatment depends on the combination of circumstances. This is dependant on organizational, representative, informational, psychological and commercial factors of the consultation. There can be 3 patient attitudes:
Patient attitude can be positive if the counselor is doing their job well:
- explains to the patient the stages of treatment
- informs about its probable results
- coordinates the work of colleagues “here and now” - if necessary, adds information from narrow specialists
- makes transitions from the actions of one specialist to the actions of another.
The patient's attitude will be uncertain when he is unable to understand:
- what and why "they do with him"
- what will be the results of the treatment
- who is responsible for the work and the quality of treatment in general.
The patient's negative attitude towards the participants in the consultation will be formed if:
- some of the doctors makes a professional mistake (when making a diagnosis, choosing a treatment option, performing manipulations, anticipating discomfort during and after treatment)
- there is a "seizure of someone else's field of activity" - the doctor performs the functions of another narrow specialist
- the work is being redone due to the fault of one of the team members
- the patient cannot understand who is to blame for the admitted deviation from the expected results of treatment
- there is a lack of professional communication
- the patient sees formalism in the work of one of the team members, and even more so - notes collegial indifference
- there are violations of medical ethics.
Consultants - What could go wrong?
Unfortunately, it should be noted that in many clinics it is not customary to hold consultations in full understanding and scope of this type of collegial activity. There are some boundaries of consultations which must be kept at bay for a smooth functioning of dental practice. These boundaries may be certain thought processes or actions such as:
1) The owner of clinics thinks that it is unprofitable to conduct consultations.
Time should be allocated for them, but there is no certainty that patients will sign up, therefore, the office will be idle, doctors will be left without work. But there are clinics that set aside the day of the week for consultations in the schedule, and consider this practice to be justified. If team councils are not appointed, which is rare, patients with acute pain are admitted in the office, under guarantees, or invited from an existing record.
2) A consultation becomes a referral of a patient from one narrow specialist to another.
Case Example 1 - Referring to the wrong consultant. The endodontist, at his initial consultation, makes violations by identifying periodontal problems in teeth other than the one he was given to treat,instead of leaving it upto the principal dentist. He advices making an appointment with the periodontist. The periodontist advises the same patient to visit the surgeon,since there is a possibility of tooth extraction. And so the recipient of services goes from one narrow specialist to another due to the lack of a real consultation by a senior therapist, and a slight violation of the ideology of medical service, which states that the patient must receive the fastest provision of services.
Case Example 2 - Too much information in a haphazard way. The prosthodontist proposed the patient with a treatment plan, in which the participation of the therapist, periodontist and surgeon is required. The prosthodontist tells the patient about the stages of his treatment, determines the predicted result the parameters of the quality of treatment, discusses the possible risks in his section of work, the need for preventive measures after prosthetics, as well as the cost of prosthetics and guarantees. Other specialists, while consulting the patient separately, also talk about the technology of their treatment, about the predicted quality, possible risks, as well as the cost of their work and guarantees. As a result, the patient's head mixes information received from different doctors,the individual stages of treatment are not entirely clear, and some of the information received does not fit together
According to the literature, the lack of continuity between doctors and departments has become one of the reasons for patients' complaints to expert commissions operating under the auspices of the American Dental Association.
3) Narrow specialists, accepting the patient separately, do not consider it necessary to form a team to achieve effective treatment results.
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