November 23, 2016
by Dr. Mark H. E. Lin
As a long time devout Christian, I have listened to many inspiring sermons by numerous Pastors over the years. One particular Pastor’s sermon style stands out in my mind with a transferrable concept that is very practical and relative to the practice of clinical dentistry. He titled his Sunday morning presentations as The 3 Point Sermons. We can all appreciate that most adults have an attention span of less than twenty minutes, especially on early Sunday mornings. His core message was simple and succinct so that we should LISTEN, UNDERSTAND, REMEMBER and IMPLEMENT the three main points of his sermon once we have left the church service that day.
Several years ago, a senior prosthodontic resident was nearing completion of his post-graduate studies. He asked me if there was any specific advice I could give him that would empower him to be more effective at managing clinical complications and challenges. I reminded him that clinical complications are a fact of life and a significant component to our skill development as expert clinicians.
There are so many factors that will influence the overall success of a clinical procedure or treatment plan. In light of this it is a forgone conclusion that every clinician will experience complications or failures from time to time. In some cases depending on the complication we may even find it necessary to redo our clinical treatment. This unexpected event can be perceived as frustrating and inconvenient for our patients. It can also interfere with their confidence and with the quality of our underlying professional relationship.
Complications and failures in dentistry can range from minor to major, reversible to irreversible and problematic to detrimental. These problems can have many different levels of undesirable consequences such as:
1. Compromised or less than optimal clinical results for our patients with guarded prognosis
2. Nonproductive wasted clinical chair time
3. Unexpected rising costs leading to financial burden to the patient and dentist
4. Potential antagonistic tension with our patients and deteriorating rapport
5. Ultimately affecting the reputation of the dentist as well as their future trust in our profession
These clinical problems can lead to disappointment on the part of the patients as well as frustration for the dental professionals involved in the delivery of their care. For this reason, it is extremely important that we provide our patients the most optimal treatment options for their specific clinical requirements. As well, we must be proactive and prepared for any challenges that may arise balancing risks versus benefits in each treatment protocol. Upon some deep thought and reflection of my clinical experiences, I decided to create a strategic acronym that would help us more effectively deal with these complications and failures when they occur. It is called the “Rule of 3 P’s” for dealing with dental complications or failures.
The first “P” is to PLAN. The term “Treatment Planning” has been overused and under appreciated by our patients and the profession. As dentists, our ability to gather a proper history with comprehensive diagnostic records is of paramount importance and a key step towards formulating the correct diagnosis. After an accurate diagnosis of the various oral diseases, we can formulate numerous treatment plans and options. Within each treatment option the risks, benefits and alternatives must be communicated and weighed for that individual patient’s care. Without proper diagnosis and treatment planning, some clinical procedures may yield short term success but can lead to inevitable failures.
The second “P” is to PREPARE. In this context, preparing may require consultations with various specialists or communications with our laboratory technicians or colleagues to review the case in question. It may also mean taking various continuing education courses to obtain the body of knowledge as well as hands on skill development courses. Some continuing education courses may offer animal jaw, human cadaver or even live patient treatments under the mentorship of highly experienced instructors. When it comes to choosing your continuing education, the choices are plentiful and broad. Every dentist has their own personal preferred higher learning CE methods to prepare them for the clinical challenges. We can choose from online CE based training taken from the comforts of your home or office, to programs delivered at vacation resorts, to local study clubs, to intensive long term residency programs or one can simply take the traditional text book approach.
The third “P” is to PREVENT. Of course the preferred way to deal with complications is to avoid having them in the first place. We can all appreciate that
once the reality of day-to-day clinical practice is upon us, this is easier said than done. When a clinical procedure encounters a complication or failure, it will in many cases lead to a compromised outcome. Depending on the expectations of the patient and objectives of treatment, a compromised outcome may be the best one can expect without affecting that patients’ quality of life. From time to time, the compromised result may not be acceptable to our patients in which case we will have to resolve the problem to the best of our abilities. Knowing the various modes of failures related to all aspects of clinical dentistry and addressing them preventively or proactively before treatment can minimize headaches to the patient as well as undesirable outcomes.
After some deep thought and clinical reflection I decided to share the “Rule of 3 P’s” for dealing with dental complications or failures with the senior prosthodontic resident. They are…PLAN, PREPARE and PREVENT in order to optimize our clinical results and outcomes. As the senior resident and I were discussing this rule, I suddenly realized there could conceptually be a fourth “P”, which to me might be the most important, it is to PRAY. This means that despite all of our best efforts and intentions for optimal results, dentistry is not an exact or perfect science. In certain unique cases, we can only aim for reasonable results and not perfection. I’m reminded of the words of the great physician Dr. Patch Adams “We can always promise care…we can never promise cure! With this in mind, I often remind myself and all practitioners alike to not quickly assume or hastily judge other colleagues clinical work, especially when we are not privy to the full pretreatment circumstances, clinical conditions and discussions. When complications or failures arise; as dental professionals and in the best interest of our patients, we should support the patient by focusing more on resolving the clinical dilemmas as a team rather than laying blame.
Applying my church Pastor’s sermon methodology to dentistry, the “Rule of 3 P’s” for dealing with dental complications or failures is to: PLAN, PREPARE, PREVENT …and to PRAY. OH
About the Author
Dr. Mark H. E. Lin graduated from the University of Detroit Mercy for his dental program. He then completed a one-year General Practice Residency program at the Miami Valley Hospital in Dayton, Ohio. He practiced general dentistry for 13 years and then returned to complete his post-graduate training in the specialty of prosthodontics at the University of Toronto. He maintains a full-time specialty practice as a prosthodontist at Dr. Mark Lin Prosthodontic Centre.