"Doctor! Mrs. Jones is in chair number three. She called in because she had a tooth break and didn't want it to start hurting over the weekend. She has broken off the lingual cusp of number 4. She is not in pain but knows she needs a crown like last year when the same thing happened on the other side. What do you want to do?" The assistant stands in the doorway waiting for an answer.

The doctor is thinking: Let's see, it's 3:45. I can probably finish up here in a couple of minutes. It shouldn't take an hour to squeeze in that crown on my production today. Besides, we don't want Mrs. Jones going down the street because we didn't take care of her here. "O.K., Betty, get a tray setup for a crown, and I will be there as soon as I finish up here. Oh, I will need to check hygiene first, so it will be a few minutes. You know what to do."

The doctor didn't remember that the patient was a gagger, difficult to get numb, and had periodontal problems on which she had refused treatment a couple of years earlier. So, what time did everyone go home that night? What was the stress level?

Does your practice run you?

Some things seem to make perfect sense until you stop and think about them. Yes, the doctor seemed to be giving the patient good service by doing the crown at that time. After all, she did not have to make another appointment and come back. Would he have lost her to another doctor? Maybe. Did doing the crown seem to help with the income of the office? Of course, and we all have to make money, or we will not survive. Or is there another way to look at it?

Take care of patients PERCEIVED needs first.

Let's look at it from the patients' perspective. After all, they are the ones we need to satisfy first. As dental team members, we have forgotten what it is like to know nothing about dentistry. We expect that they are thinking like us but they are not. The question to ask yourself is, what was the patient thinking and feeling when the tooth broke? In other words, what was his/her perceived need? Was it to get a crown right there and then and be finished with it? Or could it be they were afraid that the tooth might start hurting at a time when no help was available?

Here is what has been field tested and proven to work in a situation such as this: "Mrs. Jones, it looks like the tooth broke in such a manner that we will be able to save it. Thank goodness it broke the way it did. Some teeth break in such a manner they cannot be saved. Since it is not hurting you, chances are it will not hurt over the weekend. Therefore, my main concern is not this tooth - it is for all of your other teeth. You have already had one tooth break before this one. Your body is telling you something, Mrs. Jones. It is saying that your teeth need a lot of help. We need to develop a plan that will not only fix this tooth but will prevent this from happening in the future.

"Unfortunately, we do not have enough time to fix your tooth correctly today. The crown procedure is very precise and time consuming. Today, to keep you comfortable and to protect your broken tooth, we are going to place a temporary filling. Then we will have you back to do all of the necessary x-rays and an exam to determine what is best for your mouth. Does this all make sense to you?"

How is the patient feeling right now? Is her perceived need being taken care of? Will she be upset and go some where else? Not if she is a rational thinking person and trusts you. You have satisfied her immediate need. She doesn't have to worry about the tooth hurting over the weekend, and she knows you will take care of her by doing a thorough job. The ultimate benefit to her is she is going to be healthier by having the exam and a treatment plan that is complete, one that will help save her teeth for the rest of her life.

What does this mean for your office?

The benefit to the office is that the schedule is not messed up. And even more importantly, more dental disease is usually found upon complete diagnosis - quite extensive work, in fact: periodontal disease, overhangs, broken down fillings, cracked teeth, etc. In other words, instead of doing one crown on an emergency basis, the patient may actually need several quadrants of scaling and root planning and several crowns. It is a true win-win situation.

Controlling your practice.

All good management begins with a S.O.P., which stands for Standard Operating Procedure. A good S.O.P. for emergencies looks like this:

1. Identify which of the two types of general emergencies this is:
   1. Patient is in pain
   2. Patient is not in pain
2. The perceived problem must be taken care of as soon as possible:
   1. In pain: Most patients this day and age expect to be given a prescription for pain and infection before surgery is performed.
   2. Not in pain: Provide temporary treatment, i.e. smooth off sharp edges, temporary filling, etc.
3. Reschedule the patient for a complete exam.

I can say without reservation that the complete comprehensive exam is the most valuable management tool within a dental office. We all know that the office is controlled by the appointment book. The appointment book - plus that very wonderful person up front that works it - is capable of giving us a good day or a horrible one. By following this S.O.P. and then scheduling complete exams for diagnosis and treatment planning, you provide the framework needed to maintain control of the appointments.

Why should you follow these procedures?