How to Improve the Treatment Planning Process with Asynchronous Communication

Episode #589 with Dr. Christian Coachman

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Links Mentioned in This Episode:

DSD Residency 1

Main Takeaways:

Start asynchronously communicating professionally. 

Building a plan by yourself is not interdisciplinary dentistry.

Have standardized protocols for improving communication.

Leverage your smartphone as a piece of dental technology.

Empower your lab with fast, real-time, clear communication.

Quotes:

“In books, you can find definitions of interdisciplinary dentistry, the meaning, the official definition of interdisciplinary dentistry. But I have my own unofficial definition of interdisciplinary dentistry, and that is treatment plans that are built through many brains. Meaning, if you have one dentist that is extremely knowledgeable in interdisciplinary dentistry but is building a plan alone, in my humble opinion, this is not interdisciplinary dentistry. Interdisciplinary dentistry, interdisciplinary treatment planning, depends on this brainstorm, this beautiful, beautiful brainstorm, of several professionals exploring together the best way to treat that specific patient. And of course, ideally, professionals with different specialties and different backgrounds, even better. So, this is the definition.” (9:17—10:23)

“If you agree with me that interdisciplinary dentistry or interdisciplinary treatment planning means building plans based on several people building it together, then it brings us to a very simple problem. It means that we need to get together to plan every case. Right? A regular practice has, I don't know, 20, 25 new patients per month, 30, 35. It depends. It varies. But let's say 20 new patients per month. It's normal. It's a normal number. It means that you need to have a system that you can treatment plan, as a team, 20 times a month because every patient deserves it. Not only a special patient, but every patient deserves it. So, as I always say, one thing is to understand what you need to do. The other thing is to understand a system that allows you to do it every single day for everybody.” (10:25—11:31)

“We go to courses, and we learn a lot about interdisciplinary dentistry. But nobody actually teaches us how to go back to our practice and implement a system that allows us to plan interdisciplinarily every time, for every patient, every day. Nobody talks about that. What is the system? All the major courses are about the philosophy, the concepts, the know-how that you need to have to plan interdisciplinarily. But nobody talks about the systems that you need to implement to allow you to do it every day, every time, for every patient. And most of the ways that people usually use to plan as a team are not feasible. The conventional ways to sit down and plan as a team, when you see a periodontist, an orthodontist, and a restorative dentist, the way that they usually connect and interact, you cannot multiply 20, 25 times a month for 25 patients.” (11:34—12:39)

“We see a huge number of poor decisions being made in dentistry, in the treatment planning phase, because we are not leveraging the most powerful thing that we should, and that is collective intelligence. Interdisciplinary dentistry is leveraging collective intelligence. If you don't leverage collective intelligence, you are not planning interdisciplinarily, in my humble opinion. So, to leverage interdisciplinarily, you need to connect as a team. So, the question is, how do you create a system to connect 20, 25, 30 times without going crazy, without working during the night, without working on the weekends, working less, more efficiently, treatment planning as a team in a feasible way? That's the magic.” (12:43—13:34)

“Having all the specialists under the same roof is not the solution to develop team communication, interdisciplinary communication. So, we need another formula. We need another system. And that's when we bring the discussion into visual asynchronous communication. For me, the solution for modern interdisciplinary dentistry only happens — only happens — if the practice has a system for visual asynchronous communication. If you don't have a system for daily visual, asynchronous communication every day, every moment, working for you, in my humble opinion, you are not doing interdisciplinary dentistry for every patient.” (17:17—18:07)

“Asynchronous communication means communicating as a team without being available at the same time, nor at the same place. So, you communicate as a team, but you don't have to be in the same place, nor available at the same time, and the communication is still flowing at high quality. Now, the high quality depends on visual communication. So, that's why I call it visual and asynchronous. You need both.” (18:18—18:50)

“[Asynchronous communication is] actually not that difficult. Everybody's already exploring asynchronous communication daily. We just need to be conscious about it and implement an official protocol for daily work in our practice with it. So, every time you're communicating with friends on a chat group, you're doing asynchronous communication. Any kind of chat group is asynchronous communication. Any kind of social media is asynchronous communication. And that's why it's so big, because you can express an idea, post an idea, write down an idea. If it's an open social media or a closed group, it doesn't matter. You have dozens or hundreds or thousands of people there that are looking at your question or at your comment and they will interact with your comment whenever they are available.” (19:00—19:56)

“Nobody is doing [asynchronous communication] in a professional way, in an official way, in a pragmatic way, in a routine way, in a way that every treatment plan follows the same process of visual asynchronous communication. People are using asynchronous visual communication casually. Serious companies, serious systems don't rely on casual things. They rely on professional, official, mandatory, replicable, routine steps. And that's what we need to do. That's the magic. That's what we need to do in our practices.” (21:32—22:16)

“There are so many cool, sophisticated technologies that appeared in dentistry in the last two decades, even more in the last decade, from digital X-rays, digital anesthesia, scanners, intraoral lab scanners, milling and printing machines, CBCTs, jaw tracking devices, digital occlusion, sensors, you name it, the amount of AI X-ray interpretation, and the list goes on. Amazing technologies that appeared in dentistry in the last decade that is changing the way we do things in such a beautiful way. And I usually say, even though you have all these unbelievable technologies, for me, the number one most powerful piece of technology that appeared in dentistry in the last decade is called the smartphone. The smartphone is the best dental technology around that people are not leveraging.” (23:05—24:16)

“Before you buy any technology, you should leverage your smartphone. You should make it official. You should make a professional usage of the iPhone, not casual. Because the iPhone opens the door of collective intelligence in an asynchronous way. Again, if you can meet every day with all your mentors and discuss all your cases with your mentors, you're done. You don't need it. But you cannot. So, how do you connect yourself to people that can help you make better decisions since, in my opinion, making poor treatment planning decisions is the number-one, by far, biggest problem in dentistry? By far, the number-one biggest problem in dentistry, the biggest challenge in dentistry, is improving decision-making on the treatment planning phase. This is the most difficult part of dentistry. This is where I see the most mistakes, the biggest mistakes. And the quality of the outcome is only as good as the quality of the plan. So, the focus should be on the planning. And we are biased towards execution.” (24:33—25:51)

“How do you how do you improve decision-making? There's a tough way, and there's an easy way. The tough way to improve decision-making is to become more knowledgeable by yourself — yourself. And this happens year after year. This is a long-term journey that every dentist should go through. We invest in ourselves, and year after year we become more knowledgeable. And because we are more knowledgeable, we make better decisions alone. But this is a long-term improvement. Now how do you improve decision-making tomorrow, early morning, 8 a.m.? Collective intelligence. Tomorrow, collective intelligence will make you make a better decision, leveraging the people around you. How do you do this? How do you leverage collective intelligence? Asynchronous communication. How do you make it happen? There's only one way: the phone. You leverage your phone, again, not in a casual way, but in an official way.” (25:54—26:57)

“Transform your phone. Transform your phone in the third eye of your specialist. Transform your phone in the third eye of your technician. Every time you're doing something or thinking about something, or you're about to make a decision and you think to yourself, ‘Oh my God, I wish my orthodontist was here with me,’ yes, he can be there. Through what? Through your phone. Not synchronously — don't call them because they're not going to be available. Don't try to speak on the phone even if they answer because it's a bad way to communicate. Take your phone and express yourself to the phone. Film, take pictures, print screens. Translate your question. Translate your doubt. Translate your challenge. Translate option A, B, and C in images, and then explain with simple words. Write down and share that image into the cloud, into the pocket of everybody that can help you.” (27:01—28:11)

“It's expensive to have an in-house lab, and it's expensive to have a very great ceramicist. And then, you need to match the relationship, and you need to like each other, and you need to be under the same roof. It's not easy. So, how do you solve the problem? Transform your phone into the third eye of your technician routinely and start recording everything and sharing with your technician what you want, what you don't want, what is good, what is working, what is not working. Every try-in, you record the try-in. If it's looking good, you record because your technician will be super happy to see that it worked out well. If it's not working good, you're going to see what is not working good on the video, on the pictures, a hundred times better than through words.” (28:42—29:34)

“So, the first step, you need to build your dream team. You need to build a team. You need to not only select the people, but you need to onboard them on the process. They need to agree that we are making poor decisions alone today, that we can make better decisions together, that collective intelligence is the best way to go. Way before artificial intelligence and sophisticated solutions, we need to leverage collective intelligence. That's the concept of a study club. That's the concept of morning huddles, collective intelligence. But we don't have the time to do it synchronously every day, so you need to create an asynchronous system. So, you need to explain this to your periodontist, to your orthodontist, and to your lab, if you're a restorative dentist. And usually, the restorative dentist, or many times a restorative dentist, is playing the central role of a quarterback in this process. But it can be the orthodontist or the periodontist. Somebody needs to be the one leading the process. Then, you need to talk to the specialists and the lab, explain this, and they need to say, ‘Yes, that's it. I agree.’ So, that's the first step.” (30:52— 32:08)

“Now, the second step is empowering your lab. Why? Because I said visual asynchronous. It needs to be visual. Your lab is going to play a key role generating the visuals because they have the software, not the dentists. So, every idea, every design, the diagnostic digital wax-up, the functional design, the facial analysis, the lines on the software, the auto simulation, the perio simulation, implant simulation, restorative simulation, the digital articulator, these are the images that will help you make visually guided decisions or will allow you to test your ideas. So, the lab needs to be transformed into a content generator. The lab needs to be brought into the treatment planning moment way before the treatment starts.” (32:17—33:19)

“Step number three is to decide what shared platform you're going to use, if it's iMessage, if it's WhatsApp, if it's Telegram. For example, our lab, we have our own specific platform. There's Rocket.Chat. There are many protected HIPAA compliant platforms that you can use and create your own chat group, invite the specialists, invite the lab. So, that is number three. Define the platform that you want to communicate with as a team. WhatsApp, even though it’s not specific for dental, you can debate the HIPAA compliance, etc. It’s by far the best one. It’s by far the best one still. But there are many others, and you need to choose which one. Again, not casual — official, professional, and you need to then write down exactly how the system will work.” (34:31—35:33)

“It's in our hands. As you listen, it may feel overwhelming. But in reality, to start taking advantage