Sustaining Doctor/Technician Relationships

Today, more than ever, we are highly dependent on effective interpersonal relationships with our laboratory technicians in order to accomplish the best in form, function, and aesthetics. Selection of the right dental laboratory is a serious decision with many potential long-term implications.1 The positive financial and emotional impact on our practice of making the right decisions can be dramatic. Building and sustaining the doctor/technician relationship has become a critical element of achieving the ultimate in technical success.
Related to this concept, a recent survey reflects a dramatic need for better doctor/ technician relationships:2 73% of doctors surveyed stated that they use 3 to 5 dental laboratories; 28% of responders stated that they have changed laboratories in the past 2 years. Of these doctors who changed laboratories, 66% cited inconsistent quality as a factor, 24% cited poor communication, and 37% cited the inability of the laboratory to meet their technical needs.
While we can easily agree that differences exist in the quality levels and abilities of both doctors and dental laboratories, do we look at the possible correlation between the survey results cited above and the quality of our interpersonal relationships? If nearly one third of us admit to changing laboratories every 2 years, the implications are rather obvious. Aside from decisions to terminate relationships related to fees or value for service, many doctors and technicians have simply not taken sufficient time to establish a strong, team-based relationship in which they can discover the full impact that this process can have on their collective efforts. Even those of us who have made a thoughtful selection in dental laboratories, and have enjoyed a long-term relationship of 5 or more years, will be tempted to follow the urge to cut and run when the inevitable happens, only to find that the grass usually is not greener on the other side.
Figure 1. Dr. William Stewart (left) and Dirk Albrecht, CDT, build their relationship by personally meeting and discussing cases.

In this article we will take a fictitious, tongue-in-cheek look at the "honeymoon phase" of a doctor/technician relationship, a situation similar to that which can, and most likely has, occurred in some way in many offices. Then we will review some essential leadership principles that can serve as guidelines to assist us in establishing and sustaining a more communicative, productive, and consistent doctor/technician team. Finally, as examples we will look briefly at 2 doctor/technician teams that have shared long-term relationships and discover the essence of what has made their relationships successful.

THE HONEYMOON BEGINS!

As the doctor passed into the second month of the relationship, he remembered his first 12 cases with this new dental laboratory; they had been completed without a hitch! This still-naive doctor, who believed he had finally found the perfect dental laboratory he had always dreamed about, thought, "I'm on cloud nine!" After all, he had personally seen those sterling case samples that were proudly displayed at the recent dental show. Besides, he had heard great things about the laboratory from the local sales representative who regularly visited his office. Just as he had done with the other 4 laboratories in his 10 years in practice, his assistant called the laboratory and asked for boxes, prescriptions, and a fee schedule. That was the standard procedure, and it pretty well took care of all that doctor/laboratory relationship stuff.

THE HONEYMOON IS OVER! ALREADY?

Then one day, case No. 13 came back from the laboratory. The doctor opened the beautifully prepared case box with eager anticipation. He and his staff were viscerally ecstatic at what they saw! There, lying innocently in a personalized, velvet-lined box, were 10 beautifully pressed and layered all-ceramic crowns gleaming with exquisite anatomy and incredible fit to the carefully trimmed dies. The assistant and the doctor double-checked the shade. A perfect B1! A veritable miracle had been delivered from that wonderful dental laboratory. All together, he and his team members took them proudly into the operatory and showed them off to their eager patient. The patient, happily anticipating her new "million-dollar" smile to be bonded in by this amazing dental guru and his team, nodded smugly with approval.
The provisionals were removed, and the beautiful crowns were carefully lined with transparent try-in paste and readied for insertion. (Drum roll please.) The first one went to place. Well, almost to place, that is. Almost? (Gasps were faintly heard behind the masks.) "Nothing that a little adjusting will not correct," the doctor quickly thought to himself. The second one, the third, the fourth, and so on were tried in. They, too, almost fit! (Audible sighs! Then a hint of nervous perspiration began to break out on the assistantís forehead.) In the doctor's first thought that actually personalized "the laboratory" since he first began to use "it," the doctor diplomatically thought to himself in contempt blended with a sarcastic dose of disgust, "What did my lab guy do to cause this?" The staff members simultaneously had similar and, to their credit, private thoughts, "Great lab? Right!" Now the patient, with her radar up and running, started to pick up on the not-so-subtle signals of this drama unfolding around her. She slowly sunk into the chair and looked straight ahead with an obvious glare. "Guru dentist? Yeah sure! This doctor probably used one of those cheap, off-shore labs that I have heard about recently!" She thought angrily about the idea of needing yet another appointment to get what she came in for today. For doctor and his staff members, high anxiety a la Mel Brooks caused by minor impression distortion (unknown to this doctor and staff, who had used a double-arch plastic impression tray with no adhesive while exceeding the working time on this large aesthetic case) became the unfortunate major reality for the day.
The doctor personally made what was his first call into the laboratory. In his heightened emotional state he leveled at least 2 veiled threats to leave the laboratory and complained bitterly about the horrible fit and the price of his case. In the end, he was told it would be a no-charge remake and received several apologies from the laboratory owner, who met the doctor for the first time on the phone. Satisfied, the doctor hung up. Within the month he was happily working with his sixth dental laboratory in 10 years.

YES! THINGS CAN AND WILL GO WRONG!

This fictitious example may seem a bit far-fetched, but we all know that it does not take much, nor does it need to take long, to really put a doctor/ technician relationship to the ultimate test. Sadly, the reasons and the decision to end a relationship are sometimes not even based on any or all of the facts. Maybe understanding and remembering this as a fact of life, as difficult as it may be to swallow, will help us when we are faced with the inevitable call from our dental technician asking for a new impression, warning of possible impression distortion, or suggesting that repreparation to fit the aesthetic or functional needs as outlined in our prescription might be warranted.
There is no way anyone or any procedure can be totally perfect. Within the disciplines of dentistry and dental technology, it is known that fabricating restorations that bring together excellent fit, function, and aesthetics can be a stressful and sometimes elusive technical task. Aesthetics, and even function to a lesser degree, can be quite subjective at times, with beauty being determined in the eye of the beholder. All these things tend to add to the potential stress and reasons for doctor/technician break-ups. The important thing to focus on is the need to learn and practice the leadership skills that it will take to get the entire team, including our laboratory partners, through the adversity that will surely come our way.

HOW WE HANDLE ADVERSITY IS THE SIGN OF A TRUE LEADER

When it hits, adversity tests our abilities as the leader of our business. Of course, the time we took to build a meaningful relationship (or not) will come back to help us (or haunt us), usually during one of the first cataclysmic events. Our handling of situation after situation will be etched into the minds and potential actions and reactions of all those around us, including our patients. There needs to be a healthy balance between the perfection that is always our ultimate goal and the clinical realities with which we all live.

Figure 2. Dr. Stephen Jacobson (right) and Robert Wisler, CDT, have sustained their relationship even in the wake of change brought on by technological advancement.

Laboratory technicians will often act and react to their doctors as their doctors act and react toward them. (This is true in reverse, as well.) Deep down, inside each and every one of us, we need personal and professional relationships in which we are respected and revered. Some people seem to have that interpersonal magnetism that naturally draws those around them to listen and to share. Others need to search deeper and open themselves to developing and improving their relationships, especially their personal leadership skills. With this in mind, let us briefly review some of the qualities found in a leader. These will help guide us in the quest for great long-term relationships with our dental team, patients, and perhaps other personal relationships as well. All professional leaders should have the following:

• a defined vision
• a personal and business philosophy that is specific and consistent
• strong relationships built through time, based on congruent visions
• character that reflects integrity, commitment, and self-discipline in all dealings
• communication skills that include charisma, focus (listening), and compassion
• a positive mental and verbal attitude
• competence in any skills employed in serving others
• a sincere sense of responsibility when things go right and when things go wrong
• a balanced, healthy ego that can accept criticism as well as dispense criticism with grace and effectiveness
• an ability to take the initiative when required and to follow when it is better to do so for others
• generosity and graciousness in dealing with others
• courage to say and do what is necessary when essential for team success
• a real heartfelt passion for people, work, and play
• a realization that real success lies in service for others above service for self.

An example of a strong relationship based on many of the above principles can be found between Dr. William Stewart and Dirk Albrecht, CDT, and his staff at Oral Designs Dental Laboratory, working together in San Antonio, Tex (Figure 1).

Mr. Albrecht has many long-term relationships with his doctors. He attributes this to distinguishing his laboratory with great service and making certain that his customer relationships are the top priority, driving his vision, business decisions, and work culture. When a doctor walks into his laboratory, they can soon feel and see the effects of his vision and begin the process to determine if a relationship could be established and sustained over time.
Dr. Stewart states that excellent communication with his technicians has been vital to him. He likes his dental technicians to take a solution-oriented approach when addressing any problems they may identify. Dr. Stewart also enjoys getting together with his technicians to discuss some of his cases in a more personal way. These positive interpersonal behaviors have sustained this teamís relationship for more than 12 years.
Another example incorporating the above leadership principles is the more than 14-year relationship between Dr. Stephen Jacobson and Robert Wisler, CDT, owner of Alpha Dental Studio of Farmington Hills, Mich (Figure 2). Dr. Jacobson started to utilize a Cerec 3 (Sirona) in his dental office, and a majority of the cases that were once destined for Mr. Wislerís dental laboratory no longer went there. Probably helped by his own desire to keep his lab up to date (he owns a Cerec inLab system), Mr. Wisler decided to put service above self and worked to sustain the relationship. This positive decision was taken despite the high-tech intrusion that temporarily impacted the bottom line of his laboratory business. He offered to teach Dr. Jacobson and his staff how to use a stain and glazing oven to improve further the aesthetic and long-term results of the Cerec 3 restorations. Knowing there would be work that would not be so easily accomplished with the Cerec 3, Mr. Wisler continued to treat Dr. Jacobson as he had always done, with the hope that he would keep as much work as possible still coming into his dental laboratory. That strategy has paid off for this dynamic, continuing relationship.
It is interesting to note that Dr. Jacobson describes a good laboratory as one that can distinguish itself from the competition. He believes that the doctor/technician relationship is sustained by having a technician that produces a predictable, consistent, quality product that is fairly priced and delivered on time. It is the authorís opinion that producing a predictable, consistent, and quality product is a shared responsibility, 50/50 between the doctor and technician. However, distinguishing oneís business from anotherís, as in the preceding examples, is the sole responsibility of the business owner.

CONCLUSION

Superior doctor/technician relationships have the best chance to be sustained when they are born out of, and developed within, a congruent and shared vision. Utilizing solid leadership principles and effective communication skills in an atmosphere of mutual respect will provide the tools needed for success. As doctors and dental technicians, we should direct more of our collective energies toward establishing long-term relationships in which we are willing to share in the problems that we have in common and in discovering the solutions. The best chance that we have to realize our complete human potential lies in our commitment to developing and sustaining healthy, service-above-self relationships.


References

1. Adams DC. Selecting the right dental laboratory for your practice. Dent Today. Oct 2005;24:118-121.

2. Dentist-Laboratory Communications Survey. Dental Products Report. 2004.


Dr. Adams is a graduate of the University of Michigan. He is the owner of Bay Area Consulting, located in Traverse City, Mich. Dr. Adams is also an assistant clinical professor at Medical University of Ohio, Division of Dentistry, Department of Otolaryngology, in Toledo, Ohio. He presents seminars and workshops internationally that are primarily devoted to troubleshooting doctor-laboratory technical issues and to improving doctor/technician relationships. Dr. Adams is listed in Dentistry Today's 8th Annual Top Clinicians in CE. He can be reached at (231) 642-7785 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it .