How valuable is the written word? Think about the professionals who actually depend on the written word to make their living—lawyers, authors, marketers, and journalists, to mention a few. The written word is also extremely important to many other professions, including medicine and dentistry.
How frequently do you receive a professionally written piece of correspondence? What kind of impression does it leave on you? If you’re like me, you’re very impressed. The person who wrote it is obviously very attentive or very organized, or both. Think of the old adage, “the pen is mightier than the sword” in the political arena. Or, “if it isn’t written, it didn’t happen” in terms of medico-legal protection.
Do you know that your ability to succeed is directly proportional to your ability to communicate? It’s true. Your ability to manage your employees hinges on your ability to communicate with them constantly, and written directives are probably the most powerful form of communication. Your ability to attract and hold a patient base is dependent on the way you communicate with them and treat them. Many times the only written form of communication you send to a patient is a cheap postcard that a computer prints out. How endearing is that? First impressions are lasting impressions.
It is frequently customary in our social relations to follow up personal visits with a note or a card. Professionally, what happens when you come across a new patient who presents with a wide range of dental conditions that require a more sophisticated diagnosis and a more complex treatment plan, with attending options? How well equipped are we to handle these cases in terms of documentation and communication with the patient? I would suggest that we often fail to handle the documentation, development, and communication that such complex cases require.
What if there was a way to make it easy for you to never forget what you wanted an employee to do, or when you asked them to do it? What if there was a way for you to send out multiple pieces of correspondence inexpensively and with little effort? What if there was an easy and efficient way for you to capture your decision making, including all alternative treatment options with prognosis? Can you imagine how much more successful and productive you would become, or how much better your level of medico-legal protection would be?
There is now a way to accomplish these tasks, thanks to a convergence of multiple technologies that have only recently made this possible. The resulting solution to many communications problems is called digital dental voice transcription (DDVT). This article discusses the benefits to be gained from organizing and managing our professional communications, and how DDVT can make this possible.
THE POWER OF PERSONAL CORRESPONDENCE
Let’s say a patient visits two healthcare professionals in 1 day. A few days later the patient receives two letters in the mail. The first letter can hardly be differentiated from any piece of ordinary junk mail. In fact, the patient almost trashed it, but recognized the return address of the healthcare professional she recently visited. The mailing address was printed on a computer label. When she looked inside there was a preprinted form letter thanking her for her visit, with the signature of the healthcare professional beneath it.
Now consider letter number two. It’s hand addressed. It has a nice stamp on it. She opens it, and immediately realizes that it’s impossible for this to be a form letter because the letter makes mention of some personal information that is unique to her and her conversation with the healthcare professional. The letter is pleasant, warm, and attentive. To which healthcare professional does this patient feel more connected?
Documentation of clinical procedures performed on a patient is another form of written communication, with medico-legal benefits. In addition, written narratives describing the patient’s oral health status, complete with personalized treatment plan and prognosis, are extremely valuable tools for use with both patients and specialists to whom you refer patients.
If personalized, written communication is such a valuable tool for patient and staff management, for referrals, and for medico-legal documentation, why don’t dentists use it more often? The major reason is that it has been prohibitively time consuming, and therefore not feasible from a financial standpoint.
THE PROHIBITIVE EXPENSE OF COMPREHENSIVE DOCUMENTATION
If we timed how long it took to perform handwritten correspondence, comprehensively written charts, and written staff directives, we would probably find that we spend about as much time writing as we do treating. Have you ever wondered why doctors’ handwriting is so poor? The doctor is trying to get through with his notes because he knows his schedule will back up if he doesn’t. Therefore he “rushes” his writing. If dentists kept great records, dentistry would probably cost 30% more. We don’t get paid for writing, we get paid for treating, and our treatments are usually “piece-meal,” so we have to keep moving or we won’t be profitable. It’s a lot easier to take the time to write up a $20,000 heart transplant case than to write up the application of a sealant.
Consider the following written narrative for sealant application in terms of the time it takes to write, in terms of the fee for the procedure.
Sealant Narrative
Findings: During the course of a periodic exam it was found that said patient had a lower left second molar with a dark stain in a central groove. Using an explorer, I carefully probed the groove. No decay was found.
Diagnosis: A moderate invagination of the enamel into the tooth with organic debris and stain was visible. It is my opinion that this tooth is more susceptible to decay, as is evidenced by the ability of debris to make its way into the invagination and accumulate there.
Treatment recommendations: In my opinion, the treatment of choice would be a sealant.
Alternative Treatment Options
Option No. 1: Do nothing and monitor groove carefully on subsequent visits. Advise the patient to reduce sugar intake and brush at least twice a day using the Bass technique and an OTC fluoride toothpaste.
Option No. 2: Prescribe a prescription strength fluoride. I would instruct the patient to place a small bead of the fluoride on a soft bristled toothbrush with polished end bristles (to reduce the likelihood of toothbrush abrasion), then to apply the fluoride to the teeth for a period of at least 2 minutes, followed by expectoration. I would be careful to instruct the patient not to swallow the fluoride.
Prognosis With and Without Treatments
Suggested treatment recommendation: With careful placement and reasonable home care and regular dental visits, with careful periodic inspection to ensure that the sealant remains intact, and assuming no sudden change in the oral environment, the sealant has a reasonable chance of lasting 5 to 7 years.
Option No. 1: There is a possibility that the tooth might become decayed because the invagination is not possible to keep clean. Reduced sugar intake and OTC fluoride toothpaste afford a degree of protection.
Option No. 2: This is better than option 1 but probably not as good as the treatment of choice recommendation. The prognosis is fair that the tooth would remain decay free if the patient devoted himself to good preventive home care and appropriate application of prescription strength fluoride.
Ask yourself a question. Why do we find it necessary to write long and detailed narratives on major treatments, but find such narratives completely unnecessary for simple, inexpensive treatments? What merits documentation and why? How do we decide? As you can see, the sealant narrative seems ridiculous even though it follows a format recommended by an important dental association as the standard of care for record keeping. Why does the sealant narrative seem ridiculous and an endodontic narrative seem okay?
The answer is, if we took the time to write comprehensive narratives on our “piece-meal” procedures, it’s my contention that we would quickly go out of business. Would it make economic sense for you to perform prophies all day in your dental practice? You’d probably go broke. If you think that’s a bad strategy, think about writing your own charts by hand, assuming you wrote a nice narrative instead of some cryptic chicken scratch. At least when you perform a prophy function you are engaging in a $30/hour task. If you perform your own typing, you are probably performing a $12/hour task. Hardly cost-effective.
However, there is no doubt that written documentation and communication have definite benefits for everyone involved. How, then, can we realize these benefits in a financially feasible fashion? The first step is to take advantage of digital voice recording.
MY FIRST EXPOSURE TO DIGITAL VOICE RECORDING
One day on an airplane I was looking through a catalog and saw the very first digital voice recorder. I ordered one immediately, and I have owned them ever since to manage my thoughts and ideas, for staff management, for development of articles, for treatment planning, and many other uses. There is no tape to rewind and fast-forward, or time delays and confusion. Voice files are stored digitally so that they may be accessed by going to different folders. These days you can even name those folders, and there are many ways to manage voice files. There is no question in my mind that the ability this technology provides for capturing and converting my thoughts to written text has helped me to succeed in my professional career better than I ever could have without the technology.
Here is an easy way you can record a voice file. Buy a cheap microphone for about $9 from radio shack. Plug it into the sound card in the back of your computer or on the side of your laptop. Click on “programs.” Click on “accessories.” Click on “entertainment,” and click on “microphone.” Click the red button, which is the record button, and began speaking into your microphone. Hit “stop” when you’re finished recording, then click on “file save,” type the name of the voice file, and save it to your desktop. Now, right click on the voice file. Click on “mail recipient,” add an e-mail address, and hit the “send” button. There now…you’ve just sent a voice file to a friend.
Voice files are really cool. They sound much better than talking on the telephone, and they’re much better than an answering machine. Instead of accessing messages linearly you may simply treat them as an e-mail. You may choose to delete them, or you may choose to click on the voice file and listen to it. Telephones compress your voice into a very narrow range, where a lot of the frequencies are missing. When you listen to your voice through even a cheap pair of computer speakers from a voice file, it sounds like the person is right there! You’ll be really impressed, and your message is so much more interesting. Voice files are the way to go, and they are much easier than typing!
HOW TO HARNESS THE POWER OF DDVT
Now that you understand how to create voice files, you can take the final step and use DDVT to create all forms of written communication that is personalized to the specific individual or situation for which it is intended. To use DDVT you create a voice file that contains the information you desire, then this file is e-mailed to a DDVT service such as DentalVoice.com, where your file is transcribed into written form and e-mailed back to you. In this modern world of global communications, it is interesting to note that the actual voice files are e-mailed by DentalVoice.com to transcribers in India or other global locations, where labor is so much less expensive than in the United States. Transcribers in India and elsewhere do an excellent job of converting your voice files into written form at a cost that now makes DDVT affordable for dentists. You may have to make minor corrections to their transcriptions, but this is done very quickly. Once you receive the transcribed file, you can then e-mail it to whomever you wish, or print a hard copy if desired.
To use DDVT you will need:
- A digital voice recorder (Olympus DM-1)
- Flash media (Smart Media 64 Megs [holds 12 hours])
- A flash media card reader (hooks into your computer)
- An account with a DDVT service (DentalVoice.com).
The Olympus DM-1 comes with a holder that hooks to your belt like a cell phone. Whenever you want to dictate something you simply pull it out, press “record,” and begin to speak. At the end of the day, you pull the flash media card out of your recorder, plug it into a card reader that is connected to your computer, and then you simply send an e-mail and attach your voice files. The files are sent to the DDVT service where they are transcribed and e-mailed back to you, and they will be waiting for you the next morning. It’s easy.
(Note: To order a detailed audiocassette tape and/or videotape that includes step-by-step instructions for harnessing the power of DDVT, call [800] 454-5161 or visit Simpledental.com.)
WHY HAVEN’T WE EVER DONE THIS BEFORE?
It has been only very recently that several technologies have converged to make DDVT affordable and profitable for the field of dentistry. The technologies are dense flash media, cheap broadband width that allows fast internet connections, the ability to digitize voice files, and more recently, the latest voice compression algorythms that allow files to be compressed 20 to 30 times the size of a WAV file.
DSS is the new voice compression format from Olympus that compresses WAV files. Now you can send long voice messages quickly and cheaply! You can go to OlympusAmerica.com and get a free download of the software that allows you to listen to DSS files. You can experience this technology by sending an e-mail to “DDVT.com,” and a voice message in DSS format and a message in WAV format will come to your e-mail.
Factor in the fact that voice transcription is outsourced via Internet to Asia and other offshore locations, and we experience the economic effects of “globalization” of this previously very expensive service.
WHY NOT USE COMPUTER VOICE TRANSCRIPTION?
The promise of computer voice transcription (talking into the computer, whereby specific software transcribes your voice into the written word) has been around for more than 10 years, but it still has problems. It is much better than it ever was, but it takes a lot of effort and time to make it work. You must be in the same environment every time. You must make frequent corrections. There is a high degree of error as the software attempts to translate an individual human voice into the written word.
With human transcription and a portable digital voice recorder, thoughts can be captured wherever you are, wherever you go, whatever the background noise (within reason). You may be in a car, on a plane, chairside, in your office, walking the dog, etc.
CONCLUSION
As dentists, our communications are generally horrible. Ask any malpractice attorney what kind of records the average dentist keeps and he will simply laugh. How many personalized pieces of written correspondence do you put out per month right now? Probably none. How many fully developed patient narratives do you produce each month? Again, the answer is probably none. How many written directives do you produce to organize and mobilize your employees each month? If you are using verbal commands, chances are that all sorts of tasks are delayed. Delayed tasks decrease productivity. Decreased productivity shrinks profits.
DDVT provides thought capture, which allows a dentist to capture his/her thoughts as they come at random times, allowing management of employees in a more efficient manner. DDVT also provides voice capture, which allows a dentist to capture examination findings, diagnosis, treatment recommendations, alternative treatments, and prognosis with and without treatments. These are then transcribed and used to develop the treatment plan, patient correspondence, and superb medico-legal protection. Using DDVT, the voice can be transcribed for use in correspondence to new patients, professional acquaintances, and anyone else, whether it is for the purposes of business or personal communications.
The written word has a lot of power. Recent technological advances have made it possible for us to harness this power in an easy and cost-effective manner. There are substantial economic benefits to be gained from DDVT because it requires relatively little time on the part of the dentist. Improved patient care and medico-legal protection are additional bonuses that come to us as a result of incorporating this high-tech approach to communications.
Dr. Perkins lectures and writes on efficiency systems in practice management, and developed a software package for the diagnosis and management of periodontal disease. He maintains a private practice in Houston, Tex, and can be contacted at (713) 658-8636 or sperkins@neosoft.com.
Disclosure: Dr. Perkins has a partial financial interest in SimpleDental.com.
