By Eric K. Curtis, DDS, MA
Dr. Nathan Yang â06 was floored when his receptionist disappeared. Yang and his wife, Dr. Joanne Jeng â04, had been thrilled about the practice they bought in San Francisco in 2008. But the excitement soon turned to dismay when the woman working the front desk left without warning, creating both a security breach and a practice management headache. Yang, who teaches part-time at the Dugoni School of Dentistry, thought long and hard about his options. Instead of hiring a new receptionist, he installed an electronic front desk.
Yangâs solution involves two separate Web-based services, Demandforce and ZocDoc, the latter of which was suggested to him by Pacific alumnus Dr. Jared Pool â09. Together, the services create an integrated system for managing patient flow. The system puts Yangâs practice among the first five dentists in his zip code to appear during Google searches. It invites patients and potential patients to view available openings online. It prompts patients to make, confirm, cancel and reschedule their own appointments, or leave a message for his assistant to call them back. It then sends patients appointment reminders by email or text message.
This system, synchronized with the officeâs existing scheduling software, allows Yang and his assistant to monitor their appointment books and interact with patients from any location. Much of this patient interaction occurs in the operatory. âMy assistant can make appointments and handle patient questions while Iâm looking at X-rays,â Yang says. The office computer generates recall reminders and even sends patients surveys via smart phone after appointments to gauge their experiences, transforming Yangâs patient base into a private, interactive social medium. âIf I get a bad comment,â he says, âI have a staff meeting right away to fix the problem.â
The two services together cost less than $7,000 per year to maintain. âI realized I could either set up an electronic front desk,â Yang says, âor hire a new person at $25 an hour, with the accompanying ebb and flow of emotions that hurt us before.â With his virtual receptionist up and running, Yang discovered that his scheduling improved. Open spots filled up with less hassle. His no-shows dropped. âI havenât really had a front-desk employee now for four years,â he says.
Yang concedes that some people are âweirded outâ by his technological leap of faith. âIt might seem sort of âout there,ââ he says of his lack of a human receptionist, but insists he is technologically conservative. He doesnât maintain a conventional website, or an office Facebook presence, and he doesnât participate in crowd-sourcing platforms such as Yelp. âI donât believe in tech for techâs sake,â Yang says, âbut I have to ask myself whatâs reasonable. I want to be accessible.â His system, he says, is low key and professional, and not self-promoting: âThere is no way my patients canât get in touch with me. Iâve found a way to communicate without being overbearing. Itâs fast, easy and discreet.â
[pullquote]The upshot is this: Nate Yang runs his practice over the Internet using his smart phone. Welcome to the brave new world of communications technology.[/pullquote]
Dr. Parag Kachalia â01, assistant professor and vice chair of pre-clinical education, research and technology in the Dugoni Schoolâs new Department of Integrated Reconstructive Dental Sciences, keeps his finger on the pulse of technical innovation. Communication is the essence of both education and patient care, and the Dugoni School of Dentistry has worked hard to attune the flexibility and sensibilities of its humanistic philosophy to changing technologies. âWe try to analyze not just whatâs happening now but also anticipate conditions two to five years out,â Kachalia says.
Whatâs happening, of course, includes new technology. The dental school, which previously pioneered clinical studies of InvisalignÂź, is currently testing a system for digital dentures with a computer-based occlusal scheme. On the first appointment, the dentist takes a traditional impression and creates a jig to capture occlusal records; on the second appointment, the dentist delivers the denture.
Such technologies may improve both clinical practice and the quality of the educational experience itself. The 3M ESPE company recently donated to the school 12 Lava Chairside Optical Scanner (COS) devices, digital impression machines that let dentists produce a three-dimensional model of a patientâs mouth. The fact that studentsâbringing long-practiced video game-playing skills to bearâcan easily manipulate the hardware to visualize the mouthâs hidden recesses in magnified 3-D signals a truly collaborative approach to education. Developments such as the COS, Kachalia says, âallow us to dramatically bring the intraoral environment out of the mouth and in front of everyone.â
But Kachalia explains that the dental schoolâs sensitivity to trends in technology also involves a close reading of how people accept and use that technology. Accordingly, instructors are exploring the educational opportunities of social media, preparing virtual classrooms on Facebook and experimenting with communications via a Twitter feed. (Email, it turns out, is so ten minutes agoâwhile electronic messaging used to be the vehicle of choice for rapid information exchange, people have become bombarded with spam to the point that many mostly ignore it.)
To be sure, social media represents both rewards and risks for dentistry with pitfalls lurking next to the promises. Facebook, as Kachalia describes it, may be âthis generationâs gathering around the coffee table,â but confidentiality is a concern, as are implications for ethics and professionalism. âFacebook has great educational potential,â he says. âWe need to learn how to properly navigate it and put up appropriate filters.â
Yang believes that one danger of social media for practitioners is the temptation to chase immediate gratification; some may see those communication channels as a vehicle for making quick money without consequences. Another risk lies in giving the public open access to pass judgment on a dentistâs practice. The instant interactions that social media provide invite raw, unvarnished comments that can severely affect a dentistâs reputationâcomments that patient confidentiality laws prevent the dentist from fully addressing. When you give the world a free canvas to paint on, Yang says, âYou have to take the bad with the good.â
[pullquote]E-mail, it turns out, is so ten minutes ago…[/pullquote]
Yelp, the user review website, also presents a double-edged sword. While unedited patient testimonials can be a source of free advertising, the ability to post anonymously can provoke abuse, because, true or false, statements posted online may come to define a dentist. âSites like Yelp, Twitter and Facebook are powerful tools,â Yang says, âthat can quickly build or tear down your practice.â
âYou canât base your whole professional identity on whether you have two or four stars,â observes Kachalia, referring to Yelpâs rating system. âWe need to be careful as a profession to create value within ourselves.â
One of the complications of this everyone-in-touch age is that communication is often multidirectional. âAt school you have to bridge communications in a triangle, from faculty to students, then from students to patients,â Kachalia says. In one such bridge-building venture last year, the school introduced iPads, loaded with an application aimed at communicating with patients, into the Main Clinic. Students pull up the DDS General Practitioner patient education app to show photos, diagrams and animated images of common oral conditions and dental procedures, as well as present clinical findings, prevention recommendations and treatment plan options.
The electronic world has altered not just how students teach patients but how the faculty teaches students. Students today learn differently, Kachalia reflects. Having grown up in an environment of continuous stimulation, they may chafe at the traditional âsage-on-the-stageâ lecture format. They are more comfortable with a two-way model of education. They want to be able to respond. More than just facts, they want applications. And because students have quick access to information, instructors must keep very current. âI can be lecturing,â Kachalia says, âand a student might be Googling to verify what Iâm saying.â
Yet for all the potential insecurities that technology may serve up, even mature Pacific alumni remain enthusiastic about its possibilities. Dr. Kenneth Frangadakis â66 is founding partner of a multi-specialty dental group in Cupertino, California, most of whose partners and associates are also Pacific grads. âAs dentists,â he says, âwe have to stay well educated and try to stay ahead of developments. If you are just keeping up, youâre falling behind.â
While Frangadakis admits heâs a âhybridâ dentistââI write in the chart, and the staff puts it into the computerââhe keeps a careful eye on new developments. His current favorite clinical technologies include digital X-rays (âWeâre upgrading from phosphor plates to sensorsâ), the iTero digital impression system and the Onpharma buffering setup for local anesthetic invented by Pacific alumnus Dr. Mic Falkel â87, which Frangadakis liked so much that he invested in the company. âIt really works,â Frangadakis enthuses. âThe anesthetic is fast, it doesnât hurt and itâs very profound.â The next piece of equipment on his list: âWe need to get a three-dimensional imaging machine.â Frangadakis is also planning to incorporate an automated patient messaging software system, similar to Demandforce, called Smile Reminder.
Pacific alumni agree that no amount of technical innovation can compensate for poor patient care or sloppy interpersonal skills. âThere is something to be said for treating people like family,â says Yang. âRegardless of technology, you still have to gain and keep peopleâs trust. You have to believe that itâs a privilege to treat people and an honor to make a living by helping people.â
âSuccessful practice is about giving value and service,â Frangadakis says. âTake care of people the way you want to be taken care of.â
Eric K. Curtis â85, DDS, of Stafford, Arizona, is a contributor to Contact Point and is the author of A Century of Smiles, a historical book covering the dental schoolâs first 100 years.