THE EDITOR'S CORNER
The most important thing that I have not done in my practice is that I have neglected to conduct routine parent-patient conferences at regular intervals for progress during treatment, following the completion of treatment, and at the time of dismissal of the patient. I want to discuss how and why I think these meetings should take place.
How to do it is not too difficult to plan. It should be done in twenty- to thirty-minute appointments with the patient and both parents present. Saturday morning should be devoted to this endeavor.
The purposes of the progress meeting are:
1. To review the treatment plan and its implementation to date; progress that has been made; problems that have been encountered.
2. To discuss the level of cooperation of the patient.
3. To reinforce instructions to the patient.
4. To renew everyone's understanding of the goals of treatment and the means necessary to arrive at those goals.
5. To discuss specific problem areas of treatment -- care of appliances, keeping appointments, wearing headgear or elastics, keeping time records, toothbrushing, chewing gum.
6. To discuss finances if necessary.
7. To explain any change in treatment plan that may be required, including the possibility of termination of treatment or setting a deadline for the termination of treatment.
The purposes of the post-treatment conference are:
1. To show what has been accomplished in treatment.
2. To emphasize the importance of cooperation in the post-treatment period of retention and settling.
3. To explain to patient and parents what to expect in the future.
4. To establish the pattern for the post-treatment period.
5. To refer the patient to the family dentist for a check-up.
The purposes of the dismissal visit are:
1. To show the patient and parents what the final results are.
2. To explain what to expect in the future.
3. To speak about future care of the teeth.
4. To conclude a long, close relationship on a note of positive optimism.
The interval between progress visits may vary, since you might want to see a recalcitrant patient and his parents more often. However, an average interval might be six months. If active treatment were to take two years, there would be three progress visits, one posttreatment visit and one dismissal visit for a total of five visits for that case.
The trouble is that if you have an active case load of 200 cases and you are going to see them at least twice a year and you have 300 retention cases to see once, if you work 40 Saturdays a year, you need something like twelve conference appointments every Saturday in order to get them all in. At twenty minutes each, it will take four hours every Saturday. At thirty minutes each, it will take six hours. How long it actually takes will be a matter of individual experience, but, obviously, it would be well to organize these conferences very well in order to expedite them. Of course, this means that you will have to spend some time with each case preparing the conference. However, this will become routine and the information to be discussed should appear on the patient's diagnostic, treatment, and financial records.
It is a problem that Saturday may also be the best available day for case presentation conferences and, in the practice described, there would be about two of these a week. Therefore, we are talking about a Saturday that will be a five to eight hour working day. If you are not accustomed to Saturdays that are that long, try to make some of these conferences on weekday mornings. Perhaps early in the day.
What is there about these conferences that I think is so important that I contemplate including four to six "unproductive" hours in the work week? They promote cooperation, they clear up misconceptions and misunderstandings, they enhance your professional image, they permit you to provide a better service. It is just amazing how parents and patient can forget what you said just six months ago about the need for extracting permanent teeth. Now that you are ready to proceed with that, you can remind them about it. It is amazing how a patient can hear you say that they should wear rubber bands full time, twenty-four hours a day and not understand that this means sleeping time too. It is astonishing how short a period of time a headgear or plastic appliance can be worn in spite of what you consider to have been repeated, clear, explicit instructions to patient and parent, reinforced by written instructions at the time of insertion of the appliance. Similarly, it can be downright depressing how patients, and parents too, can ignore your instructions on candy and gum, on proper toothbrushing, on keeping appointments, on referrals to the family dentist.
So, here is an opportunity for a formal get-together. The ceremonial nature of it makes it more impressive than brief demonstrations or remonstrations at treatment visits.
What is the meeting like? You bring diagnostic, treatment and financial records, and progress models, photographs, cephs, and x-rays as indicated. Certainly these things should be all brought to the dismissal meeting. And you have an opportunity to show and tell about treatment, progress, cooperation, results, and the health and care of the teeth. Patient and parents have an opportunity to ask questions about any part of the treatment and they should go away knowing what progress has been achieved, what remains to be done, what you plan to do and what they must do to make treatment an optimum success. If they don't go away thinking you're the greatest orthodontist in the world, at least they will be thinking that you care to an extraordinary degree about what happens to the course of treatment.
If the parents have been in arrears in payment, now is the time to tactfully, but openly speak of that problem as well. If there has been undue damage and breakage or loss of appliances, this must be discussed thoroughly and, if necessary, the need for an additional appliance fee explained.
Could all this not be done by auxiliary personnel? Probably. But, I think that these conferences should be conducted by the doctor. Some of the more mechanical tasks should be assigned to auxiliary personnel to free the doctor for this important professional task. 
