THE EDITOR'S CORNER
A wise man once said that it is not the number of cases that you start a year that indicates the health of your practice. It is the number of cases that you finish that is the true measure of your success. Each one of us has his own standards for a finished case and the difference between a poor result, an average result and an excellent result often will depend on the quality of the finishing procedures. But, assuming the highest standards and unstinting effort on the part of the operator, a system for keeping track of treatment schedules will expedite finishing of cases.
One way to do this is to pre-program treatment timetables into individual patient treatment records to keep track of the progress of the individual, and into a composite practice treatment record to keep track of the entire practice.
Many orthodontists are now using this kind of pre-recording on patient treatment cards for caries checkups and progress reports. Pre-recording a treatment timetable is an extension of that idea. In the case of the checkups and progress reports, the time interval, let us say six months, is set and some reminder marking is coded onto the treatment card at that interval. To do the same for a treatment timetable requires setting up some estimated schedule of treatment with treatment goals along the way and coding these goals onto the treatment card for individual patient treatment timetable control, making allowance for your average interval between visits plus a margin for error, for alterations in schedule and for extra visits. When this is done on the individual treatment card, it is also recorded in a similar manner in a book or chart which becomes the practice treatment timetable control.
There is no virtue in finding out after two years of treatment that the case is not completed as estimated. Shorter interim goals can be devised and applied. For example, Begg technique has three classical stages. If, for a particular case, one were to estimate six months for Stage 1, three months for Stage 2 and nine months for Stage 3, these are readily coded onto the treatment card and the master control chart. If six months for Stage 1 were considered too long range a goal, this stage could be broken down by, let us say, assigning two months for bite opening. Similarly in Stage 3, the nine-month interval could be broken up into interim goals for uprighting and progress in torque.
Even for treatment systems that divide into stages less readily than Begg therapy, timetables can be devised for bite opening, space closing and other movements. If you expect to see a one-cusp correction in nine months time, then you might plan on a half-cusp correction in four and one-half months and a quarter-cusp correction in two and one-quarter months. Not that one need be that precise, nor that you will always make a perfect estimate, nor that all teeth move on the same timetable, nor that things cannot go wrong and delay treatment; but having a guide to treatment timing calls attention to cases that are not proceeding according to schedule and expedites case finishing.
In making use of the individual patient treatment timetable control system, once your system tells you that a case is not progressing according to its timetable, what do you do about it? First, reevaluate the diagnosis and treatment plan. Was the timetable correct? If not, make a realistic correction in it. Then evaluate patient cooperation. If necessary, arrange a patient and parent conference to review the case plan and goals, and to discuss frankly the problems in treatment. This is not to confront the patient as a slacker or a liar, but rather with the need for more cooperation because the present amount is not accomplishing the job. Also, to explain the alternatives which might include a change of plan, tooth extraction, prolonged treatment, additional fee, termination short of the goal. These are not punitive; they are necessary alternatives.
Having laid out the alternatives, one should set up a timetable for putting them into effect by pre-recording an interval or intervals on the patient's treatment card. If things do not improve within a stated period of time, then one of the alternatives must be instituted. It is fruitless for all concerned to follow a treatment plan that is not working. The earlier in treatment that problems can be identified and discussed, the happier the practice will be.
One should not expect that the individual patient treatment timetable control is sufficient and neglect the practice treatment timetable control. Individual patient control is the day-to-day activity in the practice. Practice control is something else and can provide the practitioner with information that is essential to controlling his practice and expediting the finishing of cases. If a practice treatment timetable control system is maintained and systematically used, no one will get lost in a practice. Almost at a glance, you will have an awareness of the status of all patients. In addition, comparisons of actual treatment times with estimated treatment times throughout treatment can be made. This will either confirm your estimates, your timetable and fee, or indicate necessary adjustments.
Incidentally, if you determine fees based on one and one-half years of active treatment and are actually averaging two years of treatment, you are fooling yourself and cheating yourself out of a substantial percentage of your fee. You are also encouraging unnecessary patient pressure in anticipation of the earlier estimate.
The practice control system may tell you other things about your case finishing that you did not realize. For example, it may be taking you longer to finish cases than you are estimating. On the other hand, you may be shortchanging your case finishing procedures without being aware of it in order to satisfy your overall treatment time estimate. Thus, using the Begg example, if Stages 1 and 2 took, not the nine months that you estimated, but fifteen months, are you giving just three months to Stage 3 instead of the nine months you planned?
If timetable control records are kept for observation and retention patients, it provides an easy way to validate the time interval between these visits and an assessment of the backlog that may be building in the observation file with reference to future case load and in the retention file with reference to present case load.
Installing treatment timetable systems offers the orthodontist more control over his practice and zeros in on one of the most frequently neglected areas of practice administration, which is the expediting of the finishing of cases.
