5 Ways to Stop Running Late – PDP176

Jaz’s Introduction:
So in my values, not breaking that promise and being punctual is actually really important. Now, interesting thing that I think maybe Jordan Peterson said, or I read somewhere, was that this isn’t like a blanket rule. Like, even with me, if I’m running late, I’m not happy. However, there are some things that I value more than other things.

So, for example, going to a party. Like, if I’m late to a party, I’m chill. I’m okay. Because parties aren’t my highest values. Not anymore, they used to be, but that was a long time ago, right? So they’re not my highest value. So if I have to do a few tasks or quick do a few emails before I have to go to a party, for example, and I end up running late for that party, it’s okay with me.

That can sit okay with me. But if I’ve agreed to meet a friend at a cafe or some friends at restaurants, then you bet I’ll be there on time, maybe even early. Because I value those kinds of encounters and those relationships. Now bringing about dentistry, a long time ago I made an episode called Six Signs That You’re A Comprehensive Dentist.

And one of the signs was that you’re running late a lot because you’re trying to give your patient a lot of value. And you talk to them, and you nurture them and you answer all their questions and give them that little bit extra of yourself. And if that sometimes means you’re a few minutes late. I think that’s worth it.

But I have got to terms that in operative dentistry, we can sometimes run late and it’s okay. You’ve got to accept that sometimes you underestimate the situation, especially when we have less experience. For example, that caries cavity, which was way bigger than you anticipated, or that extraction where you didn’t actually notice that that mesial root had a bit of a curve on it.

So these little things, sometimes we underestimate it. Sometimes what happens is that the air abrasion sand needs changing, and the water needs changing at the same time, and your ID block didn’t work, and that was the case that you decided to finally pick up your camera again, dust it off, and start taking photos step by step, because Jaz told you to do that.

Oh, and of course you found a crack under the amalgam, so you took a photo of that and then you showed the patient and then that led to the discussion of all the different things that can happen for that crack tooth, so you can see how sometimes it’s just Sod’s Law and you’re going to run late. However, what today is about, what this episode is about, is to make sure that it’s not happening consistently.

If you’re running consistently late, there’s something systematically wrong. There’s a bigger picture problem, which me and Dr. Nikhil Kanani, my guest today, are going to cover. So it’s the Five Ways to Stop Running Late. The kind of advice he focused on was actionable. I said, Nikhil, please make it very actionable for dentists and their DAs or nurses to be able to implement.

So naturally it contains themes of note taking, protocols, and team working to be able to achieve this. It’s a more lighthearted episode of Protrusive, but it’s still eligible for CPD because it still meets the GDC development outcomes of B, which is like the effective management of yourself and working as a team to give your patient the best.

And also outcome D, which is about maintaining the right skills, behaviors, and attitudes. Now, talking of CPD and being lighthearted, I also did something live last night on our brand new shiny platform, Protrusive Guidance. If you’re a member of the old app, even if you did like a free trial in the past, that old app was good to host the videos, but we totally outgrew it.

We now have a thriving community. So the website for that is protrusive. app, but the whole network is called Protrusive Guidance. It’s a name that you guys helped me to come up with. And actually it was really nice going live on a light hearted topic, which was my biggest regrets in dentistry. And I had like some clinical regrets I had, including some radiographs, some perforations I’d done in the past, as well as some more non clinical and lifestyle and general work environment regrets that I’ve had or some of my colleagues have had.

I just want to give a quick shout out to some of the people who were there engaging on the live last night. And these are all members of Protrusive Guidance. So, April, Alex, Mustafa, Zach, Oli, Megan, Shilpi, Anna, Nisha, and Lorna. I mean, there was some others as well. I mean, thank you so much for engaging last night.

I think that was quite a special connection that we’re building on Protrusive Guidance. So, if you’re a dentist who craves a sense of community and a safe place. The way we’re keeping Protrusive Guidance a safe space is that to be able to enter the network, you have to answer some questions. And if we’re not convinced, if you have any little doubt that you’re not a dentist or dental professional, we will email you.

And sometimes we’ll be asking for certificates of proof if you can’t find you in the dental register. This is all a bit like airport security. Like, no one likes it, it’s a nuisance, but we’re all glad that it happened. To make this network a nice and safe place that we can actually share our failures.

That’s what I’m most excited about as we grow our community in the next year. I have added the replay, the one hour replay of my biggest regrets in dentistry to the webinar replay section, which is part of the ultimate education plan of Protrusive Guidance. Home of the nicest and geekiest dentists in the world.

So do check out protrusive. app to get in on that. There’s also a one week free trial you can do of that plan to watch that video and maybe vertipreps for plonkers or quick and slick rubber dam while you’re there, and of course soon we’ll also be launching sectioning school. Now in the sequence of recording, I don’t even know if I introduced myself or not for some new listeners, maybe.

Protrusive Dental Pearl:
Hello, Protruserati. I’m Jaz Gulati and welcome back to another episode. Every PDP episode we give you a Protrusive Dental Pearl, a quick win and some clinical or sometimes communication-based advice. But today is recommending a product that I’ve been in love with for the last 18 months. It’s completely changed my restorative dentistry.

It’s a matrix band. Now, as you might’ve seen mine in Maciek’s video on YouTube and the previous episode, which is called Which is the Best Matrix System. And on that episode, we discussed my challenges of using different matrices, but recognizing that actually you do need different matrices. You can’t just have one matrix to rule them all.

It’s just there’s no such thing as a perfect matrix for every single cavity design. But since I’ve been using the greater curve matrix patterns for about 18 months now, about 70 percent of the restorations I’m doing, I’m using the greater curve, which is pretty impressive. It’s still not 100%, nothing’s 100%.

But to go from a matrix that I knew existed in America to it now becoming a staple in my daily restorative dentistry is pretty cool when I think about it. Now, those of our colleagues from America listening, they’re thinking, wait, has Jaz just discovered the greater curve matrix band? We’ve been using this for years.

And it’s true. In fact, there was actually some UK dentists that were importing the greater curve matrix band. Because they realized on forums like in Dentaltown that actually this is the best matrix. Now, what happened a little while ago is Dr. Sunny Sedana got the license to dispute the Greater Curve Matrix Band in the UK.

And he’s the only one who does the courses on the Matrix Bands. Now, wherever you are in the world, find your Greater Curve dealer and check it out. It’s a really fantastic matrix and it’s going to blow your mind that you don’t even need to use a wedge. Like, the seal it makes is so good, you don’t even need to use a wedge.

And then you’re thinking, well, how are you going to get a contact then? Well, this is going to blow your mind even more. There’s some special techniques, which I don’t want to freak you out, I guess, but there’s something called the contact opening technique, which means that actually you don’t need a wedge.

You don’t even need a ring, which is why for convenience sake, and also for those subgingival areas, like the seal, it gets subgingival is brilliant. And if you’ve got patients like me who are typically over 60, have got root caries, inflamed gums and bleeding, it’s just solid matrix to reduce those direct restorative headaches that we have.

If you’re working, like, a high end aesthetic clinic, then probably you’re not going to be using greater curve that much. I mean, actually, Sunny would disagree with me. He actually uses it for everything, including, like, veneers and stuff, and I actually use it for class threes, and it works really well anteriorly.

But for me, my bread and butter is posterior dentistry. But just a standard matrix band with a greater curve has just done wonders for my efficiency and my stress. My stress is way lower now that I’ve discovered greater curve. Now you could just do what I did and buy the GreaterCurve and start using it and we could talk about it on our network, Protrusive Guidance, some tips and tricks because Sunny’s on Protrusive Guidance.

But sometimes I was falling short and it’s only after I went on Sunny’s course that I realized those little nuances and little mistakes that I was making. So top tip is wherever you are in the world, use a greater curve matrix band. And number two is sometimes to get the best result, you have to kind of go on the course.

Now Sunny’s course covers a lot more than just a greater curve matrix band. But if you just walk away with that one skill of using this new matrix band day in, day out for your challenging cases, you will absolutely thank me. Sunny has put together a little discount code. It’s called Protrusive. So if you go to drecomposite.com, like DRE Composite like Dr. Dre.

So it’s drecomposite.com and if you use a coupon code Protrusive to book on to the Direct Restorative Excellence Composite course, Sunny’s going to throw in a hundred pounds worth of the bands themselves. That’s a lot of bands to get through. That’s particularly good if you’re an associate and you want to just get the ball rolling.

You don’t want to go on a course and not be able to implement straight away. So although you get a starter kit to get those extra bands for a hundred pounds to keep you going while you work on your principle and convince your entire practice to start implementing and using the greater curve, it will be a nice start.

So once again, the coupon code as ever is PROTRUSIVE, all capital letters on drecomposite.com. I’ll put the link in the show notes so you can see yourself what the fuss is about and exactly why I’ve partnered with Sunny to bring you this pearl today. That’s now dive into the main interview and I’ll catch you in the outro.

Main Episode:
Nik, Nikhil Kanani, just in case you never know, I promise you I won’t introduce you like this, but Nikhil Kanani, welcome to the Protrusive Dental Podcast. How are you?

[Nikhil]
Thanks so much for that intro Jaz. I can’t believe you did that.

[Jaz]
You’re the first person ever who’s been introduced on the Protrusive Dental Podcast with their own song, right? So for those who don’t know, I mean, I feel like you’re my tribe. You truly no gains by Serrani. Obviously, the classic song we used to dance to a lot about 14 years ago, right? That’s how we kind of used to party together at dance school. That’s how I got to know you. And so it’s funny, right? Who would have thought all those years ago that we’re here, sat in front of a laptop, having a chat and helping others, right?

[Nikhil]
Absolutely. It’s been a journey. I would never have thought we’d be sitting here right now, 14, 15 years ago, so it’s great to be here.

[Jaz]
Today, we are tackling something quite big, quite, I don’t know if the right term is endemic. Is that a good word to use? Like, we all do it, we’re all guilty of it, and it happens for various reasons, but through this podcast, with our time together, Nikhil, I want the Protrusive to walk away with some tactics and strategies to make sure that we can stop running late.

Now it’s funny we’re saying this because obviously I’ve turned up 24 minutes late to our recording. Right. And so just to give people the background sub-story but save the violins for another time. So my son unfortunately has been hospitalized for a couple of nights. Last night was our first night back at home, but the two nights before then I spent in a cold hostel room worrying about my son.

He’s okay now. It’s all good. He was a nasty vomiting bug. But the lesson there is and why it’s relatable to what we’re talking about is sometimes shit happens, right? Sometimes you need to extirpate the pulp and you just need to do right by your patient and you’re going to run late.

Sometimes that extraction, which you thought was simple, wasn’t simple after all. And it just, the bone was like marble and you’re going to run late, right? And so when sometimes those big things happen in your practice, it’s unavoidable. What we’re talking about, Nikhil is daily reasons for running late, right?

And people are on a daily basis, they’re finding themselves are five, ten minutes late consistently, a bit like me. So I’m actually excited to hear about all the things that you have to say. Before we dive into that, Nikhil, tell us about yourself, about the kind of dentistry that you do. How did you get to think about these kinds of topics and obviously share these with your colleagues and teach on this kind of stuff as well?

[Nikhil]
Well, Jaz, I graduated dental school like yourself in the UK, and then I went on a journey. So I did my first year as a foundation dentist, like a lot of graduates do in the UK. And then I wasn’t quite sure what I wanted to do. So I went exploring. So I did a couple of years in the hospital, working in different hospital departments and gained some valuable skills and insights.

And then I decided actually general dentistry was for me. So I went back into general practice and I worked in the NHS. Which worked there for a few good few years in mixed practice and I found this really tough for a number of reasons. Firstly the system was very tough to work in for me because I’d like to provide like yourself gold standard dentistry And I didn’t feel I had the time or resources to do that.

So I went on this whole journey to figure out what I wanted to do, but also to do the type of dentistry I wanted to do, which has allowed me to end up where I am now, which is in private practice in London. And I love what I do. I offer a wide range of treatments to my patients and I like to focus on aesthetic stuff, but I do offer general dentistry as well. So it’s somewhere-

[Jaz]
Something you’re a true generalist, you’re a true generalist like me, you’re a true generalist.

[Nikhil]
I am.

[Jaz]
Are there any things that you don’t do? Like sometimes part of the lesson that I want to pass on to Protruserati always is, it’s okay to say that, okay, these are four or five areas that interest me, that I want to do to serve my population of patients.

And all these things, the specialists have to feed their families as well. Let me refer these out. So what have you accepted as, your main things? And what are the things that you’ve accepted that, you know what? I don’t need to think about this anymore because I’m going to choose to refer this.

[Nikhil]
So, I think it comes down to two things. First thing, what do you like doing and what don’t you like doing, and also what are within your competencies and what are not, and whether you want to expand your skill set, in which case go and learn more, or you want to refer to someone who has those skills. So, I don’t particularly enjoy doing non surgical perio treatments, so I refer that, as well as at the moment, soft tissue grafting for perio.

I tend to refer all of those things and recently I started to cut down the number of root canals I’m doing. I do enjoy it, but I find that there are people who can do it faster and better than I can. So I refer a lot of my endos out in-house to our endodontists in house as well. So those are the two things we-

[Jaz]
A funny story about that, Nikhil, if you don’t mind just a detour, there is, you mentioned about people being able to do it faster, better than you. And that’s so true. I used to work in a practice whereby our hourly rate was pretty good, right? It was fancy practice and not earlier. It was good. And because I was doing everything by the book and endo something you want to be very meticulous and stuff the amount of time I was spending on endo meant that the patient was paying a fee that was sizable, which is good it reflected my hard work and I was proud of it.

So don’t get me wrong. There’s no mindset issue I was proud to charge that fee but the specialist endodontist down the road was about 20 percent cheaper than me. It’s just the way it works. And so that didn’t sit well with me. I know that that is a mindset issue there, right? That didn’t sit well with me, but just in the theme of sometimes what’s in the best interest of the patient is to actually focus on certain things and be the best you can be in that and be happy to refer us.

So it’s good that you’ve identified, okay, root canal says there is someone available in house in your practice. And I’m a big fan. We had this meeting, like, the other month in our practice, Nikhil, with all the other associates, right? I’m an associate as well. That’s it, okay, like I do the TMD stuff. I’m happy to tackle your more difficult extractions.

I’m cool with that. Any complex tooth wear occlusion type of people, send them to me. But what do you guys want, right? So all the Botox I’ll send to you. All the sort of alignment that’s a bit more simple. That you’re, hey, Wilson, you’re starting Invisalign. Let me send those simple cases to you kind of thing.

So it’s nice to have that sort of skill mix in a practice whereby we know, okay, who likes doing what and who’s good at doing what? So even within the practice, you had this referral network.

[Nikhil]
So if you keep all the work for yourself, that’s fine. However, if you refer patients within the practice, quite often patients can get better care if the other practitioners are more skilled in certain areas, but also they can get their treatment plans done a bit quicker sometimes because they’re able to see different people simultaneously in different streams. So I think if you work within a multidisciplinary team, it can really elevate your dentistry and make it more smooth and a better journey for your patient.

[Jaz]
Perfect. And now part of making your patient’s journey better, it’s important to run on time, right? It’s like, especially if you’re in a kind of practice that pride yourself on quality and your whole marketing message and everything is all about quality, then if you’re consistently making your patients wait.

It’s not nice and something that I’ve suffered with and so I’ve had some strategies that we’ve employed to help stop me running late. Basically. It’s like a practice effort to help start Jaz running late, right? And quite often I’ll skip my breaks because I will do admin or I’ll just catch up or I’ll just you know spend a bit more time with this patient or whatever.

So sometimes these things that we we do with the way we torture ourselves but what are the strategies so if you start with the first, I think you have got five strategies want to discuss basically.

[Nikhil]
That’s right.

[Jaz]
What’s the first strategy? And maybe before we do that, maybe in tandem with the five strategies, maybe you’re going to cover the subject of why we run late.

[Nikhil]
Yes. So number one, like anything in life is preparation. So for those of you who work in the hospital or have seen the way surgeons work, at the beginning of their list in the day, they will have a team meeting and they’ll go through every single patient on the list. What equipment’s required, any special considerations, and then every member of staff on the team will know what’s going to happen, and roughly their plan of action.

Okay, so why don’t we do the same in dentistry? So what I would recommend is, before you start your day, get into work a bit earlier, and every day have this meeting. It’ll only take a minute with your nurse. With each patient you will write down or verbally agree. with the nurse, what they need. So for example, if you’ve got checkup, filling and an extraction on the first patient need checkup tray or need bite wings, second patient will need your specific equipment for your composite.

Third patient, you’ll need the specific forceps, this specific anesthetic. And over time, of course, when you work with your nurse, you’ll get more familiar, but there might be some specifics to each case which you need. If the nurse is aware of this beforehand, okay, the room will be set up right, you’ll have the right equipment in the room, there’ll be less faff, so the nurse won’t keep going in and out of the room to get equipment that you need. And therefore you’ll be more efficient and you can focus on the task at hand. So that’s my first key tip, that be prepared.

[Jaz]
It’s a simple one, but so effective. It’s something that me and Zoe do and if I’m working with a different nurse, Zoe’s doing other things on decon whatever, then especially because we don’t have that as good a relationship that me and Zoe have at work, then I’ll spend a bit more time doing that.

But the way Zoe does it is that she’s kind of done all this stuff for me, and then she’s just double-checking Jaz, the third patient. I think I’m using G-ænial. Is that correct? I’m like, yes. Or the fourth one, you’re using the greater curve matrix band and usually the matrix bands. I’m like, I’m not sure, but more, 70 percent chance, looking at the radiograph is subgingival.

I’ll be using this matrix man, for example, right? So she likes to know and set that up basically, which is great. And that has helped us profoundly in terms of running in time and just being organized and slick and making sure that sometimes we’ve got one scanner, right? And so just plan. Okay, who’s going to use a scanner first rather than panicking at the time.

So looking ahead and being prepared is totally a great tip. Okay. I had another guest before, Dr. Nick Simon, who talks about doing ortho as a GDP. And he mentioned about coming into work every morning at 8am, just like you said, basically, and just going through it all, basically. And other business gurus would recommend that have a team huddle, right?

So what you’re describing is kind of like a team huddle, but almost like in a surgery specific, just you and your assistant having that in a mini huddle to make sure that you’ve got a nice smooth checklist for the day.

[Nikhil]
Absolutely. Yes. And I found it. It’s allowed me to be more time efficient in my appointments and cuts out that a waste time where you’re waiting for things to come for your patients because you haven’t prepared well enough and before the appointment.

[Jaz]
If an assistant or nurse is not used to this and then you imagine being that practitioner who’s trying to lead from the bottom and say you know what I’m going to suggest a change. Any change can be met with some resistance.

So I think what we can learn from just basic psychology is you can’t just come in and give all these orders for change. Two techniques that I can think of, one would be to just give a good, clear justification of why we’re doing this, so they understand why. But the other one would be, and this is a little bit cheeky, okay, a little bit cheeky, which is basically, you go to your assistant and say, hmm, I’m having this issue where sometimes we’re running late because I feel so bad for you, you have to run down the stairs and get this piece of equipment, and then suddenly you have to get the Panavia, and we didn’t know. Is there any way that you think we can maybe streamline this and if you make it their idea, then it’ll happen.

[Nikhil]
That’s a great way of doing it. And actually, it is, it’s sort of almost like co diagnosis. It is.

[Jaz]
That’s exactly it. So just if anyone’s getting some resistance, hopefully you’re working with a nice individual and you can streamline this. But if you’re getting some resistance, those are two ideas. So I think that one for me, Nikhil personally, that’s no longer the reason I run late. I think we’ve dealt with that one. doing all the things that you said to make sure we got a nice checklist. What is the second strategy?

[Nikhil]
Number two is also a very simple one, but it’s very hard for low dentists. Stick to your time allocation, and that sounds very simple, but make sure you have booked enough time for the procedure you have in hand. Now, that’s not always going to happen, but 9 times out of 10 you should run on time. So have enough time for what you’re doing, and enough time for the record keeping, so that everything runs on time.

Because we all know the knock-on effect, running late. Has on the whole day and it can have an effect on your stress levels. It can have an effect on your nurse’s stress levels and her mood with you. It can have an effect on the quality potentially of your work and later patients because you’re rushing.

So having that extra time is not just about the patient in the chair. It’s about the whole day and the whole running of the practice. It can put pressure on the reception team because if you have patients waiting in the waiting room, they’ll be asking how long is he going to be? How long is he going to be?

And that. Again, they send you what it’s like, you get a message pop up on your screen. Just going to ask you Jaz, sorry to disturb you, but are you going to be much longer? The patient’s annoyed and then it’s even more stress for you.

[Jaz]
So it’s a vicious cycle. For reception, by the way, they have a button they’ve click on that automatically generate that message. So how long will it be? So they don’t have to type it out anymore. We’ve been through this a lot. So, totally man, totally.

[Nikhil]
But also another factor is a lot of practices. I mean, I mentor quite a few younger dentists and they are sometimes. Not get taken advantage of but they think they’re a bit of a pushover by reception trying to squeeze in patients during the day and they shorten some of the appointments that are there so for example a checkup appointment or a treatment appointment and then they’re squeezing them in without your consent or your permission sometimes And that has a big knock on effect so making sure the greater team is involved in the process and understands where the boundaries are and what they are and allowed to do and that they’re not allowed to change your diary is so important because otherwise you can get yourself in a right old mess during the day and it can really have a bad effect on you.

[Jaz]
When things go wrong, like, why do airplanes fall? It’s not because one thing, it’s about eight or different things that align and happen. So if you look at medical legal issues, right? Of the eight things that you’re having a bad day anyway, you didn’t have enough sleep and then you have the patient is really awkward and on that day that material that you needed was running out and on that day they squeeze in a few patients.

It’s just another reason to lead to issues basically. So definitely that’s a huge red flag for your list to be managed in that way. Let me tell you the way that we do it so that it’s actually done in a favorable way. What we learned is that I can run late because I talk a lot and I try and give my patients lots of value and stuff.

And so what we do now is if I say, okay, Zoe, I’m going to need 45 minutes per procedure. Okay. Zoe has my full permission to use her judgment and her excellent experience to put 50 or 55 there. She’ll never shorten it. Okay. But I said, listen, Zoe, if I’m just in this, I haven’t really thought about it.

I’m just talking to the patient. I’ve said something just put that there basically. Okay. Just give it extra time. If you think it’s a new patient, it’s an awkward patient, whatever. Right. So Zoe’s got full permission to add extra time and that’s fine. I think where that can run into trouble if that happens too often is.

In a practice where I work, we charge by time. So you don’t want to keep giving away free time, because if you’re charging 45 minutes, you’re keeping 50 minutes away, then really you’re not doing anything. So what Zoe is happy to do, and I’ve trained her for this, okay, if this is happening a few more times, then actually you should say, actually Jaz, I think it’d be a 50-minute procedure, and we need to charge for 50 minutes.

Because you can’t be giving away free time. So there’s a little bit of leeway and wiggle room for like the odd case here and there. But Zoe’s totally cool to be like, hmm, okay, she’ll give me the look. I know. Okay. We need longer than 45 minutes and then we’ll charge accordingly.

And I think part of the issue why dentists perhaps don’t, when they’re calculating how much time someone’s going to take, instead of saying 50 minutes, which is how long it’s actually going to take. Cause five minutes run late, they say 40 minutes cause they’re trying to, time is money. They’re trying to make see increase the hourly rate or whatever it might be.

And I think respect your hourly rate. But the patient has to just pay more for your expertise, for your time. And it’s not like you’re fapping around in that extra time. You’re actually giving your patient excellent care. So the lesson there is basically if you need more time, need more time and charge for it with pride. What do you think about that?

[Nikhil]
I think that’s absolutely perfect. And what I would add to that is maybe start off with a longer time. And cut down as opposed to the other way of running late. That’s what I would recommend, especially for the younger dentists. Also, a big problem, especially younger dentists have is, do not change the plan on the day.

So if you’ve decided you’re doing X, Y and Z fillings on this day. Do not go and do other stuff on the same appointment on the same day. Unless of course there is a mitigating circumstance where the patient’s in a lot of pain, et cetera, then that’s fine. But otherwise having that change, first of all, violates the first rule, which is preparing ahead with your nurse in the morning, but also it can affect the timings, which will make you run late. So that’s a top tip from me.

[Jaz]
Absolutely. Sticking, making that plan and sticking to that plan is going to go a long way. What’s the third way that we can help ourselves from not running late?

[Nikhil]
So I would say for all your procedures, have a protocol list. Now as you go through your career, you will know this a lot better, but when you’re in your first five years, I would say having, breaking down each procedure you have into stages so that you know exactly what’s required when and then actually timing yourself and coming up with an average over time and then applying this to all your future appointments.

So let’s say for me, for example, a two sided filling under rubber dam with local anesthetic will take me about 45 minutes. So I booked 50 minutes in the diary and it will run like clockwork. My assistant knows exactly what matrix system I need, which anesthetic I’m using, which composite I’m using, which instruments I’m using for my composite construction.

And that won’t change unless I can modify that if I go on a course or I’ve learned something new, then I’ll add it to this protocol list and it will change a bit. So if you have that written down, it was all well and good in my head, but if you have that written down, you can actually physically edit that. So I know I’m like a-

[Jaz]
Google Doc, for example, that’s available on the cloud. So it’s at work or at home, right?

[Nikhil]
Exactly. I have mine on my desktop on my work computer, but actually Google Doc is even better because you can access it from anywhere and that way you will stick to your times better. And you will know to the minute how long it takes you it’s funny once you do this enough times, the etch will take a certain number of time by the time building up your wall will take pretty much apart from maybe slightly easier difficult cases the average will be the same and it will be 25 minutes to do certain thing and then another 15 minutes for something else. So having that in your armory and knowing that you have that protocol to fall back on which is the same every time you’re more likely to run on time.

[Jaz]
And patients get better care that way because you’re less likely to miss an important step and it’s just it’s all like clockwork. And one good tip I have here and if you’re going to start taking photos DSLR photos you can check the time stamps of the first if you take a photo of every stage you know when you got rubber dam on what time it was, you know when you removal or restoration, you know the carries removal completion.

So you can actually build up a library of okay, let me just have like two hours of my day just to audit my last four months of photos and see roughly how long I’m spending. That may be a good way of doing things. If you can’t do it then there in the moment. And just one little side tip, I think from that I have is, as in my earlier years, the thing that was taking me a long time, which should not be taking us a long time, is removing the initial restoration, the old amalgam, for example, right?

That is completely sacrificial. Go for it. Don’t be too shy. Obviously, you want to be conservative, you don’t want to run right into the pulp, but don’t be so slow in that bit. That’s the bit that should be quite quick. And so the terminology of bur to tooth time, came into my mind, and the bur to tooth time I was taking to remove old amalgams was far too much, right?

And now, I tell my patients, okay, it’ll take me about two minutes to remove the old filling. And so, clockwise, I’m done by nine seconds, two minutes. With something that used to take me, like, eight minutes before, it takes me two minutes, just because I’m purposeful with my hand movements. Okay, so, Nikhil, hit us with the fourth tip you have to stop us running late.

[Nikhil]
So, the fourth tip involves your dental assistant, your nurse. So, If you work simultaneously and in flow with her, you will achieve the best results that includes during your consultations, which are the most unknown time allocated sort of events in your day to help for her to help you with your note taking with any documentation as much as you can and you to train her up for that the flow between getting the x rayed in getting scans in the photos.

Minimizing the waste time in that area of the appointment and also preparation for that appointment as discussed earlier. So my fourth top tip is get your nurse involved as much as possible, get her on board and things will be more efficient that way. Also, in a lot of ways, being very not strict is the wrong word, but very professional in the sense that making sure your nurses on point and not wasting time outside of the room, let’s say.

And that’s something which I’ve experienced not now, but in the past, especially when I was a younger dentist. Sometimes my nurse used to disappear a little bit, and especially in consult, because I think a lot of assistants think that it’s just the dentist doing their thing, but it’s important for them to be there as well.

[Jaz]
You’ve hit the nail on the head there, Nikhil. I’ve worked with some younger nurses, training nurses, and the first time they do a consult with me, and I’m having a deep conversation, I’m all eyes on the patient, I’m not facing to the side, I’m not facing the back, I’m just talking. And I stop, and I look at my nurse.

And she’s also looking at the patient. And later I’m like, listen, you were just staring at the patient. The conversation I was having with the patient, you pretend that this is the, I don’t know, courtroom. Pretend it’s a courtroom. You’re transcribing everything. I want you to be a transcriber, you’re my part time dental assistant.

You’re part time transcriber. Think of that as your role basically. I want every single thing that comes out of my mouth recorded and I want every single thing that comes out of the patient’s mouth recorded. Now, I am experimenting with AI at the moment so that notes will write themselves. I only have two dreams in life.

A, the notes will write themselves and B, never have to wash dishes again. If I can achieve these two, I will die a happy man, right? We don’t have a dishwasher yet so I’ll have to wait for that one but I’m almost we’ve always cracked it in terms of notes that will write themselves. So watch this space.

But the thing what you said that has meant the least, the biggest reduction in stress for me and allowing me to get home to my children the fastest is once the patient’s left, I’m just checking over and adding and refining my notes rather than writing them because the nurse has written everything.

If I say that, okay, I think you’ve got a nerve that’s dying and therefore we’re going to either have to go down a root canal extraction, that’s already written there. And what the patient communicated back to me; everything should be there. So I totally agree. And I personally think that’s, so of all you said, all the wonderful things you said, for me, that’s been the most profound change for me.

[Nikhil]
I absolutely agree. Almost, you’ve kind of sort of lent into the fifth one I had there, but yes, having, so the fifth one I would say, which is kind of merger of the fourth is having templates or other methods such as AI or I know you worked with some, I don’t know whether I’m not allowed to mention them on the podcast, but with other companies who allow you to have drop down boxes and more, more specific ways of writing notes.

[Jaz]
I’ve tried Kiroku. It wasn’t for me, but people swear by it and love it basically. For my TMD consults, I use a Dental Audio Notes at the moment. because it’s nice to refer back when I’m writing my report and stuff. I’m also experimenting with other softwares, namely Heidi at the moment, an Australian company who works with, who mostly have products for doctors, but I’m so determined to make my selfish dream come alive.

I don’t want to sell anything to anyone. I don’t want to be the next revolution, revolutionary in the way we record notes. I just want my notes to write themselves. That’s why I keep switching from softwares and stuff to find that winning formula. But you’re right. Using the systems that we have technology that we have, or just templates like on SOE exact for those who use it, we’ve got custom screens, right, which is like drop downs, tick boxes. So it’s become so much easier to do that.

[Nikhil]
Absolutely agreed. So you don’t have to be very specific, obviously, but this ties into the other point. So if you have all your protocols in place, and your stages, and you have that already in your notes, especially for procedures, and even for your consults, it will make your life a lot easier when you’re writing your notes.

Also, if you have the templates laid out, if you’re not using any AI or other things, if you have your templates laid out in a way, which is very easy for your nurse to input, which is one liners or empty spaces, which they can fill in, it will make your life so much easier. The amount of time I’ve spent in the past where I haven’t had help with the notes and going back, remembering everything from what you’ve spoken about, I have to go back, look back at the scans, I have to look back at the photos and remind myself of what we spoke about, whereas even if there’s something written, which is not quite right, it will jog my memory.

It will be a lot easier and quicker for me to execute the notes and move on. And having, speaking about notes also, how doing your notes, as soon as you can after the appointment helps a lot. So as I said before, having that time allocation within your appointment to do maybe five minutes, make your appointments five minutes longer so you can actually finish the notes on that at that time, it will mean you can leave on time from work and you’ll be a lot longer run in your practice. So will your nurse.

[Jaz]
I think having that extra five minutes of bliss, even if it means you run a couple minutes late, it just means that your notes will be contemporaneous, which is so important. But I think if you really think about it, the notes that take you the longest are consults, right? Because everything’s so unique.

The notes for my two-surface restoration, they’re the easiest because I have a protocol. I do the same thing every single time, air abrasion, the same chat, the same warnings, everything, okay? Only thing I’m adding is specific changes to the protocol. Right? And little quirks, the patient’s dog had a fifth birthday, whatever, little quirks I’m going to write in, okay, and that’s it.

Everything else with the same bond, the same time I etch basically my same protocol, I always have there basically. So, I find that the notes that take me the longest are TMD consults or just general new patient examinations. discussions, consent, that kind of stuff. Whereas actually the procedures themselves, because I’ve done all the hard work, a front load of the hard work with the templates, because I have a set way of doing things. It’s just checking. And even the nurse, he or she has had time to just tweak the right protocol that I selected that day.

[Nikhil]
Yes, absolutely. That’s exactly how I do it. And I think you can apply the same principle to referral letters or treatment planning letters as well. In the sense that If you have that probably won’t necessarily do this during clinic time.

But if when you do them, you have a set structure and certain things in place, you can really expedite your timing so that you’re doing stuff you want to do in life, not just dentistry, but stuff outside work, instead of doing treatment planning letters and referrals after work. So I would say it’s a game changer if you can do that.

[Jaz]
Amazing. Nikhil, you’ve covered five good ways to help us start running late and I hope you didn’t mind me chiming in with my own experiences because I find it very helpful. I think I resonate with all of them, and I’ve been through the whole shebang and I think everything you said is very relatable and very implementable and just needs a little bit of hard work from you to initially set these things up.

But the dividends that come in the future are just profound. Because time is the most valuable asset. And if it frees up more time, makes your notes more watertight. And in the case of medical legal issues, it’s just a win-win formula. Nikhil, I know you do a lot of mentoring to younger dentists about designing their ideal workflow, design their ideal work environment. Tell us more about how we can learn from you.

[Nikhil]
So Jaz, I run a program for younger dentists, typically one to six years qualified. The program is a four-month program and it essentially teaches younger dentists how to increase the amount of private work they’re doing. So private work meaning work that the patients deserve and that you enjoy doing.

And I take the delegate from day one to improve their mindset, understand other patients and humans. So the personality typing, I take them through the processes and protocols. can have in place to make them more efficient and better dentist. And then the most important part is I take them through their consultation process.

I break it down. I make them more likable to patients. I will teach them how to understand the patients better today. They are actually focusing on the patient’s problem, not just a set structure that we were taught in dental school, and then providing a bespoke solution. In addition, I provide mentoring throughout these four months so that they have the support for treatment planning for any problems they’re having at work, and it’s something that I love doing.

I love seeing younger dentists grow because I know how much I struggled when I was that young. So it’s something which I’m really passionate about. And if you are interested, just give me a, drop me a message on Instagram or I do some webinars, which it’s okay with you, Jaz, I’ll leave a link in the thing, which you can join as free webinar. Perfect. So yeah.

[Jaz]
Your Instagram handle just lastly?

[Nikhil]
@dr.Nikhilkanani.

[Jaz]
Award winning dentist. There we have you guys. You knew I’d bring it in eventually. Thanks so much for your time, but I know you’ve got a patient to get to, so thank you so much.

[Nikhil]
That’s right. Thanks so much, Jaz.

Jaz’s Outro:
Well, there we have it, guys. Thank you so much for listening all the way to the end. Now to get half an hour CPD, you just have to scroll down and answer some questions if you’re on the right plan of Protrusive Guidance. So those who are on the Premium CE plan or the Ultimate Education Plan, and you’re watching or listening to this on the Protrusive Guidance app.

Just scroll down and answer the questions. Now, one example question is what list was Dr. Nikhil Kanani referring to as being imperative for you to be able to run on time? Is it A, a bucket list, B, a protocol list, C, a procedure list, or D, a materials list? If you get an 80 percent mark, the CPD Queen Mari will send you your certificate.

And if you’re used to listening to our episodes, then you could be racking up some serious amount of CPD by the time you get to Christmas. I want to take this opportunity to thank my team which is Mari who is a CPD queen, Erika who’s a producer, Krissel who’s been helping me so much with the Protrusive Notes and the videos and reels and of course our new recruit Gian who’s absolutely amazing at video and will be helping Protrusive to level up our videos so we can actually deliver even better content to you.

As you can see, Protrusive is a young and growing team, and we’re on a mission to really cultivate this nicest and geekiest dentist in the world. So if you’d like to support the podcast and help us to continue to do the good work we do, this is where your subscriptions really count. So as well as you getting CPD and access to all the different webinars and workshops that we have, you also keep us thriving.

I want to so much once again for coming to the end, and you do check out the show notes to reach out with our guest Nikhil Kanani.