Record Keeping and Emotional Intelligence – PDP112

Jaz’s Introduction:
I mean, it’s such a great fun chat. I mean, any episode with Zak Kara, we know we love that one. The main guests we have today who has an interest in law and ethics is Dr. Shaun Sellars. Shaun is actually the host of a podcast called Incisive Decisive, and I know you will learn so much from him today. Over this two-part episode, we’re going to cover RECORD KEEPING and EMOTIONAL INTELLIGENCE in this episode. And the next one, we’re going to talk all about CONSENT and how intricate consent can be. And they’re both really fun chats.

Actually, when I listened back to them, six months after recorded, I was just laughing at myself. And the reason why it was a big delay was, I was kind of testing some of the softwares and record keeping, best ways to record keep. I’m kind of working on something behind the scenes. I’m not starting my own product or anything like that, don’t worry. It’s more in the sense of trialing, which is the best way to record your notes. So, I can make my workflow easier. And so far I’ve been enjoying Loom, and I’ll tell you more about how I’m using Loom as part of presenting treatment plans a bit later, in the episode probably in the middle somewhere. But what I want you to tell you about the guests that we have on Shaun Sellars and Zak.

And the kind of chat we have, is all about how we can build better rapport and how it’s this concept we discussed in the podcast of having a different mask. Like we dentists, we wear a different mask, when we’re communicating with the receptionist, when we’re communicating with a patient A and patient B. We have to wear a different mask. And that’s what makes dentistry really challenging that we have to communicate differently. And actually, we should be communicating differently to each and every person, because every person is unique. And if you want to be a really effective communicator, I think we all were in agreement in this episode that you have to speak to everyone and communicate to everyone differently.

Shaun also teaches us about something called the Peak End Rule. I’m not going to tell you what it is. Listen now. It’s really cool. I think it’s really effective. It changed my mindset and I make sure I’m always adhering to the Peak-End Rule. And all the chats we had reminded me of one of my mentors and ex-principals, Dr. Hap Gill. He taught me at a team meeting one day, that actually, we are kind of in showbusiness, right? Like, it doesn’t matter if you’ve had an argument with your spouse. It doesn’t matter that someone at home, maybe your child is got chicken pox, something, okay? It doesn’t matter what other problems you’re having in your life right now. When you step through into that door, into surgery, and your patient walks in. You have to present the best version of yourself. You have to forget about everything.

I think Finlay Sutton is also quoted this either in live lecture on the podcast, I forgot now. But he’s also someone who said this, whereby, ‘You just have to forget zone, everything else out.’ You have to give your everything to that patient. Now, not at the expense of your mental health or anything, but, i.e, don’t let external things affect you inside the surgery. And that can be really tough. And that’s again, why our role as a dentist can be so tough.

The Protrusive Dental Pearl
The Protrusive Dental Pearl I have for you before we dive straight to the episode is the following. We discussed in this episode about building rapport. And one of the things we discuss was about writing down on your note-taking software, a few things, a few quirks, a few memories about your patient. They maybe they have two children, maybe their favorite team is Manchester United. Maybe they like to swim on the weekend. Whatever it might be. I think it’s a great thing to write down. I know some of my colleagues who I work with, Susie, if you’re listening I know you’re listening, Susie, you’re amazing at doing this. Like you’re amazing at writing, like everything about their children and the fine detail and you love that and your patients love you. Right?

So I like to also do this where I remember I write down a few couple things and I build them up. In case the first few times you don’t quite remember them, you read that information. You can say, ‘Oh yeah, how’s our team doing now? Or did you go for a swim today?’ And patients really love it. And I think it’s a great way, especially, if working new practice and you’re getting to know your patients. This can really accelerate the rapport that you can build with your patients. It’s likely that many of you already doing this, but it’s a great reminder to continue. Hope enjoy the episode and I’ll catch you in the outro.

Main Episode
Gentleman, Shaun Selllars, Zak Kara. Welcome to another episode of The Protrusive Dental Podcast. Very excited for this very fascinating, very huge, all encompassing topic today on record keeping and consent. We are joined today by Shaun Selllars, who is a veteran podcaster himself, Incisive Decisive, I do enjoy those episodes. Shaun, start off my friend, tell us about your journey and how you ended up going into this medical legal side, like you know, you’ve done law and ethics masters, but tell us a bit more about yourself.

[Shaun]
Yeah, so I’m a general dentist. I just do what most people would consider fairly routine dentistry. I currently work in a quite large practice in Barista, Edmonds. After moving from Lincoln, where I was working for seven or eight years. I’ve always been interested in that law side of things when I was figuring out what I wanted to do with life. The options were, I could go and do, could be assintant, go to dentistry. And it turns out that I’ve done dentistry and now to a degree in law and ethics. So, that kind of thing has always been there. And because as anyone that follows me on any kind of social media knows, I’m a little bit of a lefty. So, you know, politically, that the ethics thing kind of fits in with that as well. So, yeah, a few years ago, started on the Master’s course in Bedfordshire, University of Bedfordshire with people like Linda Cruz, who I’m sure you’ve heard of.

[Jaz]
Yep.

[Shaun]
Lecturing, and Hado Massif who is excellent, brilliant. And yeah, finished that this year. And now on to whatever’s next, really, which I’m not-

[Jaz]
Very humble, because you didn’t mention the fact they got a distinction. A distinction which is a great feat. And I asked you before we were having a little preamble before Zak join us as well about, what was the motive of someone to do law and ethics masters? And I always thought, surely has to be a means to an end, ie, I need to do this so that I can become a dental legal expert or something like that. Or it’s like when people do a PD, certain dental education. In mind, I’m saying these these people are doing it because, they can get the DF One trainer checkbox, right? Who’s actually doing it for the merit of becoming a better educator? I don’t know, right? So, we you know, just share your answer that you gave me on that.

[Shaun]
So, originally it was. Let’s try and work for dental protection or whatever. But it turns out they’re doing a master’s in dental law and ethics. Isn’t that great for doing medical legal, because it’s not a legal degree. The focus of that is very much on the ethics, which suited me down to the ground. But it turns out that it has affected every single thing I do with dentistry. My research projects that I finished this year involved interviewing dentists and talking about non-clinical skills, essentially everything, apart from what you do with your hands in dentistry. And it turns out that according to my interviewees, what you do with your hands makes up maybe 30-40% of your actual dentistry.

Whereas everything else, how you talk to your patients, managing your time, writing your notes, understanding everything else regarding dentistry is a huge, huge part of our everyday and it’s completely ignored. We don’t really get taught much of it at uni. And from a patient’s point of view, they have almost no ability to adjust to assess how good your dentistry is. All they know is were they nice to me. Did it hurt? Do I want to go back? And so after having to discuss that with a lot of dentists, it turns out that dentistry isn’t really about teeth. It’s about making relationships with people, whether that’s your patients, whether that’s your nurse, whether that’s the people you work with, whether that’s other dentists. So yeah, so that’s-

[Zak]
I think you hit that nail on the head there, Shaun.

[Jaz]
That is also with us back by popular demand. The creator of the “Am I naughty, ifs”, which will make a comeback today. Don’t worry, Zak take it away, mate.

[Zak]
As you were saying that, I actually, just thinking about yesterday’s. Today’s Saturday, Friday at the clinic was a tricky day for us Friday afternoon. And there was a patient who got scheduled into what we thought was a relatively straightforward 40 minute space. And one of our associate dentists in the team shot me named, was a superhero and put a superhero cape on and ended up knee deep and an extraction at nearly five o’clock, and we had a new patient just after them. And that was supposed to be the finish of the day. Everything went a little bit to you. And essentially, the new patient ended up delayed by about 20-30 minutes, and we ended up with a surgical and things went a little bit tricky. And so, you’re absolutely right. In my opinion, these things can actually be solved way, way, way earlier than or preempted way, way, way earlier than having to end up knee deep in that kind of saga. And don’t get me wrong, once in a while things happen, don’t they? It’s Friday, you want to help somebody out. And you do think people are favoring you thinking I was on holiday next week. And he’s the partner of a pre-existing, really well known patient in our practice, who’s very popular.

And this, you know, always looked after us, and we want to look after her and our partners in trouble. So, you want to help them out, right? And it’s all very productive to fill up space in the diary. But actually, that comes with its own compound effects of problems and things that can arise as a result of it. And it’s always, it seems productive at the time, but it might be counterproductive. And that’s kind of, it can be an initiator con it of a future complaint or a future concern, or a future thing that spirals, one thing leads to another. And that’s something I was never taught as a dental student.

[Shaun]
And part of it is experience, it comes with experience. For example, I’ve been at work this morning. It’s Saturday. I do at the moment, every other Saturday, which is a killer, but we won’t get-

[Shaun]
It’s very tough.

[Shaun]
So, I had two new patients scheduled in today. And I have a very set almost like a checklist of what I go through with new patients. Because you’ve got to hit these certain things. But the-

[Jaz]
Actual manifesto.

[Zak]
Yeah, yes, it’s on my bookshelf. There one of the best books every dentists should read that-

[Zak]
Atul Gawande is a fantastic surgeon.

[Shaun]
Although you hit each of those marks on your new patient exam, the way that you get to them is very, very different. You have to be able to judge that patient within 30 seconds of them being walking into the door. You collected your patient into the room, and you will be talking to them in a different way, you will ask them slightly different questions to try and elicit the same answers. And none of this is technical stuff. It’s having a good level of emotional intelligence, being empathetic to patients and understanding that. And actually, you can teach it, you can completely teach it, but we don’t get taught it.

[Zak]
Do you think you can teach it? Can you always teach it? As in, can you teach emotional intelligence? Because I tell you something, oh, go on, there’s a book.-

[Shaun]
This is Daniel Goleman’s Emotional Intelligence, which is the the original book on emotional, well, kind of the original new book on emotional intelligence yet you can teach it, you can completely teach it.

[Zak]
Really?

[Shaun]
Yeah. 100%. To some people that comes really naturally. Okay, some people can- So, if you meet me out of work, I’m a blank-faced robot. I’m completely useless in social situations. And I used to be like that in surgery. I used to be not very confident, quite shy. But now in-

[Zak]
Maybe you shouldn’t have done it that degree in law, Shaun.

[Shaun]
Yeah, maybe. The way that I talked about it in my dissertation is that you wear these masks you act the part of the dentist. And the masks that you put on are different for different patients. So, if you’ve got a patient that’s coming through, it’s very loud and very rambunctious, you kind of mirror that to a certain extent. But if you’ve got a little old deer who’s coming in, who’s petrified while you calm things down, you turn it down completely. So, you’ve got to be able to pick that up-

[Zak]
To read the situation, yeah.

[Shaun]
Instantly. You better be patient. Yeah. And act appropriately to situation because that’s when we get into trouble.

[Jaz]
Twi reflection is there guys. One is that the whole point of that, you know, we all believe in equality and treating everyone the same. But actually, to be a great communicator, you can’t treat everyone the same. You have to treat everyone differently. You have to speak differently to someone on the street who’s coming in wanting gold veneers versus little old lady who just needs help with her ulcerated denture. And they’re different people, different values, different cultures. So, you have to be able to, you know, dentistry is so difficult, because you have to deal with so many people. And sometimes your personality type doesn’t align with your patients’ personality type. But the other reflection I wanted to make, sorry, do you want to say something on that?

[Shaun]
No, that’s perfect. Absolutely. Right.

[Jaz]
And the other thing is we had this episode with Richard Porter, we talked about emotional intelligence and what constitutes success in dentistry. And I also asked that question Zak about can one learn, if they’re not very emotionally intelligent person in the moment? Can they become emotion intelligent? And the short answer Richard Porter gave, if you haven’t listened to things, Episode 34 go back and listen, is you have to put yourself in those awkward scenarios because that’s where growth happens. It’s like you have to do more reps at the gym. So, you have to practice being more empathetic. You have to practice, you have to really sweat it and becoming those really anxious knows only then, can you then become more emotionally intelligent. Is there any other nuggets you can add to that, guys?

[Zak]
I’ve got something on my mind related about which is that I’m in a very early growth, beginning of a growth journey as a practice principal. And there are some sticky conversations I’m having, which I’m not super comfortable with, because I’ve never had to have these conversations with colleagues before. I’ve always been the fun loving, easygoing associate who gets to be having banter with them at lunchtime. And I’ve kind of taken an evolution in my career, which I didn’t really choose. I didn’t really want this to happen, it just sort of evolved that way. It just almost happened by virtue of being a dentist in the mid-30s. And maybe there’s other ways to design your career, because five years ago, wouldn’t have never said that it would happen, but it happens sometimes. And there are scenarios where you have to kind of wear different hats, aren’t there?

You need to adapt to your surroundings. And there’s always one main thing to add to what you said about what Richard Porter gem that he gave. The thing that’s always on my mind with this, is people don’t remember what you say, necessarily. They always remember how you feel, how we made them feel. They don’t remember what you said, necessarily, they always remember how you made them feel. It’s just that kind of need to put yourself in their shoes and go okay, how would you kind of have to remember that not everybody lives in dentistry like we do. They don’t have a reference point like we do. They’re fresh to this environment. Same as I’m feeling with finding with new team members who haven’t come from dentistry, they’ve got no reference point. Yeah.

[Jaz]
What are the two feelings? What are the feelings you think that are most important to patients? Like going, you know, patients feeling X and Y when they come and see you? For me, I think confidence and hope. If they can have confidence and hope, then I think I’ve done a good job of making them feel something I want them to feel. I don’t know if you have any thoughts on that, Shaun. I mean, it’s just to set the scene here for everyone listening, Shaun’s masters was on the mammoth topic of non-clinical communication, like, that’s just huge. And that underpins everything, like you’re saying underpins everything. So, anyone on that front asking my more official questions?

[Shaun]
Yeah, sorry. So, there’s a few things on what we’ve just been talking about. Firstly, when it comes to patients, I think they appreciate honesty. So, if you can say that, if it’s beyond your skill set, you should 100% saying, right, ‘I can’t do this.’ Equally, you should be able to say, but I know someone that can. You should have those links with people, either in the practice or locally, ideally, that can do that treatment. With regards to patient experience, there’s something called the Peak End Rule. I don’t know if you’ve heard about the Peak End Rule?

So, patients will take home the best or worst experience that they’ve had in your appointments and what happens at the end. Okay, so the key thing is if even if they’ve had a rubbish appointment, you make them happy, at some point during that appointment. And at the end of the appointment, you’re really, really nice and say, ‘That was really good, you did really well’. And that’s gone excellently, or you know, you give them a little bit of an appraisal of the appointment, say, they’ve done really well, don’t worry about it, it might be a bit sore, and you’re honest with them about what’s going on. And they talk about next steps, say goodbye to them, whatever.

[Jaz]
And then you walk them to the front desk, maybe if appropriate-

[Shaun]
Not if you’refull PPE at the moment, but yeah, if you can make sure that last couple of minutes of their appointment is just spot on. You’ll have very few problems with-

[Zak]
You use the word, show earlier on. And there’s something I’ve talked to Jaz about previously, which is that there is an element of showmanship to dentistry, without being a showman and without being a fraud and a character of your own. Be yourself. But there’s definitely something that I have evolved in my career which is that you are on show, we’re on display.

[Shaun]
Absolutely, yeah.

[Zak]
And that’s cool, isn’t it? It’s completely okay to be that and Shaun puts personality only on for podcasts and for his patients, he doesn’t do it for anything else. Your poor wife- That’s okay. It’s okay to be that thing that you’ve learned.

[Shaun]
Yeah, 100% and we are the sum of everything that we’ve learned. The way that we learn from our mentors is that we take the best bits of whats other people have talked to us about and shown us. But more importantly, we reject the bad bits. So, the way that I give post op instructions after taking a tooth out, I still use some of the phrases that my dentist was using when I was doing work experience when I was 16. Because for me, it really sunk in and it works really well. Equally, if you’re talking about being a performer, Colin Campbell, who you’ve probably heard of, especially if you’ve listened to Incisive Decisive.

When I first met Colin, he was doing an all surgery lecture. And he said that the way that he does up eights extractions, gets the patient numb, goes in their, has a look, gets the nurse put suction in, tweaks the eight out with a cryers or a, takes his gloves off and then walks out of the room. It’s complete showmanship, I mean, Collins on a slightly different level than me with pretty much everything that he does. But again, it’s that in in my dissertation, I call it dentist as actor because we are acting the role of a dentist. And for the young dentist starting that’s quite a useful thing to take on board, I think. But in the world, it’s like-

[Zak]
I just wanted to say one thing related to that, which is that there is an element of a certain generation in dentistry wanting to have and these words were used in an interview with me with a potential associate dentist not long ago, the words fake it till you make it. Now, there’s a different elements of that that’s involved with showmanship. So, it’s certainly worth would you agree, it’s worth pointing that out that what we’re talking about is something slightly different.

[Shaun]
Yeah, it is, I think you have to be confident in your skills, and which is fine. But you have to know your limitations. And you have to be self-aware enough of what you can and what you can’t do. So if I said to you, I can put an implant into whatever I can’t because I don’t do implants. But so you can just make stuff not make stuff up but embellish the truth.

[Jaz]
But self-awareness is a pillar of emotional intelligence, isn’t it? It’s one of the major-

[Shaun]
It’s 100%, yeah.

[Jaz]
I’m so pleased you said it. Yeah.

[Shaun]
Going slightly back, and this is my last point on what I was saying, is that with regards to trying to understand patients trying to get on the patient’s wavelength. The way that I look at it, is that all you need is one hook. One little thing that you can relate to a patient with, whether it be, where they go on holiday, what job they do, something that you can talk to them about in a reasonable amount of depth. And you can bring that around at every appointment, and you can learn a little bit more about them. And if you’re like me, I’ve got a memory like a sieve, just the worst memory in the world. Pop up notes on your software will save your life because it’s always so you went on a holiday to wherever six months ago, then you did this, you did that you’ve got three kids. And so, you’ve got little potted history of your patients. So, they’re not patients, they’re people, they’re people first before they’re patients, and they’re certainly first before their teeth.

[Zak]
I love that. To embellish even slightly further. There’s one aspect to that I would like to tie with you in with your Peak End Rule. I presume it’s not actually your Peak End Rule. But we’re going to call it as the Peak End Rule. The end point for me of most conversations is tying that thing, that hook into the endpoint. Because if you can leave on laughter, and you can say goodbye and I sometimes I’ll disappear up the stairs, my trigger is upstairs, I’ll disappear up the stairs. And as I’m walking away, I’ll usually say something which is just a little quip. A little, ‘By the way, enjoy yourself at the blah, blah, bla.’ It’s just goes, it tells them he was listening to me. He actually got me, he was bothered about me. I wasn’t just another one on his conveyor belt today.

[Shaun]
Absolutely. And if you’ve got, after nearly 20 years have been qualified I’ve got anecdotes stored from wherever. And my nurse must hate me when I start rolling out the story that she’s heard a thousand times before but patients love it. Patients love being able to talk about your dog or, you know, where that part of the world that you’ve been to, that you’ve been to the same kind of area or something like that, and patients really love that connection.

[Jaz]
One thing which I think I’m really focusing on with the podcast as it ties in very nicely what you’re saying is, how do I connect with more people? How to connect more dentists? How can I serve more dentists? And is there something that Zak is so passionate about? In fact, he named his whole clinic after this. His clinic is called Smile Stories. And it’s about connecting through storytelling. So, you might notice about four months ago, my posts, I’ve become more story based, because I find stories are so powerful. I think Zak, you taught me once Facts-Tell-Stories-Sell. And I’ve always taken that on board as well and so true. And so, I just want to highlight one thing which, is you mentioned about this bank of stories essentially you have and I’m a big fan of having a story bank. I think every dentist should have a story bank. Something fascinating happens if you find a good way to explain something to someone using analogy or a story. Write it down like journal about it and have an actual physical bank of these stories. Because these are absolutely communication gems. Patients be able to relate to them so much more.

So I think that assess that. And then to summarize the last few minutes show business we are in show business. And just one point that I saw a Facebook point once, I know we’re going a bit random here. And this dentist was basically complaining that she was unhappy, because she felt as though that inside, she was miserable, or in a way not just not happy bunny, but then she was hating-faking it. She was hating being nice to people, her patients, but really she felt inside like she just fed up a little bit, right. So, I think her not staying true to her feelings and true to herself was adding to a degrading mental health.

Because having to be forced to be nice to your patients, that kind of thing. But to her or someone who’s going through a mental health issue, I’m not qualified to give you any advice. But what I can say is sometimes, you have to own the fact that just because you are not feeling great and you’re not feeling well. You have to be careful what image you project to the patient and that patient is so important and and ultimately we are in show business. So, you have to learn some acting skills, you just do as part of it.

[Jaz]
Hey guys it’s Jaz here. Just interfering with this thought. At the beginning in the introduction, I told you about how I use loom. So, my biggest bugbears sometimes is capturing enough information at that new patient examinations, that you can write a report or send a report and I still make my makemeclear reports. I enjoy them. But I find that sometimes, when you are making a comprehensive report or let me use the website makemeclear.com, it takes time, it takes effort to sit down. And sometimes you know an entire Saturday mornings gone. And I’ve written letters to my Invisalign, potential patients, and my brand new patients with treatment plans. It’s tough work. It’s time away from your children. Time away from your family. Time away from watching cricket and eating chips. You know, we love doing those kind of things. And sometimes the patient doesn’t go ahead treatment or defers treatment. And you think well, was it even worth it? Right?

So, the way I’ve started to do it over the last eight to nine months or so, is I’m using the website loom and you can head to www.loom.dental. That’s loom.dental, L-O-O-M. And essentially, it’s a software, which records your screen, and it can optionally record your video in the corner at the same time. So, sometimes I include the video, sometimes I don’t include the video. But essentially what I do is, I cycle through my patients photos, and I’m speaking into the microphone and say, ‘Hey, hello, Mrs. Smith. Here, as you can see, you’ve got a broken molar, and I see some decay around it. And then I also see this issue and you told me at the examination appointment that your main goal is to be able to choose stake better. And therefore here are my recommendations. Here are my fees. Is this something that you think you’d be interested in?’ Right?

So, it’s less, I mean, personally, I hate typing. I hate writing. I hate note writing. I do really hate it. I really enjoy speaking to the camera, as you know, right. So, for some of you, your personality trait will actually suit better to write letters, and that’s fine. But for me, I’m really quick at this, I send like a five minute video plan to a patient, which got all the information in there. And I much prefer doing that. And I’m faster at doing that than to insert the individual photos into a Word document type of different things. I’m just quicker and it’s easier for me to just say these things. And what then happens that, when the patient watches the video, you get an automatic email, which is linked to your loom account saying, ‘Hey, Mrs. Smith, just watched the video.’ And I’ve told Ms. Smith what to do as a next steps. And I think this is good because of consent issues. Like if the proverbial hits the fan in the future, you have a video record of everything that you might have said to a patient and stays on the cloud right, which is great. The other thing is that it’s efficient, it’s really quick and easy for me to make these videos. And then eventually, when a patient wants to go ahead, if I feel it’s a quite a substantial treatment plan, I need to break it down a bit more. I need to give him an appointment schedule. I want to double up on my consent process if you’d like, which is something that we discussed in the next episode. I will then also follow it up with a comprehensive written report.

But at least now, I know my patients committed. They paid a deposit. They’re booked in or they want it they’re very keen to book and they told me, they liked what they saw in that video. So, if you’d like that, try it out, give it a go for yourself. A loom who recognize how it can work in the workflows of dentists as well hence why you can visit loom.dental. I think they do like a 14-day free trial and even the free version, free forever version. It is good, but it’s limited to about five minutes something. It’s really cheap about 70 pounds for the whole year, or $96 something. So, it’s great value. If you like the idea, check it out. And I actually use this to communicate with my team, my producer, my editor, we all communicate via loom, how-to videos and whatnot. So, it can be used for your team as well. You can make a manual of all the how-to videos, how to find this file, how to generate that report. And you can make these local manual of loom videos. So, if that gives you some inspiration, some ideas of how you can use the modern software’s that we have today, back to the episode.

[Shaun]
And you’ve got to be able to compartmentalize things, as well. So, you can’t say you’ve got a patient where everything goes wrong. Yeah, that instruction that’s gone into a surgical. It’s taking you forever, and you’re shattered and you feel a bit of rubbish. But you can’t let that drag on to the next patient. You’ve got to be able to completely stop, move on. And that is hard. That’s one of the most difficult things I’ve learned to do. I don’t quite know how you do it, but you just learn to do it. And then at the end of the day, you can decompress and sort of analyze things. But I’m not a great fan of going right. Let’s analyze this now and let it affects the rest of my day. It’s shut it down, shut it down, shut it down. And then, once you’ve got time to chill out, for my lunch times are, I’m really anti-social because I just sit and just completely do nothing for an hour or half an hour or whatever I’ve got to do. Because I just want that time for myself.

[Zak]
Your ability to cope with that is your ability to your method. And it is coping to some extent sounds as though you’re drowning everyday. They’re using the word coping. But there is everyone has to have their own ability, their own method. I get a little wander to the shop every day, whether I need lunch or not. It’s just part of my routine. And I need to do that because it’s my switch off from the morning. And I can recoup and go on with what we’re doing this afternoon and get your head back in the game. It really does depend on the type of clinic that you’ve either built or you’ve become part of it because speed and pace is one of the things that becomes a factor in there, doesn’t it? If you’re if you’re looking after conveyor belt everyday, it is a nightmare to get up and down that many times.

[Shaun]
Completely and talking about my lovely wife, bless her. There’s nothing worse than then coming home in dentist mode. So, you know that is you need to lose that before you get home as well.

[Jaz]
Guys, I really enjoyed this introduction chat. I mean, wow, there’s so many takeaways there. I’m going to go a little bit more official now just ask you about this mammoth topic of record keeping. Right? So, the angle I’m coming in, to make it really tangible for those listening is record keeping has seen a big shift over the years. From in the days of the 90s whereby we SMP and then your signature and how much you charge the patient. Amazing when you see those paper notes. And that’s all that’s written is absolutely crazy. Compared to absolute exhaustion in the way of the use of templates, which are just laborious. A simple 15 minute exam might have several 1000 words of notes. How can we make appropriate and good notes? I’m sorry, that’s a crazy question. Have anything we can help us with record keeping? Where do we start?

[Jaz]
So we were getting right in this Jaz? Appropriate and good notes?

[Jaz]
I’ve been thinking about, I don’t know, how else to put it like what? How can we become good at record keeping? How can we not have to produce thousands of words? Or is that what we have to do? And how can we overcome this template nonsense?

[Shaun]
Template-how. So, let’s get this straight. Exam SMP has never been good enough notes. That’s the first thing. There’s this nostalgia for the time where you could just write exactly. And I used to when I qualified 2010 and we were taught to write decent notes. And then, as soon as I got into practice, exam SMP. That was the way it was done. Equally good notes are supposed to be a contemporaneous record of what you’ve just done. Okay? So, contemporaneous means there has to be done at the time of the appointment. So, if you’re a barrister, and you’re looking at some notes, that’s, really come down really heavy on someone. Now, if you haven’t written those notes before your next patients come in, they’re not contemporaneous. So, that’s the first thing to say. So, people that save them to do them via a cloud system.

[Jaz]
Guilty? Every day.

[Shaun]
Every now and again we do it but try not to do that. If you’re writing three or four pages of notes for an examination or whatever, why are you doing that? Who is that benefiting? It’s not going to save you from being sued, because the chances are what you’ve written is not really that relevant to the patient that you’ve seen. So, you’ve got to find this balance of being able to be concise, but accurate. So, when I’m doing this, I use a bit of software called Kiroku. To do almost all my notes. And Kiroku is a system where you have lots of clickable buttons, you set it, a certain number of templates. And when you’re doing your exam or doing your treatment, my nurse clicks on a lot of the buttons fills in a lot of things. And after I’m done, I spend maybe 30 seconds and minutes, filling the rest in. Copying and pasting it into my notes. So, with software like that, it takes a bit of setting up. They have their own set of templates.

[Jaz]
Do you use SOE or Dentally, what are you using? What software?

[Shaun]
So, we use exactly SOE.

[Jaz]
How is that different or superior to custom screens, which Zak and I are quite big fans of? Tell us about that.

[Shaun]
So with, so I-

[Jaz]
Can you just explain what custom screen, people listening, maybe don’t know. Just explain what custom screen is as well.

[Shaun]
Yeah, so, custom screens are, from what I understand little tick boxes that you can say-

[Jaz]
So that drop downs-

[Shaun]
Yeah, so the difference between custom screens and something like Kiroku is that I can have all the information you’ve got on your tick boxes. But then I can go in and amend it, add little notes, say that there’s a bit of borderline this pocketing here on this upper left, that I really need to keep a close eye on. And that’s intermingled with all those would be tick boxes. So, the way that I look at notes is it should be a narrative, it should tell the story of the appointment. So, from checking your medical history, to what exactly what you’ve done in, exactly what order, and then say goodbye to the patient.

The thing that I find with custom screens is they don’t tell the story, as well as having that customized way of doing things. So, for example, most of our checkups are the same, aren’t they? We do, generally, we have a set system, we do this, this, this, this and this. And we generally do it in this order. So, for my exam template, it’s that, it is the order that I go through my exam with a little discussion bit at the end that I type in, and then treatment plan and recommended treatment and what they need to come back for if anything. For my filling appointment. If we’re doing a composite, most of the time, our composites follow a fairly set rigid rule. Again-

[Jaz]
It’s should do because that’s called a protocol, right? I mean-

[Shaun]
Exactly.

[Jaz]
As a young dentist, the whole point of clinical protocols is see not guessing what works and what doesn’t work and have a protocol and stick to it.

[Shaun]
Exactly. So there’s obviously there’s there’s wiggle room in that protocol. But the basics are exactly the same. So, the way that I look at software like Kiroku is they give you that basics and you edit in the wiggle room. And things like with Kiroku in particular, it’s got some magic machine learning type thing. So, if you’re doing something routinely, that’s different than the template that you’ve got, well, it adds in automatically. I don’t now it does , it is literally magic. And that for me is better than a custom screen, because it is a little bit more customizable on a patient by patient basis.

[Jaz]
Or better than what most dentists are using, which is just pre-form templates, and then what you’re having to do is your delete, delete, delete, delete, so it’s additive and more subtractive as you get through your notes.

[Shaun]
Yeah, absolutely. And that’s where you get into trouble. So you’re never gonna get in trouble for customizing your notes. The time you’re gonna get in trouble is by using templates and forgetting to take bits out. So-

[Jaz]
Classic one being the lower molar extraction and then warning the patient about the size-

[Shaun]
Yeah, absolutely. Yeah. 100% Because then then you know, whoever’s on that appointment just hasn’t paid attention to their notes. Therefore, does that mean that it casts doubt on the rest of the note keeping?

[Zak]
Yeah, it makes you look that way just makes the notes look invalidated, doesn’t it?

[Shaun]
Completely, yeah.

[Zak]
It doesn’t make any sense. It doesn’t tell the story, like you say, and if we write in thinking, Shaun, that even if somebody comes in for a treatment appointment, which is pre-determined, pre-booked or whatever else. They should still have some notes related at the beginning of current concerns. I try to avoid complaint because that tends to become language that you then use in front of a patient and complaint then makes the person sound ike a competitor.

[Shaun]
Yeah. So, the way that I tend to work, let me think, is a patient comes in. They sit down, have a little chat, say that this is what we’re planning to do today, because that’s part of the consent process, which we’ll come on to later, I’m sure. And then ask them if they have any questions and see if they’ve got anything else. That’s more pressing. So yeah, I think it’s always, always worthwhile having a little preamble with a patient beforehand, that no matter what they do. Partly, because it’s part of that we’re treating people rather than pick. If someone’s just come in and had a really bad day. Their dogs just died. But they’ve come through a point and they don’t really feel up to the appointment. Well, actually, maybe you should reschedule that free tooth extraction or whatever. Because, maybe they’ve got other things that they need to be thinking about.

[Zak]
Jaz, I don’t put words in your mouth. But can we make this tangible? It’s catchphrase, by the way, Shaun. Jaz’s favorite catchphrase, because he says it 500 times in episodes, ‘Let’s make it taangible, let’s make it tangible? So Shaun, Jaz you’ve got a comment? I can’t say, you’ve got to say.

[Jaz]
Shaun, can you make that tangible?

[Zak]
Could you give us something along the lines of what is your preamble? If somebody comes in for a pre-determined, pre-arranged 60-minute restoration appointment? What do you say?

[Shaun]
‘So, hello, Mrs. Smith, how you doing? Have a sit down, always.’ I always stand in the same place. Actually, that’s not true. I’ve changed where I sit in my surgery. So, you have to understand where I’m coming from. I’ve got a chair here. And I have a post that I lean against. So, much so that the color of my scrubs is rubs off onto the air.

[Zak]
I’ve got a ball that I lean against.That’s great!

[Shaun]
But I realized that I’ve also got a very large window in front of me with a windowsill that’s about two foot off the ground.

[Zak]
Oh lovely.

[Shaun]
That I can sit on and come face to face with patients at their eye level. So, depending on the patient, I will either lean on this bit of wall, that’s blue with my scrubs or sit on the windowsill and have a chat with them about it. For a lot of my patients, certainly at the moment, they’ve been going through a bit of a tough time, because it’s been a bit of rubbish for the last year and a half for a lot of people. So, I have a bit of a chat. And if there’s something that’s been going on, like, for example, their husband or wife’s been having chemo, what’s been going on this, have a little chat about that. So, you’re instantly humanizing yourself and to them and then to you. So again, you’re having a personal first reaction, interaction with patients. And then as part of my consent process, I say, right. ‘Okay, so plan of action for today is my classic phrase, as soon as my nurses plan of action for today, her ears prick up, because then I go through what we want to do. So, we’re going to, you’ve got this old filing that is some decay underneath it, for example, we’re going to replace that for you today. So, big picture thing to start with. And then I go through, so bit of anesthetic, while you’re going numb, we’re going to put all our PPE on, and then we’re going to use something called a rubber dam. And I explain what a rubber dam is, and why we use it. And then we’re gonna take the filling out. And then we’re going to clear out any kind of debris, make sure it’s nice and clean and put in the filling in should be nice and straightforward. Or, actually, this one’s quite deep.

So, there might be a few things that may well change the way that we have to look at things. So, because it’s quite close to the nerve, the risk there is that X, Y, Z, and then if that happens, this will happen. And then this has happened. So, you’re going through every single pot, not every single, the most common things that may go wrong in that appointment. But if you explain them to your patient beforehand, they haven’t gone wrong, because you have a plan. If you have to take the rubber dam off and do whatever, and you haven’t warned the patient about that you are already fighting a losing battle, because although you’ve properly planned for it, your patient doesn’t know your plan for it. So, what you’re doing is you’re fighting that fire, aren’t you?

So, if you’ve already done it, and it is a really important part of the process, because your patient is down on your side. And you can say that I don’t think this is going to happen, but there is a risk that’s going to happen. Or you can say actually there’s quite a high risk that this is going to happen. And if this does happen, this is what we’re going to do.

[Zak]
It’s also worth making it the patient’s responsibility. Can I also just add that one thing there because-

[Jaz]
Just add that but I also want you to do that, if there’s anything you do differently, let’s use this opportunity as a case study. It’s just how we do things which might be very different. I’m happy to tell you what I do but Zak you go first.

[Zak]
My method with that is very similar to Shaun. I will always have and then nurses in our team that are trained so there’s one thing to definitely say preemptively for this. This comes down to teamwork. This is not a process you can do alone. And any dentist who is one year out of university and is about to start, like the first week in their new job. Listening to this is thinking, ‘Oh, this is straightforward. I got this, I got this down.’ But if your nurse, for example is on it, and he’s got photographs on the screen and radiographs and all that kind of stuff, then you don’t look like a FAFSA. You don’t look like you’re kind of making up as you go along. You’re actually there, you’re on it, and you can then explain.

So, my method I’ve explained and shared some of this with you before Jaz, it’s called A Benefit Procedure Feature Statements. That’s my initial kickoff, which is usually benefit first, so that we can minimize your chance of this to becoming painful at some point. What we’ve planned, as you know, is that we’re going to do X, Y and Z procedure in patient for any terms. And the benefit of doing this early, proactively, is that we’re trying to reduce the chance of the same thing happening. Remember that tooth last year Mr. Smith? Usually it’s Josie with first name terms is typically how I work. So, remember that tooth last year, when you’re on holiday, Josie, part of it broke off, and then he came in quite a lot of pain. So, we’re trying to prevent and be proactive for the future. Is that we’d expected today? Or sometimes I do reverse and I say, ‘Just to make sure we’re on the same page as each other. What are you expecting today?’ Let’s just make sure we kick off on the right foot kind of thing. And when you embellish like that, I tend to find that people are kind of on the side. And we’ve called it co-discovering before, Jaz, where you kind of co-discovering people’s diagnosis.

But actually for a treatment appointment like this. The scenario we’ve just laid out, what you’re trying to do is just kind of co-plan together. You’re kind of going, let’s just make sure we get this. I also start with subtle things like, by the way, let’s say you started the appointment 10 minutes delayed. Thanks for your patience today, by the way, we keeping you from anything, or are you dashing back to work or because we started talking earlier on in this podcast about how to keep people on site. Like you said, Shaun there people first. And an easy way to, sorry to use this word, but piss people off is actually cut into their day. It’s to mess them around. It’s to mean they’re late to pick their kids up from school. It’s a very quick way to get people off site. And then on top of that, if you’re telling me, okay, you didn’t even prep properly. So, you had to take a rubber dam off with an exposure and the rest of it to go what we’re going to do now that like a right Muppet, then what happens is they go home and go, it was late. It was rubbish. He charged me too much. And you drilled into my nerve. That’s how bad things happen, isn’t it?

[Shaun]
Yeah. And the one thing you said there was? Yeah, thanks for waiting. Because it’s never ‘Sorry, sorry, we’re late.’ I-t’s always, ‘Thank you for waiting.’ Especially at the moment with-

[Jaz]
That’s a gem right there.

[Shaun]
Yeah, everything else that’s going on, I’m pre-preparing patients for treatment appointments, saying that, at the moment, appointment times are a bit like when you’re at school, and your teacher said the bells for me not for you. Because at the moment, we’re having to set up everything before we get you in because I can’t open the drawers when I’m in. And then once you’re gone, we have to do some various bits and bobs before we can clean down. So, although I’m booking you in for an hour, you probably won’t be sat in the chair for an hour, but you might be sat in the waiting room for a little while before you come in. So, they’re already pre-prepared.

[Jaz]
That is so good.

[Shaun]
But yeah, so that’s been able to preempt any issues that come along. And then you look like you’re planning for things which you are, because we do that we plan for things otherwise, we wouldn’t be even half decent dentists if we didn’t realize what was going to happen once you take that concept and take care of it.

[Zak]
And then it’s also important to and the only final thing I had to add to that was, when you then describe, for example, a radiograph or a photograph of somebody’s tooth on the screen. And there’s nothing better than a visual by the way. We’re back in the day when I was showing them tiny little, you know, I could size to radiograph film, old school processing. Can you see that tiny little dot on there? And they’re like, ‘No. Because I haven’t seen 400 radiographs like you have.’

So yes, basically, if you then can explain it to them in their terms to say, ‘Josie, this is a deep cavity and this tooth. We really caught this as soon as we could pause feasibly get to it. But there is something to say which is that there could be secondary things that need to be happened or discussed later. We’re going to get you out of trouble today we’re going to keep it safe, we’re going to do everything possible. So, you go home with no discomfort or very minimal discomfort as possible.’ But that said there’s likely to be a follow up blah, blah, blah, blah, blah, and I tend to say the words likely or unlikely because you don’t want to put yourself can’t go to black and white. There’s always a gray area in health care.

[Shaun]
At the end, very much at the end of the point as well. A little recap, guy, it’s gone really well went really smoothly. You might get a little bit of discomfort, especially when given the anaesthetic but that should calm down so they know exactly what to expect. And also to contact you if something is different. So, if it becomes really painful just to get the straight on the phone. Give us a ring don’t hesitate. Don’t suffer in silence. And again, they appreciate by being taught to like a person not just like a walking set of teeth.

[Zak]
I also along similar lines use the words to reduce the risk of, or to maximize your chance of a lot. It’s not to make this pain free. There’s always going to be a limit, you know, you need to give you some wiggle room. If you pick yourself as a pain-free dentist, and they can even feel a pinch of local going in. You’re not a pain free dentist.

[Jaz]
Well said and I just want to share just something I do all those things that you guys say thankfully, one different thing that I do sometimes at the beginning of the appointment before we then talk about consent is something that I was inspired by an eighth and eighth this whom I saw, because the year is 2008. It’s match with Liverpool national and Chelsea playing in the Champions League final. I think it was Moscow. I was in a pub in Hounslow watching that match. May not have won, I was really happy. And I was walking back home in Hounslow, which is late at night, which is not a smart thing to do. And I stumbled across some Chelsea fans who proceeded to headbutt me and hence why I’ve got a dodgy nose, if you ever wondered, and anyway, did the worst knows procedure ever? Because they didn’t improve it at all.

Anyway, Dennis says when he was talking to me, walks in. And he goes to me, ‘What are you having done today?’ I’m like, and the way he said it was, I didn’t even think he knew what was happening today. The way he said it, right? It really took me by surprise. I was like, ‘I’m having this procedure’, is like, ‘All right’. And he’s like, ‘Why?’ And then I clocked, oh, this is awesome. Okay, this? And do you know what could go wrong? Yeah, this. So, I love that. And sometimes I use that sometimes? I don’t know. It depends on my mood. It’s not every patient, but sometimes they do you know, we haven’t done today? Why are we doing it? What could go wrong? Very good. Let’s get started, I suppose some personality types, that might work better as well. So, something I’d like to do.

[Shaun]
That’s interesting. Just be patient on that one.

[Zak]
That can come across as quite a pragmatic and quite a sort of slightly more old school way to do things, you know, the paternalistic. I’m the clinician type of approach. But to be fair, some people bounce well off that type of thing. Absolutely, there is the risk of something like that. And by the way, this is something I was taught by the neurosurgeons in Sheffield, as an undergrad. They can come across quite like that by saying things like, do you remember Jaz being taught? So, what did they teach us to say exactly but before you take a tooth out before you do an extraction? Was it something like? So, what’s happening today? Or what is it we’re doing for you today? The risk is that you can come across like you say that you don’t know yourself?

[Jaz]
You don’t know, you know?

[Zak]
Yeah, actually.

[Jaz]
That was very apparent.

[Zak]
You’ll try to consent that person. But actually, you can come across as you’ve kind of not quite planned ahead. So careful.

Jaz’s Outro:
But I think the crux of it is sometimes to ask questions to validate their understanding. I think is a good way to do it in certain procedures. Which leads me nicely to consenting patients. And Shaun, there’s something that I know you’re quite hot on. There we have it, guys. Hope you enjoyed that lovely chat with Shaun and Zak, and we’ll be seeing you next time when we talk about the consent process. If you like this episode, please do give us a five star review. If you found this conversation interesting. Why don’t you share it with your colleagues? That’s how my podcast grows. And I’d really appreciate it. Thanks so much!