The Basic Rules of.....
Basic Rule 5: 6 E's
When I first started to read about Dr. Earl Pound’s removable prosthodontic technique what immediately became apparent was how organized he was with his patient care. His organizational skills were such that he made removable prosthodontics a predictable procedure or at least as predictable as one could make such a discipline. He did this by having multiple steps and appointments with each one obviously being a precursor to the next but also involving the patient in the process along the way. This had the effect of doing two things. Firstly, the patient was apart of the process and could put their input in as required or desired. If they were agreeing with each step along the way then a successful outcome for treatment was more or less assured. What a relief to know we are on the right track, isn’t it! Secondly, and most important, if the patient was not satisfied with the process no matter what the cause, the services could then be terminated. Wow. Imagine, your half way threw treatment and you leave on pleasant terms. Why was this possible? Because before treatment commenced he followed the 4 E rule (I have added two more “E”‘s to make it the 6 E rule).
The E’s are:
3. Empower (my “E”)
5/ 6. Enter or Exit (Pound had Eliminate)
The process of the E’s means that we are thorough with our patient interviews, case work-up, and case treatment planning and execution. By making the patient an equal partner in the process, ie. co-discovering, with us we are working towards a common goal like a team.2-4 We are up front with our patients with regards to treatment options, treatment length of time, costs, and efficacy. There are no surprises. And we expect to get renumerated at each appointment, just as Dr. Pound did. Dr. Pound received a fee at each appointment so that if services were terminated he was not out of pocket, the patient paid for what was done to that point, and the patient left the practice knowing full well that the pre-treatment contract had been honoured. Pretty smart. This concept can be applied to 21st century dentistry be it comprehensive fixed or removable prosthodontics, or just the routine everyday basics.
In my practice I follow the 6E’s. We thoroughly evaluate. There are no exceptions to this rule. Then we educate. Remember Basic Rule 2. Empowering of the patient results whereby they become a participant in their own care. Furthermore, this education process is not only about our diagnosis, treatment options, and empowering but also about fees and termination of services. We make each step of the way sequential and progressive such that records and treatment to date can be picked-up and continued at another practice of choice if in the unlikely event that “E” #6 (exit) occurs. We insure also that our fees have been looked after as well to this point.
A good example of our approach to comprehensive oral rehabilitation is the common way we provisionalize. In generalized moderate wear, erosive cases we frequently directly bond with hybrid composite; we like to call this the “prototype phase”. We do our thorough examination and evaluation followed by a thorough education of etiology, risk factors, treatment options, and efficacy. Costs are estimated and agreed too. We then perform our diagnostic provisional “prototype” phase (i.e. we have entered (“E” #5) into the treatment phase; in this example we bond establishing form, function, and vertical dimension re-establishment (Figures 1-3).
Figures 1-3: Composite bonding done in one appointment reestablishing form and function to the stomatognathic system.
This can usually be done in maximum one appointment per arch. At this point we have accomplished the first 5 E’s and have been renumerated. We can then proceed to the definitive restorative phase with the material of choice (gold or porcelain) at our leisure (ie. reenter (“E” #5) the relationship again) or services can be terminated depending on the circumstances (ie. exit (“E” #6) the relationship). Therefore, treatment has been predictable and stress free.
The 6 E’s offer another vehicle to optimize patient communication and interaction. The 6 E’s also just make good business sense. As oral healthcare providers we dance a fine line between professionalism and business. Nevertheless, a high regard for professionalism coupled with business acumen will ensure that we keep the busyness that us top professionals deserve.
Further Suggested Reading and References:
1. Pound E. Personalized denture procedures: dentist manual. Anaheim: Denar Corp.; 1973.
2. Roth SR. ProSpective volume one. Reclaiming the passion of dentistry. Seattle: ProSynergy Press; 1993.
3. Roth SR. ProSpective volume two. Defining the mission of dentistry. Seattle: ProSynergy Press; 1995.
4. Roth SR. ProSpective volume three. Advancing the profession of dentistry. Seattle: ProSynergy Press; 1996.