Boy, don’t get me started. I guess this is about as good a place as any to vent my frustration with technology. I have this saying, "computers don’t straighten teeth, orthodontists do." If most orthodontists spent as much time (me included) talking to mothers in their practice as they do fiddling with their high tech toys, we would all have massive practices. When someone asks me how to get into technology and which platform to use...I generally start out with: "Do you want to get your divorce now or later?" I think those that choose to incorporate technology into their lives go through such a steep learning curve that it literally engulfs their whole lives for a period of time. Maybe there’s no other way to become competent - I don’t know. I remember back in the 70’s when Rocky Mountain Data Systems brought us into the era of computerized diagnosis. I often went into practices where orthodontists laid out this mountain (excuse the pun) of data but didn’t have a clue as to its importance or even what a V.T.O. really means in the context of treatment decision making. They just wanted to look "high tech" to the patient. It was more a marketing tool than a value tool...I think we may be repeating some of that thinking. We generate all kinds of color printouts and data for the patient, not really knowing the true impact of the material we give out. I can treat most garden variety Class II malocclusions in about 70-80 minutes of my time. It’s almost crazy to spend that same amount of time (staff and yours) printing out inconsequential junk. Granted, there are some patients who respond positively to this kind of techno-gadgetry, but most just want a caring, responsive environment for their orthodontic care. If you spend too many of your resources on noneffectual ramblings, you loose quality time with the patient.

Plainly stated, I hate computers, but I love what computers do. They are, by definition, inhuman. The greatest orthodontic book ever written about computers will be entitled, "The Use of Appropriate Technology in the Practice of Orthodontics." Let me say it another way, let’s stop trying to kill ants with bazookas. There is something wrong when a great clinician who creates great orthodontic results and then feels inferior because he or she isn’t on the cutting edge of technology. If one uses a computer as a bean counter or a appropriate communicator or in some way it energizes the practice...well, that’s OK, that's good. As technology becomes more sophisticated and accepted by everyday society, the winners will be those who are human...who have the ability to touch the common threads in people, to reject the inhuman. Sometimes I think that the ultimate oxymoron is "High Tech, High Touch." That may be a visionary goal but at this point they don't mesh very well in most orthodontic practices.

I will give you a good example of that. The truth be known, most good clinicians can hold a head film up to the light, look at the models, peruse the patient photographs and come up with a great diagnosis. Not a computer used; no ten-page printout; nothing digitized; no computer involved. Heresy? I don’t think so. I know orthodontists who will look at a computer tracing and printout and never even view the headfilm to glean all that it offers. I wonder if digitized tracings tell us if there’s a tumor there? I once heard Reed Holdaway make the comment: "I would rather be a great chairside clinician than a cephalometric specialist." What a great line. I would only like to update it a little and say: "I would rather be a great chairside clinician (artist) than a computer specialist (technocrat). I think most of us know that intuitively but we get carried away by the "gizmotic" society we are becoming.

Every year my staff and I do a sit-down on things we’d like to change in the upcoming year. We bitch and complain at each other and get stuff out on the table. It’s a little healthy bloodletting. For the last four years running, my staff has practically screamed at me: "get your head out of that stupid computer and get back into the operatory." This, believe me, is a point well taken...and I’m trying...but I’ve gotten bitten and just mainline my Mac. Betty Ford for me, I guess.

Now, Ray, after all that expunging, I'll answer your question. It all comes back to systems and systems creation. To the extent that technology refines and defines systems in the office they are good. To the extent that they draw time and energy away from the patient, they are bad. God gave us the wisdom to know the difference. Yes, I have a moderately high tech office; but I struggle daily with the "keeping up with the technology Jones's" mentality.

You don’t need to be a visionary to know that technology is going to play a greater role in all our lives. You do, however, need to be visionary to be able to put it in its place as just a part of the greater human condition. I have tried to get my computer to settle an argument between my staff and me. So far it hasn’t worked.

The key to using computers in our workplace is to determine which technology has true impact, meaning, or determined value. That, my friend, is a tough job. If it doesn’t have true impact, chuck it...because it makes your life more complex and complexity is not the goal of systems creation.

After I have completely trashed the over-use of technology in an orthodontic practice, I will now tell you that this is a great place to use technology in the new patient communication process. It is, however, a little different than you might think. If I can walk into the new patient exam and say, "Hi, I’m Dr. Hilgers, your child needs braces and it will cost $4500 and you can leave a check at the front desk" and it works, that is what I would do. However, it usually isn’t that simple. We need to do more than just "sell" the patient. We need to truly communicate with them. We need to find out who they are, what their concerns are, how they view what we do. The answer to this, as improbable as it may seem, is to create a system that allows this human communication to flow. This communication can be implemented quite nicely when a computer is utilized. There are three things that must occur for the patient to select your practice. First, the orthodontist must convey a sense of clarity about some pretty complex issues. Second, he or she must have a sense of authority about what they are presenting. And lastly, the orthodontist must project a sense of integrity about what they are recommending. It’s simple: make it understandable, mean what you say, and treat people exactly like you would your own family. If you can master these skills and throw in a little bit of humor for spice, it's easy to be a winner in the new patient process.

Yes, although I understand orthodontists who like to use the traditional approach to consultations. I think this is a very "area" driven phenomenon. In a small town in the Midwest the patient might prefer the doctor time and hand holding that the two step process involves. In California, most people just don’t have the patience for long drawn out decision making. We find that if we can give the patient all the information that they need at initial exam they like it. If we can communicate over the phone instead of having to come in, they like it. They like it if you are straightforward and clear about your decisions...it creates a sense of confidence for them.

The best way to solve the dilemma about one or two step consults is to ask the patient. At the end of my examination, I will say to the patient, "It is very clear what is going to need to be done to correct your problem. If you would like, we can give you all the information you need to make your decision about treatment today. Is that O.K.?" By reading patient’s body language you can usually get a pretty good idea of what they need. I think I’m pretty good at it but I can honestly say that my treatment coordinators are great at it. If there is any question, we’ll schedule a second consultation. If I feel that the patient is "getting it", we try to make the process as simple as possible. It they aren’t, then we’ll do whatever we need to make sure they do.

Yes, I use Consult from Ormco. You must take that with a grain of salt though, because I developed the program.

Half-and-half. It is my belief that the patient needs to hear certain things from the doctor. Without hearing those things, without the confidence saying those things evokes, the treatment coordinator is useless. People don’t really listen until they are committed to the sale. A lot of orthodontists think that their treatment coordinator is the "closer." Nothing could be further from the truth. The orthodontist is the closer. The treatment coordinator can only serve to further enhance the process.

Actually, easiest way to enter a photographic or radiographic image is on a scanner. The digital camera that I use is the Olympus 600L. It takes remarkable quality images. I use a PC card reader (in a G3 PowerBook) to take the images into Quick Ceph Image, the diagnostic and imaging system that I use. More importantly, I use the digital camera for all sorts of other marketing and personal reasons.

Computers for more of the art portion of their management so, in general, I find more orthodontists are computer literate than general dentists. Even then, a broad spectrum of older orthodontists (like myself) is computer-phobic. I guess I don’t need to worry about hurting their feelings though…they won’t be reading this will they?

No, not because I don’t think it's a great idea, but because there is truly a sore lack of orthodontists who really know how to use the Internet properly. Whenever I ask for a raising of hands in a meeting about who uses the Internet or computers frequently, most will raise their hands. But, when you get right down to the nitty-gritty and ask some simple questions, many have a computer sitting there but mainly just circle it like the black obelisk in 2001, A Space Odyssey. We will ultimately all use this medium for many things but I think that day is further off than most would envision.

Yes, on both counts. Right now I still like the personal aspect of writing on treatment charts but I have to tell you, nothing drives me crazier than a lost treatment chart. I read somewhere that we pull paper treatment charts an average of 80 times. There is good and bad in everything. This is one of those areas that I don’t want to be the first one on the block with a paperless office. Let someone else iron out the glitches, then we’ll see. There are so many other things I need to work on in our office that being paperless isn’t a priority. Will it be there in the future? Absolutely!

Jim, we cannot thank you enough for this opportunity to "pick your brain". Your contributions to our profession are innumerable and represent the efforts of someone who can see the future. Thanks for sharing with us.