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In Conversation with Dr. Thomas Fiege
Efficient collaboration between referrers, specialists and dental laboratories

Efficient collaboration between referrers, specialists and dental laboratories

  • Communications between dentists and dental laboratories

  • Involving the dental technicians in the planning process

  • Effective communications with off-site dental laboratories

  • Virtual glasses can further improve communications with off-site teams

  • Sharing patient information in a digitized world

          

Dr. Thomas Fiege

Owner of a Dental Practice in Brakel, Germany

Am Thy 2, 33034 Brakel, Deutschland

In Conversation with Dr. Thomas Fiege

 
 

Digitization is making sweeping changes in the medical profession. Thanks to advanced technologies, dentists can now integrate dental laboratories into their practice better, consult with referral physicians, and seamlessly follow the patient’s overall medical background. However, digitization is still in its nascent stage in dentistry, and it has a long way to go. Dr. Fiege contributed his insight on digitized dentistry to discuss its potential applications.

Our team at Zircon Medical recently hosted Dr. Fiege, the owner of a dental practice in Brakel, on our podcast series to discuss the role of digitization in dental laboratories, communications, and patient information sharing.

Introducing Dr. Thomas Fiege, the owner of a dental practice in Brakel, Germany

Dr. Thomas Fiege is a dentist and the owner of a dental practice in Brakel, Germany. He completed his dental degree at the University of Jena in 2008, following which he completed a residency in radiology.

Dr. Fiege says he always knew he wanted to be a dentist because his father is one as well. However, he briefly considered mathematics when he studied it in his first semester after high school. However, while he liked the subject, he didn’t like the career prospects it offered. “I didn’t see myself in the Allianz Tower (an insurance company), calculating the risk of a family man falling off his skateboard at the age of 43 and causing potential insurance damages.”

Dr. Fiege eventually decided to study dentistry in Munich, especially drawn to the fact that the field promised self-sufficiency and self-employment. Of course, he acknowledges that being self-employed has its challenges, especially when it comes to employee management, but he still prefers it to traditional employment. He’s also drawn to the freedom of being able to change structures within his practice to make it more digitized and modern. He likes having that control.

While Dr. Fiege isn’t actively working within the field of mathematics, he says it has certainly affected how he thinks. He calls mathematics the “search for structures,” and he believes that crucial skills can be imported into his professional life, allowing him to construct effective structures for his work and practice. That’s why he continues learning about mathematics through YouTube videos, even if it’s not his primary trade.

Communications between dentists and dental laboratories

Over 30 years ago, Dr. Fiege’s father set up a laboratory within their practice because that was the only possible way for them to expand. Due to existing regulations at the time, they weren’t allowed to hire many dentists, which kept them from expanding. As a result, they expanded by including a dental laboratory and technologies. Patients see this positively and trust them because they have close access to their dental technicians.

Because of the proximity of the dental clinic and the laboratory, their workflow is fairly collaborative. In a traditional practice, the dentist would send the digital or analog impressions to the laboratory and wait for the technician to send the final products back. However, in Dr. Fiege’s dental clinic, the technicians are actively involved in selecting the material, bonding type, work processes, and other aspects of the workflow.

Dr. Fiege also says having their own dental laboratory improves the correspondence and data flow. A lot of dental laboratories and companies don’t have the digital systems established correctly, and many still work with open systems, which can restrict the data flow and enforce analog work. However, because of their in-house dental laboratory, they can be sure of optimal data flow and correspondence, which, in turn, accelerates the work process.

Dr. Fiege also works asynchronously with his lab technicians. He doesn’t have to call the technicians to his treatment rooms, but he can send digital impressions to them via the cloud. They also use Microsoft Teams to communicate directly and keep in touch with each other. Dr. Fiege is clear proud to highlight that they were the first to introduce a lab scanner in the dental clinic, long before some of the larger commercial laboratories started.

“I would say that we’re a technological leader,” Dr. Fiege emphasized. “That’s very clear to me, and that’s why we use these systems extensively.”

Involving the dental technicians in the planning process

Dr. Fiege says their dental laboratory has a significant influence on the planning process. The technician enters the treatment room and talks to the patient — understanding the patient’s personality helps them curate the ideal prosthetics, including the tooth position and forms. Depending on the patient, they may determine if they need more pointed canines or a prominent incisor. Understanding these factors helps the dental laboratory produce the right set of teeth.

Dr. Fiege says he always makes rounds of his practice and visits the lab before leaving for the day. He might look over the technician’s work and discuss it, and this also ensures that the technicians feel involved in the practice. “As a practitioner,” Dr. Fiege says. “You have to force yourself to acknowledge the technical perspective as being of equal value and respond to it. But I have the overall medical responsibility.”

According to Dr. Fiege, acknowledging the technician’s input is about more than validation — it has a significant impact on the work. He believes it’s his responsibility to develop an open and communicative atmosphere wherein the technician feels comfortable contradicting his opinion. Otherwise, the technician may not feel comfortable saying something isn’t possible or that it would be better handled differently. As such, open communication is essential.

To illustrate the value of open communication, Dr. Fiege cited the airline industry as an example. “The airline industry introduced Crew Resource Management when they realized that most crashes are not technical, but human error. Because, for example, the stewardess doesn't have the guts to go upfront and say it smells funny and smokes in the back of the plane. Co-leadership is essential for risk minimization and information exchange.”

While listening to dental technicians is important, Dr. Fiege emphasizes that the final responsibility lies with him. He gives his team the space to voice their opinions and disagreements, but the final decision must be made by the doctor. That’s because some of these decisions have to be made from a medical perspective rather than a technical one. The dental technician also understands that, at the end of the day, the dentist will bear the responsibility.

“If things go wrong,” Dr. Fiege says, “I can’t blame the technician. It has to be clear that the doctor or boss stands before his team and patient and accepts all the responsibility and blame.” This can also help the dentist gain their team’s loyalty — they’ll see that the dentist is an upstanding individual, and they’ll be more empowered to voice their opinions. This fosters an environment of healthy debates and cooperation. 

Effective communications with off-site dental laboratories

Dr. Fiege says they often work with external dental laboratories, especially when they need drilling templates for implantology cases, which they don’t manufacture in-house. These communications usually occur over Microsoft Teams. This allows him to see the dental technicians over video and exchange visual data. He prefers video communications to share a PDF or email.

Dr. Fiege highly recommends leveraging digital technologies to see each other and communicate more personally. He also advises getting to know each other on a personal level and talking about subjects other than work for a minute or two. That fosters interpersonal trust and communication, allowing each individual to see the other’s point of view. That always leads to better results in the end.

While it’s not necessary to meet every week, Dr. Fiege says it’s important to meet off-site dental technicians at least once in six months or once a year. During these meetings, the dentist can also go over their data and information, such as x-ray diagnostics, digital models, videos of the patient, etc. While Dr. Fiege acknowledges the problems associated with data protection, he’s also confident that the patient will always place the treatment’s success over data concerns.

Virtual glasses can further improve communications with off-site teams

Dr. Fiege is excited about the increasing possibilities due to digitization. He says he’s working on a project wherein Microsoft’s HoloLens 2 virtual glasses will allow their off-site team members to see and perceive things through their eyes. It will also allow them to project holograms in space. This will allow him and his counterparts in other areas to visualize the same data. His counterpart will simply have to wear the 3D glasses to gain access to Dr. Fiege’s perception.

Virtual glasses are already used for heart surgeries during the coronavirus period in London. Doctors and physicians can sit in the comfort of their own rooms without having to wear protective suits and follow one doctor who visits all the wards. As such, only one doctor has to visit the wards, and the others can simply follow them via virtual glasses. Besides following the physician, they can also import diagnostic data.

Dr. Fiege highlights several other potential uses for virtual glasses. While performing complex operations and surgeries, students and other dentists would be able to observe the procedure through the eyes of the surgeon simultaneously, without crowding around the surgeon. It can also be beneficial in large university hospitals, where an experienced colleague or head physician can observe the younger surgeon from a distance.

Dr. Fiege acknowledges that this vision of a future won’t be implemented immediately, but its adoption will happen quicker than most people might imagine. “Be it marketing, social media, software licenses, or costs, we are simply shifting from a hardware to a software world,” Dr. Fiege says, summing up his assessment.

Sharing patient information in a digitized world

In Germany, referring physicians can increasingly access updated patient information because of electronic health cards and health telematics. Once the patient provides the health card to the practice, the dentist instantly receives access to their medical history. While that certainly facilitates the streamlined sharing of information, Dr. Fiege highlights that it has also drawn criticisms because of the possibility of data breaches and the lack of data protection.

Dr. Fiege also believes most dentists are simply averse to going digital. He believes enough progress should have been made in the medical industry to facilitate the exchange of x-ray images while following fair data protection standards. He wants relevant medical information to be available in advance, so it can be entered into the system immediately. They have that in the form of digital forms on the website, but Dr. Fiege believes it can be a lot more streamlined.

According to Dr. Fiege, a patient’s dental experience starts long before they enter the waiting room of the practice. Because of increased digitization, patients’ are bombarded with information at all times, so dental practices need to focus on expanding the dental experience beyond the clinic, bringing the patient in before they even make an appointment. This can be done through design, colors, and the language of the practice.

While the electronic health record is certainly streamlining the sharing of information, Dr. Fiege believes it will be accelerated soon. According to new periodontitis guidelines, the long-term value of the HbA1c value is now relevant for the therapy decision. This means dentists need to have access to the patient’s medical history, for which they need to consult the patient’s general physician. However, they will have to find a digital way to ensure access to accurate information without calling each patient’s other physicians.

Dr. Fiege has a clear objective for his dental practice. He wants to digitize his dental practice way more comprehensively than they are currently. He says it might seem like they’re already doing a lot, but they have a long way to go. Instead of waiting for digital changes to become mainstream and then hustling to catch up, he wants to consistently advance his dental practice, all while training his employees to access these developments.

You can find Dr. Fiege at his dental practice at Am Thy 2, Brakel, or you can contact him through the dental clinic’s professional website. You can also listen to him on our Zircon Medical podcast.

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