PC Dependency: The Dark Side

Dentistry Today


Tech authors, myself included, frequently extol the prospects of expanding your office PC’s role in managing your practice. The stylish jargon “paperless office” is tossed around with promises of functionality so streamlined that it will make your head spin. While many of us have already adapted a management package to control front desk operations with one, maybe two PCs handling the lion’s share of the workload, relatively few have stepped beyond these boundaries.

The prospects, as painted by the experts, of expanding your network into every room, especially treatment rooms, are indeed tempting. Who wouldn’t like to make his/her life easier and, at the same time, be more productive? An article of mine appeared in the November 2001 Dentistry Today that made it plain—you needed a PC in your operatory, YESTERDAY!!
An uneasy feeling of responsibility has compelled me (in the interest of “equal time”) to brief those contemplating “computer expansion” on the darker elements of what I will call “PC dependency,” PCD for short. 
With the glitter comes the gore. While much business-related satisfaction can be had from increasing one’s “digital involvement,” you should be aware of what your mama never told you about PC dependency. The tone of this article is intended to be light, but I can assure you that when caught in the throes of a PC meltdown, the office mood is anything but light. At the very least, know what you’re getting into before taking the plunge. 

If we think of PCD as a syndrome, the symptoms are easy to spot. If you meander through the halls of the office to be diagnosed, you’ll notice a variety of monitors perched on countertops wherever you turn. Some will be bulky CRTs, while others will be flat-screened. In any case, signs of Windows-based applications abound. Some monitors will display the provider’s work schedule for the day, others will be tracking patient accounts, while yet others will be sifting through payroll operations. Still another will be running its own display as a queue of electronic claims is whisked away to a distant clearinghouse. If you look carefully, you may also spot a small box or two (the HUBS) with green lights flashing in symphony as network communications race from server to client and back again. 

Further inspection may also reveal a hygienist grabbing a few sips of Joe in the break room while a CAESY video (www.caesy.com) explains to a patient why their teeth are in jeopardy of falling out. A few more steps down the hall, and a peek into a doctor’s operatory might reveal a patient gazing at a monitor that displays the ravages of an unyielding kernel of popcorn. Ouch!

PCD is additionally marked by an absence of what was once known as “the appointment book.” You know, the spiral bound, frayed, antique volume that people used to write in. When asking an office worker caught in the throes of PCD about her recollection of such an entity, anticipate a puzzled, almost confused look. It’s unmistakable.

An extreme symptom, often considered PCD in its terminal stages, occurs when an unused telephone and adjacent PC conspire to confirm patient appointments sans human contact. (Such manifestations leave little hope for a turnaround. It may be best for the office to get its affairs in order at this juncture.)
Upon first encountering the patient, all would seem to be nirvana. Happy providers assisted by even happier office workers enjoying lives made easy by the wonders of computer technology. While digital utopia may prevail for extended periods, the family’s dirty laundry won’t be hung out for you to see. You ask, “What dirty laundry?” Listen up! 

I’m going to come clean. My office suffers from PCD. You’ve been told the signs of the condition, now let’s talk about what happens when the system is challenged. 

Prior to computerized scheduling and patient processing, the only thing that could shut us down for the day would be a failed high-volume suction or compressor. That’s changed. A network down is equally effective, with much greater carnage than mere suction failure. When the in-office monitors go blank, you’ve lost touch with your day, as has everyone else in the office. Patients can’t be processed, and electronic claims lie in wait in PC purgatory. You can struggle through a day, but it won’t be pretty.

What brought this to light was the havoc wrought by our local power company’s extraordinary power surge one sunny fall afternoon. Sure, we had surge protectors, some were adequate, others weren’t. Nonetheless, five PCs in a 12-PC network (the business ones to boot) began making siren sounds, much like that of a French police car. In doing so, they also seized up and then failed to boot. For most of the day, chaos reigned. To make matters worse, no one knew about the power surge until weeks later. Thus, the “what the heck is going on” search for the cause of the problem began, only to culminate with the next issue I raise. Who’s the savior?
Allow me to digress for a moment. Where I live, PC maintenance is not a regulated service. In fact, I’d venture that this is the case throughout the United States. Self-designated experts abound, some with Microsoft Certification and many without. Some outfits are one-man shows, and others are more formal groups of computer geeks, united by a common moniker. What’s more, in the majority of instances, the dental offices hiring such services don’t know enough about the systems themselves to tell the smart guys from the not-so-smart guys. A very incapable PC person dressed in a neat suit could win your heart, while the genius in waiting, with long hair, wrap-around shades, and a Nascar tee shirt, could be promptly shown the door, owing to his less-than-professional look.
The point here? Your dental fortress, mighty as it may be, is held hostage by the skills, or lack thereof, of your professed PC guru. 

You ask: “Why didn’t your software vendor take on the problem, doctor?” Well, software vendors aren’t like the phone or cable companies. They are usually located not where you practice, and their teams of service people are limited in number, and worse yet, they are most likely out doing something else when the big one hits. You need local help.

Just so you know that it doesn’t require a massive power surge to take you out, 1 month after our crisis, an employee ran a utility to “correct” a corrupt data file, which rendered a “shared” file of some sort “unsharable,” which in turn rendered our client PCs (all 10 of them) unable to hook up with the server for the better part of a normal business day. In a near paperless office, you can forget about schedules, patient balances, posting charges, electronic claims, etc. You name it. You can’t do it.
Believe it or not, both crises were solved by the guy with the Nascar tee shirt. He has since turned out to be a gem. Proof positive that “looks can be deceiving.” What still scares me though, is that in many ways we are at his mercy. 

How many of us have built our networks in one fell swoop? I would venture the vast minority. Instead, we build up the network, inching into PCD, one or two PCs at a time. Along the way, multiple former slide-rule operators piece the process together, each condemning his predecessor’s handling of the network configuration. The result is a somewhat heterogeneous mélange of PC hardware with slightly differing operating systems and hardware configurations, trying to play nice with one another. Subtle, unexplained malfunctions such as system crashes or computer lockups will interrupt the day as a brave business assistant stops what she’s doing to try and right the ship. Universal? Not necessarily, but not uncommon either. The more PCs in your network, the more potential issues to solve.

Next, consider the software conversion. Early on (maybe not so early on) you purchased an econo-management package after being told it would do what the big boys do, but for less money. Two years later, the truth emerges. Your bargain software is inadequate, and the development company has either folded its tent and vanished or been bought out by a bigger fish that no longer will support your package. It’s now time to jump ship and buy into the mainstream. 

Two problems exist. One, your current hardware is inadequate to handle the new, more powerful software, and two, your data needs to be converted to a new format that just happens to be “not all that compatible” with their data format. Enter the next set of gurus that will find a way to convert most of your data, but not all of it. Thus, weeks of balance and demographic data transfer await your staff as they try to regain functionality on the new system only. For the better part of a year, they will need to run both packages as you leave the old and grow into the new; PC dependency at its ugliest. 


The envelope arrives. Your software company has produced the latest upgrade to your management package. Perusing the enclosed letter, you take in promises of fixes for this issue and that. What’s more, a new gizmo was added, “ScanOwallet,” that will allow your checkout person to estimate how much patients are carrying in their pockets when asked for payment. You pause for a moment. “Hmmm…the package has been relatively stable for the last few months. Do I want to mess with it?” The disk stares at you, calling: “install me….install me….” In a weak moment, coaxed by the checkout person who wants ScanOwallet, you plunk the disk in the CD drive, yielding to the control of PCD. The drive begins whirring, you click “proceed,” and suddenly it hits you. “What have I done!!” 

To make a long story shorter, the next 2 weeks are spent debugging the debugger. The fix fixed, but it also didn’t like some of the peculiarities of your system and decided to punish you for being a nonconformist. Six phone calls to the software vendor later, you’re stable again. You’ve also been promised that the next upgrade disk will fix the last fix. Perspiration beads on your forehead as you make an oath to yourself to toss the next upgrade envelope as soon as it crosses your desk.


One other item needs to be mentioned. (I have a word limit, believe me, I could go on.) PCD also means that your hiring practices have now entered what I call “ the reverse limbo” (you remember the dance?). That is, the aptitude of prospective employees becomes subject to an ever-raising bar.

“Can she type?” is no longer a relevant question. Rather, “Is she computer-savvy?” is today’s prerequisite. The complexity with which the PCD office runs necessitates bright employees capable of complex problem solving and rapid learning skills. Such an office staff doesn’t come cheap. Expect to pay near the high end of the local scale if you plan on attracting and holding the brainpower necessary to maintain the status quo in a PC-dependent environment. 


Bleak, eh? Why bother? Because when it’s hummin’, there’s nothing like it. The satisfaction that results from a properly functioning network and sophisticated management software is too wonderful to ignore. More often than not, my own office hits the sweet spot.

PCD need not be a debilitating condition. One merely should be cognizant that this particular utopia can have its hellish days. From the preceding text, I’d like you to take away some key points in order to make your case of PCD one of the more pleasant varieties.

When planning on a network expansion and consequent expanded role of PCs in your practice, purchase all of your machines from a reputable dealer, similarly equipped and running the same operating system. If you’ve got a few older, straggler machines that you’re wondering what to do with, give them to the employees to take home. You’ll make your life easier and score points with the staff. Don’t skimp on CPU power.


Locate a Microsoft Certified network expert that does business right in your own town. Make sure he carries a cell phone and has been in the area for many years. If possible, have him set up your network rather than your software vendor; unless of course, they happen to be local also. He who sets it up is likely to be better qualified to service it. Remember that! When your PC person does happen to be needed on an emergency basis and saves your hindquarters, pay them very quickly! I’m sure you understand why.

If your system is stable and the latest fix-it disk addresses issues that you haven’t been troubled by, consider waiting for the next revision, and then the next, and then…

Hire the smartest people you can find and make sure they have prior Windows knowledge. You’ll have to pay, but it will be worth it. Your life will be less stressful.
Remember this: No matter how careful a planner you are, life happens! Expect it. Just be prepared to deal with it by having the right people working for you and consider some hard copies (you know, paper…?) of your daily schedules in the event of an unlikely meltdown.

Computers in dentistry are here to stay and can certainly make your office management a joy. The learning curve, however, is steep. PCD can rear its ugly head when least expected. Let calm heads prevail. There’s no turning back. 

Dr. Goldstein practices general dentistry in a group setting in Wolcott, Conn. He enjoys promoting the cosmetic side of his practice and has found it helpful to incorporate high-tech methodology into his daily routine to accomplish this. Dr. Goldstein serves on the staff of contributing editors at Dentistry Today. He can be contacted at martyg924@home.com or at his office at (203) 879-4649. He is prepared to speak on both digital imaging in dentistry and on the use of high-tech methodology to further the cosmetic practice.