Be careful : Delegation of work is a two edged sword !

"If you want to grow you need to delegate" is the core message that you get from any business coach worth his salt.Your job as a business owner is to think of ways of expanding the business and repeatable tasks should be delegated to someone who is a xerox copy of yourself.This is easier said than done.

While true,these statements are incorrect. The correct statement is "delegate but be aware" and by being aware I do not mean micromanaging things. Awareness means you need to know what is happening in your clinic and the person to whom the task has been delegated is performing according to the standards that you and your clinic is known for.

Here I share a case where I learned this lesson the hard and expensive way.

This 60 year old female booked an appointment with us to get Implants done. Let's call her Mrs. SP. She was from Jalore, a place 450 kms away from Jaipur. She wanted to get rid of her mobile lower front teeth and was looking for a fixed long term solution.

This was the condition of her lower teeth when I examined her for the first time. From left canine to right first premolar all her teeth were grade 2 or grade 3 mobile. I decided to remove all these teeth, place 4 implants and then give her fixed prosthesis immediately after placing the implants.

Incidentally on the same day another patient walked in, let's call her Mrs.AJ who wanted to get fixed teeth too and hers was a full mouth case. She also wanted to get teeth as soon as implants were placed as she had her son's engagement coming up.

So I decided that I would do the surgeries and then for prosthetic work I decided to give it to the prosthodontist whose name I had heard from a senior of mine.. We discussed SP's case and he was very confident that he will give her fixed teeth in 3-4 days after the implants were placed.

The surgery went very well, however tooth no. 34 had a buccal angulation and since it was immediate placement of implant in the socket the implant too had a slight buccal angulation.In the hindsight I feel I could have placed it in a more lingual direction.

After suturing was done the prosthodontist walked in to take the impression.I went on to perform the other patient's surgery and after 4 hours of surgical work I called the prosthodontist to enquire about the impression of the previous case as well as the time line of final execution.He said everything is going according to the plan and we will be able to give the final prosthesis in 3 days.

I was expecting the jig to come the next day which did not happen,two three calls to him went unanswered and the prosthodontist came walking in with the jig two days later.

"Sir there was some problem at the lab,There was an electricity cut hence they could not finish the work on time." I was not happy about this but decided to not escalate things in the middle of an ongoing case.

Now the metal trial at least should have come on time but the prosthodontist again got busy in some other case at some other clinic. The delay kept on happening and it was the 7 th day by then.I decided not to load the implants and asked the prosthodontist to give her a temporary instead as the window had already closed by then.

I also decided to let go of him as i found his work ethic very different from mine.I paid him his professional charges and asked him to leave the metal trial at the clinic.My mistake was i should have looked at the metal trial inspected the whole case and then should have asked him to let go of the case.

After 8 weeks of healing I called the patient for metal trial.I was aghast when i saw the metal trial for the first time.I failed to understand why was there a buccal opening of the screw hole.I called the lab,he said that's how the prosthodontist wanted it.I was fuming but could not do anything now as the casting was already done.

I called him and his reply was "Sir I had decided to give a paulo malo cap on the buccal hole."

"Why did you simply not give a multi unit to correct the angulation?"

"That is not necessary sir,I do this day in and day out,But you did not let me finish the case."

Finally the patient went with a composite filling covering the screw hole.

While I had built the composite nicely and the margins were not very obvious as seen in the pic.However I knew she would come back,usually your gut tells you what is right and what is wrong and I did not follow my gut !

After a few days the patient called me and said "Dr Saab please check your whatsapp,the implant tooth has broken down.It was a sunday morning and this pic attached below was enough to ruin it.

Now what do you do when your worst fear come alive, you sit back ,think and admit the mistake that you knew you had committed.

I recalled the patient and this time I decided to do everything on my own.

I removed the whole prosthesis and took a new impression with a 30 degree multiunit on the distal implant.

It took me just 5 minutes to change the direction of the access hole from buccal to lingual.It was a very costly mistake where I had to spend close to 12000 Rs to get the new prosthesis made.

It was as easy as it can get. But i committed the mistake of believing someone blindly and not checking the work at the right time and stage.

Delegate, it is necessary if you want to grow. But keep a check on everything, set standards that have to be met else ask the person to repeat the work.Never trust anyone blindly and never believe in long shot statements like "I do it in and out:,I do so many cases' a year"

These all statements are just boastful presentation of average clinical skills and you can any day do a better work if you put your heart,soul and mind to it. Believe in your own skills and if you do delegate,know what is the ideal work and how it has to be achieved.So that you and your patient's are happy and content in the end.