Decision Making, Fill the Gap: Water Temperature in Lobster Tanks and the Dental Connection, by Dr. Ernest A. Barbosa, DDS

In Impact by Dental Entrepreneur

After achieving a dream 20 years in the making, opportunities are opening, signaling the next phase of my professional career. Plans for this phase of my career will create the most productive step providing everything for the rest of my life. Embracing my blessings while at the same time looking for what is lacking seems hypocritical. However, I am at this point due to the decisions I made. Decisions are a part of life and are made several times a day throughout life. Dentists make decisions every day in the business of dentistry and the treatment of patients. Decisions vary in importance to one’s life, some affecting a wide range while others are not as important with little impact on anyone’s life. The choice of which opportunity I take will affect the remainder of my life. Therefore, the right decision is important because the selection effects will ripple through the rest of my life.

Fortunately, education and experience provided situations to shape and hone the process of series decision-making. Business school taught fundamental analysis. Experience taught me to set milestone short-term goals in enhancing achieving long-term goals. I want to share some of the fundamental decisional theories employed in making decisions for consideration by the reader.

Learning from business cases

The case method is used in business schools to teach concepts. For example, a famous case used in many graduate-level programs is the Prelude Corporation case. Prelude, a lobster supplier, wanted to become the preeminent lobster supplier in America. The following discusses the development of decision analysis, and the case is important in forming a foundational understanding.

Decision framing

Dental students receive an introduction to tooth preparation during the first few days of pre-clinical instruction. The number of burrs, diamonds, and hand instruments is overwhelming. Believing the purpose of the course was learning to use all the tools available on every preparation, I decided to illustrate to instructors that I understood how to prepare teeth. I tried to exhibit having command of each device and tried to use every one of the tools on every preparation. That approach was wrong.

Critical to entering clinical training, students had to exhibit skills demonstrating a level of competence before entering the clinic. Remembering those days in pre-clinical lab are cringeworthy and especially overlooking the most obvious path to competence.

At that time, I forgot the importance of three things: 1) understanding the problem, 2) setting goals, and 3) how issues link to objectives. My college courses taught the vital issue to solve a problem was understanding the problem. Understanding the problem is difficult as complexity increases. Experience changes understanding because experience changes perspectives and reveals previously unknown knowledge. I prepare teeth differently today than I did in dental school because of the experience years of preparing teeth provide.

Prelude’s teaching points analogously illustrate the process of achieving a goal like mine in dental school of “preparing a tooth.” For several weeks, “prepping the tooth” meant I used every burr, diamond, and hand instrument available. My preparation initially took hours. Imagine the unfortunate patients enduring crown preparations taking hours to finish. At some point, I realized, after a kind word from an instructor, that patients do not tolerate lengthy procedures. Treating patients in the clinic required the ability and skill to prepare teeth quickly, with relative comfort for the patient. 

Experience from the pre-clinical instruction revealed that besides preparing teeth, time was an essential factor. The instructor’s guidance helped disclose the information I needed to change my preparation method to include the time involved in the preparation. 

Identifying the issue: Business Case Analysis

Business school graduate programs teach decision theory. After practicing for several years and buying and selling a few practices, I felt successful. However, I wanted to go to a higher level than what my experience provided. So I decided, contrary to expert advice, to get an MBA. Business classes used business cases to teach business theory. One case illustrated that the smallest “gap in knowledge” provided the solution to the problem. In that business case, Prelude Corporation wished to become the preeminent lobster supplier in North America. Like the choice of burrs and diamonds that I had to deal with in dental school, the managers of Prelude had boats, crew, lobster traps, and lobster tanks to deal with. Like my goal of preparing the tooth, Prelude contemplated bringing more lobsters to the market. 

Using the analogy of Prelude helped me make decisions by recognizing options, not only in patient care but in businesses. In this case, Prelude managers looked at each process of the lobster industry. Then, much like I wanted to use every tool available to me for tooth preparation, Prelude evaluated every tool for catching lobsters.

First, the managers asked a good question, how does Prelude achieve its goal of preeminence? The pertinent question in dental school was what do I need to know about preparing a tooth to gain the skills to advance to clinical training? Then the managers asked what was preventing Prelude from reaching that goal. Analogously, I wanted to prepare a tooth by not considering time; my goal was not attainable. Pursuing the correct milestone is critical to arriving at the goal. One must comprehend the endpoint. Otherwise, one does not know how to achieve a destination. 

Setting the correct goal

Understanding a problem is essential. Equally important is understanding the goal. Then by linking the two together, goals are achievable. Furthermore, it is critical to know that dreams are adjustable as new information becomes available. Imagine the unfortunate patient having to endure a tooth preparation without regard to the patient’s comfort. 

Adjusting goals: what is a gap

Initially, Prelude considered increasing the size of the crew and the number of boats in the fleet in pursuit of dominance in supplying lobsters. Increasing the size of the catch was initially assumed the answer because Prelude thought the catch size was the key. However, the managers lost sight of the fact that the “size of the catch” is not the same as “bringing more lobsters to market.” Likewise, the fastest method of preparing a tooth is not the same as considering patient comfort during the preparation. 

Prelude eventually realized, through analysis, that bringing more lobsters to market was achievable by increasing the survivability of the lobsters. At the time, the survivability of lobsters was generally low throughout the lobster industry. Prelude’s analysis revealed that the number of lobsters brought to market alive was the key. Thus, Prelude Corporation set a milestone that increased the survivability of the lobsters. The gap preventing achieving the goal was the water temperature in the lobster tanks. Maintaining the proper range of temperature filled the gap by providing water the lobsters tolerated. Thus, Prelude brought more live lobsters to market and achieved preeminence.

Prelude’s goal versus my goal

Prelude achieved the goal of becoming the preeminent lobster supplier by correctly identifying the issue of survivability and linking that to water temperature.

As I started to treat patients in the clinic, I learned that diamonds generated substantial frictional heat, causing patient discomfort. The new information impacted the path to my goals. First, I limited the number of instruments used in tooth preparation. As a result, the appointment time decreased, and patient satisfaction increased. Realizing that some diamonds create more frictional heat than others was a milestone. Limiting the time for treatment and not creating pain-inducing heat during the preparation was like Prelude, realizing survivability linked to water temperature.

My career opportunities: same process more or less

Opportunities require decisions anticipated to have lifelong effects. My analysis is complex, accounting for years of experience of accomplishment and failure. Although I love my life now and am grateful for my many blessings, I want new career adventures and challenges. Fortunately, there is no pressure to decide, and there is time to evaluate every option. Assuredly, the process described above will form a portion of the decision-making process.

I hope this article has helped even one person’s decision process. If you have any questions, criticisms, let me know. I am always learning.


Dr. Barbosa dedicates his time to business issues affecting dentistry and, as a recent graduate of law school, will focus on legal matters affecting dentistry, Patent Law, and Tax Law. After receiving degrees in Biomedical Engineering and a Doctor of Dental Surgery, Dr. Barbosa received admittance to medical school. However, a cancer diagnosis caused numb fingers after the chemotherapy, and Dr. Barbosa switched focus. After owning many dental offices and other businesses, Dr. Barbosa recognized the gap in knowledge requiring pursuing the MBA. Dr. Barbosa maintains his dental license and is awaiting licensure as an attorney in Texas and admittance to the Patent Bar. He continues to Dream Big.