“Just” a Checkup?

I was reading a Facebook thread about the current tension between dentists and hygienists, when I came to a comment that stopped me in my tracks. It was from a periodontist who also teaches in a hygiene school. He wondered, at the risk of being seen as “sacrilegious,” if hygiene exams were really necessary. I wanted to stand up and cheer!

In another thread about PPE’s there were questions about how the dentist would manage all the donning and doffing of gear while coming in and out for hygiene checks. I commented that, regardless of what PPE’s we are using, this might be the time to end hygiene checks as we have known them. My comment was mostly ignored.

I’m not advocating for a revolution in dentistry, but I have questioned the rationality of the hygiene check for some time. In fact I wrote a deep dive Leadership Guide about it with this title in 1998 in which I suggested we re-think the whole system.

I want to be clear: I am not questioning the value of a doctor exam, just the system that has grown up around it. I believe the periodic dental exam is one of the finest services offered in health care. It is a regularly scheduled opportunity for a caring, knowledgeable clinician to partner with patients to focus on their health. So why don’t patients grasp the value of this service?

I believe part of the reason our patients don’t value their hygiene exam is because those of us in dentistry don’t always value it.

We have a love/ hate relationship with the periodic exam.

Dentists see it as an interruption of their restorative work. Hygienists get frustrated that they are kept waiting. Everyone else stresses about its effect on the schedule. It is not on the doctor’s schedule but is supposed to seamlessly fit into his or her day.

Liability is of course a factor, and Dental Practice Acts vary from one region to another as to the standard of care. We could have an extensive conversation about changing the laws, and I think there would be value in that. But that is not what I wanted to help you think about today.

I’d like you to think about your “standard of care.” I want to help you clarify the purpose of your exam and create systems which are both efficient and effective at serving that purpose.

You might begin by asking yourself some questions:

• Why do you do a periodic exam?

Outline all the reasons you do an exam, from the clinical rationale to the financial aspect, to relationship implications

• What are the elements of your periodic exam?

From soft issue to hard tissue, from whole health to dental health, from radiography to bacteriology: what do you want to assess on a regular basis?

• Who should do what parts of the exam in your practice? What agreements will you and your hygienist make about who checks for caries, perio, and TMD issues? Who will do a muscle exam, oral cancer exam, or photographic exam? What aspects will you share responsibility for?

Once you have a clear picture of what you want in an exam you can develop a system for how to make it a reality.

We stand in the middle of a major disruption to our profession due to the shutdown caused by the Covid 19 pandemic. You can invest your time and energy into trying to figure out how many times a day you should don and doff your PPE’s to continue your routine of checking hygiene patients.

Or . . . you can use this as an opportunity to raise the level of your exam process, and help your patients give it the value it deserves. I know this is a busy time, but I hope you will allow yourself to start questioning old habits as you incorporate new systems. You may need time to settle in, but I hope you won’t get too settled. I hope you won’t let this opportunity slip by.

I don’t know what that would look like in your practice. I do, however, have some questions we might ask to begin to change the way we think about exams:

What if there were significant blocks of time set aside in your practice when you didn’t wear PPE’s, when your focus was on facilitating health instead of treating disease? What if patients were appointed for an annual exam on the doctor’s schedule on those days with time for meaningful conversation? Would you take it more seriously and use it more effectively?

What if you focused on what is most effective, instead of what insurance code to use? What helps patients move forward, instead of what fits the familiar model?

What if you looked at your goals for your patients in an exam and all the resources you have at your disposal to provide that service? How can you use technology without sacrificing connection?

What if dentists and hygienists aren’t the only people who can facilitate health? How could you more effectively use the gifts and talents of every member of your team to expand your capacity to have a positive impact on all aspects of your patients’ health? What new partnerships can you form?

This disruption in our systems provides opportunities to think creatively about everything we have taken for granted. It offers opportunities to introduce changes to our patients when they are most aware that change has to happen. It is an opportunity to ask ourselves what aspects of what we do are based on  compassion, and science, and purpose. And which are based on familiar habits with which we have a love/hate relationship.

These opportunities are rare and fleeting. Don’t miss this opportunity to bring your standard of care to your exam process.