by Rob Veis, DDS
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The first thing we learned in dental school is that there are certain treatment priorities:
- Emergencies first – Evaluate and take care of any condition that causes pain or has the potential for infection.
- Disease next – Address the majors, e.g., periodontal disease and/or caries. Get the process under control.
- Evaluate and address long-term dental health needs.
We all learned this – along with the importance of prevention, oral hygiene, nutrition, and more, in promoting long-term wellness and total patient health.
The real world trade-off
When we left school, we entered the real world. In the real world there are:
1) Patient expectations – the desire to look good, which often takes precedence over actually feeling good.
2) Business demands – the economic pressures of running a business and making a living.
3) Insurance companies – the mindset characterized by the prevalent patient misconception of, "If my insurance doesn't cover it, it must not be necessary."
Social and economic realities impinge on the ideal protocols we were taught. Over time, these realities often change how we practice dentistry. The first two are certainly challenging enough. The third constitutes the biggest, most formidable obstacle to the practice of wellness-first dentistry.
Insurances cover the bare minimum. They do not cover the best. They certainly do not cover the best over the long term. Yet insurance companies set your fees, and in a very real sense dictate your treatment.
Because this is too often the case, the wellness-first dentist is often perceived by patients as someone trying to "up-sell" a service or procedure that they don't really need. The dentist is not perceived as a caregiver who seeks to educate patients as to what they need for the best long-term care and restoration.
The Problem: Confusing the protocols of insurance companies with your own.
The Solution: Deciding what type of dentist you're going to be.
Whatever your policies or procedures in relation to insurance providers, you can, by refusing to let provider pressures play on you, still provide the best care for those patients.
What I am calling for here is not a cataclysmic rearrangement of the dental landscape, but a subtle shift in how we address the core missions of our practices. I didn't go to school to have an insurance representative decide what is the best treatment possible for my patients. I tell patients, "I will help with your insurance, but you still have the responsibility to pay me appropriately for what I deem is the best care. Your insurance company is in the business of making money, not of taking care of you."
Whether you are a seasoned veteran or are just starting out, you need to periodically step back and take stock of how you are serving the wellness needs of your patients – and how you're not – in accordance with those prime first-year directives you learned in dental school.
The Plan: Get off the treadmill.
For some of you the solution is simply getting off the drill-and-fill treadmill. Examine the logic and effectiveness of changing your initial patient interface from a quick-look-and-fix appointment to a minimum of two appointments. This means thoroughly screening and evaluating your patients. It means sitting down with them and discussing their medical history, concerns, and options. Spend time at the end of the day to create complete patient records and personalized treatment plans.
This shift in thinking is one toward providing care, education, information, diagnosis, and healing, not merely a widget. Whether we are talking about periodontal or orthodontic therapy, TMD or restorative therapy, we are being paid for our diagnostic skills, not the widget. We evaluate the disease process. We devise a method of treatment in accordance with that evaluation, one that addresses, accounts for, and promotes the continuing and long-term health of the patient. We care for our patients, because caring is the core of the dentists we were meant to be.
There's more to come in relation to the subtle necessity of wellness-first dentistry and the practical solutions that can make it work for you. Stay tuned for Part 2.
Dr. Rob Veis is CEO of the Appliance Therapy Group® (ATG). Reach him through www.appliancetherapy.com or by calling (800) 423-3270.
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