During my presentation last Friday I showed the group a radiograph with a class two lesion and asked them to choose “Fill it or Watch It?” It’s a fun exercise to experience the thought process behind clinical treatment recommendations. After the program, taking the escalator down to the lobby, Dr. Gary DeWood and I were reflecting on the program and he made a comment that stopped me in my tracks. “ I hate when dentists say they are “watching” something. What are we “watching” it do? I don’t want my physician “watching” my heart disease.” I realized how something I have been saying for more than two decades must sound so peculiar to my patients, and doesn’t fit with my philosophy of practice at all. What would I think as a patient when the dentist or hygienist tells me I have a “small cavity, but we are just going to watch it”? I can think of a whole list of things that would go through my head, and most of them do not reflect positively on us as a practice.
As I thought about it I realized that when I use the word “watch” I always discuss the findings with the patient and make recommendations. The difference in the recommendations is they don’t fit a billable procedure code. Many of these recommendations are designed to create an alteration in patient behavior, things like home care, nutrition or simply being observant of a cause. In addition I am hopeful that with intervention on the patient’s behalf at home the finding may not need “in office” treatment in the future. It also struck me that all of these “watched” findings get noted in the patient’s record with a recommendation to follow-up diagnostically at a future appointment.
In the future I will be sharing with my patient’s that their exam revealed “x” and my recommendation is to implement some conservative approaches they can take at home to “manage” what we discovered. At future appointments we will be monitoring and assessing the effectiveness and can make additional recommendations if needed. I want the language we use to be congruent with the fact that we are proactive, conservative and individualized in our approach to patient’s health, so “watching” is a thing of the past.