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Second Opinion: Ice Does Exist: The Case for Dentist-graded Patient and Staff Education Dr. Thomas J. Greany


Ice Does Exist: The Case for Dentist-guided Patient and Staff Education


Second opinions are common in health care; whether a doctor is sorting out a difficult case or a patient is not sure what to do next. In the context of our magazine, the first opinion will always belong to the reader. This feature will allow fellow dentists to share their opinions on various topics, providing you with a "Second Opinion." Perhaps some of these dentists' observations will change your mind; while others will solidify your position. In the end, our goal is to create discussion and debate to enrich our profession.

— Thomas Giacobbi, DDS, FAGD
Dentaltown Editorial Director
 by Thomas J. Greany, DDS

At the American Dental Association’s annual session in October 2008, the House of Delegates passed three resolutions regarding oral health literacy. One was an official declaration that we have a problem with patients who do not understand what they’re buying when they purchase dental services. A second was a call to lobby national organizations like the National Institutes of Health (NIH) to secure funding, and develop systems to promote oral health literacy in the United States. The third was to form a committee to perform a five-year study on oral health literacy and its impact on dentistry. It’s like that ubiquitous winter road sign, “Ice May Exist.” Ice does exist. The question is, “What are we going to do about it?”

There is a lot of confusion among dentists with regard to oral health literacy. On one hand, we listen to practice management gurus who tell us that educating patients about their options for care does not “help sell dentistry.” While that might be true, educating people about their needs and treatment options is not about selling. As health-care providers, we have a moral imperative to educate our patients according to the doctrine of informed choice. It’s just that doing so efficiently is difficult, and getting more so every year.

Historically, diagnoses and treatment recommendations have been passed from clinician to patient through a formal consultation process – with study models, radiographs, patient charts, photographs and other necessary props. The level of trust between patient and provider was once higher than it is today. There were no third-party intermediaries to muddy the waters of the decision-making process with cost-related issues and the injection of doubts regarding the necessity of treatment. Oral diagnosis was simpler in the past, and the number of treatment options much more finite.

Now, however, we live and practice in the digital era of informed consumers whose thirst for knowledge to enable decision making seems insatiable. If a person wants to buy a vacuum cleaner or a pair of skis, all he needs to do is surf the Internet, and the answers he seeks will be forthcoming. It hasn’t been that easy in health care, where treatment options multiply from one year to another, and the time to explain them dwindles. Time is particularly short in managed care settings, but that’s another story. Moreover, diagnostic complexity and treatment options have increased non-linearly.

Although information abounds on the Internet, there has been no efficient, logically oriented system to filter, consolidate and present reliable data in a meaningful context that patients can understand. If a doctor is busy treating patients, performing hygiene checks, managing a practice, supervising laboratory work, staying current, raising a family and having a spare moment for him/herself, it is exceedingly difficult to dispense knowledge efficiently.

Dr. Steven Woolf, et. al., introduced these issues in the 2005 article, “Promoting Informed Choice: Transforming Health Care to Dispense Knowledge For Decision Making” (Annals of Internal Medicine, 2005 143: 298-300). In building his argument for an efficient patient education system, Woolf states, “One may safely predict that the passage of time will only increase the demand for information and guidance as clinical options increase (both in number and in technical complexity) and as the stunning expansion of information continues. Today’s health-care system is unprepared for the intersection of these two realities. The system clings to an outdated model – relying on busy clinicians to keep their patients informed – a holdover from an earlier time when a physician’s impromptu advice was sufficient and when there was little concern about its inherent incompleteness or bias.”

Harvard Business School Professor Regina Herzlinger has written several books over the past 20 years on “consumer-driven health care.” In fact, she is credited with coining the phrase. Her extensive and wonderfully reported research has led her to conclude that the solution to our nation’s health care crisis lies in the informed consumer. She describes the demise of what has traditionally been a paternalistic doctor/ subservient patient relationship, giving way to a provider/client association that exists on more equal footing.

The indispensable element in the purchase of health care is not low cost, but maximum value (quality of services per dollar spent). To make value-oriented decisions about health care, patients need to understand what it is they’re buying and what their options are.
Author's Bio

Dr. Thomas J. Greany is chief operating officer of Symbyos, developers of ToothIQ.com, a peer-reviewed, HON Certified oral health information resource for consumers and health professionals – including dentists. Available on the Web in 42 languages, ToothIQ.com provides unbiased content to facilitate informed choice and guide decision- making for patients and their dentists. Professional memberships are available at ToothIQPro.com, which provide dentists with access to a catalog of dental procedure animations and practice-building Web microsites within ToothIQ. ToothIQ Pro also allows dentists to e-mail their patients customized “playlists” of animated educational content, and receive an e-mail receipt when the patient has viewed it.

We all have patients who surf the Internet, looking for information about dental symptoms, diagnoses and procedures. They come into our offices with a stack of paper, convinced they know more than we do because they’ve spent a few hours gathering random factoids. Usually their search is completely out of the context of their needs and we spend extra time reeducating these patients. Small wonder dentists and physicians have resisted patient rights to surf.

Nonetheless, we are naïve to believe that today’s patients are not going to search, or that they’re going to trust everything we tell them. The sooner we accept that reality and guide these patients to material that is representative of the current standard of care, the better it will be for the profession. We have a choice. We can either deny or facilitate these people.

If we elect to facilitate them, our systems for doing so need to be adaptive, real time and accessible – both physically and intellectually. They need to provide rapid assimilation of knowledge for short attention spans. They need to be efficient at guiding the decision making process with minimal doctor time away from care giving, where, like it or not, the bills get paid.

Facilitating patients builds trust and lifelong relationships. It is virtually recession-proof. It generates referrals and thriving practices. The long-term value of the informed patient far exceeds that of patients who enter dental purchases completely blind to their options. Moreover, the satisfaction of treating people with full knowledge and realistic expectations about care surpasses that of blind prescription, no matter how large the “case.”
Dentaltown Magazine
October 2025
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