imagine that you’re getting ready to go
to bed tonight struggling to fall asleep
because you know that tomorrow you are
going to have all of your teeth taken
out how does that make you feel
are you scared at the thought of the
blood and the anesthesia and the
injections and the extractions and the
swelling and the stitches you kind of
experience
are you actually frightened at the
thought of having no teeth and what will
people think of you on the other hand
you might actually be excited perhaps
this is a chance for you to get rid of
the smile that you’ve never liked and
move on and wipe the slate clean and get
the smile you have always dreamed of
well those emotions are exactly the
emotions that Teresa went through a few
years ago this is the smile that Teresa
had with which to communicate with the
world a one tooth smile in the upper jaw
and a lower jaw that all she had left
with some decayed rotting stumps of
teeth Teresa tells a story of being at a
family event and offering her nephew her
water bottle and he recoiled from her
and refused to take it and said I don’t
want to touch the bottle from which
Teresa makes the decision to turn her
life around to reinvent herself in many
ways and one of those ways is through
her smile a typical conversation between
a dentist and a patient about the
patient’s choices are often centered in
what today we call evidence-based care
whether it’s evidence-based medicine or
evidence-based dentistry this is all the
rage today and the evidence is taken
from scientific research these might be
research studies on ten or hundreds or
thousands of patients and from the data
from these studies general guidelines
are developed the problem with
practicing evidence-based care this way
in my opinion is that we tend to take
these research findings that tell us
what the average outcome in the average
patient might be but they don’t actually
help us address the unique patient
that’s right in front of us during this
conversation what I prefer to do is to
practice value-based dentistry and I
like this term because it has a double
entendre the first part of value is our
values our preferences our beliefs our
dreams our aspirations now in dentistry
when someone comes to see me and they
have no teeth typically there’s an
emotional association with their values
they are worried about improving their
appearance maybe they want to function
better this means they want to speak
better they want to eat better or else
they just want to get out of pain and
they want to be comfortable again or in
many cases like Theresa’s it’s a
combination of these three we need to
address all of them for a successful
outcome the other part of value based
dentistry that I like though is this
equation value equals quality over cost
and the driving force here is that in
many conversations dentists have with
their patients they talk about how good
option X’s or option wires but we don’t
spend a lot of time necessarily talking
about the costs and what it will take to
achieve those outcomes sometimes people
say to me yes well quality is a very
nebulous term what do you actually mean
by that that’s hard to define and I
don’t think so I think we can quantify
and measure quality so one way to do it
is to split quality into these three
segments one being the outcomes how well
did we do at improving a patient’s
appearance how well did we do at
improving their speech or that chewing
ability and how well did we do at
getting them out of pain we have surveys
we have assessments to measure this
today we use healthcare like it’s one
word healthcare is two words health and
care I think we all accept that we
cannot always be healthy but we will be
all
cherish is to care so the service side
of quality can also be assessed we can
measure how well we did at the
experience we provided for our patients
and how well they felt cared for and
then there’s the safety element did we
manage the risks properly do certain
options come with much more risk and if
so what are our strategies for managing
those risks when it comes to cost people
tend to think that it’s only a financial
cost decision but I’ll suggest you that
it’s actually not the case in a study
from the University of British Columbia
patients who had been suffering wearing
their dentures were recruited to a study
where they were randomized into one of
two groups one group was to receive
brand-new dentures the other group was
going to get state-of-the-art
implant retained dentures and both
groups were going to receive their care
for free after being randomized to the
group that was to get the implant
dentures for free over 30% of those
patients immediately withdrew from the
study when asked why did you pull away
from a study where you were about to get
free implant dentures the most common
reason was a fear of surgery the
financial cost was not an issue at all
the biological cost was too high then
there’s the time and effort that it
takes certain treatment options will
last a lot longer they’ll need a lot
more appointments do I need to get a
ride do I have to find a babysitter do I
have to take time off work real-world
challenges right then there’s a
psychological cost I mean for Theresa to
go through having all of her teeth taken
out it’s a very very hard line to cross
psychologically and there’s always the
opportunity cost what could I have done
with these resources that might have
brought me a different kind of positive
outcome so for Theresa dentistry would
suggest that for someone with no teeth
there are three classic options and of
these options each comes with a very
different
level of quality of life outcome a very
different level of risk and biological
invasiveness and need for surgery and
they also come with very different
financial costs and my job is to explain
to my patients what these options are
and to try and do it in as an eloquent
and as a transparent and clear way as
possible so the patient can make the
best decision for themselves
having said that many times a patient
will turn to me and ask me this question
they’ll say doc thanks for that
explanation but what would you do if you
were me now it could be that actually I
didn’t do a very good job explaining it
at all and they’re completely confused
and I have to start over okay it could
be actually they did understand
everything quite well but they want me
to just give them my opinion as
confirmation one of the most common
reasons though is that patients quite
understandably feel like I don’t know
much about this stuff but you’re the
expert you’ve been to school you have
all this experience surely you can guide
me because you have treated patients who
have had no teeth before I find this
question a very difficult one to answer
and many times I don’t do it you see to
answer this question what would you do
if you were me I would use the golden
rule the Golden Rule says do unto others
as you would have them do unto you the
problem here is that I’m not the patient
I don’t want to give them what I want I
want to give them what they want so in
this particular scenario although the
golden rule is a wonderful thing in many
parts of life here in this context it is
the wrong path to take the better path
to take is to use the Platinum rule and
the Platinum rule says do unto others as
they would have you do unto them this
requires me to take the time to make the
effort to sit down and learn about my
patients their unique fears their unique
aspirations their dreams
and only then can we have a conversation
a shared conversation that will allow us
to choose the option that is best for
that particular patient I’m fascinated
by this question of what would you do if
you were me a few years ago we conducted
a research experiment of dentist in
North America and we gave them the same
scenario that Teresa has imagine you
have a patient that has no teeth you’ve
gone through all the options and when
you’re done explaining the options the
patient turns to you and says what would
you do if you were me we asked the
dentists how do you respond then when
you get that question 19% of the dentist
said well I just declined to answer the
question I’m not going there 58% of the
dentists said they would use the golden
rule and they would answer the question
as if they were choosing for themselves
or as if they were the patient
fifty-eight percent six percent said
they would answer as if the patient in
front of them was the average patient in
essence using the scientific research to
say well you’re an average patient we’ll
take the average findings from the
research studies and apply that to you
and tell you which one you should do
only 17% use the Platinum rule only 17%
took the time to find out who the
patient was and then offered to engage
in answering the question what would you
do if you were me a few years ago this
studied identified from interviews with
thousands of patients what are the
characteristics we really want from our
physicians and healthcare providers and
these were the seven things that came
forth they want us to be empathetic
forthright confident humane respectful
thorough and personal and I’ll suggest
to you that to be personal to respect a
patient and to be empathetic to a
patient cannot be done with the Golden
Rule it has to be done with the Platinum
so Teresa here is contemplating a life
without teeth hopefully none of you have
to contemplate the same scenario but if
you do I will suggest to you that at
some point you will realize it’s
actually not about the teeth it’s about
can you imagine how you would feel
looking in the mirror if you had this
smile every day
what would your self-confidence in your
self esteem be like probably be pretty
low right hard to feel good about
yourself when this is the image that you
present to the world Teresa tells a
story of chatting with a couple of
friends in her neighborhood and saying
to them you know I think I can really
turn my life around when I get a job and
one of her friends with brutal Candice
said to her Teresa would that smile
you’re never getting a job if you were
an interviewer and Teresa comes to see
you with an amazing CV and she’s
immaculately dressed and then she smiles
at you with this smile you can imagine
how you would feel probably have some
mixed emotions then there’s the issue of
going out with friends so much of our
social calendar today is built around
meals now you may think that you need
teeth to chew up your food so that you
can digest it better and that therefore
you will be more healthy well I can tell
you there’s actually today little
evidence to support that notion we need
teeth to eat food to enjoy the process
of eating food to be out with our
friends and eat what everybody else is
eating and not be embarrassed because we
cannot participate fully today we can
get all the nutrition we need from
liquids we don’t actually need teeth to
be able to digest our food so this was
Theresa before she began her treatment
and the image I’m going to show you now
is an image of a young lady completely
she’s a remarkable young woman but here
you see a face of passion of vitality of
someone who is now ready to fully engage
with the world so the next time you seek
care from a health care provider dentist
physician any form of provider and
especially for care that is elective
where you have choices whether to even
do it or not I hope you feel that you
can reinvent the conversation that you
have with that provider to make sure
that they are using the Platinum rule
and that this conversation is centered
on you so that whatever the care is that
you’re trying to get you get that care
and you cherish the outcome that results
thank you very much
[Applause] [Music]
to bed tonight struggling to fall asleep
because you know that tomorrow you are
going to have all of your teeth taken
out how does that make you feel
are you scared at the thought of the
blood and the anesthesia and the
injections and the extractions and the
swelling and the stitches you kind of
experience
are you actually frightened at the
thought of having no teeth and what will
people think of you on the other hand
you might actually be excited perhaps
this is a chance for you to get rid of
the smile that you’ve never liked and
move on and wipe the slate clean and get
the smile you have always dreamed of
well those emotions are exactly the
emotions that Teresa went through a few
years ago this is the smile that Teresa
had with which to communicate with the
world a one tooth smile in the upper jaw
and a lower jaw that all she had left
with some decayed rotting stumps of
teeth Teresa tells a story of being at a
family event and offering her nephew her
water bottle and he recoiled from her
and refused to take it and said I don’t
want to touch the bottle from which
Teresa makes the decision to turn her
life around to reinvent herself in many
ways and one of those ways is through
her smile a typical conversation between
a dentist and a patient about the
patient’s choices are often centered in
what today we call evidence-based care
whether it’s evidence-based medicine or
evidence-based dentistry this is all the
rage today and the evidence is taken
from scientific research these might be
research studies on ten or hundreds or
thousands of patients and from the data
from these studies general guidelines
are developed the problem with
practicing evidence-based care this way
in my opinion is that we tend to take
these research findings that tell us
what the average outcome in the average
patient might be but they don’t actually
help us address the unique patient
that’s right in front of us during this
conversation what I prefer to do is to
practice value-based dentistry and I
like this term because it has a double
entendre the first part of value is our
values our preferences our beliefs our
dreams our aspirations now in dentistry
when someone comes to see me and they
have no teeth typically there’s an
emotional association with their values
they are worried about improving their
appearance maybe they want to function
better this means they want to speak
better they want to eat better or else
they just want to get out of pain and
they want to be comfortable again or in
many cases like Theresa’s it’s a
combination of these three we need to
address all of them for a successful
outcome the other part of value based
dentistry that I like though is this
equation value equals quality over cost
and the driving force here is that in
many conversations dentists have with
their patients they talk about how good
option X’s or option wires but we don’t
spend a lot of time necessarily talking
about the costs and what it will take to
achieve those outcomes sometimes people
say to me yes well quality is a very
nebulous term what do you actually mean
by that that’s hard to define and I
don’t think so I think we can quantify
and measure quality so one way to do it
is to split quality into these three
segments one being the outcomes how well
did we do at improving a patient’s
appearance how well did we do at
improving their speech or that chewing
ability and how well did we do at
getting them out of pain we have surveys
we have assessments to measure this
today we use healthcare like it’s one
word healthcare is two words health and
care I think we all accept that we
cannot always be healthy but we will be
all
cherish is to care so the service side
of quality can also be assessed we can
measure how well we did at the
experience we provided for our patients
and how well they felt cared for and
then there’s the safety element did we
manage the risks properly do certain
options come with much more risk and if
so what are our strategies for managing
those risks when it comes to cost people
tend to think that it’s only a financial
cost decision but I’ll suggest you that
it’s actually not the case in a study
from the University of British Columbia
patients who had been suffering wearing
their dentures were recruited to a study
where they were randomized into one of
two groups one group was to receive
brand-new dentures the other group was
going to get state-of-the-art
implant retained dentures and both
groups were going to receive their care
for free after being randomized to the
group that was to get the implant
dentures for free over 30% of those
patients immediately withdrew from the
study when asked why did you pull away
from a study where you were about to get
free implant dentures the most common
reason was a fear of surgery the
financial cost was not an issue at all
the biological cost was too high then
there’s the time and effort that it
takes certain treatment options will
last a lot longer they’ll need a lot
more appointments do I need to get a
ride do I have to find a babysitter do I
have to take time off work real-world
challenges right then there’s a
psychological cost I mean for Theresa to
go through having all of her teeth taken
out it’s a very very hard line to cross
psychologically and there’s always the
opportunity cost what could I have done
with these resources that might have
brought me a different kind of positive
outcome so for Theresa dentistry would
suggest that for someone with no teeth
there are three classic options and of
these options each comes with a very
different
level of quality of life outcome a very
different level of risk and biological
invasiveness and need for surgery and
they also come with very different
financial costs and my job is to explain
to my patients what these options are
and to try and do it in as an eloquent
and as a transparent and clear way as
possible so the patient can make the
best decision for themselves
having said that many times a patient
will turn to me and ask me this question
they’ll say doc thanks for that
explanation but what would you do if you
were me now it could be that actually I
didn’t do a very good job explaining it
at all and they’re completely confused
and I have to start over okay it could
be actually they did understand
everything quite well but they want me
to just give them my opinion as
confirmation one of the most common
reasons though is that patients quite
understandably feel like I don’t know
much about this stuff but you’re the
expert you’ve been to school you have
all this experience surely you can guide
me because you have treated patients who
have had no teeth before I find this
question a very difficult one to answer
and many times I don’t do it you see to
answer this question what would you do
if you were me I would use the golden
rule the Golden Rule says do unto others
as you would have them do unto you the
problem here is that I’m not the patient
I don’t want to give them what I want I
want to give them what they want so in
this particular scenario although the
golden rule is a wonderful thing in many
parts of life here in this context it is
the wrong path to take the better path
to take is to use the Platinum rule and
the Platinum rule says do unto others as
they would have you do unto them this
requires me to take the time to make the
effort to sit down and learn about my
patients their unique fears their unique
aspirations their dreams
and only then can we have a conversation
a shared conversation that will allow us
to choose the option that is best for
that particular patient I’m fascinated
by this question of what would you do if
you were me a few years ago we conducted
a research experiment of dentist in
North America and we gave them the same
scenario that Teresa has imagine you
have a patient that has no teeth you’ve
gone through all the options and when
you’re done explaining the options the
patient turns to you and says what would
you do if you were me we asked the
dentists how do you respond then when
you get that question 19% of the dentist
said well I just declined to answer the
question I’m not going there 58% of the
dentists said they would use the golden
rule and they would answer the question
as if they were choosing for themselves
or as if they were the patient
fifty-eight percent six percent said
they would answer as if the patient in
front of them was the average patient in
essence using the scientific research to
say well you’re an average patient we’ll
take the average findings from the
research studies and apply that to you
and tell you which one you should do
only 17% use the Platinum rule only 17%
took the time to find out who the
patient was and then offered to engage
in answering the question what would you
do if you were me a few years ago this
studied identified from interviews with
thousands of patients what are the
characteristics we really want from our
physicians and healthcare providers and
these were the seven things that came
forth they want us to be empathetic
forthright confident humane respectful
thorough and personal and I’ll suggest
to you that to be personal to respect a
patient and to be empathetic to a
patient cannot be done with the Golden
Rule it has to be done with the Platinum
so Teresa here is contemplating a life
without teeth hopefully none of you have
to contemplate the same scenario but if
you do I will suggest to you that at
some point you will realize it’s
actually not about the teeth it’s about
can you imagine how you would feel
looking in the mirror if you had this
smile every day
what would your self-confidence in your
self esteem be like probably be pretty
low right hard to feel good about
yourself when this is the image that you
present to the world Teresa tells a
story of chatting with a couple of
friends in her neighborhood and saying
to them you know I think I can really
turn my life around when I get a job and
one of her friends with brutal Candice
said to her Teresa would that smile
you’re never getting a job if you were
an interviewer and Teresa comes to see
you with an amazing CV and she’s
immaculately dressed and then she smiles
at you with this smile you can imagine
how you would feel probably have some
mixed emotions then there’s the issue of
going out with friends so much of our
social calendar today is built around
meals now you may think that you need
teeth to chew up your food so that you
can digest it better and that therefore
you will be more healthy well I can tell
you there’s actually today little
evidence to support that notion we need
teeth to eat food to enjoy the process
of eating food to be out with our
friends and eat what everybody else is
eating and not be embarrassed because we
cannot participate fully today we can
get all the nutrition we need from
liquids we don’t actually need teeth to
be able to digest our food so this was
Theresa before she began her treatment
and the image I’m going to show you now
is an image of a young lady completely
she’s a remarkable young woman but here
you see a face of passion of vitality of
someone who is now ready to fully engage
with the world so the next time you seek
care from a health care provider dentist
physician any form of provider and
especially for care that is elective
where you have choices whether to even
do it or not I hope you feel that you
can reinvent the conversation that you
have with that provider to make sure
that they are using the Platinum rule
and that this conversation is centered
on you so that whatever the care is that
you’re trying to get you get that care
and you cherish the outcome that results
thank you very much
[Applause] [Music]
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