Interdisciplinary Approach to Care: Collaboration, “Listening,” and the Patient’s Needs
Is dentistry truly representing interdisciplinary patient care, and how is technology helping facilitate this?
When we think of “interdisciplinary” dentistry, the triad consisting of the general dentist (ie, the access to care), laboratory, and specialist comes to mind. Organized dentistry promotes a model similar to the one shown in Figure 1 that resembles a patient-centric approach. While, in principle, this reference seems accurate, perhaps it is time to question the integrity and effectiveness of this skeleton model. A truly interdisciplinary approach requires the efforts of many, not just a skilled few.
To be genuinely patient-centric a more robust model needs to be implemented, one that includes the many force multipliers all working together driving the diagnosis through effective communication and education (Figure 2). Dentists around the country often tell me that the moment they leave the room after an “Oscar-award winning” case presentation, the patient turns to the dental assistant or registered dental hygienist (RDH) and peppers out a list of questions seeking validation. This is where force multipliers step in and continue to reinforce the dentist’s diagnosis and recommendations.
The RDH often spends the most one-on-one time with the patient. The dental assistant and administrative team members play a key role in ultimate patient care—from assessment to elevating the findings of primary diagnostic criteria needed for the dentist to make a diagnosis. Experts in the field, better known as industry representatives or territory managers, can be valuable assets to a practice. When our focus is expanded to include a truly interdisciplinary approach we bring value to the necessary dentistry of the patients we serve.
While advances in technology have elevated dentistry’s diagnostic and treatment modalities, effective communication among the dental team—the general practice, specialist, laboratory partner, and manufacturer representative—is critical in a truly interdisciplinary approach. Establishing clearly defined communication systems utilizing today’s technology is paramount. Dental professionals need to engage in the power of listening and asking versus simply telling all they know and expecting the rest to fall into place.
Technological advancements such as 3-D imaging, CAD/CAM technology, digital impressions, electronic health records, and even social media have significantly changed the dental industry, contributing to its sustainable growth and evolution. As many have experienced, an increase in automation can lead to a smaller margin of error and a wider door for communication. Technology has aided in the ease of flow of information and dialogue between general dentists and specialists as well as dental laboratories and manufacturers. It has enabled more efficient and effective communication and, thus, delivery of a more predictable approach to treatment and care for patients.
Embracing an interdisciplinary approach and including the patient in the decision-making process enhances dentists’ ability to optimize and execute highly individualized comprehensive treatment plans. It is important to recognize patients as key partners in the team approach and keep them well informed of their options. The key to implementing the interdisciplinary model, according to Dr. Frank Spear, is to form the correct team of individuals that exude self-confidence, are competent, and are committed to achieving the team’s ultimate goal.1
For proof of how dentistry is embracing and acknowledging the interdisciplinary approach to patient care, one needs to look no further than many of the dental academy agendas. In March 2015, for example, the Academy of Osseointegration commenced its annual meeting with an opening symposium titled “The Power of Collaboration and the Team Approach.” This session set the tone for the whole meeting as experts explored success through collaboration and clearly displayed why the team approach is essential. In May, the American Academy of Periodontology hosted its 2015 Spring Conference, “Embracing Technology to Enhance Your Clinical Practice,” at which renowned speakers focused on how the entire dental team can integrate the latest advances in diagnosis, treatment, practice management, and communication systems within their practices.
Technology will continue to evolve and greatly impact dentistry. The profession should embrace this opportunity and collaborate to enhance patients’ experiences and long-term successful outcomes.
As I travel across the country I find that an increasing number of general practitioners are performing dental care services “in house” that were once considered cases for referral. One reason for this, it appears, is that dental professionals connect to their patients in a unique and personal way, and when discussing treatment options they sometimes might base decisions on knowledge of their patients’ circumstances outside the realm of oral and systemic health. Finances, insurance, and family situations might dictate matters, and, though well intentioned, dental professionals may unwittingly talk themselves out of discussing with their patients the optimum treatment that is best for them. An interdisciplinary approach utilizes all members of the dental team, from administrative to specialist, and helps allow patients to make educated choices based on all of the treatment options regardless of their personal circumstances.
There also seems to be a disconnect in dentistry driven by insurance, misguided education, and, sometimes, misguided business practice. Thus, a greater emphasis is needed on interdisciplinary collaboration and evidence-based decisions.
One of the first questions a patient asks is, “Will my insurance cover it?” In this scenario the power of care is given to the insurance company, which may not always be optimal for the patient because insurance does not cover many therapies that create health. We must approach patients in a manner that elevates their oral health to its proper place within the realm of systemic health and employ all members of the healthcare team so we can begin to bridge the gap between true dental health and the mere appearance of dental health.
Next comes the issue of proper education. As a dental hygienist, my efforts for patients with active disease are nonsurgical. Hygienists have been trained to manage active-disease patients and only to refer when the case approaches a hopeless state. The vital role hygienists play as members of the dental team lies in their power to educate, inform, prevent, and/or help patients control inflammation. Hygienists do not have the power in their arsenal to treat the foundation (bone); they are inflammation/prevention specialists. However, they have a valuable resource in the fight against periodontal disease: a foundation expert in their referral circle. They have the power to refer to the periodontist. This is an interdisciplinary approach to periodontal disease.
Finally, there is a business perspective involved. Many dental students have amassed hundreds of thousands of dollars in student loan debt. It follows that these new graduates entering into practices or opening their own want and/or need to create as much income as possible to help pay off the mountain of debt. Unfortunately, this can lead to what is known in economics as “zero-sum theory,” whereby gain is directly balanced by loss for another, eg, a patient kept “in house” who should be referred, which happens often with periodontally diseased patients. If, however, all clinicians decided to practice in the opposite manner, it would make dentistry truly patient-centric and interdisciplinary. The return on investment in each other would exponentially outstrip anything we could accomplish on our own.
Dental professionals are part of the ever-expanding structure that is healthcare. By utilizing each member of the dental team to his or her full capacity, dentistry can be truly interdisciplinary and take a genuinely patient-centric approach to care.
1. Spear FM. Forming an interdisciplinary team: a key element in practicing with confidence and efficiency. J Am Dent Assoc. 2005;136(10):1463-1464.
About the Authors
Tracy Anderson Butler, CRDH, MFT
Hygiene Education/Public Relations
Straumann USA, LLC
Jennifer Hirsch Doobrow, DMD
Private Practice, specializing in periodontics and implant dentistry
Amy Kinnamon, RDH, EFDA, BSASc
Hygiene Advisory Board/Speakers’ Consortium
Straumann USA, LLC
Ohio Dental Hygienists’ Association