By Lee Ann Brady, DMD 

When you are managing the care of an older patient, I encourage you to take time to look up their medications and the medication you are considering prescribing, even something as simple as antibiotics or pain medication. 

A resource I use when I am writing prescriptions and also managing existing pharmaceuticals that my older patients are taking is the Beers Criteria published by the American Geriatric Society (AGS). The AGS Beers Criteria® lists the Potentially Inappropriate Medications (PIMs) that are typically best avoided by older adults in most circumstances or under specific diseases or conditions.  

Some listed PIMs should not be written for people over age 65 and some are okay with caution or in moderation. There is a long list of medications people can take until they are ages 65 to 70 without a problem. After that age, there are side effects. 

Some of the medications cause adverse reactions on their own or in interaction with other medications. Some of these PIMs are common over-the-counter antihistamines. 

By David R. Rice, DDS 

I’m guessing your practice is a whole lot like mine. People can be challenging. Patients are people. Ergo, yes, patients often bring us challenges. With that and 29 years into dentistry, there are a few challenges I’m willing to admit and, like you, work to overcome.  

Our great patients get great dentistry.
Our challenging patients get our best effort.
Our job is to understand who each is, what each wants,
and how we do our best to deliver it. 

As you and I learn the best techniques and technology, we have to understand that many of our patients see the world differently. They see it differently than each other, and they see it differently than we do. At first glance, yes, this is an obstacle. But for those of us willing to spend time focusing on their views, this is a massive opportunity.  

About 20 years ago, the treatment planning and presentation mantra our team developed was: Pizza by the slice or the whole pie? 

 A talented and curious team with character, plus a well-defined process,
always equals complete care and profitable production. 

 Here are the four keys: 

1. Understanding who of our patients wants complete care—the whole pie right now. 

1. Knowing who of our patients isn’t ready for the whole pie today and needs us to serve that complete care one prioritized slice at a time. 

1. Recognizing that some patients love pepperoni, some love veggies, some are all NY and thin crust, some love that Chicago deep dish, and so on. 

1. Delivering each individual patient’s pizza the way they want it without yielding on our quality. 

All our patients come with a story. Some are ready for a whole pie. They want complete care and they want it now. Other patients are overwhelmed by the whole pie. Right or wrong, some past experience makes their yes to the complete care we know they need challenging. We can push them, or we can appreciate where they are and work with them one slice at a time. 

I’m not proposing we compromise our care. I’m offering us all an opportunity to elevate it. Whether you’re scanning and milling, 3D printing, injection molding, direct bonding, or prepping and temping long-term, the materials and technology we have at our fingertips today afford us an incredible ability to segment care. 

Complete-care case acceptance at 90%+ is a reality when we add great communication skills to the clinical skills we’ve worked so diligently to achieve. Today, I challenge you to assess, calibrate, and elevate your ability to deliver pizza by the slice…or the whole pie. 

As I watched the pandemic unfold from my vantage point in New Jersey, somehow the innocence of a child passed through my mind as I thought, “That won’t happen here.” As the pandemic got a death grip on the New York Metro area, the stark reality of “It happened here” came into full view. At first, we spread the patient visits with gaps for safety and eventually just closed our doors except for emergencies. As the weeks have turned into months, the economic impact and the sense of isolation has started to metamorphosize into a NEW reality. The phrase of “epic proportions” and “uncharted territory” were thrown around on every news cast.

Is this journey really uncharted?

Are we really cast to a horizonless sea? Haven’t we been preparing for this type of event through our education, study clubs, reading, and conversations within the community we call the “Pankey Family?” These examples come to mind:

After reading Gene D. Cohen’s book The Mature Mind, I learned that I’m resilient. I survived the big “C”, a 300-year flood in Havasu Falls, and my wife’s health issues. I realize “I’ll be able to get through this.”

Through the Gallup’s Strengths Finder and the leadership program with Dr. Richard A. Green at Gallup, I learned that my strengths are Ideation, Strategic, Learner, Communication, and Maximizer. Today I trust that the ideas and strategy will come to me. I have leveraged the Strategic strength over and over again.

The book How to Think Like Leonardo DaVinci by Michael J. Gelb tells us that when DaVinci was faced with challenges such as these, he trusted the answers “would appear.” He trusted the challenges would “seed the unconscious” to find a solution.

Waiting for the Unconscious…

While waiting for solutions to challenges, I’ve learned to free my mind and spirit by “chopping wood and carrying water”—TAO! So, when my practice closed normal operation, I went to Home Depot and bought paint…a LOT of paint. On day two I started painting my office. At first, I thought I would paint just the reception room, but as time went on, I had time to paint the entire office. I know myself, and I was doing all I could not to jump onto the “downward spiral” that I learned about in The Art of Possibilities: Transforming Professional and Personal Life by Zander and Zander.

Staying in Community

As the weeks went by the first solution to pop up was creation of a protocol for dealing with virus containment. If a patient did need to come in for emergency care, I needed to have a strategy. Joan Untershuetz and Denny Byrne presented new information last year at their Inspired Facilitation workshop about how the brain needs community. So, I formed a Zoom account and started weekly team meetings. We discussed what we were each doing to stay safe. This piqued my curiosity to wonder what patients were doing to stay safe and could they help me develop a protocol that would help them feel safe?

I recalled Dr. Irwin M. Becker lecturing in C1 on first steps to integrating this new way of practicing. He challenged us to select patients that trusted us already, and he called them “friends of the practice.” I asked my current team to list those they consider to be friends of the practice—those who put smiles on our faces when we see them on the schedule. The list was formed. The ball started to roll. I facilitated my first ever Patient Focus Group and asked two simple questions:

What have you been doing to keep your home safe from Covid-19?

What would you need to know in advance of an office visit in order to feel safe?

New Dimensions of Individualized Care

The focus group responses helped me understand that the protocols they were following at home ran the gamut from washing hands and taking off shoes to something resembling a chip manufacturing plant. I realized that individualizing the protocol could be another level of “values-based relationship-driven” individualized care.  I learned that my patients had high trust in my ability to forage through the regulations and come up with a safe protocol, and they thought it would help them to know the what, how, and whys before they came to the office.

Thanks go to several colleagues who helped by reviewing and critiquing my office protocols as they developed. Much thanks to Joan Untershuetz, Richard Green, Rolando Cibischino, Christine Shagaki and Dennis Stiles for letting me bounce ideas off of them and for their in-depth critiques.

Something else I did to stay in face-to-face contact with patients was to implement a form of “teledentistry.” After watching a presentation by Laurie Owens from DevDent at one of the ACT Dental CE online CE days, I set up an account with Doxy.me and now have regular telehealth hours. I get a push notice when someone is in the “waiting room” to have a tele-dialogue.

A Journey? Yes…Uncharted? No

There are boundless opportunities to put our best Pankey training to masterful use. We were all taught to slow the practice down and be more intentional. We were taught about personality styles and values. Open dialogue and full transparency can be the threads we hold with our patients to deeper levels of trust and appreciation. I feel poised and ready to bring my best self forward in these times that hold endless possibilities for values-based, relationship-driven, uniquely individualized care.