Dr. Carter: Today's guest is Dr. Donald Curtis, a member of the editorial board of PracticeUpdate Clinical Dentistry Channel. And our topic today is going to be a discussion of Dr. Frank Spear's e-course of the ADA 2020 Virtual Connect Conference, and that was entitled Only the Strong Survive, Harness Your Strength.
While COVID-19 has certainly brought challenges to the delivery of dental care, in evolution, Darwin spoke of survival of the fittest. What do you think he meant by that and how does that concept translate into the practice of dentistry today?
Dr. Curtis: Well, good morning, and I very much enjoy providing a commentary on Frank Spear's lecture. Dr. Spear talked about dentists surviving and potentially thriving in the challenging economic environment of COVID-19. He used Darwin's survival of the fittest statement as a segue for a discussion on how dentists should consider adapting to the current challenges.
Dr. Spear also quoted Darwin's statement that it is not the strongest or most intelligent that survive, but the most adaptable. And that was the focus of Dr. Spear's lecture: the importance of adaptability; that as dentists we can't use the business as usual. And the adaptability started with some points in his lecture on patient management issues, as well as clinical technique issues, and included a more accurate assessment of patient needs and wants.
If you're interested in the concept of adaptability, I highly recommend the book called The Beak of the Finch by John Weiner. And it's a story, a five star review by Amazon, of how Darwin in the 1830s went to different islands in the Galapagos, collected birds with different beaks, of different colors, lengths and configurations, thinking they were all different species. But actually brought them back to London in the 1830s and realized they were all different beaks of a finch and formed the basis of his theory on natural selection, which is really about adaptability. And again, that's what Dr. Spear was talking about; the adaptability of dentists in the COVID-19 environment.
Dr. Carter: Please, if you would, contrast the traditional, conventional, authoritarian model of treatment planning dental care for the patient with the concept of shared decision-making, which actively involves the patient with respect to planning dental care.
Dr. Curtis: Dr. Spear made a distinction between those two. And I think most of us were trained by being told we should take a thorough dental history, complete a good clinical exam, and then tell the patient what you think would be best for them. In the literature that's called "informed decision-making." We as trained authorities gather the appropriate information and tell the patient what we think is best.
And what Dr. Spear said, and I agree, and the literature agrees, is that's not always the best approach. Rather than informed decision-making as the authoritative approach, we should consider using what's called "shared decision-making" as a facilitator, where we see ourselves as a facilitator and walk the patient through the different options without injecting our bias or assumptions about what we think they might afford or might want.
The advantages of shared decision-making over informed decision-making has been studied. And when shared decision-making is followed, there is a higher level of understanding by patients, better patient compliance, both at home and in office recalls.