This article focuses on providing the personal reasons, drivers, and motivators for implementing evidence-based decision-making (EBDM) in my practice. Writing in first person narrative for a professional journal publication is as challenging as it is transparent, revealing, and personal. My hope is that readers will find something of interest that will help create more EBDM implementation momentum for them. I will also share other observations regarding what I believe are the advantages to be gained by further implementing EBDM in the private practice setting.
Think of this series of articles as a primer for enhancing EBDM development in your practice. Hopefully, you may glean ideas that suit your practice style. Other concepts may be so off-course for you that you are sparked to jump ship entirely and go off on your own. At any rate, my aim is to be thought provoking and to share enablement concepts and tools that will enhance your experience with EBDM in the private practice setting.
Compared to mainstream dentistry, the Journal of Evidence-Based Dental Practice (JEBDP) readership may be rather iconoclastic, yet we possess a common passion for the powerful insights provided by EBDM. JEBDP readers understand and value critical appraisal skills and high-level evidence literature. These alone are very compelling reasons for why we should implement EBDM in the private practice setting and, as such, need no elaboration in this article.
Why do it? → Putting the Patient First
Simply stated, putting the patient first and foremost has always been the core theme of our practice. It is not a backdrop thought: we focus on it on a daily basis. The patient's health gains, safety, and education are central to our daily therapeutic processes and decision making. Compassionate service is our dominant management focus. Since my first days in private practice in 1981, professional and practice development to achieve these objectives has been active and ongoing. I believe that focusing on these elements above all others was central to the successful development of our practice and its reputation for therapeutic and communication excellence. We also benefited from having the opportunity to work with and further cultivate superb employees who were adept at running well-organized operational and management systems.
In 1993 I was stimulated, motivated, and compelled to further improve our therapeutic model. It was this year that the Centers for Disease Control and Prevention (CDC) recommendations for dentistry first advised that “sterile saline or sterile water should be used as coolant/irrigant when surgical procedures involved the cutting of bone are performed.”1 Then, in December, 1993 the Food and Drug Administration issued an interim rule to require certain infectious disease testing, donor screening, and recordkeeping to help prevent the transmission of AIDS and hepatitis through human tissue used in transplantation.2 This was in response to growing concerns that some human tissue products were being offered for transplantation use without even the minimum donor testing and screening needed to protect recipients against HIV infection and hepatitis infection.
Because I had been using nonsterile irrigant and human allograft tissue in periodontal surgery, these potential patient health risks ran contrary to our practice core theme of “putting the patient first.” This sparked a desire to further investigate the evidence related to these issues and ultimately served as the foundation of our Precautionary Context Clinical Practice model.3
(1)maximizing safety, effectiveness, long-term value, and patient comfort, and
(2)minimizing risks of harm.
At that time, the literature left much to be desired with respect to basing clinical therapeutic decision making on strong scientific evidence. Nevertheless, I was driven to search out the best available evidence, as well as to develop a treatment model for the many situations where there was an absence of evidence.
Access to high-quality information improved dramatically in 2001 with the publication of JEBDP. Participation in the JEBDP-sponsored EBDM workshop; use of online resources such as the Cochrane Collaboration and PubMed literature-searching tutorials; and attending the Evidence-Based International Conference also contributed to the expansion of my therapeutic vision. Table 1 provides a few examples of high-quality EBDM resources.
In addition to the professional goals noted above, there were personal drivers and motivators that fueled the desire to further implement EBDM in private practice. These are best summarized by the following quotes:
 | “First Do No Harm” Hippocrates. “Of the Epidemics” Book I, Section XI (400 BCE) | |
| “Live as if you were to die tomorrow. Learn as if you were to live forever.” | |
| “Be the change you want to see in the world.” Mohandas Karamchand Gandhi (1869-1948) | |
| “Be careful about reading health books. You may die of a misprint.” Mark Twain (1835-1910) | |
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Implementing EBDM has deepened the meaning of practice for me because I feel confident that the information I use to make therapeutic decisions is high quality and dependable. Implementation of EBDM is challenging, invigorating, frustrating, and exhilarating. It has given me the ability to improve patient care, increase patient and referring practitioner knowledge, and has resulted in an even more satisfying and flourishing practice.
Our dental team is more motivated and confident as a result of incorporating EBDM and they receive a great deal of satisfaction knowing that we are doing the right thing, constantly evolving and always putting the patient first.
| These are tangible bottom line benefits you can bank on by implementing EBDM in the private practice setting. | |
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Other Reasons to Implement EBDM in Private Practice
The wind is now at our backs for EBDM implementation in private practice. What follows are additional reasons that offer support to the view that there is no better time than the present to get going.
What's news? Too numerous to list here, the front pages of the Wall Street Journal and other lay press publications regularly run articles citing poorly controlled drug trials, insufficient evidence, health care professional conflicts of interest, and unnecessary exposure of patients to harm.4., 5., 6.
| In unprecedented frequency and detail, the public is now being exposed to the critical importance of high-level EBDM. | |
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In unprecedented frequency and detail, the public is now being exposed to the critical importance of high-level EBDM.
Free Publicity! As is said, “You pay for advertising, you pray for publicity.” Take advantage of this unprecedented free publicity for EB while implementing your EBDM practice program.
The American Dental Association is also on the “EBDM bandwagon” and has launched EB information on its Web site. Other professional organizations have similarly incorporated different aspects of EBDM (Table 2).
“Marketing 101” states that positioning your practice in the mind of the prospect (new patient, employee, referral, new associate, or partner) as a uniquely distinctive entity creates brand awareness and even greater value. EBDM is a powerful feature today that will distinguish you and your practice. If you allow it to, EBDM will show up in your case presentations, staff meetings, employee verbal skills, product selection, purchases, and much more. Educate your patients and community about your commitment to EBDM and its value to patients and you will create a very strong brand.
EBDM is not a way of doing…it is a way of thinking and positioning. It provides the private practitioner with a timely and powerful conceptual foundation, one that will provide long-lasting marketing advantage. Better thinking and positioning create unlimited opportunities for growth.
EBDM is not “treatment/technique de jour”. Consider invisible orthodontics, whitening, implants, lasers, cosmetic/esthetic dentistry, cosmetic dental surgery, hi-tech equipment, digital photography/radiology, and paperless offices. Although they were distinct practice elements only a few years ago, they are all commonplace and rapidly becoming as indistinguishable as a suburban strip mall.
Therefore, don't think of EBDM only as a tool to select the next hot product or technique. It certainly may help you decide on the validity and usefulness of a product, and in that way will help you determine if it is the right product for the right patient.
EBDM is one of the strongest tools you can use to guide your treatment recommendations and product/equipment decision making. It better enables the dentist to make value-based choices: those that bring value to the patient as well as to the practice. EBDM helps facilitate investing in your practice rather than potentially wasting the valuable resources of time and money. It enables wiser decision making.
Conclusion
| EBDM is invincible and intangible. It doesn't have procedure code. | |
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EBDM is high-end service and is quite valuable especially in today's Baby Boomer and Millennial marketplace. But, it is important to fix your service before you market it.
I propose that you consider one aspect of my approach: I assumed that the evidence I was using to base my treatment plan decisions was insufficient, even bad at times. This did not hurt and it forced improvement. Big mistakes became big opportunities; it was motivational to look for them in our practice.
There is no doubt that reinventing your practice with EBDM will be a challenge, but as illustrated, it will reward you with huge paybacks. Opportunity is all about turning life's stumbling blocks into stepping stones.
No matter where you are in the practice life cycle, give it the opportunity and EBDM will boost your practice. It will breathe fresh air into an already established practice, enhancing its value and satisfaction and it will set an illustrious foundation for a developing career path.
What's Next?
Part 2 in this series is titled “How to Implement EBDM in the Private Practice Setting.” In it, we share with you many ideas including a working model/system that can jump start your efforts to implement EBDM in your practice. From there you will spawn dozens of new and personal ways to fold EBDM into your practice model and career path.
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