Wednesday, March 18, 2020

This Changes Everything...


It’s incredible how quickly the world changes.  Probably 2 weeks ago you wondered what that little ball in the picture above was.  Now you are probably tired of seeing it on every page you visit...

If you would have spoken with me on Sunday March 15th, I would have told you that the biggest problem we faced was the “toilet paper shortage of 2020”.

That just goes to show you how fast things can change.  In the short span of about 48-72 hours, life here in the U.S. was turned on its ear.  Suddenly we were told to avoid groups of 50, then 25, then 10.  States suddenly began to create programs of their own to deal with the spread of Covid-19.  The public and medical professionals needed guidance.  Unfortunately, the guidance was haphazard at best and non-existent at worst.

I spent a great deal of time on Sunday researching the science behind the pandemic and its spread.  I began reaching out to people who I consider much smarter than myself.  The problem I encountered was that there lots of “educated guesses” based on extensive training and years of professional experience, but there was one caveat… No one was sure… and *that* was the problem.

Throughout this crisis, those of us in the trenches, on the front lines of the attack, whatever analogy you want to use, we’ve been waiting for someone to make the decision.  No matter where I looked (and I looked at *a lot* of websites), the consensus was “use your best judgement as a practitioner”.  However, as a practitioner part of my decision making process is to know when I don’t have enough information and NEED more.  So I turned to the experts who, instead of providing leadership and recommendations, went with the “use your best judgement” approach.

This approach lead to a huge hole in our defenses as tens of thousands of us tried to figure it out by ourselves.  Emails were bouncing around the Internet like Super Balls at a county fair.  No one knew what to do and no one was offering direction on what to do.  The Hypcratic Oath states “above all, do no harm”, but we didn’t have any idea what would and what wouldn’t cause harm. 

On Monday morning, one state in the union advised offices to voluntarily cease treatment of elective procedures for 14 days.  I read the web page and found very little scientific information given for the recommendation.   Several hours later, in the late afternoon in the central U.S. I received an email from the American Dental Association asking all offices to do away with elective treatment for 21 days.  Even *less* scientific information and reasoning was given for their recommendation.  

One state advising 14 days caused some commotion.  The ADA advisory rolled a shockwave through the profession.  I feel there were 2 main reasons for the shockwave.  The first was the failure to disclose why this was advised.  Dentistry is a very data driven and scientific profession.  Doctors were wondering if they had missed some vital piece of information.  Was there something we missed?  Was there a previous announcement of data that we failed to see?

The second was the simple fact that most dental offices are small independent business entities.  Our employees *need* their jobs and doing away with elective treatment meant that not nearly as many staff would be needed.  Doctors *know* that their staff relies on them for steady income and suddenly hours would be drastically cut.  Layoffs would follow.  What would happen?  What about single parent staff members with children depending on them?  How do we deal with that?

The powers that be in the government had failed to even *remotely* prepare people for this.  It was also happening all across the country.  However as this situation unfolded, the CDC was still advising Universal Precautions and asking Covid-19 interview questions of patients pre-operatively.  I feel that IF leadership from the CDC had better informed us and better prepared us, perhaps the situation could have been handled much better.  Instead we were forced to sort of “make it up as we go along” which is rarely the proper way to deal with emergent situations.

Today March 18th, 2020 a White House press conference finally addressed the situation in a way I wished the federal government had from the beginning.  Seema Verma the Administrator for the Center of Medicare and Medicaid services said directly that elective procedures, including dental procedures, should be postponed.  At long last, we have someone standing up as a leader and telling us their best recommendation of how to deal with this, something that allows us to know what to do.  If that advice had come earlier there wouldn’t have been such a scramble and confusion.

1 comment:

  1. Great post Dr. Flucke. I for one was very disappointed to see the amount of polarization among the dental industry on social media. It made me wonder if some of them want to be considered part of the healthcare system only when it is profitable or convenient.