We find ourselves suddenly living in a time that few of us, even a few weeks ago, could have imagined possible. Yet here we are.
As many of you are aware, dentists, chairside assistants and dental hygienists are at some of the highest risk of any health care professionals in the world right now, due to the fact that we create aerosols during routine treatment. As hygienists, we use our ultrasonics, as dentists, our high-speed hand pieces, etc. Unfortunately, despite screening patients for symptoms and travel history over the phone or when they arrive to our offices, we may still unknowingly treat patients infected with COVID-19. The patients may not be symptomatic, may not know they are ill and may not even understand they are at risk.
We use this COVID-19 screening form (PDF) in my practice in Colorado. Feel free to download and share with your practice team.
The moment we aerosolize respiratory droplets that may be infected with the coronavirus, we have increased the risk to spread this virus within our offices, our teams, our families and our communities. And how far does that aerosol travel? How long might it live on other surfaces? These are very important questions that we do not have the answers to right now. As a doctor, my first ethical obligation to a patient is to do no harm. If I treat patients right now, I honestly don’t know if I am causing harm or not. Therefore, my private practice will be closed for three full weeks, other than to treat dental emergencies.
I know we are all watching the Centers for Disease Control and Prevention for their guidance, monitoring federal and state government mandates, and following the American Dental Association and our state dental associations closely. As many of you are aware, the ADA along with several state dental associations have recommended that dental offices close their doors for the next three weeks.
TURN TO SPEAR TALK: Chat with Dr. Pettyjohn and other Spear dentists on Spear Talk, the Spear Online discussion forum where clinicians are sharing their stories about navigating the realities of COVID-19.
In Colorado, the following statement was released March 16: “The CDA and ADA recommend that all dentists close their offices for three weeks to patients seeking elective and non-urgent care. During that time dentists should provide only emergency dental care and medically necessary care. This will allow us to care for our most critical patients, while also alleviating the burden that emergency dental care would be on hospitals.”
I would like to encourage practices that remain open, whether for routine care as allowed in their area, or only for emergency care, to please screen your patients over the phone and when they arrive for an appointment for signs and symptoms of COVID-19, as well as their travel history.
Lastly, please use N95 respirator masks if you will be treating patients where an aerosol of respiratory droplets will be produced as a result of your treatment. I understand these are difficult to come by. Consider reaching out to your friends and colleagues in the medical profession and beyond. These masks are often used in construction and painting, and we may be able to find them through different sources than we would normally consider.
In our office, we were wearing N95 respirator masks to see each patient, and our normal mask over the top for splatter, etc. Not perfect by any means, but at least it provided us the ability to wear N95 masks until they were no longer usable. Think of the N95 mask as protection for the clinician creating the aerosol and our regular masks as our normal level of protection.
What can dentists do in this crisis?
My goal for this article is not actually a “how to” for following the CDC guidelines, government regulations and professional association recommendations, but rather a look into the things that we can do during a time that feels like a crisis for so many.
By no means am I trying to underscore the severity of this issue for our profession and for the health of our families, teams and communities. During this time there will be so many things that feel like negatives, that feel crushing, exhausting or debilitating. How will I make payroll if I have no revenue coming in? How will I pay the bills I already have with no revenue coming in? Will unemployment help pay my employees during a shut down? Will the government offer tax incentives for paying employees during time off? There are so many difficult questions and fewer answers to those questions than we would like ...
In light of that, I would like to propose a few thoughts about the things we can do, the things we can control, the ways in which we can make the very best of a very difficult situation.
For years, I have joked that if I could just have some more time, I would be able to accomplish so many of the things that I never have the time or energy to do. The single largest reason for my time crunch is my very busy private practice. People are always saying to me “Being that busy is a great problem to have.” I typically don’t voice my response out loud, but what I want to say is “It’s a great problem to have until it isn’t.” Meaning you are so busy taking care of everyone else's families, that you don’t have the time to take care of yourself or your own family.
So, what happened in Colorado last night? In the most unforeseen, unfortunate circumstance, the universe just gave me time. That is so mind blowing, I need to say it again. The universe just gave me time.
What I choose to do with this time is up to me
How do I plan to spend my gift of time?
- Of course, I will care for emergency patients in my practice utilizing the most up-to-date COVID-19 screening over the phone and with a questionnaire when patients arrive for an appointment. Myself and any other team members will be wearing N95 masks under our regular masks as well as our regular personal protective equipment. And like all of you, we are doubling down on every disinfection and sterilization protocol we can think of.
- Just like you, I am a practicing clinician and a small business owner. The livelihood of my family and my team’s families are highly dependent on my decisions. I will evaluate our financials, cut costs wherever possible and do the best I can to offer our employees what I can in terms of hours, payroll, retirement plans, etc. Do I have a magic wand? No. Can I tell the future? No. I can only be open and honest with our employees and make decisions as time passes with the information presented to me as this situation develops. What I will say, is if you have excellent team members, care for them as if they were your family to the best of your ability. As we all know, exceptional human beings and great employees are very hard to find. People will remember how you handled yourself and your business during a very difficult time. We can be myopic or we can shine.
- I am going to REST. This may not be popular during a time of crisis, however I want to give us the opportunity to see this situation through a different set of eyes. How many of us are tired? Exhausted? Worn out? From the ‘normal’ demands of practicing dentistry, running businesses, managing teams and many of us have families with children as well. It is okay to be tired and to say it. I am tired. I burn the candle at both ends, always have, probably always will, but only with the things in life I am truly passionate about.
Are there many of us in the Spear family who wouldn’t benefit from a little downtime, some yoga or meditation (of course from home right now), a hike, reading a book, playing with our kids, cooking? Whatever it is that allows you to feel some peace, some perspective, some joy. It’s such a cliche, but if we don’t take care of ourselves, there will come a point when we can no longer care for others. Our teams, our patients, our communities need us. Let’s take care of ourselves so that we are healthy and strong and ready when the time comes for us to return to practice.
- I am going to spend some time with my family! I don’t spend nearly as much time as I would like with my husband and my 5-year-old daughter. My husband is also a business owner, thankfully outside of health care, but his demands and stresses are great during this time as well. I want to be home more, make dinner for my family, take walks around our neighborhood, ride our bikes, bake and decorate cupcakes, do some science experiments, make some fairy houses ... This extra time with my family is a precious gift and I am grateful for it.
As every working parent in health care understands so deeply, we sacrifice time with our children and families for our patients, colleagues and our profession. I would never wish to be in our current situation, but since I am, I am going to love my family and spend as much time as I possibly can with them right now.
One example from our home. My daughter is often the last child to be picked up from her school. And whose fault is that 99.9% of the time? Mine. Because I chose something in patient care or professionally that kept me later than I had planned. Being pulled in both directions is REALLY hard. And the parental guilt is SO real. I realize that most schools across the country are already closed, but I am going to relish in my time with my daughter, especially at the end of our weekdays when I am normally less than I wish to be for her. I am a lucky mama right now...
- I am going to “catch up” at the office as we all like to say! As a business owner, a solo practitioner, an educator, a wife and mother, there is never enough of my time to go around. How many projects would I love for my team and I to complete if we just had some more time? Well, now we do. Let’s take advantage of it!
A few items on our to do list: Finish data entry into Dentrix's new and improved Health History module, updating our templates for clinical notes and lab prescriptions, tweaking our new patient phone call checklist, and clarifying our sleep disordered breathing/integrative dental medicine protocols ... There are always things we would like to work on and improve, let’s tackle some projects around the office. It will feel great to finally check them off our list, we can offer our team members some hours and payroll, and serve our patients better when our offices reopen!
- Last but not least, let’s use some down time to improve our knowledge and clinical skills by utilizing the vast resources available to us on Spear Online. I have joked for years that if I was unemployed for an entire year, maybe I could watch all of the Spear Online content that I wanted to! Again, we have this gift of time ....
Instead of binge watching Netflix, worrying about the budgets in our practices, or having a few too many, let’s make ourselves better instead. Better clinicians, better business owners, better leaders, better teams, better interdisciplinary teams with our specialists. Let’s utilize this amazing tool that we all have access to, but often do not have the time to dig in to. If you are already familiar with our online content, there is plenty more out there for you to explore. If you have not yet had a chance to utilize our online content, please do! It’s amazing!
In closing, the world is in a delicate state. I believe that this will all get worse before it gets better. But we have choices to make. Are we going to allow the burdens, negativity and uncertainty to define us? I hope not. We are strong, we are smart, we are resilient. Let’s face this situation with knowledge, curiosity, openness, collaboration and a positive spirit. This life is what we make it. These next three weeks, or months, or however long it takes the world to return to “normal” are also what we make it. As I tell my daughter daily – “Work hard, have fun, be kind.” Sometimes it really is as simple and as complex as that.
Take care my friends. Until we meet again in Scottsdale, Arizona ... And we will!
Kate Pettyjohn D.D.S., is a member of the Spear Resident Faculty