PAGD Keystone Explorer Summer 2020

LESSON #3: Get It in Writing At the time, the May 8 guidance from the Department of Health (DOH) seemed to address our requests. It allowed practitioners freedom to “apply their clinical judgement” in determining whether or not to re-engage in non-emergency care. Even in the meeting with the PAGD board that evening, the guidance was welcomed. But wait: In press conferences that following week, DOH personnel repeatedly stated that “routine dentistry” or “routine hygiene” should not be done at the time. So now we have written guidelines allowing for clinical discretion, and verbal guidelines taking it away. This was complicated even further on May 19, where the CDC issued revised guidelines allowing for even greater practice freedom, and a press conference on May 21 when Secretary Levine stated that routine hygiene can be done in counties that “go green.” Dental offices had been instructed that as essential providers of healthcare, we were not subject to the color-coded reopening standard. So for two weeks in May, dentists had four different standards to follow for this one important practice: DOH written guidelines, CDC written guidelines, and two different DOH verbal instructions that seemingly contradict each other. In retrospect, if hygiene was to be prohibited, it should have been definitively spelled out in the guidelines, or DOH personnel should have stuck with their guidelines allowing for interpretation in subsequent public statements. LESSON #4: People Will Hear What They Want to Hear I know that this is an appropriate tenet of 21st century life in general, but it couldn’t have been better exemplified in the days following May 8. Dentists who were chomping at the bit to get back to work were excited to read the words “clinical judgement” in the DOH guidance. But hygienists with both defensible and indefensible concerns were producing DOH tweets and soundbites from press conferences about how this was not the time for hygiene. When practitioners are relying on Twitter for governance, that should be evidence that there isn’t enough clarity in what was issued. So what did we learn for the next time something like this happens? Ask around to find out who your allies are. Make specific recommendations and make sure that those recommendations are reflected in written guidelines. And play nice right up to the point where you shouldn’t anymore. Advocacy has always been a second priority to PAGD behind educating dentists in pursuit of practice excellence, but if we’re going to get better at it, we’re going to need to learn from both our successes and our mistakes. Keystone Explorer |  Summer 2020  5 executive director’s message |