A Picture Is Worth A Thousand …

by Peter Birek, DDS, MSc., Dip Perio

My dental assistant figures that I did go to dental school to learn “dentalese,” a language patients can’t understand. What happens is that I dictate my findings during examination of a patient and she transcribes it into the chart. Nothing unusual so far. But stop for a moment and “think different,” if I may invoke a grammatically incorrect Apple Computer Inc. slogan. What in reality happens is that a clinical appearance is converted into a graphics via visual perception and stored into the cortex of the examiner. Then, it is translated into text, another conversion from graphic data stored in the cortex to the patient’s chart, via speech. So far so good, although, the more conversions the less accurate the outcome. The more serious problem really occurs when the textual data in the chart is read by another person, at another time, under another circumstance, at a disciplinary dispute for example. Without the benefit of examining the patient, the reader has to reconstruct a mental picture from the text as it appears in the chart. At this junction the information has gone through several conversions raising serious doubts about its authenticity.

Let’s do a quick test. After reading the description of the position of the surgically exposed maxillary canine please close your eyes and try to mentally visualize it. (Clinical chart entry: “normal looking clinical crown pointing to the midline and positioned 5mm distally from the incisor papilla. The root of the canine does point towards the tooth number 1.5 and it is on a lateral slant of approximately 30). Now turn the page and see the actual picture. You can be the judge as to the accuracy of your conversion from text to graphics.

In a recent article discussing the ten most important trends in computer design, Deke McClelland, the author of several books including Real World Digital Photography (Peachpit Press, 1999) felt that our ability to capture and share photographs without constraint will and perhaps already has changed our world.

So how does this relate to everyday dentistry? Well, just think about our clinical records and how cumbersome those conversions are: first we look (at clinical situation), then we speak (describe lesion) followed by transcription (assistant writes chart); read again (another person reads the chart) picture it (will translate textual data into a mental picture). One can circumvent all these conversions by taking a picture or two of the real thing, preferably a digital one. Printed or shown on a monitor — it is there to see, almost instantly, accurate, clear and transportable as well as ready to be stored. Could we not examine a patient, in customary manner and instead of clinical description, take a few pictures to be append to the chart, electronically or by hard copy? We can then write down a few lines of text as an interpretation of our findings (diagnosis) and then a treatment plan and rationale. Treatment progress and outcome is best captured by pictures rather than textual descriptions.

Andreas Vesalius (1514-1564) the great anatomist composed the seminal “De Humanis Corporis Fabrica” in Latin. He did abandon the simple style characteristic of the scientific literature of that period and introduced a strict and cumbersome terminology instead. Sounds like the “dentalese” we learned in dental school. It was a revolution of sorts though. In an era when we can communicate visually to anyone, anywhere on the planet with the event still fresh and vibrant in our minds it is high time that we review our standards of record keeping.

By the time you read these lines I will be on my way to the e-Health Asia Conference in Singapore. This meeting is organized by The Medical Records Institute (http://www. medrecinst.com/tepr/asia/index.shtml), which has been leading the process of creating healthcare information standards. I will report my experiences at later time, but then again, I may just sent in a picture or two — electronically of course.