Show Me Yours and I’ll Show You Mine

by Dr. Peter Birek

The other day my son called me and said: “Dad I remember what I wanted to give you for your recent birthday.” Yes – I had one of those birthdays you want to ignore but your loved ones refuse to honor that request.

Expecting a long-awaited first installment check as a payback for the million dollars I had spent for his upbringing, I learned that the birthday gift was not the first payment, but rather “one hour in a sensory deprivation tank.” As my learned son said, “It will be good for you Dad!”
I said to him, “Thanks Steve, but I do belong to a tribe (i.e. dentists) that is thought to be working in a lonely environment, in their own offices, often shielding their work from colleagues and peers. After all, we as dentists have developed “overly sensitive shoulders” from our demonstrators constantly looking over our shoulders in dental school as we were learning our procedures.

Imagining being lonely for a full hour, in a tank, completely cut off from the world – including my iPhone – made me think about the often-mentioned allegation that dentists are loners in their practices. They are cut off from others and work in isolation. Indeed, we rarely allow anybody to look over our shoulders once out of dental school. Dentists share their golf scores more readily than their treatment outcomes. And heaven forbid we SHOW our cases to each other. In the digital galaxy there’s hardly a dentist this side of Pluto who doesn’t take pictures of most of his/her cases. So why keep it to ourselves and not show it to colleagues?

As I am getting to a “retrospective age,” I look back on the best learning experiences I have had in dentistry. Certainly, there were many and varied. Among the most valuable ones of more recent years was the benefit of taking, cataloging and reviewing over 30,000 pictures I have taken of most of my cases; before, after and sometimes during the procedures. And this is how the process of learning goes: after finishing a day and all the people are gone, I close the door of my “sensory deprivation tank” and look at my cases – sort of a debriefing process. Not having peers during debriefing, and taking a dose of “honest-to-good-assessment” pill, I critically review my cases. It is a real eye opener for any practitioner to look back, with critical eyes, and answer questions in PRIVATE without having to SHOW it to peers. There is so much to learn from both mistakes and excellence in my cases – a truly valuable resource. Peer review is essential but since a very small percent of one’s cases will leave the “bubble” of isolation, in which a dentist practices, to make it to a venue of peer review, it is so important to be one’s own reviewer on a daily basis as well. In his very excellent treatise on how to avoid medical errors and optimize patient care, “Checklist Manifesto,” Dr. Atul Gawande reminds us that DAILY, post-procedural debriefs are the most important factor that determines a medical team’s success rates after integrating new treatments. And in the medical world, “success” means decreasing mortality and morbidity. We must take inspiration from this concept of a daily debrief, even if it happens in a solitary environment.

My colleague, George Freedman, noted in his recent editorial “Putting Education to Work” (Oral Health, July 2015) that “peer group evaluation” is a very valuable educational endeavor. I fully agree – you show me your cases and I will show you my cases. We will both benefit from it. But just note that we do not always have to travel somewhere, eat the rubber chicken, and listen to a speaker we may not like, in order to learn. Also not insignificant is the fact that the presenter selects the cases they show. What may be more important is to show our run-of-the-mill, everyday cases without prejudice.

One of the stellar graduates of our periodontal program has the habit of inviting “leading practitioners,” often from far-away places, to review his modus operandi and specific cases and make recommendations. No wonder his practice in the Niagara peninsula is top notch and thriving.

So I will take my son’s offer and go to the “sensory deprivation tank” but with my cases to review. And then perhaps we could have a tank that can accommodate several of us where the motto would be, “You show me yours and I’ll show you mine.” Is that what you had in mind, Steve?OH

Dr. Birek is an Associate Professor in the Department of Periodontics and staff surgeon with the Oral Reconstruction Unit at the University of Toronto. He maintains a private practice in Periodontics and Implant Surgery in Toronto. Peter is the Peridontology editor for Oral Health Journal.