The furious pace of change for dentistry during COVID-19 did not leave much time for reflection. But now that we have returned to some semblance of normalcy (albeit a far cry from how you practiced in January), and in discussing it with colleagues in the association and organized dentistry community, it seems like a good time to take a look back and consider what lessons I feel were learned through our experiences.
Lesson #1: We Work Better Together
I know I prattled on with this a bit too long in the last Executive Director’s column, but by regular communication, coordinating messaging, and cosigning letters, major dental organizations and the three major dental schools in Pennsylvania were able to reverse an effective shutdown in March with a more reasonable version of emergency-only guidelines. This reversal could have taken months in normal times but was accomplished in five days through our collective advocacy and coordination.
I’m not delusional enough to think that coordination between all groups can be achieved for all issues. We will always have our differences in priorities and tactics. But when the stars align and we find ourselves in agreement, we can accomplish much more.
“I’m not delusional enough to think that coordination between all groups can be achieved for all issues. We will always have our differences in priorities and tactics. But when the stars align and we find ourselves in agreement, we can accomplish much more.”
Lesson #2: Being Nice Doesn’t Always Get Results
This lesson was learned through the struggle in securing PPE. In the early days of the pandemic, many dental offices saw the train coming, and realized that they were in for some downtime. As a result, offices contributed much of their valuable PPE to hospitals and first responders that so desperately needed it in that difficult and uncertain time. The MOM-n-PA dental clinic, scheduled for early June, had to be cancelled, and contributed its substantial PPE inventory to Philadelphia area hospitals.
Then, in mid-April, the Governor’s office issued an executive order allowing the Pennsylvania Emergency Management Agency (PEMA) to inventory and potentially commandeer any PPE collected. In my opinion, this heavy-handed and legally murky maneuver did not sit well. Fortunately, it did not appear that PEMA utilized this option for any seizures. But the fact that it was even on the table seemed that bridge too far.
Then, when practices were freed up to expand practice on May 8, it was made clear that they could only do so if they had the adequate PPE. In a Catch-22 that Joseph Heller couldn’t have better written, dental offices donated their PPE, were prohibited from purchasing it for months, and were threatened to have PEMA take it away, but were now given the freedom to practice if they have it. And the May 8 guidance made it clear that no department in our government would make it available to you. It makes it harder to be generous for the common good when parochial hoarding would allow offices to open sooner.
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.