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One Thing that Will Give Your Exam Process a Quantum Leap

April 28, 2010

Filed under: Art of the Examination — Tags: , , — Barry @ 2:12 PM

I have done a lot of examinations in my career.  Readers who are familiar with my book, The Art of the Examination, know how much stock I place in the examination process.  As the years go by I only become more firm in my admonition about the importance of a comprehensive examination.  I know what it has done for my practice and career, and I know what it can do to practices when it is not included in the daily management.
As the owner of Niche Dental Studio, I get to see cases that either go well or are filled with problems.  Many of the issues can be linked back to a hasty exam, a treatment plan not based on good diagnostics or a breakdown in case sequencing and presentation.  I so want to call the dentist and review the cases at this level, but there is resistance…that’s why I know how important these “soft skills” are.
There is one thing that I may have neglected to emphasize in my book.  I certainly explained how to do the exam, how to sequence the exam, and the components of a complete exam.  But that is like telling someone how to sing.  The singer must place the style and emotion, and energy into the exam process…or another way of saying it is, “it’s the singer not the song.”
Creating the examination process and practicing it has become my magnificent obsession.  It has become the theme for my career in dentistry.  It has helped me combat the apathy that plagues our profession.  The wonder of dentistry and the people we serve is discovered in the examination process.  Yet…that doesn’t mean, that after doing literally thousands of exams over the years, we can’t become blasé, about it.  This can become our enemy.  Being blasé is the lighter side of being indifferent or apathetic. We must stay concerned and involved with our patients.
We must work constantly at improving our process either through the use of photography and technology, or through the use of language, by using new and different questions.

Use your Journal

Every night I write in my journal.  I review the days events.  If I did an examination, I think about the things I did right or wrong, and what I could do better.  Some nights I think about an event that I convert into a story that I can go back and use for telling other patients.  Or I create a mini presentation that I can use in conjunction with photographs.  Sometimes I stumble upon an approach or new question that seems to change everything.
I like the term, stumble upon, because that’s really when most creativity takes place.  The journal helps to review my “stumble upons.”
I review these “stumble upons” regularly.
Just this morning I asked a new patient, in a kind a gentle manner, “Can you please tell me what you expect from me, as your dentist.”  Amazingly she went on and on about her dental experiences.  She told me all of her concerns including her financial concerns, her desire to keep her teeth for her whole life and how she really wants to fix her front tooth.  Her front tooth had a twenty-one year old crown that didn’t match its surroundings.
I just sat back and listened.
Then I did my examination with…high energy.

High energy is a key.

The question opened the door that sparked my energy level.  Of course I always come to work well-fed and well-rested, because I don’t want a built in excuse for not engaging with patients.  But sometimes, let’s face it, all the exams don’t go well.  It’s human interaction.  However this one question or request, seemed to open the door.
Well, this particular exam revealed a very healthy mouth in all respects.  The only thing I found was the single central incisor.  Photographs and radiographs were taken for review.  By the time the patient reached the front desk, she wanted to schedule for the crown.  I told her I wanted to review the films, models and pictures.  During the examination she learned the nuances and difficulties in making a single central incisor crown.  She was ready, and to think she started the morning thinking only about a check-up and a cleaning.
That’s the power of a great comprehensive process…plus the energy.
The Japanese have a term for constant and never-ending improvement.  It’s called Kaizen.  Its literal meaning is improvement.  Motivational speaker, Anthony Robbins calls it “CANI,”  or constant and never-ending improvement.
Through Kaizen I have improved every component of the process…and that supplies the needed energy.  And it’s the energy, and the attitude that becomes the one missing ingredient in our exam process.
We must value the process more than the patients, more than our staff and certainly more than the insurance companies.


  1. Hay Barry: Nice to see you back . I missed your sage commentary. As soon as I catch up I will be a active contributer to the blog. Allan

    Comment by Allan Melnick DDS — August 7, 2010 @ 5:17 PM

  2. Hi Allan, nice to hear from you. Please comment and join the conversation. In our own way we can change the dental profession.

    Comment by Barry — August 7, 2010 @ 10:14 PM

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