J Oral Maxillofac Surg 73:1029-1030, 2015
It’s Not Easy, Minor, or Simple Daniel L. Orr II, DDS, MS, PhD, JD, MD Since entering private practice almost 35 years ago, my most important office decision ever was hiring my mom as office manager. One of the most valuable pieces of advice she brought to the practice occurred after watching postoperative interactions with patients for a short time. When previously anxious patients would breathe a sigh of relief upon the better-thananticipated completion of a procedure, mom would cringe when hearing me iterate something like ‘ It was actually pretty simple.’’ After work one day mom kindly advised that this was the wrong message to send. She was countered with: ‘ Mom, it was simple!’’ Patiently, mom explained: ‘ Maybe after going to school until age 30.’’ It took a little while to understand the concept, but now it is hard to believe an oral and maxillofacial surgeon would ever tell patients that successful surgical procedures are anything less than pretty impressive.1 Mom’s wisdom is now passed on to dental students on a daily basis as they routinely bring self-described ‘ simple’’ extractions to oral and maxillofacial surgery (OMS) clinics nationwide. Offering this pearl is a never-ending project, sometimes requiring several such consultations with the same student. At times, the unconvinced future dentists are asked additional questions such as ‘ If it’s so simple, what are you needed for? Let’s just call an other-level provider.’’ (The politically correct term is ‘ midlevel provider,’’ but not understanding what qualifies someone as midlevel and finding my preferred ‘ low-level provider’’ frowned upon by dental political types, I have opted for ‘ other-level provider.’ ) The second query is usually something like ‘‘Show me ‘simple extraction’ in the CDT [Current Dental Terminology] codes.’’ Of course, there is no such designation. The nomenclature for D7140, the usual suspect, is currently ‘ extraction, erupted tooth or exposed root (elevation and/or forceps removal),’’ not a mellifluous or simple description to offer anyone, especially patients.
The third question might be ‘ If it’s so simple, why bring it to the OMS clinic instead of keeping it in team?’’ The student’s usual response is ‘ I was told it would be better to do it in OMS.’ My quizzical expression to this predictable answer hopefully conveys the concern that someone would injudiciously opine the procedure is ‘ simple,’’ advise the student and patient of that opinion, and then shift the operative responsibility to another without consultation. To drive the point home a bit more as needed, the student might be directed to head back to the team and start some ‘ simple’’ operative or prosthetic project, followed by the clarification that there are none. At times question 3 needs to be modified slightly, as when D7140 is attempted outside OMS and, predictably, the ‘‘simple’’ procedure cannot be completed, necessitating an emergency call to OMS. Sadly for patients, because of such ubiquitous training in dental schools, some dentists think nothing of routinely starting a surgical procedure and then cavalierly referring it to a specialist if it turns out to be a bit too difficult. An example of this mind set was an ‘‘emergency’’ alveoloplasty required after a straightforward total odontectomy elsewhere. Society is fortunate this phenomenon seems to be limited to dentistry. A fourth request is used occasionally: ‘‘Please define simple.’’ The definition is actually pretty convoluted, but one component in Merriam-Webster’s is critical, and that is ‘‘without complication.’’ Then, students are queried what should D7140s that have ended up in sinuses, gastrointestinal or pulmonary tracts, etc, be called? Plaintiff attorneys are appreciative of any doctor who denigrates the knowledge and skill needed for a procedure right before the complications occur. Enough about pervasive dental education concerns; what about others who depreciate dental procedural expertise?
Professor and Director, Department of Oral and Maxillofacial
Vegas School of Dental Medicine, 2040 W Charleston Boulevard,
Surgery, University of Nevada Las Vegas School of Dental Medicine, Las Vegas, NV. Dr Orr is the Immediate Past President of the American Associa-
Suite 201, Las Vegas, NV 89102; e-mail: [email protected] Received December 5 2014 Accepted December 8 2014
tion of Dental Editors and Journalists and President Elect of the
Ó 2015 American Association of Oral and Maxillofacial Surgeons
American College of Legal Medicine.
0278-2391/14/01817-5
Address correspondence and reprint requests to Dr Orr: Depart-
http://dx.doi.org/10.1016/j.joms.2014.12.011
ment of Oral and Maxillofacial Surgery, University of Nevada Las
1029
1030 Patients, often very apprehensive about any dentistry whatsoever, rarely proffer such simple minded opinions themselves, but, predictably, patients will present and advise that the referring doctor shared that ‘‘this will be easy’’ because of the receiving doctor’s ‘ special instrument,’’ not necessarily additional skill or knowledge. In this case, the patient needs to be educated in such a way that the referring doctor is not made to look . well, use your own terms. Patients also can extrapolate prior experiences to current operations, that is, if the first experience was so easy, or hard, the second one will be, too. Dental insurers selfishly jump on this disparagement bandwagon (what better way to justify decreasing benefits?). This year a patient reported that dental benefits were in place. When attempting coordination with the patient’s carrier, staff was advised that coverage was for ‘‘simple extractions only.’’ When the staff asked the carrier what the nascent CDT code for ‘‘simple extraction’’ was, the unsurprising reply was good old D7140. Although the term simple is still nowhere iterated in association with D7140, insurance apparatchik regularly use the term.2 Regretfully, we must also consider the devolved use of simple by dental professionals. A recent article in the Journal of the American College of Dentists opined that some emergency room–based dental procedures are ‘‘simple.’’3 If so, why are the emergency room doctors even calling? Even more painful is what OMS occasionally presents for the world to see. In the last issue of AAOMS Today, the Practice Management Note stated that: ‘‘. documentation must specify whether the extraction is simple or surgical. .’’4 This article was
IT’S NOT EASY, MINOR, OR SIMPLE
actually written to help optimize clinical documentation for oral and maxillofacial surgeons. Colleagues, we have a problem. I submit that nothing in dentistry should be dubbed simple, easy, or minor. If simple and similar terms should be taboo in dentistry, how should entities such as D7140-ish extractions be referred to? Daniel Laskin, editor of AAOMS Today, wrote that he has often used routine, but believes that routine might have its own problems (personal communication, December 2, 2014). Perhaps the following can be a starting place: ‘ Thankfully the surgery was fairly straightforward, but we need to watch the postoperative course closely.’’ Whatever verbiage is developed individually or officially, such as via CDT or the AAOMS, remember what basketball great Bill Walton said when his career was ended after an unsuccessful ‘ minor surgery’’: ‘‘I learned a long time ago that minor surgery is when they do the operation on someone else, not you.’’
References 1. Orr D: It’s not easy, it’s not minor, and it’s not simple!. Nev Dent Assoc J 14:3, 2012 2. Orr D: Of insurance consultants and tooth fairies and Luke. Nev Dent Assoc J 16:4, 2014 3. Stein PS, Kim J, Adkins B, et al: Dental pin in the ED. J Am Coll Dent 81:46, 2014 4. AAOMS. Clinical documentation improvement for OMSs. AAOMS Today 12:1, 2014
Editorial Note: The Editor-in-Chief has routinely replaced the terms ‘‘simple’’ and ‘‘easy’’ with the term ‘‘straightforward’’ in accepted articles since 2011.
It’s Not Easy, Minor, or Simple Daniel L. Orr II, DDS, MS, PhD, JD, MD Since entering private practice almost 35 years ago, my most important office decision ever was hiring my mom as office manager. One of the most valuable pieces of advice she brought to the practice occurred after watching postoperative interactions with patients for a short time. When previously anxious patients would breathe a sigh of relief upon the better-thananticipated completion of a procedure, mom would cringe when hearing me iterate something like ‘ It was actually pretty simple.’’ After work one day mom kindly advised that this was the wrong message to send. She was countered with: ‘ Mom, it was simple!’’ Patiently, mom explained: ‘ Maybe after going to school until age 30.’’ It took a little while to understand the concept, but now it is hard to believe an oral and maxillofacial surgeon would ever tell patients that successful surgical procedures are anything less than pretty impressive.1 Mom’s wisdom is now passed on to dental students on a daily basis as they routinely bring self-described ‘ simple’’ extractions to oral and maxillofacial surgery (OMS) clinics nationwide. Offering this pearl is a never-ending project, sometimes requiring several such consultations with the same student. At times, the unconvinced future dentists are asked additional questions such as ‘ If it’s so simple, what are you needed for? Let’s just call an other-level provider.’’ (The politically correct term is ‘ midlevel provider,’’ but not understanding what qualifies someone as midlevel and finding my preferred ‘ low-level provider’’ frowned upon by dental political types, I have opted for ‘ other-level provider.’ ) The second query is usually something like ‘‘Show me ‘simple extraction’ in the CDT [Current Dental Terminology] codes.’’ Of course, there is no such designation. The nomenclature for D7140, the usual suspect, is currently ‘ extraction, erupted tooth or exposed root (elevation and/or forceps removal),’’ not a mellifluous or simple description to offer anyone, especially patients.
The third question might be ‘ If it’s so simple, why bring it to the OMS clinic instead of keeping it in team?’’ The student’s usual response is ‘ I was told it would be better to do it in OMS.’ My quizzical expression to this predictable answer hopefully conveys the concern that someone would injudiciously opine the procedure is ‘ simple,’’ advise the student and patient of that opinion, and then shift the operative responsibility to another without consultation. To drive the point home a bit more as needed, the student might be directed to head back to the team and start some ‘ simple’’ operative or prosthetic project, followed by the clarification that there are none. At times question 3 needs to be modified slightly, as when D7140 is attempted outside OMS and, predictably, the ‘‘simple’’ procedure cannot be completed, necessitating an emergency call to OMS. Sadly for patients, because of such ubiquitous training in dental schools, some dentists think nothing of routinely starting a surgical procedure and then cavalierly referring it to a specialist if it turns out to be a bit too difficult. An example of this mind set was an ‘‘emergency’’ alveoloplasty required after a straightforward total odontectomy elsewhere. Society is fortunate this phenomenon seems to be limited to dentistry. A fourth request is used occasionally: ‘‘Please define simple.’’ The definition is actually pretty convoluted, but one component in Merriam-Webster’s is critical, and that is ‘‘without complication.’’ Then, students are queried what should D7140s that have ended up in sinuses, gastrointestinal or pulmonary tracts, etc, be called? Plaintiff attorneys are appreciative of any doctor who denigrates the knowledge and skill needed for a procedure right before the complications occur. Enough about pervasive dental education concerns; what about others who depreciate dental procedural expertise?
Professor and Director, Department of Oral and Maxillofacial
Vegas School of Dental Medicine, 2040 W Charleston Boulevard,
Surgery, University of Nevada Las Vegas School of Dental Medicine, Las Vegas, NV. Dr Orr is the Immediate Past President of the American Associa-
Suite 201, Las Vegas, NV 89102; e-mail: [email protected] Received December 5 2014 Accepted December 8 2014
tion of Dental Editors and Journalists and President Elect of the
Ó 2015 American Association of Oral and Maxillofacial Surgeons
American College of Legal Medicine.
0278-2391/14/01817-5
Address correspondence and reprint requests to Dr Orr: Depart-
http://dx.doi.org/10.1016/j.joms.2014.12.011
ment of Oral and Maxillofacial Surgery, University of Nevada Las
1029
1030 Patients, often very apprehensive about any dentistry whatsoever, rarely proffer such simple minded opinions themselves, but, predictably, patients will present and advise that the referring doctor shared that ‘‘this will be easy’’ because of the receiving doctor’s ‘ special instrument,’’ not necessarily additional skill or knowledge. In this case, the patient needs to be educated in such a way that the referring doctor is not made to look . well, use your own terms. Patients also can extrapolate prior experiences to current operations, that is, if the first experience was so easy, or hard, the second one will be, too. Dental insurers selfishly jump on this disparagement bandwagon (what better way to justify decreasing benefits?). This year a patient reported that dental benefits were in place. When attempting coordination with the patient’s carrier, staff was advised that coverage was for ‘‘simple extractions only.’’ When the staff asked the carrier what the nascent CDT code for ‘‘simple extraction’’ was, the unsurprising reply was good old D7140. Although the term simple is still nowhere iterated in association with D7140, insurance apparatchik regularly use the term.2 Regretfully, we must also consider the devolved use of simple by dental professionals. A recent article in the Journal of the American College of Dentists opined that some emergency room–based dental procedures are ‘‘simple.’’3 If so, why are the emergency room doctors even calling? Even more painful is what OMS occasionally presents for the world to see. In the last issue of AAOMS Today, the Practice Management Note stated that: ‘‘. documentation must specify whether the extraction is simple or surgical. .’’4 This article was
IT’S NOT EASY, MINOR, OR SIMPLE
actually written to help optimize clinical documentation for oral and maxillofacial surgeons. Colleagues, we have a problem. I submit that nothing in dentistry should be dubbed simple, easy, or minor. If simple and similar terms should be taboo in dentistry, how should entities such as D7140-ish extractions be referred to? Daniel Laskin, editor of AAOMS Today, wrote that he has often used routine, but believes that routine might have its own problems (personal communication, December 2, 2014). Perhaps the following can be a starting place: ‘ Thankfully the surgery was fairly straightforward, but we need to watch the postoperative course closely.’’ Whatever verbiage is developed individually or officially, such as via CDT or the AAOMS, remember what basketball great Bill Walton said when his career was ended after an unsuccessful ‘ minor surgery’’: ‘‘I learned a long time ago that minor surgery is when they do the operation on someone else, not you.’’
References 1. Orr D: It’s not easy, it’s not minor, and it’s not simple!. Nev Dent Assoc J 14:3, 2012 2. Orr D: Of insurance consultants and tooth fairies and Luke. Nev Dent Assoc J 16:4, 2014 3. Stein PS, Kim J, Adkins B, et al: Dental pin in the ED. J Am Coll Dent 81:46, 2014 4. AAOMS. Clinical documentation improvement for OMSs. AAOMS Today 12:1, 2014
Editorial Note: The Editor-in-Chief has routinely replaced the terms ‘‘simple’’ and ‘‘easy’’ with the term ‘‘straightforward’’ in accepted articles since 2011.
