Value-Based, Diagnostically Driven Decision-Making

Guiding patients to maximize their health and well-being

Elizabeth M. Bakeman, DDS

In dental school, we are taught to diagnose and to heal. However, because much of our education is devoted to the techniques of restoration, the methodology of establishing a diagnosis is often given less than adequate consideration and the idea of "healing" tends to focus on repairing or replacing and then repeating. We promote increasing access to care as a means to improve the care that we provide, but we rarely discuss ways to increase the value of that care.

More than 2,000 years ago, Hippocrates counseled physicians to "declare the past, diagnose the present, foretell the future; practice these acts." His profound words remain amazingly applicable today. His sentiments stress the importance of evaluating the patient's history and presenting situation, establishing a proper diagnosis, and defining an anticipated prognosis. Establishing an accurate diagnosis requires us to "push the pause button" on our desire to fix and repair. Instead, we must give thought to the underlying causes. Why do the teeth and oral environment look the way that they do? What are the causative factors that are contributing to breakdown? How susceptible to disease is the patient?

Failure to acknowledge a patient's previous disease history and susceptibility to future disease misleadingly insinuates that state-of-the-art treatment solutions and meticulous home care regimens can avert if not eliminate future disease. When treatment is initiated prior to the establishment of an accurate diagnosis, the provided solutions become little more than temporary fixes over the lifetime of the patient. This can occur even when a well-intentioned, well-trained, and caring clinician meticulously executes the treatment. Spending all of the time and money in the world on the best of treatment solutions can still have unfavorable outcomes if they are the wrong treatment solutions.

When time is spent focusing on the diagnosis, we are better positioned to develop a treatment plan that serves to reduce the risk of disease, manage the risk when it cannot be reduced, and avoid increasing risk as a result of the treatment itself. The legitimacy of treatment decisions is supported when they reduce risk and refuted when they involve increasing risk. Using a diagnostically based approach leads to greater predictability and better health as well as less time, effort, and cost, expended over the lifetime of the patient. In summary, diagnostically driven treatment solutions improve outcomes, which provides increased value.

Establishing an accurate diagnosis for an individual patient requires focused curiosity, intelligent thought, and genuine effort. We do not receive direct monetary compensation for establishing a diagnosis, but the effort is invaluable and the compensation comes indirectly. A thorough diagnostic effort provides precious information for both the provider and patient. This information allows patients to make more informed decisions about their care, which in turn leads to treatment solutions that provide greater longevity, predictability, and value. The results are a dental practice filled with healthy, stable patients and an increased sense of purpose, worth, and joy for the provider.

Validation of our aptitude as healers is evident when patients require less of what we do. In order for patients to require less of what we do, we must design treatment plans that are built on a diagnostic foundation. Insurance companies, employers, and patients are increasingly aware of the benefits of a healthcare model based on wellness. As a profession, we will benefit by striving to provide personalized, transparent, diagnostically driven information to patients and by guiding them in their decisions to maximize their health and well-being.

About the Author

Elizabeth M. Bakeman, DDS, is an adjunct faculty member of the Kois Center in Seattle, Washington, and maintains a private practice in Grand Rapids, Michigan, focusing on advanced restorative and cosmetic dentistry.