EP 68: Clear Away the Confusion (Covid-19 Update)

To open or not to open?

What infection control procedures are necessary?

What should we currently be doing during this transition period?

In this episode of the Double Your Production Podcast, Dr. John and Wendy address these concerns and more.

They’re sharing another Covid-19 update to clear away the confusion that has permeated the dental profession. Their guidance will allow you to make clear decisions regarding your practice during these challenging times.

For more updates from Wendy and Dr. John, follow The Team Training Institute on Facebook.

Welcome to the Double Your Production podcast with The Team Training Institute. The one place designed for dentists and their staff who want to grow their practices by following in the footsteps of those that have done it, who are in the trenches, we know exactly what you're going through. And, now, you're leaders, the stars of the podcast, Dr. John Meis and Wendy Briggs.

Hey. Welcome, everybody. How's it going, Wendy?

Great. I'm excited to visit with everybody today. There's a lot happening.

There is. You'd think everything is starting to kind of stabilize and then something happens and it goes haywire, right? But not haywire, right? There's a lot of great things going on right now.

Absolutely. So we thought it would be a good idea to connect with everyone again. We joke and laugh about how we loved the Facebook live updates every week, but we also hated the Facebook live updates every week. So now that we've kind of eased our foot off the gas a little bit as people are getting back to work, it's good to be here with everybody again.

Yeah, for sure. So now, I believe, every state in the country, practices are open. The restrictions are different from state to state. Some of it makes sense. Some of it makes no sense, does it?

Right. Very, very confusing. I just got a text today from a practice that I know about in Arkansaw and I saw them post a message that they were not yet open so I reached out and said, "Can we help support you? What's going on?" And this is the practice that has recently been sold and she said that they had hired an [inaudible] trainer to come in and guide them on what they needed to reopen, and this [inaudible] trainer scared them to death. They're still not open just because they don't have the confidence to do that. So I'm so glad that many of the practices that we work with are open. They knew what to do. They were prepared and they've had a very successful reopen.

Yeah. So we did multiple Facebook live updates to give the most current information as to what we thought was responsible ways to reopen. We had Dr. Gordon Christensen on giving his thoughts. As the CBC's information meandered up, down, back, around, we kind of kept people updated on that, and then once the state boards decided not to require compliance with regulations from the CBC that made no sense, at that point, everybody was kind of a-- and not every state has done that, by the way, but most have, and so here we are in this time where there's been a lot of confusion and there are still practices that are struggling on whether to open or whether to open fully or whether to not.

Right, and, as you said, a lot of the confusion stems because even now, even today, we're hearing completely conflicting statements from sometimes the same organization, right? So that's causing a lot of confusion as well. We've seen this and we've laughed about it in previous reportings as well when we'd say, "Oh, gosh. COVID-19 can survive on surfaces, and then they came out maybe a week, two weeks later and said, "Actually, maybe not. Maybe it doesn't spread on surfaces," so there's s much confusion.

And then came back and said, "Well, yeah, maybe it can, but not really that well." So the WHO this week has been on the turntable, haven't they? It's absolutely a cast of characters. They make a statement, then they come out, make another statement to clarify the first one and then the second one creates more confusion and nobody knows what's up. So here's what I know [Wendy?], wearing masks is helpful or it will kill you, one or the other. The scientific evidence is clear. It'll either help or kill you. It's crazy.

I have a statement right here from the US Surgeon General warning that wearing face masks could increase this spread of Coronavirus. Now that was published March 2nd. So then we have-- no wonder the public's confused. We have some businesses mandating the wearing of masks. We have other people that have kind of become social justice warrior saying if you are wearing a mask in public, you are a stooge. Right? So I can see how the public is seriously confused and frustrated. I mean, how frustrating is it?

And as you move forward, it's starting-- the public is starting to not pay attention. And certainly, the tragic events in Minneapolis have really taken a lot of the country's attention away from COVID-19 and rightfully so. But yeah, I've been out and around in Phoenix, I've been through Dallas, through Tulsa. And so I can tell you that the public is for the most part-- other than on planes, for the most part, they're just doing what they normally do. There may be a little effort at distancing, but not much. In my hometown, some of the restaurants have things spread out. Some of them don't. It's all over the map.

Right. And when we look at the questions, the confusion that's happening in dentistry, there's still some questions, right. We had quite a few practices reach out with some clarifying questions about new information that has been released, right, back before-- even just a few short weeks ago, we didn't have any specific guidance from the CDC on what we should be doing in dental practices. Well, they came out with very specific guidance from the CDC. And that in and of itself created some confusion. So here we go again, right back on that merry go round.

It would be really great if they maybe talk to a dentist and kind of got some input as to what happens in dental offices. It's as if they're just pulling this stuff out of the air. It's crazy. So what's the current CDC-- what's the most ridic-- I've got mine. You give me yours. What's the most ridiculous thing in the recommendations? What's your most ridiculous?

Well, I have to say that the most ridiculous is about patient volume. And we've gotten a ton of questions on this statement that to allow time for droplets to sufficiently fall from the air after dental procedure, the dental health healthcare professionals should wait at least 15 minutes after the completion of treatment and departure of the patients to even begin the room cleaning and disinfection. So this is to allow time for droplets to sufficiently fall from the air. That is absolutely ridiculous. As you mentioned, I don't know anybody who's doing that.

That's my favorite ridiculous one. We do have some folks in Northeastern state that are doing that. Their governor actually mandated it, and they actually had to sign a document to attest the fact that they were doing it. So they are doing it. But again, the governor is following the CDC, but the CDC is-- okay, so what is it? Is it droplets? Is it aerosols? Well, if it's aerosols, 15 minutes makes no difference whatsoever. If it's droplets, it should be 15 minutes. I could maybe think of 15 minutes from when you did the last part of the procedure that droplets would be-- would happen, right? There's no droplets in an exam. It's like they never went to a dental office and saw how procedures were done. And 15 years minutes for a droplet. I'm going to create a droplet right now [laughter]. We'll see how long that takes to drop to the ground. It's not 15 minutes.

Right. And it's not backed by science at all, because that's what we wanted to do. The first thing we do is we go look at the science, right? So I found an article just published April 17th of 2020 on saliva and the potential diagnostic value and transmission of COVID-19 in saliva, and it was published in the International Journal of Oral Science. And in this article, they talked about how-- obviously, we're concerned about the transmission from saliva. It's a biofluid. It's been known to carry COVID particles, although there is a difference in saliva in the oral cavity and deep throat saliva, right? There's a big difference in transmissibility there. Deep throat saliva is more than double the risk of oral saliva, and that's why they have to jab that Q-tip clear back to your brain --to do a COVID-19 test, right, and get the most accurate reading. So it's fascinating when you look at what they publish in that article. In that article, they were talking about particles settling in the air. And when we have a particle size of COVID-19, it takes 41 hours for that particle, if it's aerosolized, to drop to the floor. So 15 minutes makes zero difference via science. If they're really worried about a particle that's aerosolized, it just doesn't make any sense to me. I can't figure why they are saying that other than just making it up as they go along which, sadly, we've seen some of that happening, right?

Yeah, for sure. And I don't mean to make light of COVID-19. It's a very serious illness and has killed many, many people. And I think we're at 110,000 people now that have died from COVID-19, flu, and pneumonia combined. That number they're reporting is the combined of all those. And it's tragic, it really is. But the same time, it doesn't mean that we should lose our common sense. And still, to this day, there is not any-- now they're doing the tracing of people who have it, seeing their connections. There still is no connection to a dental office in the United States or in Europe. So it's not from using the PPE before and not from using the current PPE standards. So some of this is just government regulation gone amok. And I know they're doing the best they can with limited information, but before they make recommendations like that that seriously affect patient care and the healthcare of communities, they really ought to do-- they ought to have a better idea of what actually happens.

Right. So we're seeing as we-- are seeing practices that-- when we talked about some of these on previous episodes, of the hypochlorous acid foggers or the UV lights, if you're using those, the acid foggers actually are used in the air, right, the UV lights are taking care of anything that may have settled on inanimate surfaces. Although it's interesting because in the same study, they say that coronavirus on inanimate surfaces could be efficiently inactivated by 0.1% sodium hypochlorite, 62 to 71 percent ethanol, or 0.5% hydrogen peroxide within 1 minute, the same study. So, wait a second, what is it, 15 minutes to allow it to settle, or 1 minute it can be eliminated? So that's why people are so confused.

And I actually mentioned, the same study says no solid evidence to consistently support that COVID-19 in saliva droplets can keep vital in airflow for any long period of time. And they actually collected 35 aerosol samples from patients in Wuhan, China. They did this study so-- I mean, they were right in the thick of it, right? So they said that not much vital virus was found in airflow but tend to deposit to the floor which is similar to the movements of large saliva droplets as noted previously. So again, if it's dropping to the floor in large droplets, what good is that 15-minute wait time going to do? So a lot of confusion, a lot of frustration. Because we also have hygienists that are following the CDC's recommendations very closely to make sure they're safe, as they should, but it's creating again another round of unnecessary panic and frankly, some unnecessary demands as people are trying to figure out what their new normal is.

Yeah. And the way I look at it, you really don't have a choice but to follow your state's mandates. But many states have said the CDC's recommendations are not valid and therefore you're not required to follow them. So that's where it is. So I expect that they'll be another correction to the CDC. We've had several already. And I imagine there'll be more coming. And I hope it's soon for those practices that are really unable to care for the patients that want to get in. That's really unfortunate.

Right. Very good. So the other question that we're getting a lot is about changing the gowns, right. SO that's another question we're getting all the time. Some states have said they need to change the gowns between every patient. Some states have said when the gowns are soiled. The World Health Organization, the CDC are at odds about this as well. So what are your practices doing? Dr. John, what do we see our members doing in regards to that?

So our practices are not using the disposable. They're using the washable ones. And they are washing them at the end of every day or sooner if soiled.

Yeah. That's what we see the majority doing as well. So that was another point of confusion. A question that was asked this week was, "How are often are people really changing this?" And we did a series a while back where we showed some pictures that kind of helped us laugh a little bit. And, man, there's plenty of those now. People really taking things seriously. My daughter visited a local sushi restaurant yesterday. And she said she walked in and at first thought, "Well, they must be remodeling because literally everything is draped in plastic." And they had cut out a little pocket in the plastic. And that's where you handed your payment, through the cutout, and you got your food through the cutout.

So I think we're seeing the-- in our area here, most are not like that as you mentioned. Most are tables are spaced a little bit apart. And we might see our servers wearing masks and gloves. But for the most part, that's really all the evidence that we would see. And then, you have the complete opposite end of the spectrum. And I think we're seeing the same in dentistry. Some people are following basically our universal precautions that we did before with a few subtle changes. And some people have draped their offices in plastic and have really gone to the fullest extent because they wanted the changes to be visible, right. But the good news is we're seeing just about everybody back to work. And the clients that we've been working with, we're delighted to report, are really doing well.

Well, they are. I knew that there would be a lot of pent-up demand and the practices would start off really fast. But I didn't realize how fast they would start off. So in our client base, we have a lot of people that are having records, having record months. May was a very, very good month. And interestingly enough, there is a higher comeback in high-dollar procedures than I would have guessed. I would have guessed that those would have been kind of the last to come back. But that's not what we're seeing. We're seeing ortho, implants, things like that, are on the rise faster than other dental procedures. So that's pretty exciting news as well.

Absolutely. I just got a text we had one of our fairly new clients just had a record-production day, a new office record. They did $22,000 in productivity today, and of course, for us, it's not about the dollars. We often say that production's never the goal, and said production's the result that comes when we take great care of our patients. So there are a lot of patients in that practice that got truly excellent care today, and we're delighted to hear that.

And it just lets you know that the public values what it is that we do. They value their general health. They value their dental health, and they want to get things taken care of. And so if we do the right things, we're going to be able to take care of a lot of them. And that's why we're seeing numbers that are really, really positive coming out of practices.

Right. And we can share a lot of great success stories. We've had a few hiking coaches now back out on the road and doing our one-day kick-off event with practices, and I just reviewed stats from one of those this morning. And just a quick glance at the dental intel, their training was on Friday, and on Monday, they did 200% more than was scheduled. So it's a great start, right? So we love to see these types of things happening, and I'm just so pleased that so many practices have reached out to us to share the impact that some of their preparation has had and the fact that their teams are happy to be back, and their patients are so happy they're back. So we hope that sounds familiar to those of you listening that you're experiencing something similar.

The strategies that we laid out at the very beginning really have gotten these people to the place where they really are having a quick start, and they're starting to-- and they're starting to sleep really good at night again. And they're starting not to have that yucky feeling in the pit of their stomach, and so this really is a super positive start. And on the economic front, we had this tremendously great news. Last week, when they announced the unemployment rate went down significantly. It was expected to go up significantly. And when I heard the number, I thought, "Oh. That just doesn't sound right. You don't think they manipulated those numbers for purposes?" And as it turns out, the numbers were wrong. It wasn't manipulated that way.

They made a mistake in the calculation. They counted furloughed employees in the wrong category, and so when they make the correction, so when you see-- but they figured out what the correct number would be. They didn't announce it very loudly, but they did. And the real number's around 16%. It was expected to be at 19 or 20 though. So 16 really is a good number, and when they come out with a number tomorrow, we will see what's happened. 16 is really the number we're comparing against, and I believe it's going to go down because I do believe that the economy is opening up. I believe that companies that are opening up are really doing well.

I was on a call with 30 CEOs this morning, and of those 30 CEOs-- except for the ones that are in industries that you know are hammered, so entertainment, food service, travel, lodging. Other than those, there was one construction company that does private paving. They were struggling, but everybody else was doing really, really well. The business was coming back. They're busy. There are backlogs, or the business that they have planned for the future and sold for the future is up. So the economy is starting really faster than I feared it would, which is great so [our recession?] which we're in officially, it may not be as deep as I fear.

And that is terrific news, right, because we've said we know have pent-up demand and we're going to have this real big buck and we're hearing that, right. We're hearing from people. I just did a call with the group practice yesterday that has no available openings for any kind of procedure until the end of August. So we are supremely capacity blocked even with adding extra days and adding extra providers and trying to catch up. We might think that's good news but we know that it's bad news, right. We know that that's going to limit growth and limit our opportunity for the same day. So there are those challenges--

Yeah, it's going to reduce retention as well because some of those patients are not going to wait till the end. They're going to find somebody that does have the capacity now. So they have already been put off for a while, they don't want to be put off until then. So it really is an important thing to try to match your capacity with your demand. But when we have this big load of demand right now, the adaptive strategies that we've been talking about, having blips days, expanding hours, expanding days, just temporarily, you don't have to do it forever but do it now because as we go through this pent-up demand, really, when you look at your own patient base, you're going to do it or somebody else is going to do it. And it might as well be you.

And our employees really have and had a difficult time with changing up their schedule somewhat, and adding in blips days so they've been very flexible about it. A lot of them appreciate the fact that they're going to earn some more and yet, it's a little more expensive because often we have to pay overtime. But it's still worth it in order to serve our patients, give them what they want, give them what they want when they want it to make sure that we have great patient retention.

Right. So Dr. John, if we were going to come up with three things that every practice owner should be focusing on right now, I would say that's thing one, right. We're really focusing on patient retention and capacity, making sure we have capacity for patients [and on?] appointments. And to illustrate this point, I've got a story to tell you because I tried this call and schedule an appointment with my physician for my son, right. So we always talk about how every business, whether they know it or not, has systems and processes that are what we call sales prevention [laughter] system. So they minimize people's ability to get the care or the services that they want.

So I have a perfect example of this. He had injured himself doing some construction in the backyard, so he'd scraped himself with [inaudible], a 19-year old kid so we're talking, "When was the last time you had tetanus shot?" couldn't remember so I called a physician. I want to schedule appointment for tetanus shot. And of course, then they had me speak to someone else because you couldn't just have a tetanus shot, he needed to have a full physical first. And he'd had a full physical within the last year, he just had it with a different provider because when he needed that appointment, they weren't available, right.

So we went through this whole [inaudible], I had to talk to three different people and it took 42 minutes for me to schedule an appointment for the tetanus shot. Because, of course, they were trying to talk him into the whole series of injections and I'm like, "Seriously, people, can you give me what I want?" And so that's the thing too, I would say. We got to be super focused on giving patients what they want in this moment. If we do not, the frustration is only going to build and they won't be patient and they can't and will choose to seek treatment elsewhere. So thing one, really focus on capacity and retention. The second thing I would say, you've got to give patients what they want.

Very good. And I would say the third thing to add to that was fundamentals. We've noticed in our practice some of the things that were systems, that were processes that were followed are starting to not be so good. Our phone answer rate has dropped a little bit. Our reappointment rate is got the little bits. So those blocking and tackling things, people just got away from it for a while and got out of the habit of doing it. So making sure that you're focusing on those things that are just so critical as far as your absolute practice fundamentals-- and, of course, included in that would be same-day dentistry, making sure that you are doing everything that you can the day it's diagnosed so that we don't have-- when you can't appoint them for a long ways up, that's even another reason to do it right now [crosstalk] you can and when you can.

And I couldn't agree more, Dr. John, because what we're seeing is with all of the new changes and the unknowns, we're seeing that on the hygiene side too, right? Practices are coming back. And the things that they had dialed in and were super good at in January have kind of dropped off, things like risk assessment, right? I was looking at the numbers. And there was a practice in January. It did almost 700 sealants in January alone. And now, we see sealants just kind of trickling in, right? I think we're worried about the time. We're worried about having enough time for some of those things. And we've gotten away from everything we knew worked when it comes to same-day services. So I couldn't agree more. I think we've got to get back to the basics, start doing our risk assessments, having some of those conversations, giving patients the opportunity to choose, right? Because we talk about how, sometimes, we make an assumption that the patient's not going to want to spend money on that right now. Or maybe it's not in their budget. But we've got to remember that it's really the patient's role to choose. We shouldn't be making those decisions or withholding those opportunities from anyone regardless of what the treatment may be.

And there is a large segment of the population that not only has been unaffected by this - their income has been unaffected - but their expenses have dropped because they've been just staying at home doing nothing all the time. They haven't traveled. They haven't done a lot of recreational kind of things. And so there are people with more disposable money now than they had before COVID. So we can't pretend as though everybody's been financially injured from this because not everybody has. And those people that have, we're going to have to be patients. So we're going to have to be able to talk both languages, the languages that we normally talk and the language of, "Okay, how do we make this work for you financially?" And that's not easy for team members to do that. But if you follow our processes, that's what naturally occurs. It allows people to get what they want and get what fits into their budget.

Yeah. I love that. And like you said, the diagnostic assertiveness level, the doctor should not change. Your treatment philosophy and what you feel is the right thing to do for patients, you still got to be doing that day in and day out. And we often say don't allow insurance coverage or lack of or financial circumstance to dictate treatment. But sometimes, saying it is one thing. And actually doing it is another. So hygienists can be the same. If you worked on your treatment planning for predictability process, make sure that all parties are sticking to that and honoring that because it is the right thing to do for your patients.

And whatever their financial situation shouldn't affect your diagnosis. It may affect what treatment you do initially, right? It may take you a little longer to get through the treatment that they need and what. But it shouldn't affect how you diagnose. And so that diagnostic assertiveness should not change at all.

Very good. Well, awesome. They got their top three. So let's refresh their memories real quick. It was retention and capacity, number one. Number two was, give patients what they want. Don't take 40 minutes to schedule a tetanus shot, right? And the third thing is really making sure that-- what was your third thing?

Third thing was fundamentals. So what are those things? Reappointing patients, answering the phone, converting calls to appointments, and same-day dentistry. Those are the key ones. And those are the ones that we've seen slip a little bit. So those are the three that I would really check your data to see if it's maintaining, if it is fantastic. If it's not, it's time for a refresher for your team. They'll get it. It's just kind of out of mind for right now.

It was good to be with you all here today. And we're back on our regular schedule beyond once a week to share with you ideas, what's going on in the dental marketplace, what's going on with what we see with patient care, with team safety, patient safety, and any new government actions, either on the fiscal side or on the regulatory side. We'll keep people updated as to what's happening.

Thanks so much, Dr. John.

You bet. Thank you, Wendy.

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