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The Possibility Session


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Lesson #5: CORE Lesson #5 – Current Risk Assessment vs Desired Risk Assessment

About This Lesson

Instructions coming soon..


Action Items

  1. Have a blank Risk Assessment Pyramid and fill out with patient during this possibility session!

Full Video Transcript / MP3

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Hey, what's up everybody? This is Dr. Steve Schluentz and I want to welcome you back to another video as we continue on with the possibility session. And we've covered a lot of material so far in a very, very short period of time. And this is going to be another vital, vital step. And as you're going through this ... Let me go to the tenets, here. As you go through these tenets, understand that each one of these tenets has a very specific function during the possibility session.

As you're going through this ... We're on number five now, which is evaluating current risk assessment pyramid versus desired risk assessment pyramid. And you can interchange this ... As I talked about on the last video, you can interchange this with the road, but really I'd like that big picture concept, the road in the potholes and all that stuff and then dig into their risk assessment pyramids.

They've done a few things now. They've looked at what health looks like, disease and their current state. They got this big picture idea of what ... Do they want to build a new road? Do they want to patch the road? And now we're going into the current risk assessment pyramid versus the desired risk assessment pyramid. This is a really, really cool concept. This is something that I picked up almost on my own. The current reality versus where they want to go. And then put that into this health related context that we're talking about.

If you guys remember, the risk assessment pyramid is something that we discussed about with perio and the decay and the bite and then longterm care, then overall health. And you have these four different levels of of risk categories and you can be very objective with them, somewhat subjective with them; however you want to do it. There's just a ... You got to paint a picture of where they're currently at and then you're going to get a declaration of where they want to go. And that's why you check in with the patient to see where they want to move.

Now, what's fascinating to me is, the way that I do this, is they have their current risk assessment pyramid and I ask them before I show them where I think they're at in this risk assessment. I say, "Where do you think you're at in each one of these care categories After we've talked about this stuff?" And you would be amazed at how closely they get it to where they're actually at. When you're looking at pictures and you're pointing out decay and things like that, you will notice that they, almost to a T, can say, "Well, I'm probably here and I'm probably here and I'm probably here based on the pictures that I'm seeing." And then I said, "Oh, that's fantastic."

Then I show them their current risk assessment pyramid. And then I said , "More importantly, where do you want to go? What level of health do you hope to accomplish?" You know?

That is amazing to me because I'm not worried about treatment plans. I'm not worried about pricing. I'm not worried about anything right now. What I'm just asking is based on what you're seeing and you're your current risk assessment where would you ideally like to go with your oral health and then you shut up again and you let them tell you. That desired risk assessment pyramid will dictate the initial plans with the patient.

Now if you look at the way the risk assessment pyramid is laid out ... Go to another slide where ... Find that thing, print it out and actually study that. You'll see there's that blue line in the middle. And what I tell patients is typically when patients can stay to the left side of the blue line, we know that the chances of getting really bad periodontal disease, really bad tooth decay that we can't save these teeth anymore, a really bad bite to where we need a full mouth rehabilitation to rebuild function, things like that. We typically can avoid those if we stay to the left side of the blue line.

What I recommend every patient is that if you can stay to the left side of the blue line, you probably will be able to keep your teeth for a lifetime without spending an inordinate amount of money to do it. And I do lay that out because I want them to understand where they should maybe be thinking about because they might think green is like, well I don't ... It's not important to me. Well if you stay in orange and red, you need to understand the ramifications of that. Right? So however you want to lay this out, I'm just trying to give you the big picture concepts here on these videos.

Understand that we're putting them back into a goal setting mode by having current risk assessment and desired risk assessment. Goal setting is everything in this game. If you get them to understand that they're moving towards something, they're going to go there a lot faster. If they think what they've been doing is fine and they don't have any goal to set, they're probably going to continue to go downhill.

Now you might be able to ... You might do this and they might be orange and red and they say, "You know what, doc? I really ... I don't care. I'm happy with where I'm at and I just want to stay in the orange and red." And you say, "That's totally fine, sir. Or, "That's totally fine ma'am. This would be the desired plan in order to get you what you just said you wanted, which is to continue to stay where you're at and possibly go further and further down hill. This is what would be something that we would do. We would take care of these obvious areas of decay so they don't blah, blah, blah, blah blah. They don't cause pain. I'm assuming you don't want pain, right?

And most people say, "Yeah, I don't want pain." Well these will probably cause you some pain. So you take care of obvious decay. You probably ... May take care of obvious perio pockets or whatever. But again, it goes back to current where they're at, where they say they want to go, and you can document all that. And that's the power of this is that they said, "You know what? I really don't want to address any of this." As long as they have informed consent of what that ramification means, then you've done your job, okay?

So the action steps on this video is have a blank risk assessment pyramid and fill out what the patient during this possibility session. This is where they want to go. So you filled out where they've been. And as I told you, the way I lay it out is I actually have them fill out a blank one with me where they think they're at, then where they're at, where I think they're at, and then ultimately where they want to go. And again, we're starting to fill this out together. You have to do these kinds of things to really enhance this co-discovery process. And I try to keep this very, very simple. I've, I've been to a lot of relationship based stuff. Some of it is so esoteric that there's no concrete plan as a doctor to be able to put this in your practice.

Listen, I created this as a way for you to be able to take this from day one and put it into your practice and be successful with it. Not something that you have to learn for 30 and 40 years how to be a great relationship based dentist. That is very important and there's resources and tools to be able to further enhance this process, but DSS is all about getting you concrete steps you can put in plan, into your practice tomorrow to differentiate yourself from other doctors. And I feel very, very strongly about that.

Make sure you're doing these things that I'm recommending. Try them out. See how is it working in my practice? What do I need to enhance? What do I need to get better? And you'll be amazed at the results that you'll get.