Are Clinical Exams a Thing of the Past?

There’s a new trend that’s gotten a lot of discussion over the last year; The exam-less new patient process. Yep, there are a lot of offices that have now chosen to skip the clinical exam. That doesn’t mean the patient doesn’t get a diagnosis. Two different variations have popped up. There is the version where everything happens like normal, except there is no clinical exam, and the second version where the doctor doesn’t even come into the new patient process to meet the patient until after they’ve accepted treatment.
Here’s how it works: The patient gets a full set of images and radiographs. The TC shows the records to the doctor and he/she diagnoses the case and gives the TC any relevant information such as treatment time and treatment plan. The TC works up the fees, etc and the the doctor either comes in, meets the patient and gives a treatment summary to all included or, the TC does that under the tacit permission of the doctor. (There’s a third version where the doctor does a telio-consultation with the patient through the computer, but the assumption would be they aren’t on site at the time, and we can discuss that another time.)
There are some who say that meeting the doctor is an indispensable portion of the process. They say that without the doctor, we’re nothing better than a shop that does “teeth moving”, and as a specialty it’s essential that we stand out by doing what others cannot; A comprehensive clinical exam by an orthodontist.
There are others who say that in this day of digital records, an exam is superfluous. After all, a live patient isn’t necessary for online case discussions, the ABO exam, presentations at conferences or in journal publications, so why do we need an exam in an office? Spend the time getting to know the patient or treating patients in clinic.
Some go so far as to say that the we regard ourselves too highly. That patients come because of the outcomes we provide and that we need to trust and empower our team members to do what they have been taught to do, namely, present care, with or without us.
All of the aforementioned processes require exceptional clinical photography (something I’ve taught for the last 20 years and discussed on my “all things clinical photography” blog). As my post HERE explains the danger of diagnosing off clinical images that aren’t perfect. IF YOU ARE CONSIDERING REMOVING YOUR CLINICAL EXAM, YOU MUST BE AWARE OF WHAT I DISCUSS IN THAT POST.
There are cases where an exam will be necessary irrespective of your philosophy. Cases with insufficient records, functional shifts or other issues may require more direct attention from the doctor, but many clinicians have said that in all of their years of practice, the clinical exam has changed their records-based treatment plan  very few times. Some would say that things like midlines and cants can (sorry for that) be better viewed from images than live patient exams. Others say that for things like interdisciplinary cases, they couldn’t even begin to think of skipping the exam because of all of the vital information they would miss. Is this true, or is the exam nothing more than a comfortable blanket that we’ve held on to because it makes us feel safe?
I am not telling you what you should or shouldn’t do with regard to your office’s new patient flow or whether or not you should do an exam. I simply want to point out to you a new trend which may or may not help you become more efficient in your practice life.
This past week I tried to create a number of treatment plans from simply examining the records and I have to admit that it was quite liberating. I still met with the patients and discussed the case in full detail and of the 8 cases I presented, all 8 accepted care. Some were simple class I crowded, some were complex interdisciplinary cases and others were mixes of issues. I still followed up with TMJ and oral cancer exams at the start scan (I DID ask about possible TMD issues at the consultation), but otherwise did no other clinical exam. I wanted to “dip my toe in the water” and see how it felt.
The question I pose is this: Do we place too much weight on the clinical exam and if you cannot get around the idea of needing one, why is that? Are the records you are viewing insufficient or is there genuinely something you can see in the exam that simply cannot be seen in the records (images, radiographs and scan)?
No matter how you look at it, the digital process in which we capture records is changing the way we interact with patients. How do you view theses trends and where do you see the new patient process in 1, 5 or 10 years?
Best wishes,
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