Are you ready to elevate your orthodontic practice while sidestepping legal pitfalls? Curious about harnessing AI ethically or managing patient challenges with confidence? Dive into this episode of The Golden Age of Orthodontics with hosts Dr. Leon Klempner and Amy Epstein, joined by Trey Lawrence, CEO of the AAO. We explore essential strategies for today’s orthodontists: navigating the complexities of social media to avoid HIPAA violations, crafting airtight informed consent processes to shield against malpractice, and responding to negative reviews without escalating risks. Trey shares critical advice for new grads on spotting contract red flags, like misleading non-compete clauses, and offers best practices for dismissing disruptive patients while protecting your staff and practice. Plus, we tackle the ethical and legal questions surrounding AI’s growing role in diagnosis, treatment planning, and marketing. There’s never been a better time to be an orthodontist—tune in to stay informed and thrive!
IN THIS EPISODE:
(00:00) Intro
(07:27) Discussion of being an introvert and the impact that has on professionals
(12:35) Common legal blind spots for orthodontists are HIPAA violations and Social Media Litigation
(17:38) Trey Lawrence advises new grads or young associates on interviewing and job offers
(20:39) HIPAA laws on negative reviews, malpractice and informed consent
(30:38) Should you dismiss a patient, and if so, what is the best practice
(35:52) What legal and ethical questions should orthodontists consider regarding AI
KEY TAKEAWAYS:
EPISODE TRANSCRIPT
What follows is an AI-generated transcript. The transcript may contain errors and is not a substitute for watching the video.
GAOO Ep 72 - Trey Lawrence, CEO, American Association of Orthodontists
(00:00:00) Dr. Leon Klempner: Protecting CEO, American Association of Orthodontists your practice is not optional. It's essential. Today we're diving into the legal landmines. Every ortho needs to understand from contracts and HIPAA to marketing mishaps and patient dismissals. Our guest today is Trey Lawrence, CEO, and former general counsel of the A A O. You may know him on Instagram at.
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(00:01:53) Narrator: The future of orthodontics is evolving and changing every day, but although the way to achieve practice growth has (00:02:00) changed, there's never been a better time to be an orthodontist.
(00:02:03) Let's get into the minds of industry leaders, forward-thinking, orthodontists and technology insiders to learn how they see the future of the orthodontic specialty. How will digital orthodontics, artificial intelligence, clear aligner therapy, remote monitoring, in-house printing, and other innovations change the way you practice?
(00:02:22) Join your host, Dr. Leon Klempner and Amy Epstein each month as they bring you insights, tips, and guest interviews focused on helping you capitalize on the opportunities for practice growth. And now welcome to the Golden Age of Orthodontics with the co-founders of People and practice, Dr. Leon Klempner and Amy Epstein.
(00:02:44) Dr. Leon Klempner: Welcome to the Golden Age of Orthodontics. I'm Leon Klempner. I. A retired board certified proud board certified orthodontist, director of, uh, orthodontics at Mount Sinai Hospital here in New York. Part-time faculty at, uh, Harvard and the (00:03:00) proud CEO of the best marketing company in the world, people and practice.
(00:03:05) And today, as usual, I'm joined by my daughter and my partner Amy, and I must say that, uh, I feel really blessed. To be working with my daughter. We have a lot of clients, uh, that work with us that are also, uh, family, uh, uh, kids working with their dads, brothers, sisters, legacy, um, practices. So, uh, you guys all know, uh, what it means for those that you, that don't.
(00:03:35) Have that privilege. Um, sorry, but it's great. So Amy, how you doing today?
(00:03:41) Amy Epstein: I'm doing well. We're fresh off the a a o. So we heard a lot of those stories and met a lot of parent child, uh, you know, ortho practices and was telling the story to some somebody that we met, I think. But you know, my. I have two sisters, and, uh, you tried (00:04:00) to pitch being an orthodontist, like over, over and over, almost caught one of us almost.
(00:04:07) Um, and it's, it's, you know, it was a, a nice offer coming to the practice, two thriving locations and, you know, best profession in the world. You always say that. So, yeah, but
(00:04:18) Dr. Leon Klempner: you know, it, it, the only thing that, uh, got in the way was organic chemistry.
(00:04:23) Amy Epstein: I know. Well, it's, it's an ortho killer and it's just like, it's take you right outta the game if you can't do that.
(00:04:29) Gone on. I know. Yeah, I know. I wasn't, I wasn't about to do that. I mean, there you have to, it takes a special person. You have to have a lot of skills in a lot of different areas and, um, you know, the, the people person and the kid person and then the technical skills. And you gotta be at the top of your dental school class.
(00:04:47) Oh, you have to go to dental school too, by the way. So like. It's a lot. It's a lot. Anyway, here I am. We're working together now. We circled back after your 38 40 year career as an orthodontist, and we're working together. (00:05:00) So you did it. You caught one of us. Just in a different way anyway. No, I think
(00:05:03) Dr. Leon Klempner: you caught me.
(00:05:04) You caught me.
(00:05:08) Amy Epstein: I, I know an opportunity when I see one.
(00:05:10) Dr. Leon Klempner: Okay.
(00:05:10) Amy Epstein: Um, yes. I'm Amy Epstein. I am the first daughter of Dr. Leon Klempner and also of. Career marketer, um, spent some time outside of the industry of orthodontics and spent about 15 years inside the industry of orthodontics, bringing some of the tenets of marketing over to the industry of orthodontics because marketing, the framework of marketing, although changing a lot of the core pillars of marketing are the same.
(00:05:38) No matter what kind of business that you're in, they're business skills. So anyway, thrilled to be in ortho. Um, I recognize it as the best profession in the world as well. So I talked about the a a o fresh off the a a o annual meeting. Here we are. And today's guest is Trey Lawrence. We're super honored (00:06:00) to have him here only a couple of days later.
(00:06:02) Um, you know, Trey, he's the CEO of the a a o, and he has had a long and distinguished career in law and advocacy. Uh, he's been on the show before and we've asked him all the questions and we're gonna ask him some, some different ones again because we know that they're always top of mind. He's been a pivotal figure, uh, in guiding orthodontists through complex legal and regulatory landscapes.
(00:06:25) Uh, prior to this being the CEO, which is just this year, he was the general counsel of the A A O leading ADV advocacy efforts on both state and federal levels. I. Trey holds a degree from Missouri State University, Washington University. Washington University in St. Louis and Harvard University. And as my dad mentioned, he's also known to many as the North attorney on Instagram.
(00:06:51) So, and that, um, you know. I think is a great way to, it illustrates Trey's commitment to making the legal (00:07:00) information that he has both accessible but also actionable for orthodontists. Um, and so we're excited to talk about his insights and the evolving challenges that we're facing today. Trey, thank you for being here.
(00:07:12) Trey Lawrence, CEO of AAO: Absolutely. Thank you all. I hope I live up to all of that now. We'll see what we deliver in the next 20 minutes. You're always,
(00:07:17) Amy Epstein: we're not, you're not new to our podcast and we know you do. So Yeah. You don't have anything to work worry about. But I wanna say one thing before we talk about all the, the questions that we have for you.
(00:07:27) I was recently on your LinkedIn and I saw a post that you shared about, um, being an introvert. And being in this profession, being an introvert. And so as a fellow introvert, um, I wanted to say I felt very seen by that. You know, I gave it the little clap and a lot of people did too. Um, you know. One of the things for those that didn't see Trey's post, um, the idea of sitting back and listening first, which is one of the core traits of introverts, it's like not necessarily to have the (00:08:00) loudest voice, but to stop and listen first and then react after you've been able to take in all the information that's being shared in a conversation.
(00:08:09) And it can sometimes, I've gotten this feedback before. In my professional career, in in public relations as being like a little aloof and for by others that are more extroverted. And if you spend enough time with introverts like us, you realize that we're really paying attention to all the details. And so I wanted to say thank you for that.
(00:08:29) And also I wanted to talk about how. That, um, character trait is shaping you as a CEO now or if it's influencing your approach?
(00:08:41) Trey Lawrence, CEO of AAO: Yeah, no, absolutely. It, it influences everything you do. And I, I'll start with, you are not alone in feeling heard by that. So that post did better than I, you know, not a huge. Uh, presence on LinkedIn, but that one certainly got some link attention on LinkedIn.
(00:08:57) So later on I (00:09:00) created a Post and TikTok being my primary intended audience, and that has been by far the most successful thing I've ever posted. A hundred thousand plus views. And, but, but the comments were what were just amazing because so many people, like you said, say, I, you know, I've worked in my job for 10 years and I've been frustrated the entire time.
(00:09:19) I feel like nobody understands me. And so that's been. The big piece of me, of, of it for me is first of all, recognizing there neither, neither. Neither, you know, mindset, an extrovert introvert is better or worse than the other. They just have strengths and weaknesses. And you, to start with, you have to start in yourself and lean into the strengths that your own skillset possesses.
(00:09:42) So for me, it was that listening piece. And so like how I've played that out as CEO for the ao, even though I have been at the AO for almost six years before I stepped into the CEO role, I really took the first six months to still kind of sit back and listen and listen from a little different.
(00:09:59) (00:10:00) Perspective I was hearing from a different group of members than I dealt with mainly in the advocacy part of the world, and, and hear what they were saying needed to be done and then start to take action after that. And we have, and we've got some things going on, some revamp social media that's coming in particular for a, a o that was a result of that listening.
(00:10:19) Um, as opposed to, you know, because the pressure is this. CEO, even someone who's already been at the AO, is to come in and just launch some revolutionary new thing the first day, you know, the a hundred first a hundred days in office kind of thing. Mm-hmm. But I fought against that and just really laid back and listened for a while as I started.
(00:10:36) Mm-hmm.
(00:10:36) Dr. Leon Klempner: Yep. Well, well, let me, lemme tell you, Trey, um, I have been, let's see, I graduated in 77. So I have not missed an a, a o meeting since I graduated, and I honestly will tell you this was the best one. And it, it, it, for those of you that have stopped coming, you gotta start coming back again because it's a (00:11:00) different a a o under this leadership.
(00:11:02) It was fun, it was informative. Um, it was, it had a whole entirely different vibe.
(00:11:09) Amy Epstein: So we look forward to seeing, uh, everyone who's listening here next year at the ao. 'cause it really was, uh, it's the, I've been going for probably 15 years and it's the best one I've ever been to.
(00:11:18) Trey Lawrence, CEO of AAO: Yep. That's, no, that's what we wanna hear.
(00:11:19) And again, we've been listening, uh, you know, I know all those who know Dr. Callahan as our president that just finished his term. Many would not maybe summarize him as a list. I mean, he's got a very outgoing, flamboyant personality, but he's a listener. Mm-hmm. And so we listened to what members were saying about not so much the saying about, uh, listening to members about why there aren't coming to meetings in particular, what they're really looking for in addition to ce.
(00:11:44) And I'm very excited. We've got several board members coming as the next few presidents that are equal listeners, and we're going to continue to listen and do those things that our members want. And I think you saw that this year.
(00:11:55) Amy Epstein: Mm-hmm. Definitely. Well, let's dive into some of the questions (00:12:00) that, um, our listeners have shared with us that, that they'd love to have us talk with you about.
(00:12:06) And, um, no surprise that a lot of these are in the, um, legal landscape, risk management arena. Um. You know, first we wanted to ask you from your vantage point, um, the most common legal blind spot for orthodontists today, and that may have changed. This question may have been, have been answered differently last year or the year before.
(00:12:29) Um, but today, what are your thoughts on the most common legal blind spot?
(00:12:35) Trey Lawrence, CEO of AAO: I still continue to think that it's a combination of primarily HIPAA violations, but some other things all wrapped up into social media. Because social media is, I, I mean, it's still relatively new. I mean, the law lags way behind, you know, when something develops.
(00:12:50) So the law is just now starting, you know, the court cases in the litigation are just now starting to catch up to social media. But I think the other thing (00:13:00) that makes it the big. Area that that practices are making mistakes now is because they're, my, my anecdotal, I don't have numbers back this up. My anecdotal observation is that the last three years or so have really seen kind of a flood of practices that have finally realized, Hey, we gotta step up our social media game.
(00:13:18) We've gotta get active there. So it's really this huge movement of people who have never really even. They, they've not been in that arena to begin with, period. Much less thought about the legal risks in that arena. And that's where I continue to see. I, I always joke every time I get on Instagram, I see somebody that's breaking a law somewhere among all the practices that I follow, I.
(00:13:39) Amy Epstein: So tell me like an example what common example of a, because now everybody's listening,
(00:13:47) Trey Lawrence, CEO of AAO: oh, I'm doing this,
(00:13:48) Amy Epstein: what am I doing wrong? So what are some of like one or two just common? I mean,
(00:13:51) Trey Lawrence, CEO of AAO: a big, big category is, is practices not really realizing the. Stint to which HIPAA protects patient information so (00:14:00) everybody knows you can't turn loose treatment details, those kind of things.
(00:14:03) But HHS has been very clear over the last couple of years that just the fact that a patient is treating at your practice is PHI. That's protected under hipaa. So anything that you do disclosing. The fact that the patient treated at your practice, unless you have their consent specifically for social media to do it, is a HIPAA violation.
(00:14:24) So things like, I see like when practices have drawings and they pull out a winner's name and they read the name and I see them reading the full name. Uh, so I'm hoping every time they do that, they've got a signed HIPAA release from that patient or mom or dad, because otherwise they've just. Disclose the fact that that patient treated there and that's a HIPAA violation.
(00:14:43) So, or, or the, you know, photos that have patients in the background and not really being as hygienic as they need to be about minding who's in the background and you know, not, oh yeah, we've got a signed release from the patient in the chair who we're getting on this reel, but we didn't think about the (00:15:00) three others that are walking through in the background behind them.
(00:15:03) So just any of those things that just show that somebody's in your practice receiving treatment. You've gotta have either authorization from them or you've gotta make sure that they're screened from making it into those posts. Yep.
(00:15:16) Amy Epstein: Yeah, that makes total sense.
(00:15:17) Dr. Leon Klempner: Yeah. So Trey, you know, if I'm a listener and I'm listening in on here, I'm saying, okay, there's risks here.
(00:15:22) I'm not going on social media. I'm not gonna do any of that stuff. So what do you say to those listeners that are, are afraid and nervous about, uh, utilizing it and just kind of abandoning it all together?
(00:15:35) Trey Lawrence, CEO of AAO: Yeah. Uh, well, so the short answer is don't say that. I mean, you have to be on social media. Our a a o data is showing the, the trend that patients who are first come into contact with their practice, you know, it's increasing dramatically.
(00:15:49) Is social media and online research being. Two primary ways now. I mean, that's replaced the, it's, it's almost to the point where it's replaced the friends and family referrals and only (00:16:00) referrals from gps, um, are still ahead of social media and online research. So you have to be there. I think so the. The thing is then just make sure you know what the legal risks are.
(00:16:11) So certainly I think working with a reputable, uh, you know, marketing company or practice management team that can help you, you know, working with experts in that area can help you guide, guide you through some of those risks. And then I, I. Obviously the AO legal resources, my own social media, and so much of it is not necessarily, you have to have the law memorized, it's just be conscious of what the risks are and that's, that's easier than knowing exactly what the law is.
(00:16:37) You just, but you have to be exposed to it and read about it or, or see it. And I think that that combination of working with a really reputable, knowledgeable. Marketing team for your practice and utilizing a a o legal resources can get you about 90% of the way there. Mm-hmm.
(00:16:54) Dr. Leon Klempner: All right, great. Uh, so, you know, we have a lot of topics to cover, so I'm gonna be flipping back and forth, kind of (00:17:00) rapid fire type of thing.
(00:17:01) Uh, so, uh, I work with residents, right? That's what I do. I, I love teaching. I'm with residents all the time. Um, they're coming out with half a million dollars or more in debt. They need a job when they get out. So, and they don't have much background in, in terms of business or legal. So my question to you is, there's a lot of confusion on a lot of topics.
(00:17:24) Non-competes come up, you know, as one topic. But you know, what should new grads or or young associates be on high alert for when they're, uh, interviewing and reviewing job offers?
(00:17:37) Trey Lawrence, CEO of AAO: Uh, there are several things that can sneak up on you. I mean, even, even something as fundamental as how the contract is structured.
(00:17:44) I've seen several. What are titled independent Contractor Agreements over the years that you start reading them, and it's very clear that that's an employment relationship, but the hiring entity, it's in their best, best interest, obviously, to classify somebody's an (00:18:00) independent contractor. And so they've titled it that way and, and as a resident who's graduating and not familiar.
(00:18:07) With all this, you might easily miss that and just take their word for it, that you're an independent contractor. That's a big one. Certainly the non-competes and what's really challenging about the non-competes is that nobody really knows exactly what the law is. Right now. The FTC has passed this ban, but like always, it gets tied up in years of litigation and nobody knows what's going to come out on the other end.
(00:18:30) I suspect that. Hiring entities are going to be looking at ways, even if that ban goes in place, to still basically do the same thing. And I think the other challenge where I've seen the most trouble lately is in multi-location. So the employer has multiple locations and your interpretation of a non-compete may only be the one specific location that you're working in, and then you go to leave and find out that they're measuring 10 miles out from.
(00:18:58) Every practice (00:19:00) location that they have. And so those are the kind of things. A, that you might not catch. And B, if you don't have experience in negotiating a contract yourself, then you might not know how to try to fix some of those things before you sign it. So I always advise residents that I know. I know a newly graduating resident is not.
(00:19:20) Point in their life where they can spend a lot of money on anything. But there are people who will review a contract and do a good job, are credible, you know, very skilled attorneys, and will charge a fee. They know where a resident is at that stage in their career. You know, their, their goal obviously is to get that resident's business later in their career.
(00:19:40) So if a resident is in that spot, please contact us at the a a o. We don't have an official endorsed program or anything like that, but we can absolutely give you the names of two or three attorneys. Needs that have worked with many other residents and I've heard good things from, and, and it's, you know, it's less than four digit dollar amount to review those things.
(00:19:59) (00:20:00) And that should be, it's, it's an investment that's well worth it for a resident as opposed to end up in a mess that you spend a lot more than that later trying to get out of.
(00:20:07) Amy Epstein: Yeah. We work with a lot of, um, you know, residents just coming out and looking to associate or, um, you know, and so this is good for us to know.
(00:20:18) Uh, so as we talk to our clients, and I'll share it with our growth consultants, um, as they talk to their clients too, that the AO can be a resource here. So that's good.
(00:20:27) Trey Lawrence, CEO of AAO: Very good. Yeah, definitely.
(00:20:29) Amy Epstein: Um, let's talk about, let's go back to hipaa, uh, for a second and talk about online reviews. And it's something that's probably makes it into every podcast we have together, uh, because it just keeps coming up and, um, we, we handle this.
(00:20:44) Uh, in partnership with our clients. So we, we know how and how not to respond and, um, but there are a lot of people who may be listening who, um, you will eventually get a negative review. You can't (00:21:00) please everybody, and that's just what it is, and that's okay. Um, and most of the time you'll hear, um, that, you know, don't.
(00:21:08) Don't respond to that or you know, just lay low. And, but the, the instinct is to defend oneself when you're being accused of something that you feel is, or mis it's misrepresenting what happened. And that's always what happens. It is never really like the honest situation about, or, you know, 'cause everybody's perspective is their own perspective, right?
(00:21:29) So who, who, somebody's upset, they write a whole thing. You're like, that's really not the whole story. And you feel like you wanna tell your story. So, Trey, you, let's just say you have somebody and they're in that position and they come to you and they're like, I gotta, I gotta tell my side of the story.
(00:21:47) What do you advise them? Yeah,
(00:21:49) Trey Lawrence, CEO of AAO: there's, it's funny, there's kind of a chain of instincts that somebody goes through here and neither one of which am I a big fan of. So, instinct number one is the defend yourself instinct. So I would say (00:22:00) stay away from that because it's. If you're not acutely aware of the risks, so easy to step into a a HIPAA violation that you weren't thinking about.
(00:22:11) And it's especially the case because anytime that you're writing one of these, you're emotionally charged and that clouds judgment and. You know, clouds the senses to be alert for these things anyway, so I, I absolutely don't go with that instinct. But then instinct number two is to not respond at all.
(00:22:29) Mm-hmm. As you just hint at. And I don't like, I don't love that one either, because to me that seems, you know, if you're a prospective patient. You see a really, what sounds like a really bad situation, and then there's just no response. I mean, this is just for businesses generally. Yep. This is not unique to orthodontists then that doesn't send the, the optics that you're looking to create either.
(00:22:51) So that's why I think a highly curated, very careful response. The, our a l recommended response is (00:23:00) always. It appears there's been a misunderstanding. Please contact our office to set up a time to discuss. You're not admitting anything factual about the patient, even that they were a patient. Mm-hmm. You, but you are responding.
(00:23:11) But the other big thing is get it offline. 'cause you don't want that thing to turn into a protracted, you know, multi post discussion online either. And so it's get it offline, even if you've already dealt with that. Issue with that patient, still get it offline. And that's why we like that response.
(00:23:27) Amy Epstein: Mm-hmm.
(00:23:28) Yep. That makes total sense. Yeah. We've, uh, we've seen, we've seen this go awry before, right. And you, um, you don't want this back and forth out there. For everyone to read and certainly, and remember how many
(00:23:42) Dr. Leon Klempner: times we, we counsel our clients, our orthodontic practices to consult with us. Don't immediately answer.
(00:23:50) Take a deep breath day.
(00:23:51) Amy Epstein: Keep it simple here. Such way, day. Yeah. Day,
(00:23:53) Dr. Leon Klempner: you know, uh, the emotions. And, you know, I, we're sensitive people as orthodontists, you know, we (00:24:00) take it seriously when, you know, one person doesn't like us and we keeps us up at night. So, uh, that's just the way they're, well, I
(00:24:07) Amy Epstein: mean, you're, you're in an.
(00:24:08) Industry where most people are really happy with what you're doing for them. Yeah. I mean, you come out and your confidence is up and everybody, you know, you look better. It doesn't matter, Amy, you feel good, doesn't, it? Doesn't matter, whatever. Well, I'm just saying, I, you're used to getting the positive feedback and then when something shows up that isn't, it's like, it's, you know, I can imagine that it's, you know,
(00:24:29) Dr. Leon Klempner: you know, let's say I'll, I'll treat a thousand cases and I get a beautiful result, and then I have one that.
(00:24:37) Something goes awry that keeps me up at night.
(00:24:40) Amy Epstein: Yeah, I know. You know, and
(00:24:41) Dr. Leon Klempner: I know that's, we we're like perfectionists, you know, we, we, we struggle over a half a millimeter midline deviation at the end of the case. It's just the way we are. So it's, it's hard for us to, to do what you're asking, but it's critical.
(00:24:56) Amy Epstein: Mm-hmm.
(00:24:56) Dr. Leon Klempner: And, and, uh, important for our listeners to understand that. (00:25:00) So let me, uh, let me flip the topic again. Um. And let's talk about, uh, malpractice. And informed consent. So, you know, I've been around for 38 years. I've taken all the, you know, uh, insurance courses and, uh, talked to different clients. So I know, uh, that informed consent is almost like, uh, the, um, iron that we have to protect ourselves against malpractice.
(00:25:27) It's gotta be, uh, solid. Um. Most of the, uh, informed consent is, at least in my practice, was, um, filling out the form, maybe asking questions, sometimes not, sometimes it would be done by, you know, the TC and not me. So give us a, some guidelines in terms of what you feel would be the best way to manage, uh, informed consent in orthodontic practice.
(00:25:55) Trey Lawrence, CEO of AAO: Yeah, the, so you already, the, the fundamental underlying truth here, you already (00:26:00) hinted at, which is that that informed consent, uh, not the signed form itself, the patient giving informed consent is the single most important element in any mal, you know, defensive any malpractice claim, because the. Vast, vast majority of malpractice claims are either I experienced a risk that I didn't anticipate, or I had a result that I didn't anticipate.
(00:26:24) And so if you have a evidence that the patient understood the risk or understood the treatment outcomes and agreed to treatment, knowing that, then that negates. Huge number of those malpractice claims, but the challenge is always that this is not, again, not unique to patients. This is just consumers generally.
(00:26:44) When your legal defense rests on a signed document, the consumer slash patient is always going to try to argue. I didn't know what I was signing. So I can't be held, I can't be bound by what's in that document because I didn't know what I was signing. So all the (00:27:00) classic scenarios of the credit card agreement that has 10 pages of fine print and no reasonable human could be re expected to read and understand all of this.
(00:27:08) So the key then. You have to design your informed consent process with a patient in a way that removes as much possibility for them to make that argument as possible. So this, this informed consent topic continues to make me nervous because as we develop. You know, all these really cool new tools for patient intake and filling out documents online before they even come in, and all these things that are so helpful in so many ways.
(00:27:36) I know the temptation is just to slip that informed consent with those, and I think the single best thing I. To help prevent a patient from claiming they didn't know what they were talking about is still having either actual contact with the doctor or at least being offered contact. I mean, the, the best practice is always going to be have the doctor actually talking with the patient.
(00:27:59) I. (00:28:00) About what's in the informed consent before they sign. I understand practices have different workflows and many don't regularly have the doctor do that. At the very, very least, give the patient the opportunity. Say, you know, do you, okay, I've explained everything to you. Do you have any questions or would you like to talk to Dr.
(00:28:17) Smith? If so, I'd be happy to have her step in here before we have you sign this, something like that. Because I think. From what I've seen, the biggest thing that makes patients claim that they didn't know what they were signing is because they, that's all essentially, everything in an informed consent is essentially, you know, treatment information.
(00:28:37) And if they don't have, if they say, well, no, I, yeah, some staff person gave me all this, but I never even had the chance to talk to the doctor about this before I signed that. That's the single biggest place where I see the challenges to an informed consent coming up.
(00:28:53) Amy Epstein: I mean, what if the, what if the patient says, like even if you said, would you like a chance to talk to Dr.
(00:28:58) Smith? And they, they say, you. (00:29:00) We, they didn't say that. Right, because the, I mean, how do you sort of, do you say that's just part of our protocol? You can see our protocols here. It includes the, you know, how do you prove that you offered that opportunity?
(00:29:12) Trey Lawrence, CEO of AAO: Yeah. I, I think the, the more evidence that you have to establish that, that's just your standard workflow for your practice, then that helps that certainly if you have a, you know, a written document that you've given to staff that says, this is our intake workflow, or mm-hmm.
(00:29:25) This is our informed consent workflow. That's going to be immensely helpful. Even short of that, just the testimony of staff, you know, if you have your. Treatment coordinator is regularly the one that walks through the informed consent and then she or he is able to testify no, every single time, it's just our policy that I would at least offer to the patient to have the doctor come in.
(00:29:45) And then that's, that matches what your testimony as the doctor is. It's just the more evidence that this is our workflow. Mm-hmm. And we don't deviate from it, that it's going to be compelling to a court, a jury,
(00:29:58) Dr. Leon Klempner: uhhuh. And what about just simply (00:30:00) putting a, a, a, a comment in. Uh, form consentment reviewed, patient, given an opportunity to talk to the doctor, had no questions.
(00:30:08) Something like that.
(00:30:09) Trey Lawrence, CEO of AAO: Yeah. Uh, that, that individual entry in an individual's chart is going to be another piece of evidence. I mean, any of these things with evidence, you know, it's always, the more the merrier, the more evidence you have, the better. So certainly that's could be an important piece too.
(00:30:25) Amy Epstein: Okay, great.
(00:30:27) Um, okay, so, um, moving on from this like negative review situation and then, you know, malpractice or whatever, um, when you see something coming down the pike with a patient or a potential patient where, um, they're either being, um, disruptive, they're not paying, um. Especially in tricky cases and, you know, um, contentious co-parents, things like that.
(00:30:58) Um, what's the (00:31:00) safest way, or I guess the first question is, should you dismiss that patient? And if so, what is the safest way to do that?
(00:31:10) Trey Lawrence, CEO of AAO: Yeah, the, I mean, the rule of thumb is that as long as you're not leaving the, by dismissing the patient, you're not leaving them in a worse situation when than when they first came in.
(00:31:18) Then you always do have the option to discontinue. I think the law is probably quite a bit broader than most doctors realize on the instances that you can. Dismiss a patient. So you know, something like nonpayment, if they're six months behind on an account and no hope of catching up, that one's more obvious.
(00:31:35) But these disruptive patient situations, I, I think to Dr. Klenner's point earlier, the perfectionist orthodontist doesn't want to, you know, kind of admit failure by dismissing a patient. You know, this situation was so problematic that we had to move on. But in many cases. That is the, that's the safest course is to move on and, (00:32:00) and two, the other thing I think sometimes the Dr.
(00:32:02) May lose sight of someone is you're honor an obligation just not only to protect yourself legally as the doctor, but you also have to protect your staff too. I know many times those problem patient situations are even worse for the team members than they are for the doctor. And so there is an obligation there as well.
(00:32:22) So as long as, I mean, certainly giving the patient or the parent notice, you know, having a conversation with them and documenting that you talked through the concerns, um, sending them a letter saying, you know, these are the concerns that have arisen and we would love to continue to treat you, but may have to consider.
(00:32:42) Other options if they don't change, you know, some kind of advance notice like that certainly helps. I mean, obviously if somebody walks in and is physically threatening staff or something like that, you can dismiss them instantaneously. But to do all of that, if you do all of that and lay the groundwork and then you send the proper documentation afterwards, the letter that (00:33:00) includes the, you know, we're dismissing you for this reason.
(00:33:03) Um. We will see you in the next 30 days. If you have an emergency, we're happy to provide copy of records to you and we can refer you to another provider if you wanna continue your treatment somewhere else. Those are the legal elements. If you do all of that, then you're covered legally. So why wouldn't you avoid the additional risk that could come up from trying to power through it and continue to treat that really problematic patient or parent?
(00:33:27) Amy Epstein: Yeah, I think that one of the. Just talking about the process there. One of the hardest things in that process, I would imagine is the first thing you mentioned, which is have a conversation first and then follow up. I don't know, I know many orthodontists that don't want to do that, but as a communicator of, you know, at the AO I gave a talk on like transition communications and how.
(00:33:56) Tell, you know, something's happening at the practice and you wanna tell patients (00:34:00) as soon as possible, as clearly as possible. They don't wanna hear it from somewhere else face-to-face, especially as you're talking to your team about a change is, is the best way to do it, you know, and I would imagine that, that it would go really far to be able to have a face to face and be like, look, we're we're facing these, uh, challenges.
(00:34:19) These are the things you know, I just wanna make sure that you are aware of them and that, you know, before sending a letter. Would be a best practice, right? Like that would probably make things go much more smoothly than just receiving a letter in the mail.
(00:34:32) Trey Lawrence, CEO of AAO: Yeah, absolutely. I mean, certainly just on a basic human.
(00:34:35) Exactly. You know, it just the personal dynamics as opposed to getting something in writing, which is, you know, or same. Same thing goes for trying to raise the concerns first through an email. Or whatever now, exactly how to have that conversation. That's where I will happily defer to the experts, like the people in practice team, you know, as the lawyer, I can only tell you, you need to have that conversation.
(00:34:57) Yeah. But I know that there are others like you (00:35:00) all that are much better situated to you, you know, provide a, a framework for how to have that conversation.
(00:35:05) Amy Epstein: Yeah, for sure. Well, we do know you have to do it privately for Yes. EHI purposes. So we, we know that much.
(00:35:13) Dr. Leon Klempner: So Trey time's flying by, but I can't let you go without talking about my favorite subject, which is AI gave a talk at the a a o about how, how quickly this technology is permeating into the orthodontic profession.
(00:35:28) So, um, I'm curious, uh, from your perspective, so as. AI becomes, uh, plays a greater and greater role in orthodontics and diagnosis treatment planning, and even in marketing, people in practice are, are investigating, uh, this area very thoroughly. Uh, what legal and ethical questions should orthodontists be thinking about?
(00:35:53) Trey Lawrence, CEO of AAO: Yeah, it, the AI is like so many other technologies that have come along that offer so much promise from the (00:36:00) proper use, but so many risks or challenges from the misuse of it. And the AI in particular, I think really goes to Dr. Callahan as our president that just wrapped up. He ca, he's called this the existential question for dentistry and it's protecting the sanctity of the doctor patient relationship by not allowing technology.
(00:36:20) To replace the role that only the doctor can fill. And so, and, and so that, and that's really the standard by which any of these technologies, I mean, it's the same thing with Teledentistry and direct to consumer that hopefully we're starting to see a little bit of, um, sub subsiding. Finally that, but it was the same thing where technology was used to replace the doctor in the role that only the doctor can fill.
(00:36:45) And that's the question for ai. So the. Challenges the ai, I think those lines can get a little blurrier. And so this is going to continue to be a conversation that will go on, (00:37:00) I'm sure in the foreseeable future. I will a little a a o commercial here. The a a o has assembled a task force on the use of AI and orthodontics.
(00:37:10) It's comprised of educators and researchers, clinicians, and then some of our industry partners as well, and they are. Nearing completion on a position paper. That is the first step in helping to clarify some of that blurry area in when the AI is replacing the doctor. The central thesis of the position paper is just exactly what I said, that the ai, AI should be used as a tool to assist.
(00:37:39) The doctor, but should not be replacing the doctor in the, the areas that only the doctor, uh, you know, that, that are solely the doctor's role. And so, but I, I'm certain that this position paper, once it's finished, uh, like, like they say about so many things in it, it will never truly be finished. I think it will be going an ongoing process, processes, new (00:38:00) particular technologies come out to help define when is this being used properly or when is this replacing the doctor.
(00:38:06) So, um, you know, I, there. I, I anticipate probably a year or two from now we could probably sit and have a whole 30 minute conversation just about specific applications and where that line rests with those applications. We're not quite there yet, but this is something the a a O is acutely aware of and wanna be sure that we're on the forefront of helping our members deal with it as much as we can.
(00:38:30) Sure.
(00:38:30) Dr. Leon Klempner: I'm gonna put it on the calendar for one year from now. Okay. Deal.
(00:38:35) Amy Epstein: Right after the a a o next year. So, Trey, thank you for being here. Thanks for sharing all of this, uh, really valuable information with us. Um, and the, and illuminating where the a a o can be a resource. For orthodontists, um, to get really thoughtful, well-researched, um, information about these questions that we had.
(00:38:56) If there are specific questions that we didn't cover (00:39:00) today that maybe our audience members would like to address with you, is there a way to reach out to you directly?
(00:39:05) Trey Lawrence, CEO of AAO: Yeah. The easiest way is if you get on the AO member website, there's a legal resource center. One of the tabs there is they contact the AO legal team tabs so that you, you or a team member, as long as they, you know, if you wanna have one of your team members submit a question, I.
(00:39:21) Just fill out your name, your member number, and put the question in, and then an AO attorney will get back to you by email. So that's one way for me personally at the ortho attorney on Instagram. It's gonna be the easiest way. So, um, try as I can to post content there, but certainly, always happy to respond, you know, through DMS or other outreach by.
(00:39:43) Members or anybody in dentistry, honestly, through Instagram. Mm-hmm.
(00:39:47) Amy Epstein: It's great. I mean, you're so, you're, you're really accessible. I mentioned it at the top of the show, and, uh, you make the information accessible and you are accessible, which I know is, uh, really appreciated by, by many orthodontists and AO (00:40:00) members.
(00:40:00) So thank you for that.
(00:40:01) Trey Lawrence, CEO of AAO: Yeah, no, ab Absolutely. Absolutely. That was one of my priorities, even well before becoming CEO, and the my little secret that I always spill is all that legal information on Instagram. I mean, I'm very happy that that's helpful to a a o members. Really, that was just my little secret, and to make more connections with AO members and just use the legal information as a tool, but the connections are really the most important part.
(00:40:25) Amy Epstein: Mm-hmm. Yep. And for all those that think that introverts don't like to make connections and be connected to people, like you're looking at a couple of 'em right here and uh, you know, we just take a different route to getting there. So Trey, thank you again for being here. I look forward to seeing you again soon, and if not before, then one year.
(00:40:43) Same place, same time
(00:40:45) Trey Lawrence, CEO of AAO: deal. Thanks. Thank you all.
(00:40:47) Amy Epstein: You can subscribe or download other episodes on Apple Podcasts, Spotify, SoundCloud, YouTube, or wherever you get your podcast. And if you enjoyed it, as always, we'd appreciate it if you would tell a colleague about us. (00:41:00) For more information about people in practice, you can visit our [email protected].
(00:41:06) Dr. Leon Klempner: Thanks for watching and listening. I'm happy to say that we've, uh, reached our 1000000th download last month for people that's practice. Mm-hmm. So, um, appreciate everybody there. By the way, it's the ortho attorney I made this mistake. Mm-hmm. It's not the ortho attorney. It's the ortho attorney.
(00:41:23) Amy Epstein: Fourth attorney.
(00:41:24) Dr. Leon Klempner: Ortho attorney, like orthodontist,
(00:41:26) Amy Epstein: ortho attorney orthodontist.
(00:41:27) Dr. Leon Klempner: Ortho attorney. Okay. Uh, if you wanna reach me, talk about marketing, talk about. AI talk about risk management, anything that we've talked about here on the podcast, uh, it's [email protected]. If you're looking for a deal, our sponsors are offering, uh, uh, a deal to our listeners on our partner page, you go to ppl practice.com and remember, most important thing for forward thinking orthodontist, it has never, ever.
(00:41:55) It's been a better time to be an orthodontist. We are in the golden Age. Take (00:42:00) advantage of it. Bye for now.
(00:42:05) Narrator: Thank you for tuning in to the Golden Age of Orthodontics. Subscribe now on Apple Podcasts, Spotify, or visit our website at the golden age of orthodontics.com for direct links to both the audio and video versions of this episode
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