The Dental Form Nobody Owns

Provenance

By John F. Groom 

I recently visited my local dentist for what should have been one of the simplest appointments imaginable: a routine cleaning.

I've been a patient there for seven years. I visit regularly, and nothing about my medical history has changed since my previous appointment. Yet before I could sit down in the dental chair, I was handed another annual medical history form that needed to be completed before treatment could begin.

Some of the questions made perfect sense. Allergies, current medications, and significant medical conditions all have an obvious connection to dental care and patient safety. As I continued reading, however, the questionnaire gradually moved far beyond information directly related to my treatment. It asked whether I was under the care of a psychiatrist, whether I used recreational drugs, whether I consumed alcohol, and if so, how much and how often. Women, of course, are often asked additional personal questions regarding pregnancy and related medical issues.

What struck me wasn't simply that these questions existed.

It was that there was no explanation for why they were being asked, who required them, whether answering them was optional, or who would ultimately read the responses.

Curious, I asked where the questionnaire had come from.

No one in the office knew.

The receptionist could only tell me that the form had to be completed before treatment could proceed. I doubt the dentist personally designed the questionnaire, and he probably didn't. Like thousands of other dental practices, he almost certainly inherited it from somewhere else—a practice management system, an electronic health record vendor, a professional association, a malpractice consultant, an insurance recommendation, or perhaps a corporate template that had been passed from one organization to another for years. Somewhere, at some point in time, someone decided these questions belonged on the form.

Today, however, no one in the office can tell you who that person was.

That observation reveals a much larger issue.

This is a provenance problem.

Most people associate provenance with famous paintings, historical manuscripts, or rare artifacts. We ask who created them, where they have been, and whether they are authentic. Those are important questions, but provenance applies just as naturally to ordinary administrative decisions. Every question on a form has a history. Someone decided it should be asked. Someone believed there was a reason for collecting that information. The problem is that, over time, those decisions often become disconnected from the reasoning that originally justified them.

A Requirement Without an Owner

Once that question occurred to me, a series of others naturally followed.

Who decided this particular question belonged on the form? Was it required by Virginia law? Was it recommended by the American Dental Association? Did an electronic health record vendor include it as part of a default template? Was it suggested by a malpractice insurer? Or was it simply copied from another questionnaire twenty years ago because no one wanted to remove it?

Those possibilities are fundamentally different.

A legal requirement carries a different weight than a professional recommendation. A recommendation is different from a software vendor's default setting, and a default template is very different from a question that has simply survived decades of copying without anyone remembering why it was included in the first place.

Yet to the patient, every one of those questions arrives wrapped in exactly the same explanation:

"It's required."

Required by whom?

That answer is rarely available.

The more I thought about it, the more I realized that this pattern extends far beyond dental offices. Modern life is increasingly filled with anonymous requirements that ask us to surrender another small piece of personal information. Many of those requests may once have had entirely legitimate reasons, and some undoubtedly still do. Over time, however, the justification often becomes separated from the requirement itself until the question continues to exist while the reasoning behind it quietly disappears.

That is not merely a paperwork problem.

It is a provenance problem.

Anonymous Requirements and Invisible Responsibility

The more I considered the questionnaire, the more I realized that the most troubling aspect was not the questions themselves. Many could very well have legitimate medical, legal, or administrative purposes. What concerned me was that nobody seemed able to explain why they were there. Responsibility had become so thoroughly distributed that it effectively disappeared. The receptionist wasn't responsible. The hygienist wasn't responsible. The dentist himself might not have been responsible. The software company that supplied the forms was invisible, and whatever organization originally recommended or introduced the questions had long since faded into the background.

Yet despite that absence of accountability, the requirement itself remained.

From the patient's perspective, there were only two practical choices: answer the questions or leave without treatment. Whether the request originated from a legal mandate, a professional recommendation, an insurance guideline, or simply decades of inherited administrative practice made little difference because none of that information was visible. The requirement survived, but its provenance had been lost.

That imbalance struck me as far more significant than the questionnaire itself.

Every discussion about privacy eventually turns to data breaches, cyberattacks, surveillance, or unauthorized access to personal information. Those concerns are unquestionably important, but they are not the only challenge associated with modern data collection. There is another problem that receives far less attention: organizations continually expand the information they collect because every additional question reduces some amount of institutional uncertainty or legal risk, while the cumulative cost of answering those questions is distributed across millions of individuals.

From the perspective of the organization asking the question, the additional burden appears almost negligible. Adding one more checkbox to a form costs virtually nothing. Across an entire lifetime, however, those small additions accumulate. The cost is paid not only in time, but also in privacy, uncertainty, frustration, and the gradual normalization of surrendering increasingly personal information without understanding why it is being collected.

No single question is especially burdensome.

Thousands of unnecessary questions over a lifetime can be.

Provenance as Accountability

Perhaps the most remarkable aspect of this process is how difficult it is to challenge.

If I refuse to complete the form, the dental office is free to decline treatment. Finding another provider is rarely a meaningful solution because the next practice may use an identical questionnaire—or an even more intrusive one. In many situations there is no practical market mechanism encouraging greater transparency, no easy way to compare one provider's information practices with another's, and very little visibility into how those forms evolve over time.

This is precisely where provenance becomes valuable.

Imagine if every individual question carried its own documented history. Instead of presenting patients with an anonymous list of requests, each field could identify its origin, purpose, and level of authority. A question about current medications might indicate that it is required under Virginia regulations because it directly affects patient safety. Questions about blood thinners could reference recommendations from the American Dental Association explaining their importance during dental procedures. An alcohol consumption question might state that it was added by the practice's policy committee in response to malpractice concerns, while a psychiatric treatment question could identify itself as part of an electronic health record vendor's default template and note that it is optional for individual practices.

The experience would immediately become different.

Patients would understand not only what they were being asked, but also why.

Some questions would almost certainly remain because their value could be clearly explained and defended. Others might quietly disappear the first time someone was required to publicly justify their existence. Provenance does not automatically eliminate unnecessary requirements, but it makes inherited assumptions visible by reconnecting every requirement with the reasoning that originally created it.

That is one of provenance's most overlooked strengths.

It is not simply a system for tracing the history of famous paintings, scientific discoveries, or valuable datasets.

It is also a system for tracing responsibility.

When Requirements Lose Their History

One of the most important consequences of losing provenance is that responsibility gradually disappears.

When nobody knows where a requirement originated, nobody feels accountable for defending it. Questions remain on forms not because they are regularly evaluated and reaffirmed, but because they are inherited from earlier systems. Over time, they become permanent features of the administrative landscape, surviving not because they continue to serve an important purpose, but because the reasoning behind them has been forgotten.

This pattern extends far beyond healthcare.

Government forms, employment applications, financial institutions, educational systems, software platforms, and countless other organizations collect information that has accumulated over years or even decades. Many individual questions undoubtedly have legitimate origins. Others may once have addressed problems that no longer exist. Still others may have begun as recommendations before quietly evolving into perceived requirements simply because no one ever questioned them again.

Without provenance, there is no practical way to distinguish among those possibilities.

Every requirement appears equally authoritative, even though the reasons for its existence may differ dramatically.

That is precisely why provenance should be viewed as more than a historical tool. It is an operational framework for preserving accountability. When every decision, requirement, policy, or data field remains connected to the person, organization, regulation, recommendation, or evidence that created it, those decisions become easier to understand, easier to evaluate, and easier to improve over time. Provenance transforms inherited assumptions into transparent decisions that can be reviewed, challenged, updated, or retired as circumstances change.

A Better Question

Modern organizations often ask a familiar question:

What additional information should we collect?

It is an understandable question. Better information can improve decision-making, reduce uncertainty, strengthen compliance, and lower organizational risk. Viewed in isolation, almost every additional question can appear reasonable.

But there is another question that may be even more important.

Who decided to ask this in the first place, and can anyone still explain why?

That question changes the conversation.

Instead of assuming every inherited requirement remains justified, it asks organizations to preserve the history behind their decisions. It encourages transparency rather than anonymity and accountability rather than institutional memory loss. More importantly, it acknowledges that policies, forms, and administrative processes evolve over time, and that understanding why something exists is often just as valuable as knowing what currently exists.

This is one of the broader ideas behind DataUniversa.

Provenance is not limited to preserving the history of paintings, scientific discoveries, or valuable datasets. It also applies to the ordinary decisions that shape everyday life. A field on a form, a software setting, a business policy, a workflow, a recommendation, or an institutional requirement all have histories. Preserving those histories makes organizations more explainable, their decisions more transparent, and their systems easier to trust.

The dental questionnaire is therefore not really a story about dentistry.

It is a reminder that every requirement has an origin, every decision has a history, and every system becomes more accountable when those histories remain connected to the decisions we continue to make.