In a Spirit of Caring Revisited (eBook)

Chapter 1 - The End of an Era

When I first started practicing dentistry in 1968, I was amazed that my patients did not accept my recommendations for dental treatment. I had assumed that all I had to do was tell them what they needed and they would immediately schedule the treatment. After all I was a dentist, an expert in dental disease, and I knew what was best for them. When they did not accept the treatment I had recommended, I assumed that it was ignorance (or stupidity) on their part. It did not cross my mind that I was the one that was responsible for creating the problem.

As I look back, I realize that I was the naive and ignorant one. Fortunately for me, I became interested in the preventive dentistry movement that was beginning then. Preventive dentistry put dentistry in a different context for me. I taught patients disease control techniques and encouraged them to eat properly. However, I still had trouble motivating my patients to accept the treatment I felt they needed and to practice better oral hygiene. My frustration led to a search for the formula that would magically correct this problem.

Persistence is a strength and weakness of mine. So I persisted and kept looking for the magic answer. This search led to my fascination with how people learn and grow. It has enabled me to participate in dentistry's contribution of two of the most significant accomplishments in health care during the last 25 years. The first contribution is the reduction of two of humankind's three most common diseases dental caries and periodontal disease (the common cold is the third). The second contribution is the development of a humanistic model of health care. This model includes the human dimensions of caring, respect and compassion with the techniques of repair and prevention.

THE PREVENTIVE DENTISTRY MOVEMENT'S CONTRIBUTIONS

Both contributions originated in the preventive dentistry movement of 1965 to 1975. Since this time, the dental caries rate has dropped as much as 50% and in many children is non-existent. Periodontal disease rates have also declined during that time.

The discovery in the late 1940's and early 1950's by C.C. Bass and Sumter Arnim of the importance of dental plaque removal in controlling dental disease ranks with Ignaz Semmelweiss's great work on asepsis in the middle 1800's. Bob Barkley introduced their work on dental plaque to practicing dentists during the sixties and seventies. The work of these men along with Weston Price, Royal Lee and Melvin Page's recognition of the importance of proper nutrition in preventing dental disease laid the foundation for the preventive dentistry movement. (Frederick McKay's discovery of the role that fluoride plays in preventing dental caries was also a key factor in the reduction of dental caries.)

The work of these pioneers in preventing dental disease led to a dramatic reduction of dental disease. Practicing dentists used their findings to help their clients control their dental disease through proper dental plaque removal. This reduction of dental disease has become dentistry's greatest accomplishment and I think is among the most important developments in health care in the last 20 to 30 years.

The following quotation reflects the significance of this accomplishment. The quotation is from an article written by Daniel S. Greenberg in the Boston Globe on March 29, 1987.

Front page homage and reverence are heaped on organ transplants and other medical high wire acts. Meanwhile dentistry goes unnoted, except as the butt of harebrained television humor. But, it is one of the few health technologies that almost invariably succeed, both in prevention and in treatment. There is little else in the health care arsenal that can share that claim.

Dentistry is one of the great success stories of our time. Viewed against the economic turmoil and limited achievements that generally afflict medical care, dentistry is especially notable for its advocacy of health education and public preventive measures.

Comment: Prevention has been a huge success for dentistry. It is dentistry's greatest accomplishment and I think it was the greatest accomplishment in health care at the end of the 20th century.. We should be proud.

A HUMANISTIC MODEL OF HEALTH CARE

The second contribution, a humanistic model of health care, evolved out of the efforts of a group of people in dentistry to help patients carry out the knowledge of what prevented dental disease. This knowledge of how to prevent dental disease created a need for a new delivery model of dental care. The following conclusions on the importance of facilitative relationships in dental practice are the result of a comprehensive study done in the early 1970's by the Illinois Academy of Dental Practice Administration, Bob Barkley, D.D.S. and psychologist Nathan Kohn Jr. Ph.D. Comment: Many of the books, studies and quotes I referred to are from the 1970's, 1980's and 1990's. Don't dismiss them because of their age. Most are still relevant (maybe more) as we enter the second decade of the 21st century. The following Kohn quote is an example.

When a patient leaves your office able to explain to his friends his relationship with you and how it benefits him immediately and in the years ahead, you have established a relationship with that patient which is the only sound basis for growth of your practice and development of your profession.

Do you enjoy this kind of relationship with your patients?

Chances are that your honest answer to the question would be an unqualified "yes". If you were to appraise your practice, however, you'd probably find a large number of patients who should be doing a better job of prevention; some who need improvement in appearance, comfort and function; and some who come in for checkups only after repeated follow ups by your auxiliaries.

Psychologists have discovered, as a matter of fact, that the inability of individual dentists, or the dental profession, to establish this relationship with patients is a major contributing factor to the problem of why more people do not avail themselves to adequate dental care.

In the area of prevention, the patient's active participation in changing his lifestyle is the essential ingredient to improve his health. This placed different demands upon the doctor and patient and changed their relationship with each other. Previously the patient was the passive dependent recipient of instructions and treatment by the doctor. The different demands resulted in a relationship based on the patient becoming an active interdependent member of a team devoted to helping him become well.

The humanistic model was based upon helping patients learn new habits and health behaviors as a foundation for any dental care or treatment that they needed. Bob Barkley wrote "As my philosophy of dental care matured, my self image slowly changed from that of a "healer" to an interested, empathic teacher of health who is also capable of good restorative dentistry." Comment: This second contribution is still a work in progress. It is vital and thriving, but it hasn't shifted the super tanker of health care's direction. It has been nudged.

THE END OF THE "GOLDEN ERA"

Ironically these two contributions seem to have led to the end of the era that some people have called "the golden age of dentistry" of the 50's, 60's and early 70's. The term golden era refers to a time when there was a high dental disease rate and not enough dentists to provide dental care.

Wilson Southam has written that the natural monopoly and sovereignty that dentistry enjoyed during this era has ended. Increased treatment productivity, a higher ratio of dentists to patients, declining dental disease rates, the proliferation of delivery systems, an increasing number of governmental and private agencies that are attempting to manage and regulate dental care, the closure of dental schools, a reduction in the size of dental schools classes, and the public's wish to have a stronger voice in their health care led to the end of this era. Comment: Southam's statement which was written in the 80's was prescient, especially in the increase in treatment productivity, declining disease rates, the proliferation of delivery systems, governmental, private and insurance agencies that are attempting to regulate health care and the public's wish to have a stronger role in their health care.

In the face of the ending of this era, there is a tendency by many people in dentistry to hold on to the status quo and the past. They resist the changes that the end of this era of dentistry brings. It seems that the result of this ending of an era is the chaos that these changes are producing in dentistry. Dentistry is undergoing a period of profound change and transition in delivery systems and in the core values of dentistry. Yet out of these changes and seeming chaos there has been the quiet emergence of the humanistic model of health care.

NEW MODEL IS A PACESETTER IN HEALTH CARE

Many people in dentistry believe that this new model will be the pacesetter for all of the health care professions in the coming years. Wilson Southam believes that the humanistic approaches focus on the patient; its respect for the patient's autonomy; its respect for the patient's drive toward health and wholeness provides an environment and level of care that is very rewarding for the patient and dental team. These dental teams are doing well both in terms of personal satisfaction and financial prosperity. Some practices are experiencing extraordinary success by any standard.

Dentistry is in a unique position in health care to be the leader in this new way...