Through my involvement with organized dentistry, I have had the opportunity to interact with many leaders of our profession. After many serious conversations with colleagues, I sense an underlying concern about dentists' growing sense of entitlement and its impact on patients' trust and the direction of our profession.
I must concur. I have seen things that have disappointed and occasionally shocked me. The lack of judgement; questionable tactics and carelessness demonstrated often make no sense to me—even if I rationalize that the activities were based solely on self-interest. I do not know whether the incidence of poor judgement or substandard treatment has changed with time. Like many other things, this perception may merely be the result of my increased awareness of an ongoing situation. Similarly, I do not know whether the quality of graduates has changed with time. My subjective knowledge suggests current graduating classes occupy the same spectrum of intelligence, technical skills and ethical conduct as my class did. Perhaps it is just part of the natural order of things for earlier generations to be concerned about subsequent generations.
I truly believe both in the integrity of my profession and in my ability to make a difference. I believe that dentists and dental organizations accept the fundamental tenet that functioning in the best interests of patients and the public serves the best interests of our profession. The people I went to school with recognize our inherent privileges as dentists and obligations as professionals. The vast majority of dentists are skilled clinicians trying to do the best for their patients. That said, we all make mistakes and occasionally we confuse self-interest with a patient's interest, but these mistakes occur primarily because of our ignorance or human nature.
Evaluating the direction of our profession is essential to maintaining its relevance to society and our patients' trust. I have a few thoughts about how we, as individual clinicians and dental organizations, can work together to support our profession.
1. Establish a Sense of Community in the Profession
I live in a very small town with a strong sense of community. If I don't shovel my driveway shortly after a storm, often someone will do it for me. The benefit of that support is balanced by my recognition that my community expects me to keep my house in order. The unstated obligation is to assist other community members when they are in need.
Similarly, a sense of community in a profession has inherent responsibilities and advantages. The knowledge that support and assistance are available, that individual professionals are not isolated from their peers, encourages them to ask questions, disclose problems and seek advice. Moreover, knowing that someone is watching—someone with the knowledge to judge and the willingness to comment if expected standards are not met—has a significant moderating effect on activities, especially when the watcher is a respected peer.
I am sometimes surprised that members who are willing to tell patients about their perceptions of a colleague's inadequacies are often reluctant to say anything directly about those concerns to the colleague or to a regulatory authority. In a community, I think it should be the other way around.
Regulatory authorities, faculties, study clubs, mentorship programmes, class gatherings and member service organizations are potential opportunities, especially for new graduates, to find and develop a sense of community in our profession.
2. Focus on the Big Picture in the Education Programmes
I have a simple view of my role as a dentist: I'm here to help my patients and look after their best interests. This involves taking the time to listen to them and respecting their ability to choose the care that best meets their needs. Having the technical skills to help the patient is necessary, but these skills have limited value to a patient if they are not properly directed.
The focus of some educational programmes on acquiring technical skills and specific procedural or even billing requirements is primarily driven by necessity. The resulting challenge is to help students understand that the main obligation of our profession is to identify the cause of a problem and help the patient determine a solution rather than to perform technical tasks. Emphasizing billing and procedures as the keys to success rather than diagnosis and communication may be an unintentional consequence of a dentist's training.
During my training, what I learned about treatment planning was mainly based on what my supervisors taught me about the gold standard for treatment in specific circumstances. The patient's involvement was minimal. I have met practitioners who insist that limiting patients' options to the gold standard is the only ethical way to practise. Perhaps I'm being cynical, but the standard identified as gold often involves the more expensive options and usually focuses on options the practitioner has the ability to perform. That potential self-interest may underlie these recommendations is not discussed as a risk. Educating students about the concepts of informed consent in treatment planning may better integrate their ethical and communication skills. The Royal College of Dental Surgeons of Ontario and the Ontario Dental Association have developed an excellent project on informed consent (www.rcdso.org/quality_assurance/life/informConsent.html).
3. What You See Is What You Get
Most new graduates enter practice as associates. Their first principals can have a tremendous influence on the direction of the future practice and decision-making of these new graduates—perhaps as much as their education. Graduates are very likely to model the activities and billing practices they are initially exposed to. Dentists cast in the influential role of a principal should recognize the importance of being a mentor and ensure that their practice and activities reflect the highest standards to avoid anegative generational drift.
Change—good or bad—tends to happen only when people work for it. Rarely can we address all issues with a big idea or some large task force, but we can all influence the small areas in which we work. Cumulatively, these small influences can have great impact. Am I being naive? Perhaps. Longwinded? Undoubtedly. But if I didn't believe in this, I wouldn't waste my time trying.