Another obstacle in the way of a health-centered approach is that of having been trained solely to repair mouths and as indicated, having no training in teaching. With this early mechanistic outlook, at first I stumbled in my efforts to teach patients who were used to only having things “done” to them. I found that I was rushing my patients into solutions to their dental problems that they had not yet owned. It was too one-sided, as they did not yet realize that the best chance for success depended upon our becoming partners as dentist and patient. It wasn’t the patent’s fault, as I too had a lot to learn. I persisted, as I noticed early on that those patients with whom I had developed good relationships experienced the best dental outcomes. Those with whom this type relationship did not exist continued to have dental problems. This realization compelled me to continue integrating teaching into my practice. This learning journey taught me a lot about myself. I discovered that to effectively create this partnership with my patients, I would have to change my way of thinking, which was based on my early dental school experiences. Since I discovered this need to involve my patients more in the process of treating their dental problems, I learned to value more the initial time with them during the first appointments to develop trust. In medicine this is known as a “therapeutic relationship.” I know that without it, the process won’t get off the ground.
However, as I mentioned before, to allot this time is another risk because insurance companies provide little or no paid benefits for education and diagnosis, that only further supports the mode of “fixing teeth” for many dentists. Most patients (probably including yourself if you can admit it) are used to paying to “have something done.” To pay the dentist to take the time needed to develop a trusting relationship, and to work through a “co-learning” process, seems foreign to most patients, and I understand this. I understand that I am asking for a lot of mutual trust up-front when I suggest to you that it would be in your best interests to take this time initially to learn. For example, if I would tell you that you would benefit from special self-care training that would allow you to have better dental and general health, or that your excessive teeth wear would require more extensive investigation, would you be willing to spend the time and monetary investment necessary to do this, even if your insurance company wouldn’t cover it?
A little insight into the dental insurance industry: Insurance companies see patients essentially as “units of work” in a “factory,” to be handled cost effectively as they move along through various dental treatments. They pay mostly for basic “repairs,” not listening and learning procedures that involve prevention and the promotion of health. This emphasis on repair rather than a learning process only helps to support the public’s already low value of taking the time to learn and diagnose by offering “fix it” benefits only. The whole language of dental insurance companies presents a view of dental health not so much as a service, but as “units of things being sold,” such as fillings, crowns, partials, dentures, and cleanings. Their benefit schedules list one fee for each procedure, with no flexibility for the differing needs of each mouth, tooth or patient. I find that this way of thinking has permeated most of dentistry as well as being the expectation of many dental patients. The insurance industry is influencing dentistry in much the same way that it has the medical profession with denial of benefits, limitations on treatment, and fee schedules that necessitate increased patient visits with little time for the all-important feature of interaction.