I have noticed through the years the tremendous differential in the quality of technical care and personal service existing within the field of dentistry. I have discovered that these differences ultimately lie within the head and heart of the dentist – his developed philosophy of care based on inherently held personal values.
Every profession or business entity has a rationale – a philosophy of sorts, whether clarified in written form or not. Dentistry for example, started out as an offshoot of the “sickness” model of medicine, wherein the physician attends to disease through medication, surgery, etc. In medicine, this mode has not changed much through time as in the main, doctors are still basically providing the same type of remedies. This model that centers on controlling disease rather than developing health, is now heavily driven by the insurance industry through their regulation of doctor’s fees, and limitations of their diagnostic and treatment options. It is interesting that today’s typical patient can receive medical care so influenced by an entity more interested in its bottom line than the state of their enrollee’s health. One of the reasons that I continue with an individualized nutritional and exercise program is to lessen my chances of being in a hospital, which are inherently unhealthy places to be.
Not many physicians provide actual preventive services such as comprehensive diagnostic services and individualized nutritional and exercise programs, although some may make general recommendations and hand out literature – a basic lip service. In other words, philosophies within the same profession can run the gamut from that of controlling symptoms through surgery and drugs, to one of identifying the underlying causation and the development of a plan that clarifies mutual responsibilities of both doctor and patient. Of course, this takes desire on the part of the patient and a willingness to be accountable. In other words, the patient needs to have a personal “philosophy” that resonates with that of the practitioner.
I have found that the best of technical (preventive, esthetic, functional) dental care can only occur within the confines of a sound relationship. Time taken in the beginning to clarify the desires and expectations of the patient to determine if there is a philosophical “match.” This, I believe is a crucial first step, because care rendered without it may invite a poor outcome.
I have never seen excellence in dental treatment from HMO or insurance panel type practices. There is simply not time allotted towards the development of a relationship. Dental procedures many times are performed by different dentists. Dentistry is seen more as “units of work” being dispensed to repair the results of dental disease, in contrast to looking at the bigger picture of one’s future oral health. Some dentists are drawn towards delivering this type of treatment – they want to get in, “get the job done” and get out. Another view sees the limitations inherent within this mode as compared to one that promotes excellence in prevention and treatment for long-term oral health - a view that realizes the many dynamics involved in attaining health. Time is allotted to develop a relationship based on understanding and trust that fosters a learning environment, one resulting in health. A dentist with health-centered values may start out in a “remedial” type setting due to economic reasons, but won’t stay there long, as the philosophical mix would be painful as it would disallow self-expression of his inherent values.
For more on my philosophy of dentistry, see “About My Philosophy” on our website, www.rpmdentistry.com.