Transactional ‘care’ is not care
Dental care. A phrase very often attached to practices of a certain time period. Prior to that was the ‘& Associates’ era and the now historic ‘Pullem and Fillem’ practice names based on those in situ. The current trend for ‘Smile Design’ or ‘Boutique’ suggests a very different reality; less a solicitor’s office and more the ‘place to be’. ‘Advanced Dentistry’ seems to be a thing too. All the above are lacking in any clear idea of what is goingon the background.
I do wonder if there might come a time for a ‘Basic Dentistry’ clinic. With all the advances in care and digital workflows, I ask myself if it is my own prejudice or sheer lack of ambition or whether these changes in clinic ethos and direction are leaving me behind? Have I reached that point of the career where my entrenched opinions are entirely in need of blowing up? Those aged clinicians I lacked respect for in my twenties who, with the inevitability of older (professional) age, fail to understand how things really are.
I think there is certainly an element of my own narcissism. A confidence in my own thoughts which allows me to write to you with my vision and insight on the profession. However, bear with me and see if you agree.
Dentistry is, or should be, about healthcare. We know that current diets and eating habits are not helpful for the oral environment. We know that increased longevity with more teeth leads to greater complexity, especially as polypharmacy and age robs us of some of our most successful protective elements, from gum to saliva. Greater intervention leads to greater maintenance requirements. Add into that our vanity and its manipulation through social media, TV and film personalities with their unfeasibly white, straight teeth. This move towards the cosmetic treatment pushed by almost all clinics, mine included, is increasing our workload.
The younger practitioners’ idea that alignment and bonding is the way forward seems to be at the expense of basic care. This is my fear from a range of points of view.
The first point is about care. If everyone is focusing on the aesthetic, then who is doing the stuff in the background? Basic care which gives a foundation for everything else. Who actually tells patients off for their catastrophic sugar addiction with enough humour, good grace and gravitas to get the message across without alienating a patient and having them leave the practice? Without that solid base and ‘caring’ relationship, there is no chance of a long-lasting aesthetic result. Maybe we do not care about longevity: it is not the best for fee generation. However, if we do not have a decent longevity that exposes us to the next point.
Point two: patients have unrealistic expectations in terms of the aesthetic and functional outcome and the relative cost. With more providers, comes more competition and it is incredibly difficult to measure one dentist’s skills versus another. If all people do is look at Instagram accounts and base cost, there is a race to find people who are cheaper with better webpages. This does not equal higher skill, better results or longevity. These types of consumer are much more likely to resort to litigation, especially as they have no long-term tie to a professional. Transactional ‘care’, I would argue, is not care.
The third point follows on. If we are seeking to base our working lives on transactional treatment plans, then our professionalism and that of dentistry stops being just that. We become operators with a formula for results. The crown prepping robot becomes increasingly appealing. It will be all ‘AI’ driven and people will lap it up. If we are doing automated, picture-based results, why not go for an automated clinic? Surely those results will be more guaranteed than with a person? Cheaper and available at 10pm on a Sunday evening, if that is what suits the patient.
You need a person, I hear you say. Well maybe that is the fourth point. I still believe you do need a person. And it is that person’s ability to do the job, see the whole picture and deliver care. But if all those treatments are based on the high-value aesthetic transactions, then the value of those businesses is solely based on the operator. We can work our whole lives to become super skilled and efficient. However, if we do not do the basic care and have registered patients, then the value of that business is inherently in the individual. When we come to sell our businesses to facilitate our well-deserved retirement, then we may find the business is not worth much at all unless we have somehow found a way to clone ourselves or suffer ridiculously long tie-ins.
Back to basic care then. Relationships built on years of two-way information and understanding that create a better patient and clinician. On that foundation we can build better habits that allow for aesthetics that last. Businesses with inherent value and goodwill. Something we can sell onto the next generation of professionals and which they can cherish and grow. Improve and enhance: the patients and the business. Within all of that lies care. The fundamental reason for people to go to the dentist time and again. Not simply for one-off treatment for a wedding or other new life event. Demonstrable, consistent, improving, enhancing care. Also, it should not be underestimated, available when things go wrong.
I am getting old and grumpy and entrenched. I am back to preaching about professionalism and its virtues. I am not sorry in the slightest. Dentistry is a great, caring profession but it is at risk of losing that care.