Hail to Mediocrity, Benign Neglect, and Complacency

Ron Jackson, DDS

I have never responded to an editorial before but I just couldn't let Dr. Joe Steven's (August "Viewpoint," page 16) affirmation of the status quo and his put-down of quality dentistry — and those who offer it to every patient — go by without a response. My fear is that dentists who are trying to change their practices and improve the care they give patients would give up after reading this article and become complacent again. This would be a tragedy for them and their patients. So here goes.

Dr. Steven's divisive monograph praising mediocrity and benign neglect is full of weak justifications and seems intended to incite class warfare among dentists. Dr. Steven, when you quote our top leaders and educators who "encourage us to present quality dentistry to each and every one of our patients" and "believe this is a responsibility we have as professionals," and then insinuate this is somehow not the correct approach, you've got to be kidding! This is what makes dentistry a profession and it's fundamentally morally right.

What Dr. Steven writes perpetuates our ego-deficient (God rest Walter Hailey's soul) profession's lack of self-esteem and insecurity. He convinces us it's OK to not even offer the best dentistry because it's our duty to assume that all people want is less. We are to believe that, in spite of conspicuous consumption all around us, the masses don't want quality but only the cheapest, only what the insurance will pay for, or better yet, no dentistry at all. According to this article, dentists are the same way — they don't want quality for themselves either, unless they get it for free. Is he really saying that the majority of dentists don't highly value dental health? I have treated hundreds of dentists at full fee and thousands have attended my lectures and courses to learn contemporary, conservative, adhesive restorative dentistry. I guess I have a much higher opinion of my colleagues and my profession than you do. By the way Dr. Steven, you chose a poor example of a restoration to pick on because the indications for an inlay (of whatever color) can sometimes be very close to that of a direct composite restoration. What are your feelings between a four-surface amalgam and an onlay (of whatever color)? Still don't offer the right one unless you think the patient is wealthy? Which would you pick for yourself? The article says that many dentists who dare offer patients the choice of the best are "struggling financially — even to the point of bankruptcy." What a cynical viewpoint. I wonder how many insurance-dependent offices are struggling financially or will be struggling because benefits are reduced every year. I wonder how many dentists lack fulfillment because they feel trapped, as members of what Bill Blatchford calls the "Crown of the Year Club." Their approval addiction (another nod to Hailey) and fear of rejection prevent them from helping the patient understand all the possibilities available. The bottom line is the informed patient has the right to choose the level of care they want for themselves; that's their value decision. The dentist also has a right to choose the kind of dentistry he/she wishes to practice; that's our value decision. Neither should be criticized for their choice.

You miss the point Dr. Steven, when you refer to "Rolls Royce" dental offices — an elitist-sounding label specifically chosen to incite class warfare. But I have to tell you that if somebody truly wants a "Rolls Royce" practice (whatever that is) I say, "Go for it, you deserve it" and "I wish you luck." They don't deserve to be put down or labeled. The point is that our duty to our patients and to ourselves is to become the best we can be. Happiness, fulfillment, pride, and economic success come from doing what's in the best interest of our patient. That may be an onlay or not, depending on all kinds of circumstances. What we are obligated to do is to become educated and continue to be educated, to diagnose thoroughly, listen intently and compassionately to our patient, and then communicate sincerely, honestly and completely. Only then can we deliver our best care, whatever we and the informed patient have decided that is. This has nothing to do with insurance, ego (or lack of), amalgam vs. composite, inlays or onlays of whatever color, or anything else. Dentistry is not a commodity. It's not about price. It's about service to our patients. It's about value. It's also about enjoying what we do, taking pride in it, and fulfilling those reasons we became a dentist in the first place.